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Background The incidence, predictors, and clinical impact of lead break during transvenous lead extraction (TLE) were previously unknown. Methods We included consecutive patients who underwent TLE between September 2013 and July 2019 at our institute. Lead break during removal was defined as lead stretching and becoming misshapen, as assessed by fluoroscopy. Results A total of 246 patients underwent TLE for 501 leads. At a patient level, complete success was achieved in 226 patients (91.9%). At a lead level, 481 leads (96.0%) were completely removed and 101 leads (20.1%) were broken during the procedure. Of 392 identified pacemaker leads, 71 (18.3%) were broken during the TLE procedure. A multivariable analysis confirmed high lead age (odds ratio [OR] 1.12, 95% confidence interval (CI) 1.07‐1.17; P, The extraction of cardiac implantable electronic device leads due to infections, malfunctions, and recalls is common, and can lead to complications such as lead break resulting in incomplete lead removal and cardiac tamponade. We found that older lead age, co‐radial leads, passive leads, and non‐polyurethane leads were independent predictors of lead break during extraction. These findings will guide clinicians to make appropriate choices of procedure and take greater care when these risk factors are present.

Objectives The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors. Methods This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness. Conclusion The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level. Disclosure Work supported by industry: no.

To improve energy efficiency, flow control techniques for skin-friction drag and heat transfer with regard to wall turbulence are essential. This study performs direct numerical simulation of turbulent channel flows. The traveling-wave-like body force is employed as the flow control technique to break the similarity between momentum and heat transfer. The traveling wave control mimics the self-excited thin film in the corresponding experimental study. When the wave traveled slowly along the downstream direction, the skin-friction drag, heat transfer, and analogy factor were found to increase. Moreover, these parameters increased with an increase in the reference height of the traveling wave ( hw). Flow visualization shows turbulence enhancement owing to the increase in hw. Three-component decomposition elucidates the difference between the control effect on the Reynolds shear stress and the turbulent heat flux.

We report the case of a 74-year-old man with a previously implanted pacemaker lead. He had undergone Medtronic™ Micra Transcatheter Pacing System (TPS, Medtronic plc, MN, USA) implantation because of lead fracture. We implanted a new TPS and retrieved the dislodged one. We used a multiple-loop snare (EN snare®) and an 8.5F steerable sheath (Agilis NXT; St. Jude Medical, St Paul, MN, USA). The TPS was obstructed by the chordae tendineae of the tricuspid valve and the pacemaker lead. We pushed the TPS to the apex site; this enabled us to move the TPS away from the chordae tendineae and pacemaker lead. The TPS body was caught in the inferior vena cava and was successfully retrieved. To our knowledge, this is the first case reporting TPS retrieval in a heart with preexisting lead. Keywords: Dislodgement, Transcatheter pacing system, TPS retrieval

Cardiac rhythm management devices (pacemakers) are being increasingly implanted worldwide not only for symptomatic bradycardia, but also for the management of arrhythmia and heart failure. Despite the overall safety, transvenous lead extraction (TLE) remains a challenging procedure with inherent

As the population ages, the number of elderly patients with implantable cardiac devices referred for transvenous lead extraction will dramatically increase in Japan. We report the safety and effectiveness of transvenous lead extraction in octogenarians. Between 2005 and 2017, we collected data of

SummaryAccurate knowledge of the S-genotypes of apple cultivars is important for use in a breeding programme. We analysed the S-RNase genotypes of 65 apple (Malus domestica Borkh.) cultivars grown in Japan that had ‘Cox’s Orange Pippin’, ‘Jonathan’, or ‘Delicious’ as their progenitors, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses. In this process, we developed a PCR-RFLP method to identify the S6and S21-RNase alleles that may be present in ‘Cox’s Pomona’. We showed that one of the alleged parents of ‘Allington Pippin’, ‘Cox’s Pomona’, ‘Merton Worcester’, and ‘Webster’ might be wrong. We also showed that the S16aand S16b-RNase alleles were functionally identical, and that ‘Komitsu’ was produced by a cross between ‘Jonathan’

During ripening many important physic-chemical changes contribute to fruit quality, and they are precisely determined by gene expression. Specific genes are essential to normal ripening; however, information on gene expression about the majority of tropical fruit, such as bananas and mangoes is limited. In this way, the present study was undertaken with the objective to provide preliminary access to the changes in expression of some genes potentially relevant to banana and mango ripening. To simultaneously evaluate the changes in gene expression, a small collection of genes related to ethylene biosynthesis, starch mobilization, cell wall disassembly, pigment synthesis and ascorbate metabolism was assembled in nylon membranes and probed with cDNA from unripe and ripe fruit. Some interesting differences were observed between gene expression in bananas and mangoes. In relation to starch metabolism, banana a-amylase was induced during ripening while phosphorylase was more induced in mangoes. Similarly, expression of cell wall-related genes for polygalacturonase and expansin were also different in those fruits. Fructanfructosyltransferase, chalcone synthase, and ascorbate oxidase genes were also induced in ripening mangoes, but not in bananas. Although the number of sequences involved was relatively small, this simple and feasible approach provided interesting preliminary data that can be starting points for more in depth studies.

Catheter ablation (CA) is an effective and widely used treatment strategy for paroxysmal atrial fibrillation (PAF). According to some papers, PAF is associated with distinct mechanistic and prognostic criteria in different patient subgroups. Compared with men, women with PAF have greater

Radiofrequency (RF) ablation of the atrioventricular nodal slow pathway is the accepted treatment for atrioventricular nodal reentrant tachycardia (AVNRT), with success rates greater than 90%. The major risk is atrioventricular nodal block requiring permanent pacemaker implantation. Cryoablation is

Objectives To explore the possibility of a generally applicable tool for the immediate diagnosis of Parkinson's disease (PD) in its early stage, we compared the sensitivity and specificity of an acute levodopa challenge test with that of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Materials and methods A consecutive series of 45 patients with extrapyramidal symptoms were recruited to the acute levodopa challenge and evaluated for improvement by use of the Unified Parkinson's Disease Rating Scale motor scores. Of these patients, 32 of them were also examined by MIBG scintigraphy. The patients were followed up for at least 24 months, and 22 patients were diagnosed as having clinically definite PD. Results The sensitivity and specificity of the acute levodopa challenge test to predict clinical diagnosis of PD were 81.8% and 81.8%, respectively, which were better than those obtained by MIBG scintigraphy (62.5% and 62.5%). In both early- and middle-stages of PD, the test gave better sensitivity than MIBG scintigraphy. Conclusions Considering that the well-established and frequently referred clinical diagnostic criteria require longitudinal observation for at least 24 months, the acute levodopa challenge test can be used as an immediate diagnostic tool for PD with sensitivity and specificity comparable to those of MIBG.

Controlling the amount of chromium to be deposited on tin and iron substrates is important for the production of special steel sheet for welded can material, partially tin precoated and then fully coated with chromium. The deposition behaviour of chromium on tin and iron substrates was studied by means of the polarization behaviour of tin and iron in a chromium coating bath. For stable deposition, a higher current density is required on tin than on iron due to the higher hydrogen over-voltage on tin. Ageing in air after tin coating and preliminary electrolysis under the potential range of reduction of Cr6+ to Cr0 in a chromium coating bath are effective in facilitating the formation of a cathode film and encouraging the deposition. A study on a continuous coating line showed that the amount of chromium to be deposited on tin and iron can be industrially controlled by a process involving a lower current density in the first step and a higher current density in the second.

Substrate specificities of proteases produced by two putrefactive marine bacteria, Shewanella putrefaciens and Alteromonas haloplanktis, were surveyed by using peptidyl-7-amino-4-methylcoumarin (MCA-substrates), Shewanella putrefaciens produced trypsin-like enzyme(s) showing broad spectrum specificity and chymotrypsin-like enzyme specifically hydrolysing Glt-Gly−-Gly-Phe-MCA. Alteromonas haloplanktis produced high activity of aminopeptidase and trypsin-like enzyme(s) preferring Z-Phe-Arg-MCA, Bz-Arg-MCA and Boc-Leu-Ser-Thr-Arg-MCA. The two organisms would be able to utilize different proteins for their growth

Cefozopran (SCE-2787, CZOP), which is already on the market with a variety of approved indications in infectious diseases for adult patients, was administered to premature and newborn patients to evaluate the pharmacokinetics and the clinical efficacy. 1. Pharmacokinetics CZOP was intravenously administered at doses of 10.0 mg/kg, 21.4 mg/kg and 40.0 mg/kg to premature and newborn patients, and the blood concentrations and urinary excretion rate were examined. The blood CZOP concentrations were 31.7 and 65.5 micrograms/ml at 30 minutes after administration of 10.0 mg/kg and 40.0 mg/kg, respectively. The elimination half life was 1.78 hours and 2.31 hours, and the urinary recovery was 110.7% and 53.7% within 6 hours after administration, respectively. In the patient given 21.4 mg/kg, the blood CZOP concentration was 36.4 mg/kg at 1 an hour after administration and the elimination half life was 3.97 hours. The urinary recovery was 29.6% within 5 hours after administration. 2. Clinical results The clinical efficacy was evaluated in 19 patients and judged "good" or better in 13 of them with the efficacy rate or 68.4%. The bacteriological response was evaluated in 10 patients from whom Gram-positive cocci of S. aureus (6 strains), S. pneumoniae (1 strain) and E. faecalis (1 strain) and Gram-negative bacilli of H. influenzae (2 strains) and E. coli (2 strains) were isolated as possible causative organisms. With exception of 1 strain each of S aureus and H influenzae, which were not tested after the treatment with CZOP, all of these strains were found to be eradicated. 3. Adverse drug reactions (ADRs) of signs and symptoms and abnormal alterations of laboratory test values. Safety evaluation was made in 24 patients. ADRs of signs and symptoms were recognized in none of them. As abnormal alterations of laboratory test values, increased eosinophils in 3 patients, elevated GOT in one and elevated GPT in one were recognized. These results indicate that CZOP is a drug useful for treatment of infections in premature and newborn patients.

Azithromycin (AZM), a new oral macrolide antibiotic, in 10% fine granules or 100 mg capsules was given to pediatric patients to treat various infections. The following results were obtained in our studies of AZM for its antibacterial activities against clinical isolates, its pharmacokinetics, its efficacy, and its safety. 1. MICs of AZM, erythromycin (EM) and clarithromycin (CAM) were determined against a total of 57 strains all at 10(6) cfu/ml. Among Gram-positive cocci, MICs of AZM ranged from 0.78 to100 micrograms/ml against Staphylococcus aureus (20 strains), from 0.05 to 0.1 microgram/ml against Streptococcus pyogenes (11 strains), and from 0.0125 to 3.13 micrograms/ml against Streptococcus pneumoniae (10 strains). These MICs were similar to those of the other macrolides. Among Gram-negative bacilli, MICs of AZM were 0.05 micrograms/ml against Moraxella subgenus Branhamella catarrhalis (1 strain), from 0.78 to 3.13 micrograms/ml against Haemophilus influenzae (9 strains), 0.78 micrograms/ml against Haemophilus parainfluenzae (1 strain) and 6.25 micrograms/ml against salmonella sp. (1 strain). These values were similar to or lower than those of the other macrolides. Against Mycoplasma pneumoniae, MICs of AZM wereor = 0.0008 micrograms/ml in three strains. One strain of M. pneumoniae showed tolerance to AZM at MIC 25 micrograms/ml. The other agents exhibited higher MIC than AZM against this organism. 2. Plasma samples were collected from five patients receiving fine granules and four patients receiving capsules for drug level determination. The patients received AZM at 10.0 approximately 16.3 mg/kg body weight once daily for 3 days. Drug concentrations in plasma at two hours after Day 3 dosing were in a range between 0.02 and 0.19 micrograms/ml for fine granules and were in a range between 0.11 and 0.42 micrograms/ml for capsules. 3. Urine samples were collected from four patients receiving fine granules and four patients receiving capsules. Drug levels were determined to be 3 micrograms/ml at post-treatment 48 hours for fine granules and post-treatment 72 hours for capsules. Urinary excretion rates of AZM in three patients on capsules lied in a range between 4.69 and 10.17%. 4. Effectiveness of AZM in fine granules was evaluated in 128 patients having a total of 19 different infections. AZM was rated "excellent" in 51 patients, "good" in 63, "fair" in 8, "poor" in 6, resulting in an efficacy rate of 89.1%. Effectiveness of AZM in capsular form was evaluated in 23 patients with five different infections. AZM was found "excellent" in 13 patients and "good" in 10, resulting in an efficacy rate of 100%. 5. AZM in fine granules eradicated 45 strains of 54 in 8 different bacteria. AZM in capsules eradicated 9 strains of 10 strains in 6 different bacteria. 6. As for adverse reactions, one patient complained of eruption, one vomiting, one loose stool, five diarrhea, when administered with fine granular form of AZM. One patient on AZM capsules experienced urticaria and vomiting. 7. As for abnormal laboratory changes, three patients were found with decreased WBC, seven with increased eosinophil, two with increased GOT and GPT, one with increased GPT. They were all on fine granular form of AZM. As far as abnormalities found in patients administered with AZM in capsular form, two showed decreased WBC, one decreased WBC along with increased eosinophil, and three increased eosinophil.

An 18-day-old male baby who had fallen from his mothers arms and hit his head on the floor was admitted to our hospital. On admission, the patient was crying, but no weakness was noted in the extremities. A small fluctuant protrusion was visible in the right parietal region. The plain skull X-ray film revealed a wide linear fracture in the parietal bone. Computed tomography (CT) showed swelling of the right hemisphere and a traumatic subarachnoid hemorrhage. At 41 days old, the subcutaneous fluid collection had increased in volume and the width of the linear skull fracture was also enlarged as shown on the X-ray film. CT and magnetic resonance imaging (MRI) revealed a large cyst herniating through the wide parietal bone defect. There was also an enlarged right lateral ventricle and a torn dural margin in the brain. The cranioplasty with dural plasty was performed on the 43rd day of ago under the diagnosis of growing skull fracture of the right parietal bone. The postoperative course was uneventful, without seizure or weakness. In order to diagnose growing skull fracture, especially to show the relationship between the fracture, torn dura matter, the ventricle and the contused brain, MRI was very helpful combined with CT and plain skull X-rays. Cranioplasty with dural repair was considered the essential procedure for the treatment of such growing skull fractures.

Hepatocellular carcinomas (HCC) of various differentiation, Edmondson (Edm) grade I-IV, often based upon viral infectious hepatitis transformed through regeneration, nodular and/or dysplastic adenomatous hyperplasia. Aspiration cytology, even needle biopsy for such lesions, is very difficult to interpret. We have been studying multiparametric cytologic analysis using DAPI/Hematoporphyrin (HP) staining for the cece samples provided from exactly trimmed 50-microns thick paraffin sections, employing a new software program which we developed, combining DNA ploidy and cell protein content analysis with morphometry. DAPI indicates DNA content and nuclear size and HP indicates cell protein content and cell size. From 21 cases of HCC, 43 nodules or masses including multiple lesions and nodule in nodule were analyzed. Surrounding non-neoplastic hepatic tissues were examined as the control specimens. On DNA histogram, cases with the peak over 2.4 c are identified as aneuploid (Aneupl). Cases of Edm I, or II, 6 of 8 samples showed Aneupl., all of 11 cases of Edm II, 11 cases of Edm III, and one of Edm IV showed Aneupl. Multinodular foci in the same cases and also nodule in nodule often showed different modes of Aneupl. This suggested heterogenetic carcinogeneity. Noncarcinomatous foci often showed Aneupl. modes, which may indicate malignant transformation or malignant potential.

The in vivo responsiveness of thyroid glands to TSH at various ages in novel 'growth-retarded' (grt/grt) mice derived from Snell's dwarf (DW/J) mice and in their normal counterparts were analysed by determining serum T4 concentrations before and after the administration of exogenous TSH. The serum T4 concentration in normal mice increased in response to TSH at 2, 4 and 12 weeks of age but not at 1 week of age. A transient augmentation of such thyroidal responsiveness to TSH was apparent in normal mice at 2 weeks of age, when the serum T4 level exhibits a peak and the pubertal growth of mice starts. In contrast to normal mice, at any age examined from 2 to 12 weeks after birth, exogenous TSH did not influence serum T4 concentrations in the grt/grt mice at all. On the other hand, serum TSH concentrations in young grt/grt mice were highly elevated compared with those in normal mice and they were normalized by a 2–3 week's treatment with T3. Morphological studies demonstrated degenerated thyroid glands in the grt/grt mice. These results suggest that the severe hypothyroidism and consequent growth retardation in growth-retarded mice are due to impairment of the thyroid glands of the mutant mice in producing and/or secreting thyroid hormones in response to TSH. Journal of Endocrinology (1995) 144, 209–214

Hydrostatic pressure-induced morphological and physiochemical changes in monomeric myosin were investigated. The turbidity of a myosin solution increased after release of pressure, indicating aggregation of the molecules. Some molecules were single headed after exposure to 100-200 MPa, in contrast with an intact molecule having two heads. Small-sized oligomeric species, composed of several molecules, appeared after pressurization at 200 MPa. The oligomers were formed only through head-to-head association. Neither head-to-tail nor tail-to-tail interaction was observed. With increasing pressure to 300 MPa, monomeric myosin remarkably decreased, and most molecules formed oligomers, in which the myosin heads were tightly associated, forming a clump, the tails of the myosin molecules extending radially from the clump. Such an oligomer was shaped like a daisy wheel and its morphology was quite similar to that formed on heating reported previously [Yamamoto et al. (1990) J. Biochem. 108, 896-898]. The aggregation of myosin molecules upon pressurization was concomitant with an increase in hydrophobicity, which was measured spectrofluorometrically with 8-anilino-1-naphthalene sulfonate, a probe for apolar binding sites. Although the turbidity increased continuously with increasing pressure, the hydrophobicity remained at a constant level above 200 MPa at pH 6.0 and above 300 MPa at pH 7.0. The loss of myosin ATPase activity was accompanied by aggregation of the molecules. These results indicate that hydrophobic groups in the heads of myosin are exposed to the surface of the molecule on pressurization, so that hydrophobic interaction among the heads occurs, yielding aggregates. Beside the hydrophobic interaction, the contribution of other interaction(s) is also suggested.

A simple one-step double staining with DAPI and hematoporphyrin (HP) was used for UV-microspectrophotometric (UV-MSPM) and flow cytometry (FCM) analysis of the same samples. The specimens analyzed included fresh biopsy and/or surgical materials, trimmed 50 microns-thick paraffin sections and smears (with the latter not available for FCM). We provided the special technology for preserving the cytoplasm as far as possible to permit measurement of cell size and N/C ratio. DAPI indicates DNA content under 365 nm and HP of total protein content under 670 nm UV-MSPM. The DAPI can measure the nuclear size and the latter the cell size. DAPI/HP staining yielded much more accurate measurements than staining with FITC and PI. The use of both MSPM and FCM with cell sorting on the same samples is very helpful in cytology and histopathology for evaluating and differentiating borderline lesions and grade of malignancy, as well as oncostatic effectivity. Our goal is to combine this technology with the automated cytologic screening system CYBEST, which was developed by Tanaka et al, based on a morphometric device.

The amino acid structure of regulatory light chain which is essential to express the phosphorylation-mediated regulation of smooth muscle actomyosin ATPase was studied. Regulatory light chain of smooth muscle heavy meromyosin (HMM) was truncated by either lysylendopeptidase or trypsin. Lysylendopeptidase cleaved the regulatory light chain initially at the C-terminal side of lysine 6 (Lys C(1)-HMM) and subsequently at the C-terminal side of lysine 12 (Lys C(2)-HMM). On the other hand, trypsin cleaved at the C-terminal side of arginine 16 (tryp-HMM). While the actin activated ATPase activity of Lys C(1)-HMM and Lys C(2)-HMM was markedly activated by phosphorylation, that of tryp-HMM was not activated by phosphorylation. The exchange of cleaved regulatory light chain of tryp-HMM with undigested regulatory light chain restored the phosphorylation-mediated regulation on the actin activated ATPase activity. The regulatory light chain of the undigested HMM was also exchanged with the trypsin-digested regulatory light chain and this abolished the phosphorylation dependence of acto-HMM ATPase activity. These results show that the amino acid sequence arginine 13-arginine 16 is essential to express the regulation of actin activated ATPase of smooth muscle myosin which is mediated by the phosphorylation at serine 19 of the regulatory light chain.

A 6-year-old girl with mediastinal ganglioneuroma was reported. Preoperative examinations revealed that the tumor had both secretive activity of catecholamine and uptake of 131-I-MIBG. Clinical symptom was only supraventricular premature beat on ECG. The tumor, which was located at the left upper mediastinum, was well encapsulated. Total surgical removal was accomplished. Subsequently serum and urine levels of catecholamine were normalized. Detailed histological examination of the tumor revealed benign ganglioneuroma. No blastic change was recognized. We postulate that secretive activity of catecholamine and uptake of 131-I-MIBG cannot suggest malignancy necessarily.

A surgical case of acute pyogenic pericarditis in a 9-month old infant who developed pericardial tamponade rapidly is reported. An anterior pericardiectomy through a left lateral thoracotomy was performed. The baby subsequently made an uncomplicated recovery and was discharged on the 16th postoperative day.