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Steel structures in social infrastructures often undergo corrosion and the thickness of these steel plates decreases. Then, the strength of steel structures decreases according to the residual plate thickness. Applications of a steel plate attaching method and a fiber reinforced polymer/plastic (FRP) bonding method are effective for repair and strengthening for these steel structures. In this study, UV-curable glass fiber reinforced polyester resin (UV-GFRPR) sheet was focused instead of FRPs. The aims of this study are to confirm repair and strengthening effects of the UV-GFRPR sheet bonded on both sides of steel plate. The UVGFRPR sheet consists of a polyester resin and chopped glass fibers and is hardened by radiation of UV source for a certain time. The tensile behavior and strength of steel plate bonded with UV-GFRPR sheets were assessed under axial tensile load. After that, the tensile behavior and strength of specimens were numerically estimated from each stress-strain curve of UV-GFRPR and steel modeled by using Menegotto-Pinto model. Furthermore, nonlinear finite element analysis (FEA) taking into account of the properties of bond layers was carried out to compare the numerical results. From the test results, the yield and ultimate strengths of specimens increased linearly according to the number of laminated layers of UV-GFRPR. Both results of the numerical calculation and the FEA agreed well with the test results. It is concluded that the numerical calculation without the contribution of bond layers can estimate the tensile behavior and strength of steel plate bonded with UVGFRPR on both sides

Background Transseptal puncture and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are generally performed via the inferior vena cava (IVC). However, in cases where the IVC is inaccessible, a specific strategy may be needed. Case summary An 86-year-old woman with paroxysmal AF and an IVC filter in situ was referred to our hospital for ablation therapy. An IVC filter for pulmonary embolism and deep venous thrombosis had been implanted 15 years prior, therefore we selected a transoesophageal echocardiography (TOE)-guided transseptal puncture using a superior vena cava (SVC) approach. After the single transseptal puncture, we performed fast anatomical mapping, voltage mapping by multipolar mapping catheter, and then PVI by contact force-guided radiofrequency catheter using a steerable sheath. Following the ablation, bidirectional conduction block between the four pulmonary veins and the left atrium was confirmed by both radiofrequency and mapping catheter. No complications occurred and no recurrence of AF was documented in the 12 months after the procedure. Discussion When performing a transseptal puncture during AF ablation, an SVC approach, via access through the right internal jugular vein, enables the sheath to directly approach the left atrium without angulation and improves operability of the ablation catheter. Combining the use of general anaesthesia, TOE, a steerable sheath, and contact force-guided ablation may contribute to achieving minimally invasive PVI with a single transseptal puncture via an SVC approach.

Balloon aortic valvuloplasty (BAV) was developed as a technique to treat aortic stenosis (AS) and is associated with significant improvements in aortic valve area and trans-aortic valve gradient in the early and immediate periods after the procedure. BAV is commonly performed using a trans-femoral retrograde approach; however, trans-femoral access is associated with frequent access-site bleeding. Among 146 patients with symptomatic severe AS who were treated with BAV in our institution, 123 patients received BAV treatment via a trans-radial approach using a 7-Fr Glidesheath. The balloon size was 16-20 mm for all patients. Echocardiograms were obtained before and after BAV. Patients who received BAV alone (n = 119) were followed up for 3 months, and major adverse events (stroke, re-hospitalization for heart failure, and death) and procedural complications were recorded. At post-procedural echocardiography, the mean trans-valvular gradient (49.7 ± 21.5-42.5 ± 17.6 mmHg; p 0.0001) was reduced significantly. All patients in this study did not die or require valve surgery within the first 7 days after BAV. Successful BAV was obtained in 45.6% of the patients. No patients had severe aortic insufficiency or BAV access-site bleeding. Three patients died suddenly and 4 patients were readmitted for heart failure. Trans-radial BAV is safe and may be useful as a bridging therapy for trans-catheter aortic valve replacement or surgical aortic valve replacement.

Skeletal muscle function has been studied to determine its effect on glucose metabolism; however, its effect on glycemic variability (GV), which is a significant glycemic marker in patients with coronary artery disease, is unknown. The aim of the present study was to elucidate the association between skeletal muscle mass and GV. Two hundred and eight consecutive ST-segment elevation myocardial infarction (STEMI) patients who underwent continuous glucose monitoring to evaluate mean amplitude of glycemic excursion (MAGE) as GV and a dual-energy X-ray absorptiometry (DEXA) to evaluate skeletal muscle mass were enrolled. Skeletal muscle index (SMI) level was calculated as skeletal muscle mass divided by height squared (kg/m

Introduction Radiofrequency (RF) ablation for ventricular arrhythmia in patients with reduced left ventricular ejection fraction (LVEF) is recognized to be one of the important strategies for suppressing the fatal arrhythmia events. Although, RF ablation for those patients has been performed for decades, the optimal endpoint remains unclear. Hypothesis We assessed the hypothesis that non-inducibility of any ventricular tachycardia (VT) or ventricular fibrillation (VF) immediately after VT ablation predicts long-term recurrence free rate of ventricular arrhythmia in patients who were diagnosed sustained VT with reduced LVEF. Methods From January 2014 to August 2019, we conducted a single center retrospective analysis for 127 consecutive patients with right or left ventricular arrhythmia who performed the first time RF ablation. Exclusion criteria were LVEF >50% and RF ablations for premature ventricular contraction or for non-sustained VT. Then 26 patients (age 69 ± 7, male 92%) were enrolled. All of the ablation procedures were performed using irrigated RF catheters and 3D mapping systems. We defined non-inducible group as the patients without monomorphic VT (clinical monomorphic VT or non-clinical monomorphic VT with any cycle length), polymorphic VT and VF by electrophysiological study (EPS) immediately after the ablation. The primary endpoint of this study was a recurrence of any sustained VT and VF during the follow up period. Results All of 26 patients were followed for a mean of 30.9 ± 22.3months.Of those patients, 7 patients were non-inducible group and 19 patients were inducible group. Age, sex, body mass index, coronary risk factors, LVEF (non-inducible:42 ± 5% vs inducible:35 ± 10%, p = 0.12), renal function and the etiology of LV dysfunction did not differ between patients with non-inducible group and inducible group (all non-significant). Catheter ablation procedural characteristics including activation mapping (non-inducible:29% vs inducible:36%, p = 1.00), entrainment mapping (14% vs 42%, p = 0.19), substrate mapping (86% vs 95%, p = 0.47), pace-mapping (86% vs 68%, p = 0.63), RF time (21 ± 13vs 18 ± 21min, p = 0.70), number of RF applications (27 ± 13vs 27 ± 32, p = 0.89), fluoroscopy time (77 ± 50vs 87 ± 42min, p = 0.59) and procedure time (309 ± 87vs 282 ± 61min, p = 0.37) did not differ between two groups. Medications before and after the VT ablation did not differ between two groups. The recurrence of any sustained VT and VF significantly lower in patients with non-inducible group than those with inducible group (Figure). Conclusion This study demonstrated that, in patients with reduced LVEF presenting sustained VT who performed RF ablation, non-inducibility of any VT and VF immediately after RF ablation predicts long-term decreased risk of recurrence of any sustained VT and VF. Not only clinical but also non-clinical VT and VF may be targeted as well at the first time VT ablation for those patients. Abstract Figure

Background Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is one of the important procedures for atrial fibrillation (AF). Attaining the stability of RFA, respiratory management and pain control during the procedure are required. Purpose We compared the characteristic parameters and procedural outcomes between general anesthesia and moderate (conscious) sedation in patients with AF performed RFA. Methods We performed a retrospective, 2-center observational study to compare the general anesthesia with moderate sedation during RFA on AF from January 2018 until December 2018. In general anesthesia group, we administrated propofol and muscle relaxants under mechanical ventilation. In moderate sedation group, we administrated dexmedetomidine and/or propofol with analgesic drug. Procedural time of AF ablation, first-pass PVI (pulmonary vein isolation after completing the right or left circle) were assessed. Results A total of 98 patients with mean age 66 ± 11 years were enrolled (80 males, 81%). Of these, 19 patients were performed RFA under general anesthesia and 79 patients were performed under moderate sedation. Age, gender, BMI, medications before admission and CHADs2 score (general anesthesia:1.9 ± 1.2 vs moderate sedation:1.5 ± 1.1, p = 0.14), left atrium diameter (40.2 ± 6.2 vs 40.6 ± 6.8 mm, p = 0.81) and proportion of paroxysmal AF (47.4 vs 54.4%, p = 0.61) were similar between two groups. Our study found catheter RFA with general anesthesia to be associated with reduced procedural time (161 ± 29 vs 241 ± 58 minutes, p Conclusions RFA under general anesthesia improved first-pass PVI (quality of PVI) and shortened procedural time. General anesthesia may attribute to attaining the catheter and patient stability during RFA for PVI.

The aim of the present study was to determine whether urinary 8-hydroxydeoxyguanosine (8-OHdG), which is a marker of oxidative stress, can predict future cardiovascular death in patients with acute coronary syndrome (ACS). A total of 551 consecutive patients with ACS who underwent admission urinary 8-OHdG measurements were enrolled in this study. The patients were divided into 2 groups according to the optimal cutoff value of admission urinary 8-OHdG determined by a receiver-operating characteristics curve for the prediction of cardiovascular death: a high admission urinary 8-OHdG group, 169 patients with admission urinary 8-OHdG ≥ 17.92 ng/mg creatinine; and a low admission urinary 8-OHdG group, 382 patients with admission urinary 8-OHdG 17.92 ng/mg creatinine. The patients were followed up for a median period of 34 months. The primary and secondary end points were the incidence of cardiovascular death and major cardiovascular events (MACE) composed of cardiovascular death, non-fatal myocardial infarction, or urgent hospitalization for heart failure. Of the 551 patients, cardiovascular deaths and MACE occurred in 14 (2.5%) and 35 (6.4%), respectively. The Kaplan-Meier estimate of the event-free rate revealed cardiovascular deaths and MACE were more likely in the high admission 8-OHdG group than in the low admission 8-OHdG group (log rank, both P 0.001). Multiple adjusted Cox proportional hazards analysis indicated that high admission urinary 8-OHdG was an independent predictor of cardiovascular death (hazard ratio [HR] 7.642, P = 0.011) and MACE (HR 2.153, P = 0.049). High admission urinary 8-OHdG levels predict cardiovascular mortality after adjustment in patients with ACS.

This network meta-analysis was performed to rank the safety and efficacy of periprocedural anticoagulant strategies in patients undergoing atrial fibrillation ablation. MEDLINE, EMBASE, CENTRAL, and Web of Science were searched to identify randomized controlled trials comparing anticoagulant regimens in patients undergoing atrial fibrillation ablation up to July 1, 2021. The primary efficacy and safety outcomes were thromboembolic and major bleeding events, respectively, and the net clinical benefit was investigated as the primary-outcome composite. Seventeen studies were included (n = 6950). The mean age ranged from 59 to 70 years; 74% of patients were men and 55% had paroxysmal atrial fibrillation. Compared with the uninterrupted vitamin-K antagonist strategy, the odds ratios for the composite of primary safety and efficacy outcomes were 0.61 (95%CI: 0.31–1.17) with uninterrupted direct oral anticoagulants, 0.63 (95%CI: 0.26–1.54) with interrupted direct oral anticoagulants, and 8.02 (95%CI: 2.35–27.45) with interrupted vitamin-K antagonists. Uninterrupted dabigatran significantly reduced the risk of the composite of primary safety and efficacy outcomes (odds ratio, 0.21; 95%CI, 0.08–0.55). Uninterrupted direct oral anticoagulants are preferred alternatives to uninterrupted vitamin-K antagonists. Interrupted direct oral anticoagulants may be feasible as alternatives. Our results support the use of uninterrupted direct oral anticoagulants as the optimal periprocedural anticoagulant strategy for patients undergoing atrial fibrillation ablation.

Recently, a repair method by bonding patch plates is being applied to corroded steel structures. However, one of the issues of patch plate bonding repair is the brittle debonding of the patch plates. Generally, when the delamination of the patch plates occurs, the composite effect acting between the steel members and patch plates abruptly decreases. Therefore, to prevent the brittle debonding of the patch plates, a repair method combining an adhesive and stud bolts is proposed. Till date, tensile and compressive tests have been performed for the proposed method. In this study, plate bending tests were conducted to verify the effectiveness of this method under bending conditions. Furthermore, two types of epoxy resin-based adhesives were prepared to evaluate the effectiveness of the proposed method with different adhesive properties. The test results show that the proposed method is able to prevent the brittle debonding of the patch plates in the case of both epoxy resins.

Carbon fiber reinforced polymer (CFRP), plates bonding repair method is one of the simple repair methods for cracked steel structures. In this study, the influence of width of CFRP plates on bending fatigue life of out-of-plane gusset joint strengthened with CFRP plates was investigated from the experimental and numerical point of view. In the bending fatigue test of cracked out-of-plane gusset joint strengthened with CFRP plates, the effect of width of CFRP plates on crack growth life was clarified experimentally. Namely, it was revealed that the crack growth life becomes larger with increasing the width of CFRP plates. In the numerical approach, the stress intensity factor (SIF) at the surface point of a semi-elliptical surface crack was estimated based on the linear fracture mechanics. Furthermore, the extended fatigue life of cracked out-of-plane gusset joint strengthened with CFRP plates was evaluated by using the estimated SIF at the surface point and the empirical formula of the aspect ratio of semi-elliptical crack. As the results of numerical analysis, the estimated fatigue life of the specimen strengthened with CFRP plates showed the good agreement with the test results.

Endothelial dysfunction and increased arterial stiffness gradually develop before the manifestation of catastrophic cardiovascular events. Therefore, detection and assessment of vascular function are required to address pre-existing pathological conditions. However, the currently available diagnostic devices and methods are insufficient due to variability among investigators and the time-consuming nature of manual procedures.Recently, novel devices were developed for the detection of both arterial stiffness and endothelial dysfunction in a single blood pressure measurement using a cuff-oscillometric technique (AVE-1500, Shisei Datum, Japan). API (arterial pressure volume index) is defined as the reciprocal of the slope of the tangent of the brachial artery pressure-volume curve, and AVI (arterial velocity pulse index) is defined as the ratio of the difference between the ejection and reflection waves. In the present study, we performed retrospective, cross-sectional analyses of subjects (n = 102; mean age = 70.5 ± 10.4 years) with detailed coronary angiographic examinations and clinical background parameters.After adjusting for various variables using multiple linear regression analyses, we found that API, but not AVI, was significantly correlated with coronary artery severity and complexity scores.We propose that API may be a new vascular index useful for monitoring and assessing the severity and complexity of atherosclerosis in subjects with coronary artery disease and for evaluating atherosclerotic diseases.

Background Sleep-disordered breathing (SDB) is associated with cardiovascular complications. However, the effect of SDB on renal function in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI) remains unclear. Methods We enrolled 154 consecutive ACS patients without heart failure. A sleep study was performed immediately after PCI. Results The mean apnea-hypopnea index (AHI) was 16.4 ± 13.1, and 33 patients (21%) had severe SDB, defined as AHI ≥ 25. Estimated glomerular filtration rate (eGFR) values on admission (60 ± 12 mL/min/1.73 m2 vs. 67 ± 17 mL/min/1.73 m2, p = 0.046) and at discharge (54 ± 15 mL/min/1.73 m2 vs. 63 ± 15 mL/min/1.73 m2, p = 0.002) were lower in patients with severe SDB than in those patients without severe SDB. Multiple linear regression analysis showed that AHIs were significantly correlated with absolute changes in eGFR values from admission to discharge (β = 0.201, p = 0.004). Median 24-h urinary noradrenaline excretion measured on the same day of the sleep study was higher [297 (interquartile range {IQR}: 232–472) vs. 174 (IQR: 107–318) μg/day, p = 0.021] in patients with severe SDB. On multivariate logistic regression analysis, the presence of severe SDB was a significant predictor (adjusted odds ratio 3.76, 95% confidence interval 1.06–13.9, p = 0.047) for eGFR of less than 45 mL/min/1.73 m2 at discharge. This association was independent of age, eGFR on admission, and a presentation of ST-segment elevation myocardial infarction. Conclusion In patients with ACS who undergo PCI, severe SDB is associated with impaired renal function on admission and its deterioration during hospitalization. Further studies will be needed to conclude that SDB would be a therapeutic target in ACS.

Background A global study designed to demonstrate the safety and efficacy of a transcatheter pacing system included 38 Japanese patients enrolled at 4 sites. Subgroup analysis to evaluate the performance of the leadless intracardiac transcatheter pacing system in Japanese patients was performed.Methods and Results:Safety and efficacy outcomes, patient and implant procedure characteristics, and patient and physician acceptability from the Japanese population were compared with those from outside Japan. Differences in patient characteristics, implant procedure characteristics and patient acceptability were observed. There were no major complications in Japanese patients and pacing thresholds remained low and stable throughout follow-up. There were no observable differences between Japanese patients and patients from outside Japan in the freedom from major complication rate at 12-months post-implant (100.0% vs. 95.7%, P=0.211) or physician acceptability. Conclusions Although some differences in specific baseline characteristics, such as body size and pacing indication, and in implant procedure characteristics, including anticoagulation strategy and hospitalization period, were observed in the Japanese patients, transcatheter pacemaker performance was similar to that in the global trial. (Clinical Trial Registration: ClinicalTrials.gov ID NCT02004873.).

A 17-year-old woman was resuscitated from cardiac arrest due to ventricular fibrillation and was diagnosed with concealed long QT syndrome. She underwent subcutaneous implantable cardiac defibrillator (S-ICD) implantation at our hospital. The device electrogram immediately after implantation was normal. Four days after implantation, she received an inappropriate shock. The device interrogation revealed a continuous baseline shift and frequent oversensing for low amplitude signals, followed by a shock. A chest radiograph in the orthogonal view showed entrapped subcutaneous air surrounding the distal electrode. Entrapped subcutaneous air can cause inappropriate shocks in the early period after S-ICD implantation.

In steel members strengthened by carbon-fiber reinforced polymer (CFRP) plates, the thermal stresses are introduced in the steel members, the CFRP plates and the adhesive layers when temperature changes because the linear thermal expansion coefficients of steel and CFRP are mismatched. As so far, the authors proposed a technique to reduce the thermal stress in steel members strengthened by CFRP plates, which involves bonding aluminum alloy plates with CFRP plates. In the proposed method, the thermal stress in steel member can be reduced so that there are negligible levels of stress in steel member when the cross sectional areas of CFRP and aluminum plates are designed to correspond to the coefficient of thermal expansion of steel, even though the thermal stresses are introduced in the CFRP and aluminum plates. In this study, to confirm the maintaining the thermal stress reduction in steel member by proposed method, thermal stress measurement in steel plate strengthened by CFRP and aluminum plates was carried out about 21 months. In this research, the thermal stress introduced in the steel plate strengthened by CFRP plates was also measured. Furthermore, to assume the thermal shear and normal (peel) stresses in adhesive layers, FE analysis with plane stress element was employed. As the result, it was shown the thermal stresses in steel plate with CFRP plate were able to calculate by using composite theory and measured temperature. Furthermore, in steel plate strengthened by CFRP and aluminum plates, the thermal stress introduced in steel plate was negligible-small through the all-season. It was found the thermal stresses in steel plate with CFRP plates as well as CFRP and aluminum plates were also estimated by using composite theory and measured temperature. In the steel plate strengthened by CFRP and aluminum plates, the thermal shear and normal stresses in adhesive layer glued to steel plate become smaller than that in the conventional CFRP bonded specimen. However, the shear stress in adhesive layers between CFRP and aluminum plates in proposed method was higher than the thermal stress in adhesive layers between CFRP plates in conventional method.

Carbon fiber reinforced plastic, CFRP, plates bonding method is one of the new repair methods for fatigue cracks. In this method, propagation of fatigue crack will be delay because of the suppression of crack opening by crack bridging and stress reduction by composite effect of bonding CFRP plates. In this study, to clarify the effect of bonding CFRP plates on fatigue life extension, bending fatigue tests were carried out. First, fatigue tests on the specimens in as-welded condition were conducted until fatigue crack propagated to 10mm away from the weld toe. Then, fatigue crack was covered by CFRP plates and the specimens were re-tested until fatigue crack penetrated through the base plate. As the results of bending fatigue tests, the fatigue test data of the specimens repaired by bonding CFRP plates showed much longer fatigue life compared with that in as-welded condition, under stress ratio, R=0 and -infinity

Flavonoids, particularly those derived from plants, harbor biological effects such as anti-inflammation and the inhibition of cancer progression. In the present study, we investigated the effects of 10 kinds of flavonoids isolated from Nepalese propolis on the LPS signaling pathway in order to clarify their anti-inflammatory activities. Five types of flavonoids: isoliquiritigenin, chrysin, 3',4'-dihydroxy-4-methoxydalbergione, 4-methoxydalbergion, and cearoin, markedly inhibited inflammatory responses including LPS-induced NO production by suppressing the expression of iNOS mRNA and LPS-induced mRNA expression of TNFα and CCL2. Their inhibitory effects on LPS-induced inflammatory responses correlated with the intensities of these flavonoids to suppress the LPS-induced activation of nuclear factor κB (NF-κB), an essential transcription factor for the mRNA expression of iNOS, TNFα, and CCL2. Among these flavonoids, 3',4'-dihydroxy-4-methoxydalbergione and 4-methoxydalbergion markedly inhibited the LPS-induced activation of IKK, thereby abrogating the degradation of IκBα and nuclear localization of NF-κB. On the other hand, isoliquiritigenin, chrysin, and cearoin failed to inhibit these signaling steps, but suppressed the transcriptional activity of NF-κB, which caused their anti-inflammatory effects. The results of the present study revealed that these five kinds of flavonoids are the components of Nepalese propolis that exhibit anti-inflammatory activities with a different regulatory mechanism for the activation of NF-κB.

Background An early IV beta blocker during primary percutaneous coronary intervention (PCI) has been shown to reduce infarct size in ST-segment elevation acute myocardial infarction (STEMI), although the underlying mechanism is unknown. The aim of this study was to investigate the efficacy of early infusion of landiolol, the short-acting beta-1 adrenergic receptor blocker, on the reperfusion status in a STEMI. Methods We conducted a prospective, single-group trial of landiolol during the primary PCI for a STEMI. Landiolol was started intravenously just before reperfusion. The reperfusion status and outcomes in 55 treated patients were compared with those in 60 historical controls treated without landiolol. The optimal reperfusion was assessed by an ST-segment resolution (STR), coronary flow, and myocardial brush grade (MBG) after reperfusion. Results Patients in the landiolol group achieved a higher rate of an STR (64% vs. 42%, p =0.023) and MBG 2/3 (64% vs. 45%, p =0.045), whereas coronary flow was comparable between the two groups. A multivariate analysis showed that landiolol use was an independent predictor of an STR (odds ratio 2.99, 95% confidence interval 1.25–7.16, p =0.014). The incidence of non-sustained ventricular tachycardia (27% vs. 50%, p =0.014), hypotension (15% vs. 32%, p =0.046), and progression to Killip class grade III or IV (0% vs. 10%, p =0.028) were lower in the landiolol group. Conclusion Early infusion of landiolol during the primary PCI was associated with optimal reperfusion and a lower incidence of adverse events in comparison with the control group.

Some experimental studies have shown that direct oral anticoagulants (DOACs) have anti-inflammatory effects. However, the interval changes in inflammatory markers in patients with non-valvular atrial fibrillation (AF) who receive DOACs remain unknown. Between July 2013 and April 2014, a total of 187 AF patients randomly assigned to receive rivaroxaban (n = 91) or dabigatran (n = 96) were assessed for eligibility. The levels of the following inflammatory markers were serially evaluated: high-sensitivity C-reactive protein, pentraxin-3, interleukin (IL)-1β, IL-6, IL-18, tumor necrosis factor-α, monocyte chemotactic protein-1, growth and differentiation factor-15, and soluble thrombomodulin (sTM). The aim in this study was to evaluate the anti-inflammatory effects of rivaroxaban and dabigatran in patients with AF, in addition to the impact of markers on bleeding events. Finally, 117 patients (rivaroxaban: n = 55, dabigatran: n = 62) were included in the analysis at 12 months. Although the interval changes in sTM levels tended to be greater in the dabigatran group [0.3 (0–0.7) vs. 0.5 (0–1.0) FU/ml, p = 0.061], there were no significant differences in the interval changes in any inflammatory marker between 2 groups. There were no significant differences in bleeding events between 2 groups. The interval changes in sTM levels were significantly greater in patients with bleeding compared with those without [0.8 (0.5–1.3) vs. 0.4 (− 0.1–0.8) FU/ml, p = 0.017]. There were no significant differences in the interval changes in any inflammatory marker between rivaroxaban and dabigatran treatments in patients with AF. The increased levels of sTM after DOACs treatment might be related to bleeding events.

Background The incidence of atrioventricular block (AVB) in pacemaker patients with sick sinus syndrome (SSS) is not yet known. The aim of this study was to analyze AVB episodes in SafeR mode based on stored electrograms (EGM), and determine the occurrence rate and risk factors for advanced AVB in a pacemaker population with SSS. Methods and results The study included 50 consecutive patients with SSS without a history of advanced AVB who had a dual-chamber pacemaker programmed in SafeR mode. A total of 377 EGM stored in the pacemakers as AVB episodes fulfilling the second- or third-degree criterion were analyzed. Of 377 EGM, 73 EGM (19.4%) were appropriate episodes, whereas the other EGM did not show actual AVB, and showed atrial tachyarrhythmia, ventricular event in the blanking period, or premature atrial contractions with block. On EGM analysis, advanced AVB occurred in 9 patients (18%), and the occurrence rate was 11.7% per year. Moreover, on multivariate analysis β-blocker use was an independent risk factor for advanced AVB (OR, 9.10; P=0.004). Conclusions The occurrence rate of advanced AVB in patients with SSS is much higher than previously reported, and β-blocker use is an independent risk factor for advanced AVB. SafeR is useful to detect latent AVB. Stored EGM, however, sometimes include inaccurately classified events.

BACKGROUND The characteristics and prognosis of implanted pacemaker-identified new-onset atrial fibrillation (AF) in Japanese people has not been well evaluated.Methods and Results:A total of 395 consecutive patients with newly implanted pacemakers were retrospectively analyzed between January 2010 and December 2015 at Yokohama City University Hospital. Patients with a prior history of AF, VVI mode pacemaker, congenital heart disease, severe valvular heart disease, and cardiovascular surgery before pacemaker implantation were excluded. Among the remaining patients, 44 (21.3%) developed new AF during follow-up (mean follow-up, 1,115±651 days; range, 9-2,176 days). Patients with new-onset AF had a significantly higher CHADS2score (2.09±1.27 vs. 1.31±1.08, P

Patients with corrected transposition of great arteries (c-TGA) are generally known to develop atrioventricular block, systemic right ventricular dysfunction, and tricuspid regurgitation over time, which are associated with tachyarrhythmia and progressive heart failure. A 76-year-old man had been diagnosed with c-TGA. He developed a cardiopulmonary arrest while playing tennis, and an automated external defibrillator detected ventricular fibrillation (VF). Immediate cardiopulmonary resuscitation and intensive treatment were performed. He fully recovered without neurological sequelae. QRS duration was 172ms. Echocardiography showed marked dysfunction and dyssynchrony of the systemic right ventricle (systemic right ventricular end-diastolic diameter/end-systolic diameter=73/60mm, systemic right ventricular ejection fraction=34%). For secondary prevention and treatment of progressive heart failure, cardiac resynchronization therapy with defibrillator (CRT-D) implantation was recommended. Venography via the left cubital superficial vein revealed a persistent left superior vena cava (PLSVC) and giant coronary sinus that did not connect with the right superior vena cava (SVC). Because of the acute angle between the PLSVC and great cardiac vein, we selected a right-sided approach via the right SVC. We were finally able to deliver a coronary sinus lead to the lateral vein. CRT-D implantation can be achieved even in patients with c-TGA and PLSVC. Learning objective: CRT-D implantation can be achieved even in a patient with c-TGA and PLSVC.>

Background Research on the correlation of serum bilirubin level with cardiac function as well as outcomes in heart failure patients with cardiac resynchronization therapy (CRT) has not yet been reported. The aim of this study was to analyze the relationship between change in serum bilirubin level and left ventricular reverse remodeling, and also to clarify the impact of bilirubin change on clinical outcomes in CRT patients. Methods We evaluated 105 consecutive patients who underwent CRT. Patients who had no serum total-bilirubin data at both baseline and 3–9 months’ follow-up or had died less than 3 months after CRT implantation were excluded. Accordingly, a total of 69 patients were included in the present analysis. The patients were divided into two groups: decreased bilirubin group (serum total-bilirubin level at follow-up ≤ that at baseline; n = 48) and increased bilirubin group (serum total-bilirubin level at follow-up > that at baseline; n = 21). Results Mean follow-up period was 39.3 months. In the decreased bilirubin group, mean left ventricular end-systolic diameter decreased from 54.5 mm to 50.2 mm (p = 0.001) and mean left ventricular ejection fraction increased significantly from 29.8% to 37.0% (p = 0.001). In the increased bilirubin group, there was no significant change in echocardiographic parameters from baseline to follow-up. In Kaplan–Meyer analysis, cardiac mortality combined with heart failure hospitalization in the increased bilirubin group was significantly higher than that in the decreased bilirubin group (log-rank p = 0.018). Multivariate Cox regression analysis revealed that increased bilirubin was an independent predictor of cardiac mortality combined with heart failure hospitalization (OR = 2.66, p = 0.023). Conclusions The change in serum bilirubin is useful for assessment of left ventricular reverse remodeling and prediction of outcomes in heart failure patients with CRT.

In steel members strengthened with carbon-fiber reinforced polymer (CFRP) plate, thermal stresses are introduced in the steel members, the CFRP plates and the adhesive layers when temperature changes because the linear thermal expansion coefficients of steel and CFRP are mismatched. Therefore, the thermal stress caused by temperature change has to be considered when designing the repair or strengthening of a steel member with CFRP plates. With this in mind, the authors proposed a technique to reduce thermal stress in steel members strengthened by CFRP plate on both side, which involves bonding aluminum alloy plates with CFRP plates. In this proposed method, the thermal stresses in steel member can be reduced so that there are negligible levels of stress when the cross sectional areas of CFRP and aluminum plates are designed to correspond the coefficient of thermal expansion of steel, even though the thermal stresses are introduced in the CFRP and aluminum plates. So far, a thermal bending moment was not considered in the proposed method, because the steel members strengthened by CFRP-aluminum laminated plate on top and bottom sides were assumed. However, if the proposed method is applied on one side of steel member, the thermal stress in the steel member might not be reduced completely by generated thermal bending moment. Therefore, to confirm the effectiveness of the proposed method for one-sided bonding, heat tests were conducted on a steel plate with a laminated plate bonded on one side. Additionally, to verify test results and calculate the shear and peel stresses in the adhesive layers, a numerical model that used Eigenvalue analysis was proposed and applied. The tests revealed that using the proposed method to create a two-layered laminated plate consisting of CFRP and aluminum plates could not reduce the thermal stress completely in a thin steel plate. However, it was found that the thermal stress in steel plate can be completely reduced, even in thin steel plate, when the proposed method is used to create a three-layered laminated plate consisting of one CFRP plate between two aluminum plates, which when composited has a thermal bending moment equal to zero.

BACKGROUND Obstruction of the access vein is a well-known complication after cardiovascular implantable electronic device (CIED) implantation. In that case, well-developed collateral superficial veins are frequently observed on the skin surface around the CIED. The aim of this study was to clarify the relationship between venous obstruction and development of a superficial vein across the clavicle. METHODS AND RESULTS A total of 107 patients scheduled for generator replacement, device upgrade, or lead extraction were enrolled. The skin surface around the device was photographed. A 20-ml bolus of contrast medium was injected into a peripheral arm vein on the side of CIED implantation, and contrast venography was performed. Venous obstruction was defined as luminal diameter narrowing >75%. Venography showed venous obstruction in 27 patients (25.2%). There were no statistically significant differences in patient characteristics between the venous obstruction and no venous obstruction group. Of 107 patients, 44 (41.1%) had a superficial vein across the clavicle on the side of CIED implantation. The sensitivity of the presence of a superficial vein across the clavicle in the diagnosis of venous obstruction was 96.3% and specificity was 77.5% (P

For weight reduction of CFT (concrete-filled tube) members, concrete-filled double skin steel tubular members (CFDT) have been developed. To ensure the composite action of CFDT members, shear connectors should be installed at the interface between steel tubes and concrete. In this study, to investigate the effect of shear connector on the bending behavior of CFDT members, four-point bending tests were carried out on CFDT and CFT members with shear connectors. The locations of the shear connectors were different for each specimen. The shear connectors were found to prevent slip between steel tubes and concrete. The maximum load of CFDT members was improved by shear connectors, particularly when placed on the inner surface of the outer steel tube.コンクリート充填二重鋼管（CFDT）部材は，二重に配置された鋼管の間にコンクリートを充填した構造であり，従来のコンクリート充填（CFT）部材よりも軽量となる利点を有する。一方，CFDT部材の内外鋼管と充填コンクリートが一体となって挙動するためには，両鋼管とコンクリートの界面にずれ止めを設置する必要があると考えられる。本研究では，鋼管にずれ止めを設置したCFDTおよびCFT部材の4点曲げ載荷実験を行った。その結果，内鋼管の径が小さいCFDT部材では，ずれ止めを設置した鋼管とコンクリートとのずれが抑制され，ずれ止めの設置によって最大曲げモーメントが向上した。特に，外鋼管にずれ止めを設置した場合には，最大曲げモーメントの向上率が大きかった。一方，内鋼管の径が小さいCFDT部材では，ずれ止めを設置してもずれの抑制効果が小さく，最大曲げモーメントの向上率も小さかった。

The lacustrine shrimp Palaemon paucidens undertakes seasonal migration between shallow waters in spring and summer to deep waters in autumn and winter in Lake Biwa in Japan. Previous studies hypothesized that the migration to deep waters was for hibernation. The findings of this study oppose this hypothesis. We showed that P.paucidens is physiologically active in deep waters during winter; that the carbon stable isotope ratio indicated that the species forages in winter and that there was a difference in food sources between summer and winter; that lipid content was highest in January; and that gene expression activity (as measured by the RNA/DNA ratio) remained constant throughout the year. Thus, P.paucidens individuals that migrate to the bottom are likely to forage in winter, but do not hibernate. Nutrients gained in winter were not reflected in individual growth but may have been allocated to gonadal growth and the production of gametes, suggesting that winter foraging by this species in deep sites contributes to obtain resources for reproductive investment. In addition, we found that both small individuals with no reproductive experience and relatively large females with reproductive experience overwintered, indicating that P.paucidens has a life-cycle that is longer than 1yr in Lake Biwa.

ICR (Impact Crack-closure Retrofit) treatment was developed for extending fatigue life of cracked steel structures by closing the fatigue crack opening. By applying the ICR treatment to as-welded condition, compressive stress remains at weld toe. Therefore, ICR treatment can be used for the improvement of fatigue strength of welded joint at the same level of the other fatigue strength improved techniques. If a compression overload is subjected after ICR treatment, however, the residual compressive stress at weld toe will shift the tensile stress region. Accordingly, improved fatigue strength of welded joints by ICR treatment will be reduced after the compression overloaded. In order to investigate the effect of the compression overload on fatigue strength improved by ICR treatment, fatigue tests of out-of-plane gusset specimens were carried out. As the results, fatigue strength improved by ICR treatment was hardly reduced under the compression overload condition of nominal stress of −190 MPa.

Concrete Filled Tubular steel (CFT) member, which represents a superb deformability due to well-known confined effect between steel tube and concrete, has been used mainly as bridge pier. As a progressive composite member, Concrete Filled Double tubular steel (CFDT), which is consist of double skin steel tubes and filled concrete between them, has been proposed. Although a lot of reports on mechanical characteristics of the CFDT member are presently published, the necessity of shear connector for the CFDT member has not been addressed. In this research, the shear connector was installed at the interface between tubes and concrete in the CFDT member. To investigate the effect of the shear connector on the bending characteristics, the four points bending test were carried out. The results show that integrating the steel tubes and concrete enhances its bearing capacity. Furthermore, the strains of outer and inner tubes were also discussed in this paper.

Recently, to minimize thermal cracks that occur due to excessive temperature differences, several slits have been provided as a crack-prevention measure in the concrete guard walls of bridges. However, this practice may affect the amount of stress in steel girders due to insufficient stiffness of these bridges. This paper presents an investigation of the effect of crack-prevention slits on steel girders through the use of FEM (finite element method) analysis. A RC (reinforced concrete) deck bridge with 4 steel plate girders was used as the model bridge. The authors' analysis revealed that the stress in the lower flange of exterior girders exceeds that of bridges that have no concrete guard wall when the slits are provided at a long distance from each other.本研究では，鉄筋コンクリート床版を有する鋼鈑桁橋を対象に，鉄筋コンクリート壁式防護柵（壁高欄）のひび割れ対策として設けられる伸縮目地（スリット）の数や間隔が主桁の応力に与える影響を明らかにするために，壁高欄にスリットを設けたRC床版鋼合成桁橋のFEM解析を行った。その結果，スリットの間隔が短い場合，スリット位置の外桁下フランジ下面に生じる応力は，壁高欄が設けられていない場合の外桁下フランジの応力とほぼ一致するが，スリットの間隔が長い場合，スリット位置の外桁下フランジの応力は，壁高欄が設けられていない場合よりも大きくなることが示された。