Search

Introduction: Sprayable wound dressings containing hydrophobized microparticles (hMPs) are characterized by strong adhesiveness. We examined the effect of hMPs derived from Alaska pollock gelatin on endoscopic submucosal dissection (ESD) ulcers. Methods: (1) In an in vivo model of miniature swine gastric ESD, gastric ulcers were created by ESD and then sprayed with hMPs or untreated followed by microscopic examination. (2) In an ex vivo ESD model of resected stomach, a pinhole-shaped perforation was created on the ESD ulcer of resected stomach; hMPs were then sprayed on the perforation; and air leakage and intragastric pressure were measured. (3) In an in vivo duodenal ESD model of miniature swine, duodenal artificial ESD ulcers with pinhole-shaped perforation were examined; ulcers were classified into hMPs-sprayed and nonsprayed groups, and inflammation in the intrinsic muscle layer and serosa were compared between the groups. Results: (1) Histological observation of submucosal tissues showed a decreased number of invading inflammatory cells in hMP-sprayed tissues compared with the control in miniature swine gastric ESD (p < 0.05). In addition, the rates of anti-alpha smooth muscle actin and type I collagen positivity were significantly lower in the hMPs group than in the control group (p < 0.05). (2) Intragastric pressure could not be measured in the nonsprayed group, whereas no air leakage was observed in the sprayed group when pressurized up to 26 mm Hg in the resected stomach model. (3) The sprayed group showed suppressed inflammation of the intrinsic muscular layer and serosa in both cases compared with the nonsprayed group in miniature swine duodenal ESD (p < 0.05). Conclusions: Sprayable, tissue-adhesive hMPs are a promising medical material for intraoperative and postoperative treatment of ESD-induced wound via anti-inflammation and strong adhesiveness.

A 51-year-old man was referred to our hospital for the further examination of main pancreatic duct interruption. Imaging findings showed a 25-mm-diameter mass lesion located in the pancreatic head. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) was performed on the mass. Cytology suggested adenocarcinoma, but the histological diagnosis was not confirmed. We made a comprehensive diagnosis of resectable pancreatic cancer. The mass shrank after preoperative adjuvant chemotherapy, and the patient underwent surgery. The final pathological diagnosis was type 2 autoimmune pancreatitis (AIP). Two years after surgery, AIP had not recurred in the remaining pancreas.

Thermophilic proteins maintain their structure at high temperatures through a combination of various factors. Here, we report the ligand-induced stabilization of a thermophilic Ser/Thr protein kinase. Thermus thermophilus TpkD unfolds completely at 55 °C despite the optimum growth temperature of 75 °C. Unexpectedly, we found that the TpkD structure is drastically stabilized by its natural ligands ATP and ADP, as evidenced by the increase in the melting temperature to 80 °C. Such a striking effect of a substrate on thermostability has not been reported for other protein kinases. Conformational changes upon ATP binding were observed in fluorescence quenching and limited proteolysis experiments. Urea denaturation of Trp mutants suggested that ATP binding affects not only the ATP-binding site, but also the remote regions. Our findings shed light on thermoadaptation of thermophilic proteins.

The objective of this study was to investigate the incremental prognostic value for adverse events of myocardial blood flow (MBF) derived from stress computed tomography perfusion (CTP) at remote myocardium over cardiac risk factors and ischemia. We prospectively analyzed 242 patients who underwent dynamic CTP and CT angiography. Adverse events were defined as a composite of all-cause mortality, non-fatal myocardial infarction, unstable angina, heart failure requiring hospitalization, peripheral artery disease, and stroke. MBF value was calculated in each myocardial segment and ischemia was defined as mild decrease in MBF in two consecutive segments or moderate decrease in a single segment accompanied with a coronary stenosis ≥50%. The mean MBF of the non-ischemic segments was defined as remote MBF. We divided the patients into two groups by median MBF value of 1.15 ml/min/g. During a median follow-up of 18 months, 18 patients had adverse events. Annual event rate showed a significant difference between patients with low (≤1.15 ml/min/g) and high (>1.15 ml/min/g) MBF (6.1% vs 1.8%, p = 0.02). Univariate analysis showed that low MBF was a significant predictor of events (hazard ratio (HR): 3.4; 95% confidence interval (CI): 1.2 to 12.0; p = 0.02). This relationship maintained significant after adjusted for the presence of ischemia and cardiac risk factors (HR: 3.0; 95%CI: 1.1 to 11.1; p = 0.04). In conclusion, MBF value ≤1.15 ml/min/g derived from dynamic CTP in remote myocardium is significantly related with poor outcome and this relationship was independent of myocardial ischemia and cardiac risk factors.

IntroductionGiven an increasing use of dipeptidyl peptidase-4 (DPP-4) inhibitors to treat patients with type 2 diabetes mellitus in the real-world setting, we conducted a prospective observational study (Japan-based Clinical Research Network for Diabetes Registry: J-BRAND Registry) to elucidate the safety and efficacy profile of long-term usage of alogliptin.Research design and methodsWe registered 5969 patients from April 2012 through September 2014, who started receiving alogliptin (group A) or other classes of oral hypoglycemic agents (OHAs; group B), and were followed for 3 years at 239 sites nationwide. Safety was the primary outcome. Symptomatic hypoglycemia, pancreatitis, skin disorders of non-extrinsic origin, severe infections, and cancer were collected as major adverse events (AEs). Efficacy assessment was the secondary outcome and included changes in hemoglobin A1c (HbA1c), fasting blood glucose, fasting insulin and urinary albumin.ResultsOf the registered, 5150 (group A: 3395 and group B: 1755) and 5096 (3358 and 1738) were included for safety and efficacy analysis, respectively. Group A patients mostly (>90%) continued to use alogliptin. In group B, biguanides were the primary agents, while DPP-4 inhibitors were added in up to ~36% of patients. The overall incidence of AEs was similar between the two groups (42.7% vs 42.2%). Kaplan-Meier analysis revealed the incidence of cancer was significantly higher in group A than in group B (7.4% vs 4.8%, p=0.040), while no significant incidence difference was observed in the individual cancer. Multivariate Cox regression analysis revealed that the imbalanced patient distribution (more elderly patients in group A than in group B), but not alogliptin usage per se, contributed to cancer development. The incidence of other major AE categories was with no between-group difference. Between-group difference was not detected, either, in the incidence of microvascular and macrovascular complications. HbA1c and fasting glucose decreased significantly at the 0.5-year visit and nearly plateaued thereafter in both groups.ConclusionsAlogliptin as a representative of DPP-4 inhibitors was safe and durably efficacious when used alone or with other OHAs for patients with type 2 diabetes in the real world setting.

Dynamic myocardial computed tomography perfusion (CTP) is an emerging technique to diagnose significant coronary stenosis. However, this procedure has not been reported using single-source 64-row CT.To investigate the radiation dose and the diagnostic performance of dynamic CTP to diagnose significant stenosis by catheter exam.We prospectively included 165 patients who underwent CTP exam under adenosine stress using a single-source 64-row CT. MBF was calculated using the deconvolution technique. Quantitative perfusion ratio (QPR) was defined as the myocardial blood flow (MBF) of the myocardium with coronary stenosis divided by the MBF of the myocardium without significant stenosis or infarct. Of the 44 patients who underwent subsequent coronary angiography, we assessed the diagnostic performance to diagnose ≥50% stenosis by quantitative coronary analysis (QCA).The average effective dose of dynamic CTP and the entire scans were 2.5 ± 0.7 and 7.3 ± 1.8 mSv, respectively. The MBF of the myocardium without significant stenosis was 1.20 ± 0.32 ml/min/g, which significantly decreased to 0.98 ± 0.24 ml/min/g (p 0.01) in the area with ≥50% stenosis by CT angiography. The QPR of the myocardium with QCA ≥50% stenosis was significantly lower than 1 (0.84 ± 0.32, 95% confidence interval (CI), 0.77-0.90, p 0.001). The accuracy to detect QCA ≥50% stenosis was 82% (95%CI, 74-88%) using CT angiography alone and significantly increased to 87% (95%CI, 80-92%, p 0.05) including QPR.Dynamic myocardial CTP could be performed using 64-row CT with a low radiation dose and would improve the diagnostic performance to detect QCA ≥50% stenosis than CT angiography alone.

Aims To investigate the relationship of type 2 diabetes duration and myocardial blood flow (MBF) assessed by myocardial CT perfusion. Materials and methods We prospectively included 140 patients with type 2 diabetes who underwent dynamic myocardial CT perfusion exam. MBF of the remote myocardium was calculated using the deconvolution technique and the Voronoi method. The relationships of MBF and diabetic duration, diabetic complications, conventional risk factors, coronary calcium, and coronary stenosis were assessed by logistic regression analysis. Results A weak but significantly negative relationship was present between diabetes duration and MBF (R2 = 0.05, p 8 years was 13% lower than that of the remaining patients (1.11 ± 0.35 vs 1.28 ± 0.27 ml min−1 g−1, p Conclusion Longer diabetes duration is associated with lower MBF independent of conventional cardiac risk factors or the presence of coronary stenosis.

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

This article describes data related to a research article titled "Feasibility of dynamic myocardial CT perfusion using single-source 64-row CT", Tomizawa et al. (in press) [1]. Decrease in the myocardial blood flow could be calculated by performing stress dynamic computed tomography perfusion. This article compares the receiver operating characteristics curve of computed tomography angiography and dynamic myocardial perfusion to diagnose significant stenosis by invasive coronary angiography.

Optical coherence tomography (OCT) has contributed to a better understanding of in-stent restenosis (ISR); however, studies evaluating ISR pattern after two-stent technique in unprotected left main (ULM) are lacking. We aim to evaluate the ISR pattern of proximal LAD and LCX after two-stent technique in ULM.We performed OCT in 26 patients with isolated or combined ISR (identified by angiography as50%) after two stent implantation in the proximal LCX and LAD. Finally, 13 LAD and 22 LCX ISR lesions underwent OCT assessments. OCT analyses were undertaken in the proximal segments of the LAD and LCX. In addition, we compared OCT findings in the flow divider (FD) and lateral wall (LW).In both the LAD and LCX, the distance from the ostium to the minimum lumen area (MLA; LAD, 2.00mm [1.00, 3.00]; LCX, 1.00mm [0.00, 1.80] distal to ostium) was short. Uncovered struts were more common on the FD side compared with the LW in the LAD (6.25% [0.00, 20.00] vs 0.00% [0.00, 0.00], respectively, p=0.016) and LCX (11.32% [0.00, 19.44] vs 0.00% [0.00, 4.55], respectively, p0.001). Conversely, neointimal hyperplasia (NIH) was significantly thicker on the FD side compared with the LW in the LCX (0.31mm [0.19, 0.47] vs 0.15mm [0.09, 0.31], p0.001).While uncovered struts were more commonly found on the FD side of both arteries, NIH was significantly thicker on the FD side compared with the LW in the LCX. These unique findings might indicate inferior outcomes after two-stent techniques in ULM bifurcation lesions.

Objectives This study aimed to investigate the long-term outcomes following mini-crush versus culotte stenting with drug-eluting stents (DES) for the treatment of unprotected left main coronary artery (LMCA) disease. Background Both mini-crush and culotte stenting are considered efficacious treatment options when a planned 2-stent strategy is deemed necessary for unprotected LMCA disease. However, there are limited data available with regard to the long-term clinical outcomes of each strategy in this setting. Methods Between July 2002 and November 2013, 225 patients were identified. 135 patients were treated with the mini-crush technique, and 90 patients with culotte stenting. The median follow-up period was 1,263 (IQR 820–1,847) days. Results The mini-crush group had worse lesion and procedural characteristics when compared to the culotte group. There were no significant differences in major adverse cardiac events (MACE) at 5 years (mini-crush 36.0% vs. culotte 41.4%, P = 0.57). Myocardial infarction (MI) and definite stent thrombosis (ST) occurred significantly higher (MI; 0 vs. 11.3%, log-rank P = 0.003, and definite ST; 0 vs. 6.3%, log-rank P = 0.02, respectively) in the culotte group. Cox regression analysis indicated that full stent coverage of the LMCA and SYNTAX score were independent predictors for MACE. Conclusions The incidence of MACE and overall TLR were comparable between groups. However, the rates of MI and definite ST were significantly higher in the culotte group. Full stent coverage of the LMCA may reduce the incidence of MACE when a two-stent strategy is used for the treatment of unprotected LMCA disease. © 2016 Wiley Periodicals, Inc.

We report here that the selection of the electrode surface charge is very crucial in evaluating the adsorption of liposomes and their ruptures by means of electrochemical impedance spectroscopy (EIS). We prepared three types of electrodes whose surface characteristics were controlled by self-assembled monolayers (SAMs). The chemicals for SAM contained the same straight-chain alkanes with thiol groups at one end to bind with the Au electrode surface. The head groups were CH3 for 1-dodecanethiol (DDT), CH2OH for 11-mercapto-1-undecanol (MUD), and CH2NH2 for 11-amino-1-undecanthiol (11-AUT). The surface charges were neutral for DDT, negative for MUD, and positive for 11-AUT. Resulting from liposome adsorption and rupture, the Nyquist plots changed differently, depending on the surface charges. We concluded that the easiest and most sensitive surface to handle was obtained by 11-AUT SAM. The EIS measurements, obtained from the electrode containing 11-AUT SAM, successfully estimated the critical micelle concentration (CMC) of the surfactant, Triton X-100 through the observation of the liposome rupture process.

Liposome is well known as mimicking a cell, which is composed of lipid bilayer membrane. Liposome is spherical shape and formed by amphiphilic molecules, meaning that outer layer is composed of hydrophilic molecules and inner layer is composed of hydrophobic molecules. Evaluation of adsorption and rupture of liposome on a surface is very important to drug delivery system (DDS) or understand the capability of the cell. Many studies reported the adsorption and interaction of lipid bilayer using highly sensitive sensing methods without labeling such as quartz crystal microbalance (QCM), plasmonic devices such as SPR, LSPR and SERS, and electrochemical impedance spectroscopy (EIS). We focus on EIS as an evaluation tool for adsorption and rupture of liposome, since EIS is highly sensitive to the surface condition of the electrode and electrochemical measurement is simple. EIS is very sensitive to the surface condition of the electrode. We report here that surface charge is very important to evaluate the adsorption and interaction of liposome on the electrode surface, which are controlled by using self–assembled monolayer (SAM). So far as we know, there are little reports focusing on surface charge evaluate the adsorption and interaction of liposome on the electrode surface. Here, we report the effect of surface charge on electrochemical reactions due to SAMs which were coated on the Au electrode. Liposome preparation was described below. Thin organic film was formed with 1,2-Dioleoyl-sn-glycero-3-phosphocholine (DOPC). Then we obtained solution including DOPC which diameter was lower than 220 nm because the solution was filtered 20 times through the syringe filter (pore diameter was 220 nm). We used 1-Dodecanethiol (DDT), 11-Mercapto-1-undecanol (MUD or 11–HUT: 11–Hydroxy–1–undecanthiol) and 11-Amino-1-undecanthiol (11–AUT) for the SAM. These chemicals have same straight–chain alkane with thiol group to bind with Au surface, but head group is changed as CH3 for DDT meaning that the surface is neutral and hydrophobic, CH2OH for MUD meaning that the surface is charged negative and hydrophilic and CH2NH2 for 11–AUT meaning that the surface is charged positive and hydrophilic. Thus, we can discuss about the characteristics of Rct dependent with head group of SAM on the detection of liposome adsorption and rupture. As the results, most sensitive surface was obtained on use of 11–AUT in this study. In addition, we estimated the critical micelle concentration (CMC) of a surfactant, Triton–X 100, on the rupture process of liposome. As an example of results, we show two type of hydrophilic surface, type A and B. Type A was coated with 11-Mercapto-1-undecanol, which surface had hydroxy group and was negatively charged. Type B was coated with 11-Amino-1-undecanol, which surface had amino group and was positively charged. At first, we discussed about the results on type A. Fig. 1(Type A) shows Nyquist plots according to adsorption and rupture of liposome. After the adsorption of liposome, Rct decreased drastically. This characteristic was caused by surface charge after the liposome adsorption. As written above, the hydroxyl surface was charged negatively which repel the redox probe. After the liposome adsorption, surface charge changed to positive because the surface of DOPC was charged positively, which attracted the redox probes by charge polarity. After adding the surfactant, Rct increased and was almost same as that before the liposome adsorption. Next, we discussed about the results on type B. Fig. 1(Type B) shows Nyquist plots according to adsorption and rupture of liposome. After the adsorption of liposome, Rct increased drastically due to steric barrier of liposome. In this case, liposome adhered on the surface by hydrophilic interaction. Surface charge was not changed via liposome adsorption. After adding the surfactant, Rct decreased and was almost twice comparing with that before the liposome adsorption. This data show that ruptured liposome and/or surfactant adhered on the electrode surface. As discussed above, the amino surface was superior to detect adhesion and rupture of liposome comparing with other electrodes which coated with/without methyl and hydroxy SAM, when [Fe(CN)6]3-/4- was used as redox probes because of mixed surface conditions such as hydrophilicity and electric charge. Figure 1

In recent years, biomimetics or biomimicry have been paid attention which focus on biotic micro and nano structures. These structures show excellent and multiple functions. It is reported that the wings of cicada and dragonfly have countless nanostructures which exhibit antibacterial and bactericidal activities. These structures kill bacteria physically1-3). One of acceptable mechanism of bactericidal effect is proposed as below: the cell membrane is stretched by the interaction between the structure and bacteria, which induce the cell membrane to be deformed. Then the intracellular fluid leaks which make the cell death4). However, the detailed mechanism has not been cleared. In this study, electrochemical impedance spectroscopy (EIS) measurement and fluorescence microscopy were performed simultaneously to analyze the mechanism of cell adhesion and deformation on the nanostructure surface. The experimental method is described as below. A working electrode (WE) with the diameter of 100 µm was fabricated on a Si substrate. The WE had gold nanostructure arrays which were fabricated by using electron beam lithography and pulse deposition. In order to observe the surface of the WE by a fluorescent microscope, a counter electrode (CE) composed of Au thin film and a reference electrode (RE) were formed on a glass substrate by using photolithography and sputtering. Here, Ag/AgCl paste was solidified and used for the RE. These substrates were opposed to each other as shown in Fig. 1-a, and silicon rubber with a sample chamber with a thickness of 500 µm was sandwiched between these substrates and fixed with screws. An electrolyte solution (PBS (pH = 7.4) containing NaCl (0.15 M) and Fe(CN)6 3- / 4- (1 mM)) was injected through a hole provided on the glass substrate. Escherichia coli (E. coli) was used as a model bacteria and concentration of E. coli was adjusted to OD600 = 0.2. We used DNA staining reagent of SYTO 9 and PI. SYTO 9 diffuses into the cell cytoplasm through the cell membrane and stains DNA green. In contrast, PI enters the cell cytoplasm and stains DNA red when the cell membrane is damaged. Therefore, adhered cells without membrane damage were colored green. After mixing the bacterial broth and the electrolyte solution, the mixture was injected through a hole Then, AC impedance measurement and time-lapse observation using the fluorescence microscope were simultaneously performed every 5 minutes to evaluate changes over time. The obtained fluorescence images are summarized in Table 1, and Fig. 1-b shows the change rate of Rct over time. From Table 1, the number of E. coli stained red increased with the lapse of time on the pillared electrode. E. coli stained green was hardly observed. On the other hand, microscopic observation showed adsorption and desorption of E. coli which stained green on the flat electrode, Here, E. coli stained red could not be observed. According to Fig. 1-b, it was found that the change rate of Rct on the pillared electrode increased gradually and was much larger comparing with that on the flat electrode. In the case of the flat electrode, it is considered that the increase and decrease of impedance was due to adsorption and desorption of E. coli, respectively. In the case of the pillared electrode, the cell membrane was damaged and died after E. coli attached on the WE. The impedance continued to rise because E. coli died and remained on the electrode. At this time, only the attachment process of E. coli could be analyzed. In the future, we will aim for single-cell level analysis by reducing the electrode diameter. We plan to make measurements closer to real time and report more detailed analysis results. 【 References】 1) E. P. Ivanova, et al.：Small 8, p. 2489-2494 (2012) 2) E. P. Ivanova, et al.：Nature Communications 4, p. 1-7 (2013) 3) A. Tripathy, et al.：Advances in Colloid and Interface Science, 248, p. 85-104 (2017) 4) K. Nakade, et al.：ACS Applied Nano Materials, p. 5736-5741 (2018) Figure 1

This study assesses clinical outcomes after drug-eluting balloon treatment for recurrent in-stent restenosis lesions based on the number of metallic layers.We enrolled 304 consecutive patients (333 lesions) treated with percutaneous coronary intervention using drug-eluting balloon for in-stent restenosis lesions between March 2014 and June 2015. Per the number of stent layers previously implanted to the lesion, the patients were categorized into 3 groups, 1 stent layer (1L), 166 patients; 2 stent layers (2L), 87 patients; and ≥3 stent layers (≥3L), 51 patients. The end points were major adverse cardiovascular events (MACE), including cardiac death, target lesion revascularization, myocardial infarction, and definite or probable stent thrombosis. No significant differences were observed in patients' baseline characteristics among the groups. The 1-year MACE and target lesion revascularization rates were significantly higher in the ≥3L group than those in the 1L and 2L groups (MACE: 1L, 16.9%; 2L, 16.1%; and ≥3L, 43.1%, P0.01; target lesion revascularization: 1L, 14.5%; 2L, 14.9%; and ≥3L, 41.2%, P0.01). The multivariable Cox regression analysis revealed that the number of metallic layers (≥3L compared with 1L; hazard ratio, 3.17; [95% CI, 1.75-5.76]; P0.01 and hemodialysis [hazard ratio, 2.21; (95% CI, 1.12-4.36); P=0.02]) were independent predictors for MACE. No significant differences were observed in the occurrence of cardiac death among the groups ( P=0.34).Seemingly, drug-eluting balloon is less effective for ≥3L in-stent restenosis lesions. Hemodialysis and in-stent restenosis with the number of metallic layers are independent predictors for MACE.

Background: This study assesses clinical outcomes after drug-eluting balloon treatment for recurrent in-stent restenosis lesions based on the number of metallic layers. Methods and Results: We enrolled 304 consecutive patients (333 lesions) treated with percutaneous coronary intervention using drug-eluting balloon for in-stent restenosis lesions between March 2014 and June 2015. Per the number of stent layers previously implanted to the lesion, the patients were categorized into 3 groups, 1 stent layer (1L), 166 patients; 2 stent layers (2L), 87 patients; and ≥3 stent layers (≥3L), 51 patients. The end points were major adverse cardiovascular events (MACE), including cardiac death, target lesion revascularization, myocardial infarction, and definite or probable stent thrombosis. No significant differences were observed in patients’ baseline characteristics among the groups. The 1-year MACE and target lesion revascularization rates were significantly higher in the ≥3L group than those in the 1L and 2L groups (MACE: 1L, 16.9%; 2L, 16.1%; and ≥3L, 43.1%, P P P P =0.02]) were independent predictors for MACE. No significant differences were observed in the occurrence of cardiac death among the groups ( P =0.34). Conclusions: Seemingly, drug-eluting balloon is less effective for ≥3L in-stent restenosis lesions. Hemodialysis and in-stent restenosis with the number of metallic layers are independent predictors for MACE.

We investigated the influence of stent implanted in left main coronary artery trifurcation on blood flow by means of CFD. We simulated various stent positions and arrangement patterns considering KBT. The velocity and WSS (wall shear stress) distribution were found to depend on the stent arrangements. In addition, a strut position inhibiting the inflow velocity peaks into the branched (LCX) vessel exhibited a strong impact, which provided suppression of WSS on the high-lateralside surface of the LCX entrance. By KBT, such an impact of stent implantation can be avoided.

Background: Diabetes cardiomyopathy is raising attention recently, however, there is few clinical study to evaluate changes in the early stage before clinical signs appear. The present study investigated the risk of diabetes duration and cumulative hyperglycemic exposure (CHE) to myocardial extracellular volume (ECV), a marker of myocardial fibrosis, and coronary microvascular resistance (CMVR) assessed by dynamic myocardial CT perfusion (DMCTP). Material and Methods: We assessed 192 patients who had undergone DMCTP from April 2016 to October 2017. Patients with significant coronary stenosis and previous stent intervention were excluded. ECV of myocardium was calculated from CT delay enhancement subtraction image. CMVR was derived from the diastolic pressure gradient divided by myocardial blood flow. We defined HbA1c debt as sum of elevated HbA1c in recent 10 years as the indicator of CHE. The impacts of diabetes duration and HbA1c debt to ECV and CMVR were analyzed by multivariable analysis. Results: Diabetic patients showed significant increase of ECV (30.4±4.4% vs. 25.9±3.8%, p Conclusion: Diabetes induces myocardial fibrosis and increases microvascular resistance since the very early stage. Both longer diabetes duration and CHE are risk factors to the progression of microcirculatory disorders, suggesting that good glycemic control is warranted to reduce risk of diabetes cardiomyopathy. Disclosure S. Chou: None. M. Haraguchi: None. Y. Fujino: None. N. Tomizawa: None. T. Nojo: None. S. Nakamura: None.

This study sought to evaluate the short-term and 3-year outcomes of polytetrafluoroethylene-covered stent (PCS) for patients with coronary perforation. Implantation of a PCS has improved the immediate clinical outcomes of patients with coronary perforation. However, there are few reports regarding long-term outcomes. We evaluated a total of 57 patients who were treated with PCS for coronary perforation from April 2004 to March 2015 at a single high-volume center in Japan. Landmark analysis was performed at 30 days to determine short-term and long-term outcomes. Major adverse cardiac events (MACE) were defined as death, myocardial infarction, target vessel revascularization, and requirement for surgical repair. Of 285 patients who experienced coronary perforation, 57 patients (20%) were treated with PCS. The MACE rates were 28% at 30 days, 22% at 1 year, and 38% at 3 years. 30-day MACE was mainly driven by high rates of myocardial infarction (18%) and surgical repair (16%). The rates of target lesion revascularization were 8% and 12% at 1 and 3 years, respectively. Definite stent thrombosis was reported in 2 patients during the follow-up period. In conclusion, despite the relatively high incidence of MACE during early stage of follow-up, implantation of a PCS provides acceptable late clinical outcomes.

Constructed large-scale 3D map The method we propose for constructing a large three-dimensional (3D) map uses an autonomous mobile robot whose navigation system enables the map to be constructed. Maps are vital to autonomous navigation, but constructing and updating them while ensuring that they are accurate is challenging because the navigation system usually requires accurate maps. We propose a navigation system that explores areas not explored before. The proposed system mainly uses LIDARs for determining its own position – a process known as localization – or the environment around the robot – a process known as environment recognition – for creating local maps and for avoiding mobile objects – a process known as motion planning. We constructed a detailed 3D map automatically using autonomous driving data to improve navigation accuracy without increasing the operator’s workload, confirming the feasibility of the proposed method through experiments.

A 56-year-old man with a medical history of hypertension and diabetes was referred by his primary care physician to our hospital for an electrocardiographic abnormality. An echocardiogram showed moderately reduced left ventricular function (ejection fraction 45%). Coronary angiography revealed a

A 72-year-old man had undergone angioplasty of the left main stem (LMS) with an implantation of a first-generation drug-eluting stent (DES) (3.5 × 18-mm Cypher stent, Cordis, Johnson & Johnson, Bridgewater, New Jersey) ([Figure 1A][1]). Post-procedural intravascular ultrasound (IVUS) had shown a

Provisional single-stenting is the preferred strategy for the treatment of coronary bifurcation lesions [(1)][1]. In cases where the side branch (SB) suffers from flow compromise following main-branch (MB) stenting, stent implantation in the SB ought to be considered [(2)][2]. Currently, the use of

A 72-year-old man presented with exertional angina 22 months after percutaneous coronary intervention in the proximal segment of left anterior descending artery (LAD) and first diagonal branch (D1) with the provisional T-stenting and small protrusion (TAP) technique (Xience Prime 2.5 × 23 mm stent

Recently described, metallic drug-eluting stent longitudinal distortion is a mechanical phenomenon that leads to stent compression and strut separation (“pseudofracture”) during percutaneous coronary intervention [(1)][1]. Conversely, bioresorbable vascular scaffolds (BVS; Absorb, Abbott

We appreciate the interest and comments of Muntane-Carol et al for our article regarding the feasibility and safety of bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) implantation in chronic total occlusions.1 As reported, malapposed BVS struts are associated with high thrombogenicity and poor endothelization. Underexpanded BVS struts cause flow disturbance with low shear stress. These factors can increase the risk of restenosis and scaffold thrombosis.2 For these reasons, we performed optimal lesion preparation and postdilatation …

Background— There are only limited studies reporting clinical outcomes after bioresorbable vascular scaffold (BVS; Absorb; Abbott Vascular, Santa Clara, CA) implantation for coronary chronic total occlusions (CTO). The aim of this study was to evaluate the real-world feasibility and safety of BVS implantation for the treatment of CTO. Methods and Results— We retrospectively evaluated CTO cases treated with BVS from a multicenter registry. The primary end point was target lesion failure defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. From September 2012 to November 2015, 65 patients with CTO were successfully treated with BVS. The mean age of patients was 60.8±11.0 years; 89.2% were male and 40.0% diabetic. The mean ejection fraction was 57.7±10.8%. The mean reference vessel diameter and CTO lesion length were 3.0±0.4 and 20.2±3.0 mm, respectively. The mean number of BVS deployed per patient was 1.8±0.7, of which mean diameter and total length were 3.0±0.4 and 47.6±19.9 mm, respectively. Postdilatation with noncompliant balloons (mean diameter 3.3±0.3 mm) was performed at high pressures (18.6±5.3 atm) in all cases. Intravascular ultrasound (n=34) or optical coherence tomography (n=31) was performed in all cases. During the follow-up period (median: 453 days, 25th and 75th percentiles: 230 and 703), there were no occurrences of target lesion failure or scaffold thrombosis. Conclusions— BVS implantation for the treatment of CTO seems feasible and safe. Appropriate lesion preparation, high-pressure postdilatation, and the use of intravascular imaging are recommended to obtain the best possible final result.

Objectives We evaluated the angiographic patterns and predictors of in-stent restenosis (ISR) for ostial lesions of the right coronary artery (RCA) to clarify the mechanism of insoluble restenosis. Background Although ISR of the RCA still occurs, limited data is available regarding the associated angiographic findings. Methods Between January 2005 and September 2013, we recruited consecutive patients undergoing routine angiography 6–18months after implantation of a drug-eluting stent (DES). Multiple logistic regression analysis was used to determine the independent predictors of ISR, and the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated. Results Routine angiography revealed that 45 of 131 patients (34.3%) had RCA-ISR, which were classifiable by occlusion type into ostial (24 cases), proximal (17 cases), diffuse (3 cases), and total (1 case). By multivariable analysis, early generation DES was the only independent predictor of overall ISR (aOR, 3.54; 95% CI, 1.59–7.87; p =0.002). In a subgroup analysis of each focal ISR pattern, early generation DES (aOR, 7.76; 95% CI, 2.15–28.0; p =0.002) was associated with increased risk of ostial ISR. On the contrary, larger stent (aOR, 0.21; 95% CI, 0.05–0.84; p =0.027) was associated with decreased risk of ostial ISR. Furthermore, a ratio of the stent to post-balloon size >1.10 (aOR, 3.93; 95% CI, 1.30–11.8; p =0.002) and good left ventricular contractility (ejection fraction >60%) (aOR, 8.27; 95% CI, 1.76–39.0; p =0.008) were associated with increased risk of proximal ISR when stent fracture was observed. Conclusion The focal pattern of RCA-ISR was mostly observed after DES implantation, and the mechanisms of proximal and ostial ISR differed.

Background— There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease. Methods and Results— Between April 2005 and August 2011, we recruited 937 consecutive unprotected distal left main patients treated with drug-eluting stents (1-SS, 608 patients; 2-SS, 329 patients). Major adverse cardiovascular events were defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR) during the median follow-up period of 1592 days. Furthermore, the individual components of major adverse cardiovascular events, cardiac death, and stent thrombosis were evaluated. More complex lesions were seen with 2-SS than with 1-SS. Cardiac death occurred more frequently with 1-SS than with 2-SS (propensity score–adjusted hazard ratio, 0.52; 95% confidence interval, 0.29–0.64; P =0.03), whereas TLR occurred more frequently with 2-SS than with 1-SS (propensity score–adjusted hazard ratio, 1.59; 95% confidence interval, 1.15–2.20; P =0.005). TLR was mainly driven by revascularizations after restenosis at the ostial left circumflex artery (propensity score–adjusted hazard ratio, 1.94; 95% confidence interval, 1.33–2.82; P =0.001). However, there were no differences in major adverse cardiovascular events, all-cause death, stent thrombosis, and myocardial infarction. Of the 139 pairs that were propensity score matched, only TLRs were significantly higher in the 2-SS group (hazard ratio, 1.59; 95% confidence interval, 1.00–2.53; P =0.05). Conclusions— The difference between 1-SS and 2-SS in percutaneous coronary intervention for unprotected distal left main disease may be summarized by the high incidence of TLR, mainly because of restenosis at the ostial left circumflex artery in the 2-SS group.

A 70-year-old man with a medical history of hypertension, dyslipidemia, and diabetes was referred to our hospital for effort angina. Coronary angiography revealed chronic total occlusion (CTO) of the proximal right coronary artery (RCA) that had been collateralized by septal branches from the left anterior descending coronary artery, left circumflex coronary artery, and an antegrade bridge. Three everolimus-eluting stents (Xience-Alpine: 3.0 × 38 mm, 2.75 × 38 mm, and 2.5 × 38 mm; Abbott-Vascular Co., Abbott Park, IL, USA; Fig. 1D, indicated by yellow lines) were implanted with stent overlap. Post-procedural angiography showed double-barrel flow through the RCA. Repeat angiography after 10 months showed double-barrel flow through the RCA, the stented lumen, and the non-stented lumen. Optical coherence tomography (OCT) demonstrated subintimal stenting. OCT revealed that the entry point from the true lumen (TL) was the proximal segment of the RCA, and the re-entry point to the TL was the distal segment of the RCA. Additionally, OCT showed smooth and thin neointimal proliferation inside the deployed stent, and there was no evidence of an intraluminal thrombus. To the best of our knowledge, this is the first report describing a subintimal stenting of CTO lesion involved with double-barrel coronary artery with OCT assessment.