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Color is a critical design factor for web pages, affecting important factors such as viewer emotions and the overall trust and satisfaction of a website. Effective coloring requires design knowledge and expertise, but if this process could be automated through data-driven modeling, efficient exploration and alternative workflows would be possible. However, this direction remains underexplored due to the lack of a formalization of the web page colorization problem, datasets, and evaluation protocols. In this work, we propose a new dataset consisting of e-commerce mobile web pages in a tractable format, which are created by simplifying the pages and extracting canonical color styles with a common web browser. The web page colorization problem is then formalized as a task of estimating plausible color styles for a given web page content with a given hierarchical structure of the elements. We present several Transformer-based methods that are adapted to this task by prepending structural message passing to capture hierarchical relationships between elements. Experimental results, including a quantitative evaluation designed for this task, demonstrate the advantages of our methods over statistical and image colorization methods. The code is available at https://github.com/CyberAgentAILab/webcolor., Accepted to WACV 2023

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).

Shadow removal is an essential task in computer vision and computer graphics. Recent shadow removal approaches all train convolutional neural networks (CNN) on real paired shadow/shadow-free or shadow/shadow-free/mask image datasets. However, obtaining a large-scale, diverse, and accurate dataset has been a big challenge, and it limits the performance of the learned models on shadow images with unseen shapes/intensities. To overcome this challenge, we present SynShadow, a novel large-scale synthetic shadow/shadow-free/matte image triplets dataset and a pipeline to synthesize it. We extend a physically-grounded shadow illumination model and synthesize a shadow image given an arbitrary combination of a shadow-free image, a matte image, and shadow attenuation parameters. Owing to the diversity, quantity, and quality of SynShadow, we demonstrate that shadow removal models trained on SynShadow perform well in removing shadows with diverse shapes and intensities on some challenging benchmarks. Furthermore, we show that merely fine-tuning from a SynShadow-pre-trained model improves existing shadow detection and removal models. Codes are publicly available at https://github.com/naoto0804/SynShadow., Comment: Accepted to IEEE Transactions on Circuits and Systems for Video Technology (TCSVT), v2: fixed typos

This paper proposes an efficient image retrieval system. When users wish to retrieve images with semantic and spatial constraints (e.g., a horse is located at the center of the image, and a person is riding on the horse), it is difficult for conventional text-based retrieval systems to retrieve such images exactly. In contrast, the proposed system can consider both semantic and spatial information, because it is based on semantic segmentation using fully convolutional networks (FCN). The proposed system can accept three types of images as queries: a segmentation map sketched by the user, a natural image, or a combination of the two. The distance between the query and each image in the database is calculated based on the output probability maps from the FCN. In order to make the system efficient in terms of both the computation time and memory usage, we employ the product quantization technique (PQ). The experimental results show that the PQ is compatible with the FCN-based image retrieval system, and that the quantization process results in little information loss. It is also shown that our method outperforms a conventional text-based search system.

Background Ureteroarterial fistula is a rare life-threatening complication of indwelling ureteral stents. The mechanism has not yet been fully evaluated using intravascular imaging. Case presentation An-84-year-old female was referred to our unit because of large volume pulsatile bleeding from the left ureter during routine stent exchange in the urology department. The hematuria was initially managed by rapidly exchanging for a new stent; however, the patient went into hypovolemic shock due to acute blood loss. The patient underwent implantation of the bilateral ureteral stents due to urinary retention caused by retroperitoneal fibrosis 2 years ago. To prevent ureteral infection, occlusion of the stents and stone formation, the stents were exchanged every 6 months. Computed tomography revealed contact between the left ureter and the common iliac artery. Therefore, ureteroarterial fistula was suspected and endovascular therapy was performed. Although angiography did not show definite blood flow into the ureter, a soft guidewire was advanced from the subintima of the external iliac artery to the left ureter. The diagnosis of ureteroarterial fistula was confirmed. Intravascular ultrasound identified the stent in the ureter and its connection to the subintima of the external iliac artery. The ureter did not contact directly to the inner lumen of the iliac arteries according to the ultrasound findings; therefore, we considered that the risk of stent-graft infection might not be high. After coil embolization of the ipsilateral internal iliac artery, a covered stent was implanted in the external iliac artery to seal the subintimal entry. The patient had no further episodes of any gross hematuria on dual anti-platelet therapy, when the ureteral stent was exchanged three time during 1 year after the endovascular therapy. Conclusions We demonstrated a case of ureteroarterial fistula, in which intravascular ultrasound allowed to visualize the communication between the ureter and the subintimal lumen in the external iliac artery. Electronic supplementary material The online version of this article (10.1186/s42155-019-0060-6) contains supplementary material, which is available to authorized users.

This paper tackles a new problem setting: reinforcement learning with pixel-wise rewards (pixelRL) for image processing. After the introduction of the deep Q-network, deep RL has been achieving great success. However, the applications of deep reinforcement learning (RL) for image processing are still limited. Therefore, we extend deep RL to pixelRL for various image processing applications. In pixelRL, each pixel has an agent, and the agent changes the pixel value by taking an action. We also propose an effective learning method for pixelRL that significantly improves the performance by considering not only the future states of the own pixel but also those of the neighbor pixels. The proposed method can be applied to some image processing tasks that require pixel-wise manipulations, where deep RL has never been applied. Besides, it is possible to visualize what kind of operation is employed for each pixel at each iteration, which would help us understand why and how such an operation is chosen. We also believe that our technology can enhance the explainability and interpretability of the deep neural networks. In addition, because the operations executed at each pixels are visualized, we can change or modify the operations if necessary. We apply the proposed method to a variety of image processing tasks: image denoising, image restoration, local color enhancement, and saliency-driven image editing. Our experimental results demonstrate that the proposed method achieves comparable or better performance, compared with the state-of-the-art methods based on supervised learning. The source code is available on https://github.com/rfuruta/pixelRL., Comment: To appear in IEEE Transactions on Multimedia (TMM), Special Issue on Multimedia Computing with Interpretable Machine Learning. Extended version of our paper in AAAI 2019 (arXiv:1811.04323)

This paper tackles a new problem setting: reinforcement learning with pixel-wise rewards (pixelRL) for image processing. After the introduction of the deep Q-network, deep RL has been achieving great success. However, the applications of deep RL for image processing are still limited. Therefore, we extend deep RL to pixelRL for various image processing applications. In pixelRL, each pixel has an agent, and the agent changes the pixel value by taking an action. We also propose an effective learning method for pixelRL that significantly improves the performance by considering not only the future states of the own pixel but also those of the neighbor pixels. The proposed method can be applied to some image processing tasks that require pixel-wise manipulations, where deep RL has never been applied. We apply the proposed method to three image processing tasks: image denoising, image restoration, and local color enhancement. Our experimental results demonstrate that the proposed method achieves comparable or better performance, compared with the state-of-the-art methods based on supervised learning., Accepted to AAAI 2019

The optimal primary transradial intervention (TRI) technique has not been established in non-ST segment elevation acute coronary syndrome (NSTEACS) patients, because they often, but not always, undergo immediate revascularization after coronary angiography (CAG). Moreover, TRI failure has been reported in 5%-10% of cases. We investigated whether a newly designed strategy of immediate TRI using one sheathless hydrophilic-coated guiding catheter (SH-GC) after diagnostic CAG with one 4.0 Fr sheath via a single access site (the 1-1-1 strategy) could be beneficial for NSTEACS patients.We performed immediate TRI prospectively using SH-GC in consecutive NSTEACS patients in our hospital and compared the procedural success rate with that of conventional TRI performed before this study.Between 2015 and 2017, immediate TRI using SH-GC was performed in 330 consecutive NSTEACS patients after CAG using a 4.0 Fr sheath. Compared with the conventional TRI group (n = 330), the procedural success rate was significantly higher in the SH-GC group (P.01), as SH-GC prevented TRI failure due to radial spasm (P.01). SH-GC use was also significantly associated with completion of both diagnostic CAG and immediate TRI using only one sheath (P.001) and one guiding catheter (P=.02). Multivariate analysis revealed that SH-GC use was an independent predictor of successful TRI (P.01). The rates of major adverse cardiac events were comparable; however, rates of major access-site bleeding (P.01) and blood transfusion (P=.02) were significantly lower in the SH-GC group.The 1-1-1 strategy using SH-GC may offer better TRI treatment than conventional systems for NSTEACS patients and simultaneously prevent access-site bleeding.

We present a 77-year-old female with heavily calcified chronic total occlusions (CTO) in a superficial femoral artery treated by endovascular therapy using a Wingman crossing catheter, which is an over-the-wire catheter with a metallic blade, controlled manually. The blade could probe and track the calcified cap of CTO, wherein any hydrophilic guidewires or looped wires could not penetrate. Moreover, the Wingman could proceed through the occlusion and introduce a guidewire into distal intramedial lumen as a support catheter. Finally, wire crossing was achieved using a bi-directional approach. The Wingman can be a simple solution for crossing calcified peripheral CTO.

Proteins are prone to inactivation in aqueous solutions because chemical modification and aggregation usually occur, particularly at high temperature. This review focuses on the recent advance in practical application with amine compounds that prevent the heat-induced inactivation and aggregation of proteins. Coexistence of amine solutes, typically diamines, polyamines, amino acid esters, and amidated amino acids decreases the heat-induced inactivation rate of proteins by one order of magnitude compared with that in the absence of additives under low concentrations of proteins at physiological pH. The amine compounds mainly suppress chemical modification, typically the β-elimination of disulfide bond and deamidation of asparagine side chain, thereby preventing heat-induced inactivation of proteins. Polyamines do not improve the refolding yield of proteins, owing to decrease in the solubility of unfolded proteins. In contrast, arginine is the most versatile additive for various situations, such as refolding of recombinant proteins, solubilized water-insoluble compounds, and prevention of nonspecific binding to solid surfaces; however, it is not always effective for preventing heat-induced aggregation. Amine compounds will be a key to prevent protein inactivation in solution additives.

Objectives This study sought to investigate the 3-year follow-up results of OLIVE registry patients. Background Although favorable 12-month clinical outcomes after endovascular therapy (EVT) in OLIVE registry patients with critical limb ischemia (CLI) from infrainguinal disease have been reported, long-term results after EVT remain unknown. Methods This was a prospective multicenter registry study that consecutively enrolled patients who received infrainguinal EVT for CLI. The primary outcome was 3-year amputation-free survival (AFS), whereas secondary outcome measures were 3-year freedom from major adverse limb events (MALE), wound-free survival, and wound recurrence rate. Prognostic predictors for each outcome were also elucidated by Cox proportional hazard regression analysis or the log-rank test. Results The completion rate of 3-year follow-up was 95%. Three-year AFS, freedom from MALE, and wound-free survival rates were 55.2%, 84.0%, and 49.6%, respectively. Wound recurrence out to 3 years was 43.9%. After multivariable analysis, age (hazard ratio [HR]: 1.43, p = 0.001), body mass index ≤18.5 (HR: 2.17, p = 0.001), dialysis (HR: 2.91, p Conclusions In CLI patients with infrainguinal lesions, 3-year clinical results of EVT were reasonable despite high reintervention and moderate ulcer recurrence rate. (A Prospective, Multi-Center, Three-Year Follow-Up Study on Endovascular Treatment for Infra-Inguinal Vessel in Patients With Critical Limb Ischemia [OLIVE 3-Year Follow-Up Study]; UMIN000014759 )

Although coronary artery calcium (CAC) is an established marker of coronary atherosclerosis, whether it also reflects the physiological significance is unknown. This study aims to evaluate if CAC could indicate physiological ischemia in intermediate stenosis defined by an invasive fractional flow reserve (FFR). CAC score (CACS) derived from either whole coronary arteries or individual arteries was measured by computed tomography among patients with intermediate de novo lesions (percent diameter stenosis from 30% to less than 70%). All stenoses were evaluated by invasive FFR; lesions with an FFR ≤ 0.80 were considered significant. We enrolled 119 patients with 143 lesions. Of these, 42 lesions (29.4%) demonstrated significant ischemia by FFR measurement. FFR values had modest but significant correlations with CACS in individual arteries with intermediate stenosis (r = − 0.290; p < 0.001). A receiver operating characteristic curve analysis showed that CACS of individual arteries with intermediate stenosis had 71.4% sensitivity and 67.3% specificity as a predictor of significant ischemia at a cut off value of 145.9. Multivariable analysis showed that percent diameter stenosis and CACS in individual arteries with intermediate stenosis were independent predictors for significant ischemia. By net reclassification improvement analysis, CACS in individual arteries with intermediate stenosis provided incremental prediction for significant ischemia over minimum lumen diameter, percent diameter stenosis, and lesion length. CACS measured in each artery, but not the total CACS, provides additional information as to whether an angiographically intermediate stenosis within the artery is significant enough to cause myocardial ischemia.

Hen egg white contains more than 40 kinds of proteins with concentrations reaching 100 mg/mL. Highly concentrated protein mixtures are common in the food industry, but the effects of a crowded environment containing salts on protein stability and aggregation have only been investigated using pure protein solutions. Here, we investigated the thermal aggregation of hen egg white protein (EWP) at various concentrations in the presence of inorganic salts by solubility measurements and SDS-PAGE. EWP at 1 mg/mL formed aggregates with increasing temperature above 55 °C; the aggregation temperatures increased in the presence of inorganic salt with the Hofmeister series. Namely, the chaotrope 0.5 M NaSCN completely suppressed the thermal aggregation of 1 mg/mL EWP. As the protein concentration increased, NaSCN unexpectedly enhanced the protein aggregation; the aggregation temperature of 10 and 100 mg/mL EWP solutions were dramatically decreased at 62 and 47 °C, respectively. This decrease in aggregation temperatures due to the chaotrope was described by the excluded volume effect, based on a comparative experiment using Ficoll 70 as a neutral crowder. By contrast, the kosmotrope Na2SO4 did not affect the aggregation temperature at concentrations from 1 to 100 mg/mL EWPs. The unexpected fact that a chaotrope rather enhanced the protein aggregation at high concentration provides new insight into the aggregation phenomena with the Hofmeister effect as well as the crude state of highly concentrated proteins., AA11914091

Can we detect common objects in a variety of image domains without instance-level annotations? In this paper, we present a framework for a novel task, cross-domain weakly supervised object detection, which addresses this question. For this paper, we have access to images with instance-level annotations in a source domain (e.g., natural image) and images with image-level annotations in a target domain (e.g., watercolor). In addition, the classes to be detected in the target domain are all or a subset of those in the source domain. Starting from a fully supervised object detector, which is pre-trained on the source domain, we propose a two-step progressive domain adaptation technique by fine-tuning the detector on two types of artificially and automatically generated samples. We test our methods on our newly collected datasets containing three image domains, and achieve an improvement of approximately 5 to 20 percentage points in terms of mean average precision (mAP) compared to the best-performing baselines., Comment: To appear at CVPR2018 (poster), including supplementary materials

A new type of antireflective (AR) acrylic hard coating consisting of a surface-segregated single layer of silica nanoparticles and acrylic polymer matrix is proposed that exhibits good mechanical stability and AR capability. In addition, the polymer hard coating can be obtained by a single coating process. Porous silica particles 100 nm in diameter with surfaces modified by hexamethyl disilazane (HMDS) undergo spontaneous segregation at the air interface of the acrylic monomer film. The monolayer of porous silica particles can serve as an AR surface; a reflectance of 2.7% at 550 nm and a pencil hardness > H are achieved. The great advantage of the present approach is that a hard coating with AR capability can be obtained from an acrylic monomer solution containing porous silica nanoparticles via a presently available general polymer coating process. The present approach to an AR hard coating offers a much easier and simpler way than the conventional ones, which require multi-step coating or nanolithography.

Therapeutic protein solutions for subcutaneous injection must be very highly concentrated, which increases their viscosity through protein-protein interactions. However, maintaining a solution viscosity below 50 cP is important for the preparation and injection of therapeutic protein solutions. In this study, we examined the effect of various amino acids on the solution viscosity of very highly concentrated bovine serum albumin (BSA) and human serum albumin (HSA) at a physiological pH. Among the amino acids tested, l-arginine hydrochloride (ArgHCl) and l-lysine hydrochloride (LysHCl) (50-200 mM) successfully reduced the viscosity of both BSA and HSA solutions; guanidine hydrochloride (GdnHCl), NaCl, and other sodium salts were equally as effective, indicating the electrostatic shielding effect of these additives. Fourier transform infrared spectroscopy showed that BSA is in its native state even in the presence of ArgHCl, LysHCl, and NaCl at high protein concentrations. These results indicate that weakened protein-protein interactions play a key role in reducing solution viscosity. ArgHCl and LysHCl, which are also non-toxic compounds, will be used as additives to reduce the solution viscosity of concentrated therapeutic proteins.

Patient Initials or Identifier Number 110110 ### Relevant Clinical History and Physical Exam The patient is 90 years old gentleman with intermittent claudication. He is active and received a maximal medical therapy including cilostazol. But he still has a severe symptom. The rt-popliteal

Stanford type A and open false lumen are accepted predictors for in-hospital mortality in patients with acute aortic dissection (AAD). However, the association of renal dysfunction on admission with in-hospital mortality is not well known. The aim of this study was to investigate the prognostic value of renal dysfunction in patients with AAD. A total of 250 patients with type B AAD admitted to our institution between January 2003 and August 2011 were enrolled in this study. In multivariate logistic regression analysis, the significant predictors of in-hospital mortality were age (odds ratio [OR] 1.575, 95% confidence interval [CI] 1.078-2.864, p = 0.024), maximum aortic diameter measured by an initial computed tomography (CT) (OR 1.740, 95% CI 1.029-2.940, p = 0.039), decreased enhancement of kidney (OR 7.716, 95% CI 2.335-25.501, p = 0.001) and estimated glomerular filtration rate (eGFR)

我々はスポーツ活動時の腰痛発生予防を目的に高校サッカー選手に体幹筋トレーニングを継続して行っている。体幹機能検査にはKraus-Weber test変法大阪市大方式(以下、KW)とSide-Bridge test(以下、SB)を用い、体幹筋機能と運動時腰痛発生の経時的変化を入学年度別に調査し、検討を加えたので報告する。結果は2年以上の継続した指導によって平成19年度入学の選手はSBの点数向上に伴い運動時腰痛保有者は減少する傾向となった。20年度入学の選手はKW、SBともに点数の変化がなく運動時腰痛保有者は増加した。21年度入学の選手はKW、SBともに点数は向上し、運動時腰痛保有者は減少する傾向にあった。学年別に検討したところ、KWとSBの経時的な変化と運動時腰痛保有者の変化の傾向は異なるが、KWとSBの点数に反映される体幹筋機能を向上させることが腰痛保有者の減少や予防に関与する可能性が示唆された。, We have been providing trunk muscle training for senior high school soccer players on a continuing basis for the purpose of preventing low back pain in sports activities. We report the results of our investigation and discussion on time-dependent change by school year in relation between trunk muscle function and occurrence of low back pain during exercise which are based on Kraus-Weber tests(KW) modified by the Osaka-City-University system and Side-Bridge tests(SB) as means to examine trunk muscle function. Our findings indicated a decreasing tendency of players with low back pain during exercise among students enrolled in 2007 along with improved SB scores attributable to more than 2 years of continuous coaching. Students enrolled in 2008 did not show change in KW or SB scores and the players with low back pain during exercise increased. Students enrolled in 2009 had a tendency to improve both in KW and SB scores and to decrease in the number of players with low back pain during exercise. Our examination of the results by school year suggested the potential association between improved trunk muscle function reflected in KW and SB scores, and reduction and prevention of players with low back pain despite the difference in the tendencies of time-dependent change in KW and SB scores and in the number of players with low back pain during exercise.

A novel system for monitoring methane emission from a flooded paddy field was developed in order to quantify the greenhouse gas emission in near-natural conditions. A paddy field planted with rice was covered by a semi-open vinyl tunnel (1.8 × 10 × 2.5 m), and the methane concentrations inside and outside the tunnel were measured continuously from the booting stage to the ripening stage (August–September) using a methane gas detector. Methane emission rates were calculated on an hourly basis from the differences between the internal and external methane concentrations and the natural diffusion rates determined using a tracer gas method. The results indicated that the paddy field emitted 0.41–1.32 g methane m−2 day−1 during the two growth stages. The vinyl tunnel had no adverse effect on the growth and yield of rice plants inside. Despite the disadvantage of non-accurate estimation under windy conditions, the technique is considered to be of potential value for evaluating methane emissions from a flooded paddy field.

The purpose of the present study was to evaluate the 3-year clinical outcomes after percutaneous coronary intervention with sirolimus-eluting stents in patients with insulin-treated diabetes mellitus (DM-insulin) and those with non-insulin-treated DM (DM-non-insulin) compared to patients without DM. Of 10, 778 consecutive patients treated exclusively with sirolimus-eluting stents in the j-Cypher registry, we identified 996 patients with DM-insulin, 3, 404 with DM-non-insulin, and 6, 378 without DM. Compared to the non-DM group, the adjusted risk of a serious cardiovascular event (composite of all-cause death, myocardial infarction, and stroke) was significantly greater in the DM-insulin group (hazard ratio 1.12, 95% confidence interval [CI] 1.03 to 1.23; p = 0.01), but not in the DM-non-insulin group (hazard ratio 1.02, 95% CI 0.96 to 1.09; p = 0.47). The adjusted risk of target lesion revascularization was significantly greater in both the DM-insulin group (odds ratio 1.52, 95% CI 1.19 to 1.92; p = 0.0006) and the DM-non-insulin group (odds ratio 1.24, 95% CI 1.05 to 1.45; p = 0.009). In conclusion, a diabetes-associated excess risk of target lesion revascularization was found, regardless of insulin use in this large, real-world study of Japanese patients with sirolimus-eluting stent implantation. However, regarding serious cardiovascular events, an excess risk was seen only in the DM-insulin group. The risk of serious cardiovascular events was similar between the DM-non-insulin and non-DM groups.

Background: The use of a stent in the treatment of lesions of the superficial femoral artery (SFA) remains controversial. Although some reports have suggested that use of a nitinol stent in conjunction with aggressive medical management is effective for long SFA lesions, few long-term, large-scale studies have been done. Methods and Results: A retrospective analysis was conducted of data from a multicenter study in which the S.M.A.R.T. ControlTM stent was used for treatment of de novo SFA lesions. A total of 528 lesions in 432 patients were included. Mean patient age was 72.5±9.1 years; mean stent length was 15.7±8.1cm; 259 lesions (49%) were classified as C/D according to the TransAtlantic Inter-Society Consensus (TASC) II classification. Primary and secondary patency at 4 years was 66% and 87%, respectively. No cilostazol administration (41% re-stenosis group vs. 29% no-restenosis group, P

To calculate the cutoff value for radial artery occlusion (RAO) in patients undergoing transradial percutaneous coronary interventions (PCI) using sheathless guiding catheters for acute coronary syndrome (ACS). We prospectively screened 936 consecutive patients undergoing primary PCI for ACS, and

High-purity plates of Cu and Sn were diffusion bonded to clarify the early stage of the solid state interfacial reaction between Cu and Sn, focusing on the incubation time for the formation of intermetallic compounds. A clear incubation time for the formation of intermetallic compounds is observed at every temperature between 423 and 493 K. The incubation time changes depending on the annealing temperature. The interface annealed at 423 K for 3.60 ks maintains the direct interconnection between Cu and Sn being free of intermetallic compounds. The exposure of Cu surface to air affects the interfacial reaction. Annealing of the Cu/Sn interface at 493 K for 3600 s starts to form voids by using the Cu plates exposed for 8.64×104 s or longer to air. Furthermore, the reaction product layer formed by the same annealing condition becomes thinner when the Cu plates exposed for 8.64×105 s or longer to air are used.

Background— The influences of antiplatelet therapy discontinuation on the risk of stent thrombosis and long-term clinical outcomes after drug-eluting stent implantation have not yet been addressed adequately. Methods and Results— In an observational study in Japan, 2-year outcomes were assessed in 10 778 patients undergoing sirolimus-eluting stent implantation. Data on status of antiplatelet therapy during follow-up were collected prospectively. Incidences of definite stent thrombosis were 0.34% at 30 days, 0.54% at 1 year, and 0.77% at 2 years. Thienopyridine use was maintained in 97%, 62%, and 50% of patients at 30 days, 1 year, and 2 years, respectively. Patients who discontinued both thienopyridine and aspirin had a significantly higher rate of stent thrombosis than those who continued both in the intervals of 31 to 180 days, 181 to 365 days, and 366 to 548 days after stent implantation (1.76% versus 0.1%, P P =0.02; and 2.1% versus 0.14%, P =0.004, respectively). When discontinuation of aspirin was taken into account, patients who discontinued thienopyridine only did not have an excess of stent thrombosis in any of the time intervals studied. Adjusted rates of death or myocardial infarction at 24 months were 4.1% for patients taking thienopyridine and 4.1% for patients not taking thienopyridine ( P =0.99) in the 6-month landmark analysis. Conclusions— Discontinuation of both thienopyridine and aspirin, but not discontinuation of thienopyridine therapy only, was associated with an increased risk of stent thrombosis. Landmark analysis did not suggest an apparent clinical benefit of thienopyridine use beyond 6 months after sirolimus-eluting stent implantation.

米デンプンのα-アミラーゼによる消化特性とグリセミック・インデックス(GI)を簡易に測定するため, 近赤外分光(NIR)法による推定精度について検討した. 検量線の作成は, 部分最小2乗法による回帰分析(PLS)で行った. NIR法による推定の実用性評価は, 推定値の標準誤差を検定試料の分布範囲と比較したEI法, および予測標準誤差を検定試料の標準偏差と比較したRPD法を用いて行った. 米デンプンの消化特性は3つのパラメーターを持った非線形式で表現した. そのパラメーターは, 加熱前処理に由来する分解物の割合(パラメーターa), α-アミラーゼの作用に由来する消化物の割合(同b), 消化速度(同c)である. GIはin vitroで評価したGI(EGI)を用いた. NIR法による簡易測定は, パラメーターcおよびEGIの推定において実用性があると判断された. その精度は遺伝資源にランクをつけるような一次スクリーニングに適用できるレベルであった. このことから, NIR法による簡易測定は, 米デンプンの消化速度が遅く, GIの低いイネ品種を選抜するのに有効と考えられた. また, 推定精度の向上のためには, イネの生態型や生産地によって試料を分けることが有効なことも示唆された.

A 78-year-old woman with severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI) with a balloon expandable bioprosthesis: a 23-mm Sapien XT valve (Edwards Life Sciences, Inc., CA, USA). A set of the valve and a balloon (NovaFlex, Edwards Transfemoral Balloon Catheter, Edwards Life Sciences, Inc., CA, USA) was successfully delivered to an optimal position using a 16-French expandable introducer hydrophilic sheath. Inflation of the balloon was commenced, and expansion was initially smooth. However, it ruptured immediately before completion of expansion, resulting in a rapid deterioration in hemodynamics. Even though no migration of the stent valve was observed, transesophageal echocardiography and aortography revealed massive paravalvular aortic regurgitation (AR), suggesting that AR was attributable to insufficient expansion. After post -dilatation of the stent valve using a 23- mm balloon (Edwards Transfemoral Balloon Catheter, Edwards Life Sciences, Inc., CA, USA), the patient’s condition began to improve, and further aortography indicated an improvement in paravalvular AR. This case represented that balloon rupture could led to sudden onset massive paravalvular AR. Interventional cardiologists should recognize it as a significant complication in patients undergoing TAVI using a balloon-expandable bioprosthesis, with the possibility of severe cardiogenic shock.

We aimed to investigate the feasibility and safety of alcohol septal ablation (ASA) via transradial approach using a sheathless guiding catheter.Although ASA is conventionally performed via the femoral artery, there is a potential risk of bleeding and other vascular complications. The transradial approach may be associated with a lower rate of such complications. A sheathless guiding catheter, with an advanced hydrophilic coating along its full length, could reduce radial artery occlusion and spasm.We enrolled 14 consecutive patients with hypertrophic obstructive cardiomyopathy treated with ASA via the radial access at Sendai Kousei Hospital from December 2012 to May 2014. Left radial access was used for the sheathless guiding catheter, while right radial access was used for monitoring left ventricular pressure with a 4 Fr diagnostic catheter. A temporary pacemaker was inserted via the right jugular vein.Procedural success rate was 93% (13/14 patients). The left ventricular outflow tract pressure gradient at rest was reduced from a median of 128 mm Hg (interquartile range, 49-147 mm Hg) at baseline to a median of 16 mm Hg (interquartile range, 13-26 mm Hg) at 30-day follow-up (P=.01). The New York Heart Association functional class improved from a median of II (II-III) at baseline to a median of I (I-I) at 30-day follow-up (P=.01). There were no cases of access-site complication, including radial artery occlusion and spasm.The transradial approach using a sheathless guiding catheter was feasible and safe for ASA.

To evaluate the efficacy and safety of transradial coronary intervention (TRI) using a sheathless guide catheter (sheathless TRI) in a large, retrospective, single-center study.The sheathless guide catheter was designed to be inserted without an introducer sheath to decrease stress to the radial artery. Although the sheathless guide catheter has some potential limitations, such as its procedural complexity or the risk of coronary ostial dissection, no large studies have been reported.We retrospectively investigated all TRIs performed at Sendai Kousei Hospital from January 2004 to December 2013.Out of a total of 12,617 percutaneous coronary interventions (PCIs), sheathless TRIs were performed in 9658 cases (76.5%) and TRIs using a conventional sheath (sheath TRI) were performed in 1070 cases (8.5%). Procedural success was achieved in 98.81% of sheathless TRIs and 96.82% of sheath TRIs (P.001); after propensity matching, the success rate was 98.9% in sheathless TRIs and 97.6% in sheath TRIs (P=.01). The conversion of the guide catheter system occurred in 0.40% of sheathless TRIs and 0.28% in sheath TRIs (P=.54). Coronary ostial dissection occurred in 0.26% of sheathless TRIs and 0.47% in sheath TRIs (P=.22).Sheathless TRI was utilized in the majority of cases, and the propensity-matched procedural success was similar but statistically higher as compared with sheath TRI. Complications were rare and equivalent to sheath TRI. Sheathless TRI is effective and safe as an initial PCI technique after the consideration of its benefits and limitations.