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The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. − 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23–6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30–10.2, p

OBJECTIVES To compare the long-term clinical outcomes after self-expandable bare nitinol stent (BNS) implantation between hemodialysis (HD) and non-HD patients with femoropopliteal (FP) disease. BACKGROUND Although a BNS has been commonly used in patients with FP disease, the long-term efficacy of BNSs in HD patients remains unknown. METHODS In total, 427 HD patients treated with a BNS for FP disease were enrolled, along with 157 non-HD patients as a control group. Over the following 5 years, the incidence of target lesion revascularization (TLR), major amputation and mortality was investigated. We also performed propensity-score matching analysis. RESULTS The 5-year TLR rate (45.2 vs. 32.5%, p = .013) and mortality rate (39.3 vs. 14.0%, p = .0002) were significantly higher in the HD group than in the non-HD group. The major amputation rate was comparable between the groups (7.2% in the HD group vs. 2.8% in the non-HD group, p = .16). In the propensity-score-matched cohort, the TLR rate, and mortality rate were remained higher in the HD group than in the non-HD group (48.9 vs. 34.1%, hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.30-3.49, p = .0024, and 47.9 vs. 12.0%, HR 3.38, 95% CI 1.86-6.56, p

To investigate the clinical outcomes after biodegradable-polymer (BP) and durable-polymer (DP) everolimus-eluting stent (EES) implantation in hemodialysis (HD) patients with coronary artery disease. We enrolled 221 consecutive HD patients successfully treated with EES implantation for coronary lesions. Over the following 2 years, we assessed the incidence of target lesion revascularization (TLR) and major adverse cardiac event (MACE), defined as the composite endpoint of TLR, all-cause mortality, or myocardial infarction. We performed a propensity-score matching analysis and collected follow-up coronary angiography data. There were 91 patients in the BP-EES group and 130 in the DP-EES group. Male sex and diabetes rates were significantly lower in the BP-EES group than in the DP-EES group. A debulking device was less frequently used in the BP-EES group than in the DP-EES group (7.6% vs. 21.5%, p = 0.006). TLR occurred in 38 patients, while stent thrombosis was observed in 3 patients; 19 patients died. TLR and MACE rates at 2 years were comparable between the two groups (19.2% in the BP-EES group vs. 20.4% in the DP-EES group, p = 0.73 and 26.9% vs. 34.2%, p = 0.93, respectively). In the propensity-score-matched cohort, TLR and MACE rates were similar between the two groups (19.2% in the BP-EES group vs. 18.1% in the DP-EES group, p = 0.69, and 26.9% vs. 30.2%, p = 0.66, respectively). Restenosis rates at follow-up angiography were similar between the two groups (p = 0.79). In hemodialysis patients, BP-EES and DP-EES showed similar 2-year clinical outcomes.

ObjectiveProtein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients.MethodsWe enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5–7.0 mg/L and T3:≥7.1 mg/L).ResultsKaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (pConclusionPreprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.

Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Background and Aims Although lower extremity revascularization has been commonly performed in chronic haemodialysis (HD) patients with peripheral artery disease (PAD), poorer prognosis still remains major problems in such population. Recently, protein-energy wasting (PEW) or malnutrition have been considered to be strongly associated with chronic inflammation and advanced atherosclerosis in HD patients. We investigated the association of geriatric nutritional risk index (GNRI) as a surrogate marker of the PEW, C-reactive protein (CRP) and these joint role with prediction of amputation and/or mortality after lower extremity revascularization in chronic HD patients. Method We enrolled a total of 862 HD patients (age 67±10 years, diabetes 62.9%, critical limb ischemia 53.5%) who successfully underwent lower extremity revascularization (552 with endovascular therapy and 310 with bypass surgery). Patients were divided into tertiles according to GNRI levels; tertile 1 (T1): 96.6, and CRP levels; T1: 12.6mg/l, respectively. They were followed up for up to 8 years. Results During follow-up period (median: 43 months), 63 (7.3%) patients needed major amputation and 202 (23.4%) patients died. Kaplan-Meier analysis shows that amputation-free survival rates for 8 years were 47.5%, 51.6% and 66.5% in T1, T2 and T3 of GNRI, and were 65.8%, 58.7% and 33.2% in T1, T2 and T3 of CRP, respectively (p Conclusion Among HD patients undergoing lower extremity revascularization, those with pre-procedural declined GNRI and elevated CRP frequently experienced amputation and/or mortality, furthermore, combination of both variables could stratify the risk of amputation and/or mortality.

Background It remains controversial whether coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) should be optimized to treat coronary artery disease in patients on chronic hemodialysis (HD). Recently, further refinement of drug-eluting stents, such as the everolimus-eluting stent (EES), has led to marked development in this field. We compared long-term clinical outcomes after CABG versus PCI with EES implantation in patients on chronic HD. Patients and methods We compared 138 patients undergoing CABG and 187 patients treated with EES implantation. The endpoint was major adverse cardiac events (MACE) as a composite outcome, including any revascularization, nonfatal myocardial infarction, or mortality. To reduce the selection bias for the two procedures, propensity score-matching was performed. Results During the follow-up period (43 months), 95 (29.2%) MACEs, including 43 (13.2%) revascularizations, 14 (4.3%) nonfatal myocardial infarctions, and 63 (19.4%) deaths, occurred. The freedom rate from MACE and mortality at 5 years were comparable between groups (69.7 vs. 66.7%, P=0.82 and 75.0 vs. 80.6%, P=0.10, respectively); however, those from revascularization at 5 years was higher in the CABG group than the EES group (89.4 vs. 81.0%, P=0.030). In propensity score-matched patients (n=92), the freedom rate from revascularization at 5 years was still higher in the CABG group than in the EES group (93.4 vs. 79.1%, P=0.013). Similarly, the freedom rates from MACE and mortality were comparable (70.0 vs. 66.3%, P=0.69 and 73.8 vs. 79.7%, P=0.30, respectively). Conclusion Even in the second-generation drug-eluting stent era, CABG is still superior for preventing revascularization in patients on chronic HD. However, PCI with EES implantation might not have disadvantages compared with CABG in terms of MACE.

Aim: To investigate the long-term clinical outcome of endovascular therapy (EVT) or bypass surgery in patients on hemodialysis (HD) with critical limb ischemia due to isolated infrapopliteal disease. Methods: We enrolled 254 consecutive HD patients successfully undergoing infrapopliteal revascularization by EVT (126 patients) and bypass surgery (128 patients). They were followed up for five years. Amputation-free survival (AFS) and incidence of any re-intervention were evaluated. A propensity score from all baseline variables was incorporated into Cox analysis. Results: In the EVT group, age was higher (p = 0.039), diabetes and coronary artery disease were more frequent (p = 0.004 and p = 0.0052, respectively), and tissue loss was more rarely observed (p < 0.0001) than in the bypass group. During the follow-up period, 21 major amputations and 64 deaths occurred. The propensity score-adjusted AFS rate at 5 years was comparable between groups (61.0% in EVT group vs. 55.1% in the bypass group, adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.52–1.42, p = 0.58). The adjusted survival rates were also similar between groups for amputation and all-cause mortality. However, freedom from any reintervention was markedly lower in the EVT than in the bypass group (48.6% vs. 84.6%, adjusted-HR, 3.56, 95% CI 1.95–6.75, p < 0.0001). Conclusions: The rate of AFS was broadly comparable between the two strategies, although compared with bypass surgery, EVT had much higher rates for re-intervention.

Objectives To investigate the efficacy of drug-coated balloon (DCB) for calcified coronary lesions. Background Calcified coronary lesions is associated with poor clinical outcomes after revascularization. Recently, DCB is emerging as an alternative strategy for de novo coronary lesions. However, reports describing the efficacy of DCB for calcified coronary lesions are limited. Methods A total of 81 patients (96 lesions) who electively underwent DCB treatment for de novo coronary lesions were enrolled: 46 patients (55 lesions) in the calcified group and 35 patients (41 lesions) in the non-calcified group. Angiographic follow-up data and clinical outcomes after the procedure were evaluated. Results The diameter of the DCB used was 2.5 ± 0.5 mm. No bail-out stenting was observed after DCB treatment. Rotational atherectomy was used in 82% of lesions in the calcified group. Follow-up angiography (median, 6.5 months after intervention) was performed for 59 patients (30 in the calcified group and 29 in the non-calcified group). Late lumen loss and rates of restenosis were comparable between the groups (0.03 mm in the calcified group vs -0.18 mm in the non-calcified group, P = 0.093 and 13.9% vs 3.03%, P = 0.095, respectively). The survival rates for target lesion revascularization free survival and major adverse cardiac events at 2 years were comparable between the groups (85.3% vs 93.4%, P = 0.64 and 81.4% vs 88.5%, P = 0.57, respectively). Conclusion Calcified coronary lesions might dilute the effect of DCB. However, clinical outcomes in the calcified group were similar to those in the non-calcified group.

Few reports have characterized auditory processing in monaural listening, which is important for the understanding of auditory brain activity in subjects with hearing loss. We measure regional brain activity in response to monaural audition of 95 dB sound pressure level (SPL) monosyllables using functional magnetic resonance imaging (fMRI) in the 10 subjects with normal hearing and four subjects with unilateral deafness as controls for “cross-hearing”. Images were analyzed by statistical parametric mapping software. In subjects without hearing loss, the stimuli elicited cortical activation in the primary auditory and auditory association regions, particularly contralaterally where extent of activation was approximately 2.5 times the ipsilateral extent. All patients with profound unilateral deafness showed no statistically apparent response in the primary auditory and auditory association regions, ruling out an important influence from cross-hearing. We found fMRI to be a useful technique for analysis of auditory processing that should be applicable to patients with various hearing abnormalities.

To characterize brain activity in response to auditory stimuli during recovery from acute hearing loss, fMRI was performed at two time points in 11 patients with sudden deafness in the right ear, and 10 subjects with normal hearing. In the acute phase, right-ear auditory stimulation induced only a small response in the auditory cortex, limited to the left hemisphere. In the recovery phase, the auditory response was more extensive than in the acute phase. Stimulation of the left ear induced a more extensive response in the left than right hemisphere in both acute and recovery phases, which differed from the pattern in normal subjects. The changes in cortical activation patterns were seen within 1 week of sudden deafness. Thus, alteration of cortical response in deafness occurs earlier than suggested by previous reports.

To investigate cross-projection of pure tone stimulation, optimal stimulation level and cross-talk effect, we examined the auditory processing of monaural pure-tone stimuli using functional magnetic resonance imaging (fMRI). We examined fMRI responses to monaural pure tones (1 kHz, 95 or 115 dB SPL) in 11 subjects with normal hearing and 4 patients with with profound unilateral deafness. Group analysis showed bilateral cortical activation in primary auditory and auditory association regions at 115 dB SPL. The activation was strong and mostly contralateral. At 95 dB SPl, only 2 of 11 subjects showed weak cortical activation. No activated area in the auditory cortex was observed in subjects with profound unilateral deafness in response to monaural stimulation of the deaf ear. The results supported the cross-projection of pure tone stimulation. Pure tone with 115 dB SPL was needed to obtain intense and stable activation without cross-talk using conventional boxcar model.

The newly developed Ihara's genetically epileptic rat (IGER) is thought to be a useful tool for studying epilepsy of the limbic type. Morphological changes in the hip-pocampus, which is one of the characteristic findings in the brains of patients with temporal lobe epilepsy, were presumed to occur also in IGER during the course of epileptic activities. We investigated chronological changes in volume of the IGER hippocampal formation using mag-netic resonance (MR) imaging. The experiment consisted of two protocols. First, MR imaging was performed for volumetric measurement of the cerebrum and the hippocampus in four male IGER, each at 2, 4, 6, 8, 10 and 12 months of age. After MR examination, the brains were subjected to histological and morphometric examinations. Second, changes in the hippocampal volume were traced chronologically in three IGER at the ages of 2, 4, 6, 8 and 10 months. Age-matched Wistar rats were used as controls. In IGER, the volume of the cerebrum, especially of the hippocampus, and the ratio of the hippocampal to the cerebral volume increased, in concert with the increase in seizure activities. Histological and morphometric invest-igations revealed that there was mild astrogliosis and marked microgliosis with hypertrophic change in the hippocampal formation with aging, but no loss of neurons was observed. Neither an increase in volume nor gliosis was found in the brains of control rats. The enlargement of the hippocampal formation in IGER brains was assumed to be partially due to gliosis of astrocyte and microglia with hypertrophy.

We report a case of metastatic adenocarcinoma to the brain that appeared as a homogeneously hyperdense mass on CT. The lesion was initially diagnosed as an intracerebral hematoma. On serial CT scans, the high density lesion progressively enlarged. Pathology showed coagulation necrosis without hemorrhage or calcification. Analysis of the tumor revealed elevation of the protein content relative to the normal brain. We conclude that the high CT attenuation was due to the elevated protein content.

Experiments with and without perfusion method would be summarized in Table 1. This table shows the differences between the function of three nerve, N. laryngicus cranialis internus, carotid sinus nerve and vagal nerve. N. l. cr. int. has a important role in autonomic nerve regulation, and these differences were clearly demonstrated by our perfusion method. Therefore, the receptors in laryngeal mucosa in Table 2 and Scheme of Reflexes from N. l. cr. int (Fig. 2) will be the proposal by our results.

Eggs treated with hyaluronidase and eserine (109g/cc, 30min) were exposed at 30°C to the Ringer solution of digitoxigenin, lanatoside C, g-Strophanthin or digitoxin. Sensitivity to cardiac glycosides was more raised in the eserinized egg than in the non-eserinized, and 10-10g/cc concentration could be detected, and 1/2 × 10-9g/cc determined quantitatively, using 0.02 cc of sample solution (contained 1 or 0.1% of ethanol).

After catecholamine depletion by reserpine, the capacity of the digitalis materials to induce ventricular arrhythmia is diminished. In papillary muscles from cats pretreated with reserpine, the incidence of ouabain-induced extra beats is reduced. The dose of ac. stroph. necessary to induce ventricular arrhythmia in combination with vagal stimulation is increased by reserpine pretreatment. Threshold doses comparable to those in cats not pretreated with reserpine produced arrhythmia after the catecholamine stores were repleted with norepinephrine or isoproterenol. In dogs with A-V block, βTM 10, an agent which prevents the release of catecholamines, markedly reduces the response of the ventricular pacemaker to ac. stroph. Since the arrhythmias induced by large doses of ac. stroph. are not affected by reserpine pretreatment, it is concluded that while catecholamine release is the primary mechanism involved in the arrhythmia produced by small doses, another mechanism also plays a role in this action after larger doses. Only in the dose of 10 mg/kg did it appear that catecholamine depletion did not account entirely for the action of reserpine. The ac. stroph. threshold dose was not increased to the same degree as with the smaller doses of reserpine, and the incidence of ventricular fibrillation induced by the large dose of ac. stroph was reduced. Hypotension produced by reserpine and βTM 10 did not seem to be an important factor in depression of the responsiveness of the ventricular pacemaker to ac. stroph. While the incidence of ouabain-induced extra beats was reduced by reserpine pretreatment, the action of ouabain to increase the tension developed by isolated papillary muscles was not affected.

Studies of the mechanisms underlying the fall in blood pressure seen after administration of γ-aminobutyric acid (GABA) or γ-amino-s-hydroxybutyric acid (GABOB) showed that GABA or GABOB initially released catecholamines from sympathetic presynaptic sites. The catecholamines in turn elicited a release of histamine, causing a fall in blood pressure that was further modified by the ganglionic-stimulating and blocking actions of GABA (Ito et al., 1976, 1977a, b, 1978: johnson and O’Brien, 1976; Kawamoto, 1978). The GABA-induced hypotension was not blocked by Picrotoxin. In our previous report describing the interactions of taurine with autonomic drugs (Ito et al., 1970b), taurine was shown to: (1) potentiate or inhibit epinephrine-induced blood pressure changes, (2) reduce epinephrine-induced arrhythmias, and (3) decrease cardiac conductivity. In the work reported here, the cardiovascular actions of taurine, GABA, and GABOB were studied after chemical adrenergic denervation in order to evaluate the sympathetic pre- and postsynaptic actions of these agents.

We examined if 4-aminopyridine(4-AP) and 3,4-diaminopyridine(3,4-DAP) influence arachidonic acid(AA)-induced death and platelet aggregation in comparison with indomethacin(IM), bemegride(BG) and dimorpholamine(DM), etc. Methods and Results : In the whole animal, AA was injected intravenously. 1) Inhibitory potency order in AA-induced human platelet aggregation: IM» pyridine> 4-AP = 3,4-DAP = BG > DM. 2) AA-induced hypotension in rats was antagonized only by IM. 3) AA-induced respiratory arrest in rats was antagonized by both IM and 4-AP. 4) AA-induced death was avoided by artificial respiration in rats. 5) AA-induced loss of righting reflex in mice was completely antagonized by IM and partially by 4-AP. In the disappeared cases of righting reflex even by the others except IM, the recovery time was shortened by all of 4-AP, 3,4-DAP, BG, DM and pyridine. 6) Intravascular AA-induced platelet aggregations in mouse lungs were not affected histologically by IM. 7) 4-AP and 3,4-DAP levels in cerebrospinal fluid when intravenously injected in rats: 4-AP> 3,4-DAP. Conclusions : Above data suggest that AA-induced death and respiratory arrest originate in central nervous system and can be avoided by 4-AP. It can be speculated that the life survival effect of 4-AP on AA-induced death and respiratory distress is based on its inhibitory action on thromboxane A2 synthetase, its augmentation of transmitter release, its direct action on muscles and its central stimulating action, etc.

The cardiovascular effects of D230, 1-[(3,4-dihydro-2H- (1,3)-thiazino [3,2-a] benzimidazole-2-yl)methyl]-4-(3,4,5-trimethoxycinnamoyl)piperazine. 2HCl, were investigated in open chest dogs. Dose-related vasodilations were observed in vertebral, coronary, mesenteric and femoral arteries following i.v. administration of D230(0.3-3.0 mg/kg). Especially in coronary artery, the dilation was remarkable and long-lasting. Concomitant hypotension and decrease in total peripheral resistance without tachycardia were noted. Stroke volume and cardiac output increased with no significant change in cardiac contractility, cardiac work and oxygen consumption. Propranolol (0.1-0.5 mg/kg i.v.) and diphenhydramine(2 mg/kg i.v.) had no effect, but aminophylline(1–10 mg/kg i.v.) antagonized the coronary vasodilation and hypotension induced by D230. D230 potentiated the effects of adenosine (Ado) on coronary and renal arteries, but did not affect the responses of isoproterenol and norepinephrine. Effects of dipyridamole(0.1-1.0 mg/kg i.v.) were almost similar to those of D230, except for some vascular responses. These results indicate that the mechanism of the coronary vasodilation induced by D230 may involve Ado potentiation, similar to dipyridamole.