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Background: The efficacy of ablation targeting low-voltage areas (LVAs) is controversial, although LVA presence is well known to be associated with AF recurrence after ablation. Atrial fibrillation (AF) substrate may not localize within LVAs. Methods and results: This observational study enrolled 405 consecutive patients who underwent an initial AF ablation procedure. The left atrial voltage map was obtained after pulmonary vein isolation. LVAs were defined as areas with voltage < 0.5 mV. To estimate whole atrial electrophysiological degeneration, mean regional voltage at each of 6 regions and left atrial total conduction velocity were measured. LVAs existed in 143 of 405 (35.3%) patients. Patients with LVAs demonstrated lower mean regional voltages throughout all 6 regions than those without LVAs (1.3 [1.8, 0.8] vs. 0.6 [1.0, 0.2] for anterior wall, p

Background Drug therapy of luminal-type breast cancer has advanced remarkably; however, its effectiveness continues to be limited by primary and acquired treatment resistance. To identify the means of overcoming such resistance, in vitro disease models that faithfully reproduce the characteristics of original patient tumors must be developed. Although the three-dimensional culturing of breast cancer cells has been improved, the changes in differentiation status and underlying mechanisms require further elucidation. Methods The organoids from 33 luminal-type breast cancers were prepared using a method developed by us. Using immunohistochemistry and gene expression profiling, the levels and time courses of estrogen receptor, progesterone receptor, Ki67, and differentiation marker expression were monitored during culture as well as the variation among the patients and individual organoids. Furthermore, we examined the effect of NOTCH inhibitor treatment on differentiation status. Results We successfully prepared organoids from samples obtained from 33 patients with luminal-type breast cancer and studied their ER expression. The expression status was well maintained in primary organoids, whereas it decreased after passaging in most of the cases. In fact, the studied organoid lines were classified into those that retained a high level of ER expression (9%), those that completely lost it (9%), and those that repressed it to varying degrees (82%). In some cases, the ER expression was suddenly and drastically decreased after passaging. Marker protein immunohistochemistry revealed that after passaging, the differentiation status shifted from a luminal- to a basal-like status. Differentially expressed genes suggested the activation of NOTCH signaling in the passaged organoids, wherein a NOTCH inhibitor was able to substantially rescue the decreased ER expression and alter the differentiation status. Conclusions Our findings suggest that the differentiation status of luminal-type cancer cells is quite flexible, and that by inhibiting the NOTCH signaling we can preserve the differentiation status of luminal-type breast cancer organoids.

Introduction: Although the presence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial fibrillation (AF) after ablation, few methods are available to classify the prevalence of LVAs. The purpose of this study was to establish a risk score for predicting the prevalence of LVAs in patients undergoing ablation for AF. Methods: We enrolled 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; female, 346 (34%); persistent atrial fibrillation, 513 (51%)). LVAs were deemed present when the voltage map after pulmonary vein isolation demonstrated low-voltage areas with a peak-to-peak bipolar voltage of

BACKGROUND: Some patients fail to respond to persistent atrial fibrillation (PeAF) catheter ablation in spite of multiple procedures and ablation strategies, including low voltage area (LVA)-guided, linear, and complex fractionated atrial electrogram (CFAE)-guided ablation procedures. We hypothesized that LVA extent could predict non-responseto Pe AF catheter ablation in spite of multiple procedures. METHODS: This study included 510 patients undergoing initial ablation procedures for PeAF. LVAs were defined as regions with bipolar peak-to-peak voltages of 20 cm2 was an independent factor associated with AF recurrence after the final procedure(Hazard ratio, 7.94; 95% confidence interval, 2.91 to 21.67, P

Objectives: To compare long-term atrial fibrillation (AF)/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts enrolled in the randomized controlled VOLCANO trial. Background: Although VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal AF patients with LVAs, efficacy of LVA ablation on long-term outcomes are still unknown. Methods: Total of 402 paroxysmal AF patients were divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p

BACKGROUND Although patients with poor ability to perform activities of daily living, such as those with high Clinical Frailty Score (CFS), will often receive a cardiac implantable electric device (CIED), the indications for implantation in these patients have not been clearly defined. We investigated the association between CFS and prognosis in patients with a CIED.Methods and Results:We retrospectively enrolled 323 consecutive patients who underwent initial device implantation (age, 77 (70-83) years; male, 181 [56%] patients; high-voltage device, 49 [15%] patients), and the CFS was retrospectively estimated. Primary outcome was all-cause death, and the secondary outcome was hospitalization due to heart failure (HF). Median CFS was 4 (3-5) points. During 2 years' follow-up, all-cause death occurred in 32 patients (10%). Freedom from all-cause death was significantly lower in patients with a high CFS than in those with a low score (1-2 points: 100%, 3-4 points: 92.9%, 5-9 points: 77.3%, P

Background: Although hemodialysis vintage and serum phosphorus level adversely impact on outcomes in the field of general population on hemodialysis, it has not systematically studied whether these have similar prognostic impacts on clinical outcomes in population with chronic limb-threatening ischemia (CLTI). Methods: The current study retrospectively analyzed 374 hemodialysis patients with CLTI presenting ischemic tissue loss (age: 72.3±9.0 years, male: 73.3%, diabetes mellitus: 39.6%, Rutherford 5: 75.9%, 6: 24.1%, WIFI stage 4: 50.0%) primarily treated with endovascular therapy (EVT) between April 2007 and December 2016. Primary outcome measure was 1-year amputation-free survival (AFS), while secondary outcome measure was 1-year wound healing. Predictors for each outcome were evaluated by Cox proportional hazards model. Result: One-year rate of AFS and wound healing rate were 70.5±2.5%, and 57.1±3.0%, respectively. Multivariate analysis demonstrated that body mass index (hazard ratio [HR], 0.918; 95% confidence interval [CI], 0.859-0.981; p=0.012), non-ambulatory status (HR, 1.887; 95% CI, 1.222-2.913; p=0.004), lower serum albumin level (HR, 0.591; 95% CI, 0.414-0.844; p=0.004), WIfI stage 4 (HR, 1.782; 95% CI, 1.156-2.748; p=0.009) and longer vintages for hemodialysis with higher serum phosphorus levels (HR, 1.670; 95% CI, 1.099-2.537; p=0.016) were significantly associated with 1-year AFS (Figure), while WIfI stage 4 (HR, 0.713; 95% CI, 0.519-0.979; p=0.037) was associated and longer vintages for hemodialysis with higher serum phosphorus levels was close to significant association (HR, 0.684; 95% CI, 0.467-1.000; p=0.050) with 1-year wound healing. Conclusion: Longer hemodialysis vintage with higher serum phosphorus level would adversely affect clinical outcomes after EVT for hemodialysis patients with CLTI presenting ischemic tissue loss.

INTRODUCTION Local impedance (LI) at the tip of ablation catheter can be measured using a recently available technology. We aimed to explore target LI measurements at each radiofrequency application (RFA) for creating sufficient ablation lesions during pulmonary vein (PV) isolation. METHODS This prospective study included 15 consecutive patients scheduled to undergo an initial ablation of paroxysmal atrial fibrillation (AF). Circumferential ablation around both ipsilateral PVs was performed using a 4-mm irrigated ablation catheter with an LI sensor. Point-by-point ablation was used with a 4-mm inter-ablation-point distance. Operators were blinded to LI measurements during the procedure. Creation of sufficient ablation lesions was assessed by the absence of a conduction gap. RESULTS After first-pass encircling PV antrum ablation, left atrium to PV conduction remained in 12 of 30 (40%) ipsilateral PVs. Mapping using the minibasket catheter identified 48 ablation points through which the propagation wave entered the PV. At ablation points with a gap, the LI drop during RFA was half that at points without a gap (12 ± 7 vs. 23 ± 12 Ω; p

Global Limb Anatomic Staging System (GLASS) proposed by Global vascular guideline can anatomically stratify infrapopliteal (IP) lesions in patients with chronic limb-threatening ischemia (CLTI). This study investigated the prognostic impact of IP anatomic severity on delayed wound healing (WH) in

Although the guidelines mention that cardiac failure can negatively affect prognosis in patients with critical limb ischemia (CLI) and should be appropriately evaluated, which parameters of cardiac condition negatively affect CLI prognosis have not been well elucidated. This study was a

Late adverse events such as very late stent thrombosis (ST) and late target lesion revascularization are still concern issues. Newer-generation drug-eluting stent (DES) is expected to reduce these events. The aim of this study was to investigate clinical outcomes in patients after newer-generation

While percutaneous coronary intervention (PCI) with drug-eluting stent (DES) is widely applied to patients with coronary artery disease (CAD), high restenosis rate in hemodialysis (HD) patients treated with early-generation DES was a major clinical concern. Newer generation DES, which has thinner

The purpose of this study was to clarify the impact of atrial fibrillation (AF) on long-term outcomes after percutaneous coronary intervention (PCI). This study enrolled 1039 patients (age 70±11 years, male 74%) who underwent the initial PCI between August 2011 and June 2016. AF was assessed with

We have developed the transfer system that consists of autonomous mobile robots and the multi-robot controller that controls these robots. One of the feature of this system is the efficiency improvement of transportation that has been achieved by the hybrid control with the individual intelligence of autonomous mobile robot and the entire intelligence of mutli-robot control. By introducing this system, a space for the belt conveyer can be reduced, person's traffic line can be secured, and the risk that the entire transfer system stops due to the trouble by only one sensor can be reduced. Moreover, it is possible to correspond to layout changes because the track construction is unnecessary, and the system can be available where the person exists in the transfer area. This system was introduced into BML, INC. as “Blood samples transportation robot system”, and these features were proven to be effective by keeping really operating 24 hours. In this paper, the practical use of the developed sysytem is described.

SuiPPi is a practical robot that underwent long-term experimental evaluation at Expo 2005. SuiPPi’s mission was to clean the Expo site, for example, the Global Loop main pedestrian loop. The Global Loop is about 2.6 km long, and 21 m wide, and has many curves and slopes and obstacles such as benches and vending machines. To execute its mission, SuiPPi had to solve two problems, – (1) moving autonomously over long distances around the loop to cleaning areas, and (2) cleaning areas not necessarily rectangular. SuiPPi navigation solved these problems by recognizing and adapting to the environment. The effectiveness of SuiPPi was confirmed.

Until recently, keyboard has been used as the primary input method for machinery operation system. But in recent years, numerous methods related to direct input interface have been developed. One of them is to measure the surface electric potential that generates on the skin surface during muscle contraction. Based on this fact, hand finger operation can also be recognized with the help of the surface muscle electric potential. This report mainly explains the method of recognizing the crookedness states of the hand fingers from surface electromyogram (SEMG) signals.Moreover, the research on the biosignal control system with eye movement is also reported. We have designed a new biosignal control system that offers the disable the opportunity to control some electrical appliances. The biosignal control system is based on the signals derived from the forehead during eye movement, using five electrodes fixed on the forehead. The four directions of eye movement (up, down, left, and right) allow as four primary control signals. With selection of 2 signals from the four primary signals, we can get 16 different signals.

In Edo period, coastal service played an important role. The harbor facilities-“Gangi”, “Hato”(a breakwater), “Tadeba”(Docks), “Jyoyatou”(a lighthouse), “Funagura”(a ship house) were built up in many port towns of the Inland Sea. Now, most of these facilities were broken down and rebuilt. But at Tomonoura Hiroshima, several facilities are still existed and being used. Recently they are recognized as cultural assets by a resident's movement. So we need systematize a history and a function of them. For this purpose, this paper tries to understand over the general state of habor facilities in Tomonoura by following three steps. Firstly we collect each material of historical harbor facilities at Tomonoura, secondly make a drawing of facilities arrangement, thirdly excavate and measure existent habor facilities.This paper indicates the characteristics of historical facilities at Tomonoura from the following three view points:1) There were at least three times big constructions in the late Edo period.2) An remaining rate of “gangi” is estimated 44%.3) A size and a location of “Tadeba”(Docks) is presumed.