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Isolated right ventricular (RV) infarction is extremely rare and its diagnosis may be challenging, because RV infarction most often occurs simultaneously with infarction of the inferior wall of the left ventricle. A 66-year-old man with a history of diabetes mellitus presented with cold sweat and general malaise. Although his symptoms were atypical for myocardial infarction, he was quickly diagnosed with RV infarction and successfully underwent urgent percutaneous coronary intervention. He was definitely diagnosed with isolated RV infarction by a scintigram and cardiac magnetic resonance imaging. Our review showed the importance of the combined assessment in the diagnosis of isolated RV infarction.

Background Nilotinib, a second-generation BCR-ABL tyrosine kinase inhibitor (TKI), is highly effective in the treatment of patients with chronic myeloid leukemia (CML), despite being more vasculotoxic than older TKIs such as imatinib. Herein, we present a case of nilotinib-associated vasospastic angina confirmed by an acetylcholine spasm provocation test. Case presentation A 62-year-old CML patient treated with 300 mg nilotinib twice daily complained of several episodes of rest angina and was hospitalized at our institution. Coronary angiography revealed no severe organic stenosis, and the acetylcholine spasm provocation test confirmed the diagnosis of vasospastic angina. Although treatment with a calcium channel blocker and nicorandil reduced the frequency of chest pain, angina symptoms continued to occur. At 10 months post discharge, the patient complained of increased frequency of angina; therefore, the nilotinib dosage was reduced to 150 mg twice daily. Consequently, the patient reported a significant improvement in chest symptoms. Conclusions This case report highlights the potential vasculotoxic effects of nilotinib. Cardiologists and hematologists should be vigilant for coronary artery spasm as a possible vascular adverse event caused by nilotinib.

BACKGROUND Although elevated levels of oxidized low-density lipoprotein (LDL) could play a critical role in vulnerable plaque, there are no studies that have compared coronary high-intensity plaque (HIP) and circulating malondialdehyde-modified (MDA)-LDL levels for the prediction of cardiac events.Methods and Results:A total of 139 patients with coronary artery stenosis (>70%) were examined with non-contrast T1-weighted magnetic resonance imaging (MRI) (HIP: n=64, non-HIP: n=75). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) ≥1.4. We evaluated the subsequent major adverse cardiac events (MACE) during the follow-up period (5.6±1.3 years). MDA-LDL levels were independently associated with the presence of HIP (P

Purpose Dimethyl α‐ketoglutarate (dm‐α‐KG) promotes in vitro development to blastocysts of C57BL/6J X C3He F1 mouse zygotes cultured in medium lacking pyruvate. Here, we examined the effects of pyruvate and dm‐α‐KG on in vitro development to blastocysts of ICR mouse zygotes and their post‐implantation developmental ability. Methods Zygotes were cultured in medium with pyruvate at 0‐0.2 mmol/L in the presence or absence of 1 mmol/L dm‐α‐KG for 96 hours and evaluated for blastocyst formation rates. The resultant blastocysts were non‐surgically transferred to surrogates and evaluated for birth rates. Results In medium lacking pyruvate, zygotes could not develop beyond the two‐cell stage, in the presence or absence of dm‐α‐KG. However, the blastocyst formation rate in medium with 0.01 mmol/L pyruvate (12%) was markedly increased with addition of dm‐α‐KG (49%). Around 80% of embryos developed to blastocysts in medium with 0.2 mmol/L pyruvate, in the presence or absence of dm‐α‐KG. Importantly, birth rate was markedly improved by treatment with 0.2 mmol/L pyruvate and dm‐αKG (31.0%), compared with those with pyruvate treatment alone (16.3%). Conclusions Pyruvate and dm‐α‐KG synergistically work during in vitro culture to markedly improve the blastocyst formation rate and post‐implantation developmental ability of the resultant blastocysts in ICR mice.

The purpose of the current review is to examine the effects of high intensity exercise on bone mineral density (BMD) changes compared to moderate intensity exercise, and how the safety of exercise differs. We will cover randomized controlled trials assessing the effectiveness of high intensity exercise therapy for improving bone density in postmenopausal women. To determine the difference in effect on BMD changes at the lumbar spine and femoral neck between high intensity exercise therapy and moderate intensity exercise therapy in postmenopausal women (P: postmenopausal women, I: high intensity exercise therapy, C: moderate intensity exercise therapy, O: BMD changes at the lumbar spine and femoral neck). Six databases will be searched in this review. After screening the studies, two reviewers will evaluate the risk of bias independently using the Risk of Bias 2. To evaluate statistical heterogeneity, we will visually inspect the forest plots and calculate the I2 statistic. Meta-analysis will be carried out with Review Manager software (RevMan 5.4), using a random-effects model. Summary of findings table will be generated.

An 81-year-old woman presented with massive melena. She required urgent hospitalization because of hyperprothrombinemia (international normalized ratio >9.9), induced by warfarin treatment following double valve replacement surgery she underwent 35 years prior, and had cirrhosis caused by chronic liver congestion. The next day, she became comatose (serum ammonia level, 417 μg/dL) and was diagnosed with hepatic encephalopathy with acute hyperammonemia. Despite the decrease in serum levels (53 μg/dL) following 3-day lactulose and rifaximin treatment, her consciousness level remained low (Glasgow Coma Scale, 6). Electroencephalogram on day 8 showed triphasic waves, but no obvious epileptic discharges. Brain magnetic resonance imaging (MRI) on day 1 was unremarkable (Fig. 1A–C) and showed bilateral and symmetrical cortical swelling in the insular, cingulate, frontal, and occipital cortices on day 10 (Fig. 1D–F), and showed reduction in the extent of the lesion at 3 weeks post-hospitalization (Fig. 1G–I). Her consciousness level recovered slightly later than the MRI findings. Ammonia detoxification in the brain occurs through glutamine formation through the glutamine synthesis pathway in astrocytes, leading to glutamine-induced astrocyte swelling and subsequent cerebral edema and even encephalopathy.1 Brain MRIs – which are essential in differential diagnoses – show symmetrical signal abnormalities in the insular and cingulate cortices.2-4 Close attention should be paid to secondary encephalopathy in patients with hyperammonemia.

Background Percutaneous coronary intervention (PCI) is often complicated by periprocedural myocardial injury (PMI) manifested by elevated cardiac biomarkers. The occurrence of PMI has been shown to be associated with worse clinical outcome over short- and long-term. Purpose We performed multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (CMR) to evaluate the relationship between culprit plaque characteristics and PMI. Methods A total of 90 patients who underwent elective PCI were underwent CMR and multidetector coronary tomography before PCI. The high intensity plaque (HIP) on CMR was defined as a coronary plaque to myocardium signal intensity ratio (PMR) of >1.4. The plaque characteristics and the presence of napkin-ring sign (NRS) were analyzed on MDCT. PMI was defined as an increase in cardiac Troponin T levels to more than 5 times the upper limit of normal at 24 h after PCI. Patients were divided into 2 groups according to the presence (Group I, n=26) or absence (Group II, n=64) of PMI. Results Spotty calcification, positive remodeling, low attenuation plaque and NRS on MDCT were significantly more observed in Group I than in Group II. HIP on CMR was significantly more observed in Group I than in Group II. In the multivariable logistic regression analysis, the presence of NRS and HIP were significantly independent predictors of PMI (odds ratio (OR) 4.82, 95% confidence interval 1.13–20.60, P=0.034 and OR 3.66, 95% CI 1.09–12.30, P=0.036, respectively). Moreover, for prediction of PMI, NRS and HIP showed a high positive predictive value of 81%, and their absence showed a high negative predictive value of 91%. Conclusions MDCT and CMR may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI in elective coronary stenting. Funding Acknowledgement Type of funding source: None

Background Although elevated oxidized low-density lipoprotein could play critical roles in vulnerable plaque, there are no studies that compared coronary high-intensity plaque (HIP) on non-contrast T1-weighted magnetic resonance imaging (T1WI_MRI) and circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels for the prediction of cardiac events. Methods and results A total of 139 patients with coronary artery stenosis (>70%) were examined with non-contrast T1WI using a 1.5-T MRI (HIP: n=63, non-HIP: n=76). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) of ≥1.4. At admission, circulating levels of MDA-LDL and other lipid-related markers were measured. We evaluated the subsequent cardiac events, which were defined as major adverse cardiac events (MACE; cardiac death, myocardial infarction, and/or ischemia-driven PCI) during follow-up periods (5.6±1.3 years). Circulating MDA-LDL levels were significantly higher in patients with HIP than in those without HIP (p Conclusions MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease. Furthermore, adding PMR to MDA-LDL levels markedly improved MACE prediction. Funding Acknowledgement Type of funding source: None

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by a positive serum antiphospholipid antibody status. Patients with APS usually have an underlying hypercoagulable state, which can increase the risk of perioperative thromboembolism. We describe three patients with APS who underwent transcatheter aortic valve implantation for symptomatic severe aortic stenosis. Of them, two had complicated cerebrovascular events, and the other had no complications. Careful antithrombotic management is essential to minimize the risk of thromboembolism and bleeding in patients with APS.

Hypernatremia due to salt poisoning is clinically rare and standard care procedures have not been established. We report a case of salt poisoning due to massive intake of seasoning soy sauce. Aggressive rapid correction of serum sodium concentration should only be considered in acute phases of hypernatremia within 2–3 h of salt ingestion, before the brain cells adapt to high osmolarity., Background Hypernatremia due to salt poisoning is clinically rare and standard care procedures have not been established. We report a case of salt poisoning due to massive intake of seasoning soy sauce. Case Presentation A 40‐year‐old woman presented to the emergency department with seizures and remarkable hypernatremia with a serum sodium concentration of 183 mEq/L. The initial brain computed tomography scan showed brain shrinkage, which could occur during the acute phase of hypernatremia. We reduced her serum sodium level rapidly, rather than at the recommended slow rate. On day 3, the patient’s brain computed tomography scan showed widespread low‐density areas and edema. The patient died 8 days after admission. Conclusion After reviewing instances of resuscitation following salt intoxication, aggressive rapid correction of serum sodium concentration should only be considered in acute phases of hypernatremia within a few hours from ingestion, and 2–3 h could be one of the criteria.

Fasciolosis, a zoonotic disease caused by liver flukes of the genus Fasciola, has been reported in Hokkaido (Yezo) sika deer (Cervus nippon yesoensis) in Hokkaido Prefecture, Japan; however, the actual seroprevalence in the animal has not been adequately evaluated. The objective of the present study was to analyze the seroprevalence of the disease among Hokkaido sika deer. Recombinant cathepsin L1 (rCatL1) was used as an antigen for an indirect enzyme-linked immunosorbent assay (ELISA) to detect antibodies against Fasciola flukes. The sensitivity and specificity of the ELISA were 84.6% and 100%, respectively. The average seroprevalence in 1109 Hokkaido sika deer from 20 locations in Hokkaido Prefecture was 43.9%. Mature deer showed higher seroprevalence than younger individuals; however, even younger animals may act as a reservoir for the disease. Monitoring infection levels in the Hokkaido sika deer population is important not only for the livestock industry, but also for preventing human fasciolosis.

A 35-year-old woman who had a 15-year history of systemic lupus erythematosus and received multiple drugs, including prednisolone, presented with a 4-year history of hypertrophic obstructive cardiomyopathy (HOCM). Although she was treated with optimal β-blocker and cibenzoline, heart failure

Acute aortic dissection (AAD) is a serious disease with a high mortality rate. The mortality rate for patients with type A AAD who do not get treatment is of 1–2% per hour during the first 24 hours and almost 50% of the patients die within a week (1). The highest mortality associated with AAD occurs in the first 48 hours after onset of symptoms.