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Background A non-negligible proportion of myocardial infarction (MI) is not clinically recognized and unrecognized myocardial infarction (UMI) is associated with adverse outcomes. Purpose To determine the prevalence and prognostic significance of UMI by delayed-enhancement cardiac magnetic resonance (DE-CMR) before elective percutaneous coronary intervention (PCI). Methods In this prospective, single-center study, 236 patients with stable coronary artery disease undergoing elective and uncomplicated PCI were studied. All patients underwent DE-CMR before PCI. The prevalence of UMI was evaluated and the association of clinical and CMR-derived variables with primary MACE, defined as cardiovascular death, nonfatal MI, hospitalization for heart failure, unplanned late revascularization, and ischemic stroke was investigated. Results In the final analysis of 213 patients, 63 patients (29.6%) showed UMI. Target territory UMI was observed in 38 (17.8% of total, 60.3% of patients with UMI). UMI was significantly associated with sex, diabetes mellitus, left ventricular ejection fraction, SYNTAX score and fractional flow reserve in target vessels. During follow-up periods (median, 23 months), MACE was observed in 17 (27.0%) of patients with UMI, and 17 (11.3%) without (P=0.001). In a multivariable model, UMI (hazard ratio [HR] 2.18, 95% confidential interval, 1.10–4.33, P=0.001) remained as an independent predictor of MACE. Kaplan–Meier analysis indicated that the presence of UMI was significantly associated with higher incidence of MACE. Conclusions The prevalence of UMI in patients undergoing elective PCI was 29.6%. UMI was independently associated with an increased risk of MACE after successful PCI. Given the non-negligible prevalence and potential clinical significance of UMI, clinical studies comparing PCI and guideline directed medical therapy (GDMT) versus GDMT only strategy might have to take the presence of UMI into consideration. Funding Acknowledgement Type of funding sources: None.

Background Prognostic value of unrecognized non-infarct-related territory (non-IR) myocardial infarction (UMI) in patients with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) remains to be elucidated. Purpose This study sought to evaluate the prevalence of non-IR UMI and its prognostic value in patients with first NSTE-ACS presentation. Methods This retrospective single-center analysis was conducted in patients with NSTE-ACS without prior history of coronary artery disease, who underwent uncomplicated urgent percutaneous coronary intervention (PCI) within 48 hours of admission between August 2014 and January 2018. All patients underwent postprocedural cardiac magnetic resonance imaging (CMR) within 30 days after PCI. Non-IR UMI was defined as the presence of non-IR delayed gadolinium enhancement with an ischemic distribution pattern. We investigated the association of non-IR UMI, other CMR findings and baseline clinical characteristics with major adverse cardiac events (MACE), defined as all-cause death, non-fatal myocardial infarction, ischemic stroke, late revascularization and hospitalization for congestive heart failure. Results A total of 168 NSTE-ACS patients were included (124 males (73.8%); 66±11 years). Non-IR UMI was detected in 28 patients (16.7%). During a median follow-up of 32 months (15–58), MACE occurred in 10 (35.7%) patients with non-IR UMI, and 20 (14.3%) patients without (P=0.013). Patients with MACE showed higher frequency of non-IR UMI in RCA territory and multi vessel disease, higher level of NT-proBNP at admission, higher Genisini score, and greater extent of UMI. Cox's proportional hazards analysis showed that the presence of non-IR UMI was an independent predictor of MACE (HR 2.34, 95% CI 1.02–5.37, P=0.045), after adjusting confounding factors, such as multi vessel disease and serum levels of NT-proBNP at admission. The discriminant efficacy (IDI and NRI) of predicting MACE was significantly improved when the presence of non-IR UMI added to the reference clinical risk model. Kaplan-Meier analysis revealed that patients with non-IR UMI were significantly associated with poor prognosis. (Figure 1). Conclusions In patients with NSTE-ACS undergoing urgent PCI, the prevalence of non-IR UMI was 16.7%. Non-IR UMI provided prognostic information independent of conventional risk factors. Funding Acknowledgement Type of funding sources: None.

An in-situ cosmic-dust instrument called the Mercury Dust Monitor (MDM) had been developed as a part of the science payload for the Mio (Mercury Magnetospheric Orbiter, MMO) stage of the joint European Space Agency (ESA)–JAXA Mercury-exploration mission. The BepiColombo spacecraft was successfully launched by an Ariane 5 rocket on October 20, 2018, and commissioning tests of the science payload were successfully completed in near-earth orbit before injection into a long journey to Mercury. MDM has a sensor consisting of four plates of piezoelectric lead zirconate titanate (PZT), which converts the mechanical stress (or strain) induced by dust-particle impacts into electrical signals. After the commencement of scientific operations, MDM will measure the impact momentum at which dust particles in orbit around the Sun collide with the sensor and record the arrival direction. This paper provides basic information concerning the MDM instrument and its predicted scientific operation as a future reference for scientific articles concerning the MDM’s observational data.

Background Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. CCTA also provides two-dimensional and three-dimensional quantification of the individual component of atherosclerotic plaque and entire vessel. The atherosclerotic burden or disease extent in entire epicardial coronary arteries provides prognostic information in patients with coronary artery disease. Purpose This study sought to explore the prognostic significance of FAI values and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR). Methods A total of 277 patients (277 lesions) with intermediate coronary stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) on CCTA. CT findings including whole vessel and lesion plaque quantification, and target vessel myocardial mass were investigated. Major adverse cardiovascular outcome (MACE) was defined as all cause death, cardiac death, myocardial infarction, unplanned revascularization, and heart failure requiring admission. Survivals from MACE were assessed. Results The mean FAI and the median FFR values were −71.6 and 0.77, respectively. FFR values were weakly albeit significantly correlated with FAI values. (r=−0.016, P=0.008.) MACE was occurred 43 (15.5%) patients during 5 years F-up. ROC analyses revealed that best cut-off value of FAI to predict MACE was −73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥−73.1 had a significantly higher risk of MACE. (Chi-square 5.5, P=0.019) FFR values and the percutaneous coronary intervention were not predictive of MACE. Multivariate COX proportional hazards regression analysis revealed that age, remodeling index, and lesions with FAI ≥−73.1 were independent predictors of MACE. Conclusion The peri-coronary inflammation evaluated by FAI and CT remodeling index enhances cardiac risk prediction in chronic coronary syndrome patients with intermediate lesions. Non-invasive comprehensive CT assessment may help identify high risk patients of subsequent clinical events and provide enhanced patient management. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This study was supported in part by an unrestricted research grant from St. Jude Medical (Abbot Vascular, Santa Clara, CA, USA). The company had no role in study design, conduct, data analysis or manuscript preparation.

Background Cardiac magnetic resonance (CMR) imaging is a useful instrument for the assessment of pathological and functional conditions without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Both unrecognized myocardial infarction (UMI) and impaired global myocardial blood flow (g-MBF) have been reported to be strongly associated with worse outcome in patients with cardiovascular disease. However, their combined efficacy remains undetermined. Purpose We sought to assess the prognostic value of the presence of UMI and pre-procedural hyperemic g-MBF evaluated by phase-contrast cine magnetic resonance imaging (PC-CMR) in patients with chronic coronary syndrome who underwent elective percutaneous coronary intervention (PCI). Methods A total of 177 patients with de novo functionally significant stenosis who underwent pre-PCI CMR and PCI between September, 2016 and March, 2019 were retrospectively studied. UMI was defined as a scar detected by late gadolinium enhancement (LGE) without previously diagnosed MI. g-MBF was assessed by quantifying coronary sinus flow using PC-CMR at rest and hyperemic state. The predictors of major adverse cardiac events (MACE; cardiac death, nonfatal myocardial infarction, clinically driven unplanned revascularization, or hospitalization for congestive heart failure) during follow-up were investigated. Results UMI was detected in 40 (27.7%) patients and rest and maximal hyperemic g-MBF evaluated by the coronary sinus flow obtained by PC-CMR were 0.95 ml/min/g and 2.26 ml/min/g, respectively. During the median follow-up of 26 months, cardiovascular death occurred in 1 patient (0.6%), nonfatal myocardial infarction occurred in 4 patients (2.3%), and clinically driven revascularization and hospitalization due to congestive heart failure occurred in 25 patients (14.1%) and 3 patients (1.7%) patients, respectively. In patients with MACE, hyperemic g-MBF was significantly lower and the prevalence of UMI were significantly higher compared with those without MACE (1.94 ml/min/g vs 2.36 ml/min/g P=0.014; 48.3% vs 23.6%, P=0.011). Cox proportional hazards model indicated that impaired hyperemic g-MBF ( Conclusion In patients with chronic coronary syndrome undergoing elective PCI, the combined assessment of UMI and hyperemic g-MBF obtained by preprocedural noninvasive CMR may provide significant prognostic information. Funding Acknowledgement Type of funding source: None

Background Recent studies reported the association between elevated fat attenuation index (FAI) of pericoronary adipose tissue (PCAT) on coronary computed tomography angiography (CTA) and worse cardiac outcomes. Purpose We investigated the prognostic value of increased FAI-defined coronary inflammation status in patients with coronary artery disease. Methods Three-hundred fifty-eight patients (127 acute coronary syndromes [ACS], 231 stable coronary artery disease) with left anterior descending artery (LAD) as a culprit vessel who underwent coronary CTA were retrospectively studied. The FAI defined as the mean CT attenuation value of PCAT (−190 to −30 Hounsfield Unit [HU]) was measured at the proximal 40-mm segment of LAD. All subjects were divided into two groups according to the median value of FAI in the LAD. The association between the incidence of major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, target and non-target vessel revascularization were evaluated. Results In a total of 358 patients, median FAI values surrounding the LAD was −71.46 (interquartile range, −77.10 to −66.34) HU. Thirty-eight patients (10.6%) experienced MACE during the follow-up period (median, 818 days). Kaplan-Meier analysis revealed that high FAI-LAD (>−71.46 HU [median]) was significantly associated with the incidence of MACE (log-rank test, chi-square = 4.183, P=0.041) (Figure). Conclusions In patients with coronary artery disease with culprit LAD lesions, elevated FAI of PCAT surrounding the LAD was associated with worse clinical outcomes. Assessment of FAI may have a potential for potential for non-invasive risk-stratification by coronary CTA. Kaplan-Meier analysis for MACE Funding Acknowledgement Type of funding source: None

Background A recent study has shown that lipid-rich plaque (LRP) detected by near-infrared spectroscopy (NIRS) is a significant predictor of future adverse events. Pericoronary adipose tissue inflammation (FAI; fat attenuation index) evaluated by computed tomography angiography (CTA) has also been reported to be linked with cardiac events. The relationship between NIRS-defined LRP and FAI remains to be determined. Methods A total of 82 de novo culprit lesions in 82 patients with chronic coronary syndromes (CCS) who underwent perprocedural CTA and NIRS was retrospectively studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) of pericoronary adipose tissue. Plaque morphology was assessed by coronary CTA and grey-scale intravascular ultrasound (IVUS). NIRS-defined LRP was defined as a maximum lipid core burden index (LCBI) in 4 mm ≥400. Relationship between NIRS-defined LRP, CTA/grey-scale IVUS findings, and FAI was assessed. Univariate and multivariate logistic regression analyses were performed to determine the predictors for NIRS-derived LRP. Results NIRS-defined LRP was observed in 35 (42.6%) patients. Maximum LCBI showed modest correlations both with FAI (r=0.29, p-value=0.007) and CT-derived remodeling index (r=0.51, p Conclusions FAI of the culprit lesion in CCS was an independent predictor of NIRS-defined LRP, supporting the notion that local pericoronary adipose tissue inflammation may correlate to the presence of LRP. Comprehensive assessment of coronary CTA including FAI evaluation may provide a highly accurate information with high sensitivity and specificity for identifying high risk lesions potentially leading to future cardiac events. Funding Acknowledgement Type of funding source: None

Background The concept of coronary flow capacity (CFC) originated from positron emission tomography has been reported to provide prognostic information. Phase contrast cine-magnetic resonance imaging (PC-CMR) of the coronary sinus (CS) is a promising approach for quantifying global coronary sinus flow (CSF) and global coronary flow reserve (g-CFR) without the need for ionizing radiation, radioactive tracers, or intravascular catheterization. Purpose We evaluated the prognostic value of postprocedural CFC by quantifying CSF using PC-CMR in patients with acute coronary syndrome (ACS) treated with primary or urgent percutaneous coronary intervention (PCI). Methods This study prospectively but nonconsecutively enrolled 569 ACS patients who underwent uncomplicated primary (for ST-segment elevation myocardial infarction (STEMI)) or urgent PCI within 48 hours of symptom onset (for non-ST elevation acute coronary syndrome (NSTE-ACS)). Breath-hold PC-CMR images of CS were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after culprit lesion PCI and revascularization of functionally significant non-culprit lesions. The entire cohort was stratified by the CFC according to the thresholds of hyperemic CSF and g-CFR. Impaired CFC was defined as a severely-reduced CFC in the present study. The association of CFC and baseline clinical characteristics with major adverse cardiac events (all-cause death, nonfatal myocardial infarction, hospitalization for congestive heart failure or stroke) was investigated. Results In the final analysis of 502 patients (Male 417 (83.1%), mean age was 67 [58, 73]) and 310 patients (82.3%) with STEMI and 192 patients (38.2%) with NSTE-ACS were studied. In a total cohort, rest and maximal hyperemic CSF and corrected G-CFR were 0.93 [0.68, 1.24] ml/min/g, 2.08 [1.44, 2.77] ml/min/g, and 2.21 [1.58, 3.05], respectively. During a median follow-up of 28 months, MACE occurred in 53 patients (all-cause death: 19, nonfatal myocardial infarction: 16, late revascularization: 59, hospitalization for congestive heart failure: 9, stroke: 9). Cox proportional hazards analysis showed that corrected G-CFR and impaired CFC were both independent predictors of MACE. (hazard ratio (HR), 0.61, 95% confidence interval (CI): 0.45–0.82, p=0.001; HR, 3.51, 95% CI: 1.79–6.86, p≤0.001, respectively). Cardiac event-free survival was significantly worse in patients with impaired CFC (log-rank χ2=22.9, P Conclusions In ACS patients successfully revascularized with primary or urgent PCI, CFC categorization stratified by noninvasive PC-CMR provided significant prognostic information independent of infarction size, conventional risk factors and g-CFR. Funding Acknowledgement Type of funding source: None

Background Aortic valve calcification (AVC) has been known as an independent predictor for adverse cardiovascular events and all-cause mortality. Previous studies demonstrated that AVC was associated with aortic valve inflammation and atherosclerosis. However, the relationship between the progression of AVC and pericoronary inflammation remains undetermined. Purpose The purpose of this study was to evaluate the impact of the pericoronary inflammation on the progression of AVC. Methods A total of 107 patients with suspected or known chronic coronary syndromes who underwent clinically indicated serial 320-slice coronary computed tomography angiography (CTA) at Tsuchiura Kyodo General Hospital from January 2011 to June 2019 were retrospectively studied. Pericoronary inflammation was assessed by pericoronary adipose tissue attenuation (PCATA) defined as the mean CT attenuation value of PCATA (−190 to −30 Hounsfield units [HU]) on proximal 40 mm segments of coronary arteries. AVC was quantified by Agatston score on CTA. The mean aortic attenuation (HU Aorta) and the standard deviation (SD) in the region of interest at the level of the sinotubular junction was measured. AVC was defined as the threshold for calcium detection (mean HU Aorta + 2SD). AVC index was calculated as follows: (follow-up/baseline) AVC divided by follow-up period. AVC progression was defined as newly-developed AVC at follow-up or an increased AVC index during follow-up. All patients were divided into two groups according to the presence or absence of AVC progression, and clinical characteristics and CT findings were compared between these two groups. Results AVC progression was observed in 26 patients (24.3%) between 2 serial CT examinations (median, 34 months). There was no significant difference in age, gender and the prevalence of other cardiovascular risk factors between the 2 groups. Patients in AVC progression group were associated with higher prevalence of elevated PCATA-LAD, higher LV mass index at baseline and the initial AVC presence. Receiver-operating characteristic curve analysis revealed that the optimal cut off value of PCATA-LAD for predicting AVC progression was −68.26 HU (area under the curve 0.605; 95% confidence interval [CI], 0.465–0.745). Multivariable logistic regression analysis revealed that baseline PCATA-LAD ≥−68.26 HU (odds ratio [OR], 3.12; 95% CI, 1.04–9.35, p=0.042) and the presence of baseline positive AVC (OR, 6.84; 95% CI, 2.34–20.0, p=0.0004) were independent predictors of AVC progression. Conclusions The increased pericoronary inflammation and the presence of AVC may help identify patients with high risk for future AVC progression. Funding Acknowledgement Type of funding source: None

Background Recent studies have reported the association between periaortic adipose tissue volumes identified by multi-detector computed tomography (MDCT) and the periaortic adipose tissue inflammation (PATI) identified by positron emission tomography, which may suggest the link between perivascular inflammation and aortic dilation. However, clinical significance of the PATI identified by MDCT remains elusive in patients with asymptomatic abdominal aortic aneurysm (AAA). Methods A total of 77 patients with AAA (diameter >30mm) who underwent the initial and follow-up MDCT examinations were studied retrospectively. PATI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation). The AAA progression (AP) was defined as the growth of AAA diameter >5.0mm/year from the initial to follow-up. Univariate and multivariate logistic regression analysis were performed to determine the predictors for AP. Results AP was observed in 19 (24.7%) patient, the median initial AAA diameter was 38.9 (32.7–42.9) mm, and the median progression of AAA diameter was 3.1 (1.5–4.9) mm/year. The initial AAA diameter (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.05–1.28; p-value=0.001) and the initial PATI (OR: 1.12; 95% CI: 1.05–1.20; p-value=0.004) were independent predictors of AP. PATI of −71.08 at initial MDCT and the initial AAA diameter of 37.7mm were the best cut-off value to predict AP. Receiver operating characteristic curve analysis revealed that the best cut-off values of PATI at initial MDCT and the initial AAA diameter for predicting AP were −71.08 (AUC: 0.68, 95% CI: 0.50–0.82) and 37.7 (AUC: 0.71, 95% CI: 0.59–0.84), respectively. Addition of the initial AAA diameter to PATI at initial MDCT significantly increased the accuracy for discriminating AP (net reclassification improvement; 95% CI: 0.67 [0.17–1.17]; p-value = 0.007, integrated discrimination improvement; 95% CI: 0.14 [0.04–0.24]; p-value =0.007). Conclusions PATI was an independent and significant predictor of aortic dilation, supporting the notion that local adipose tissue inflammation may contribute to aortic remodeling. Comprehensive assessment of MDCT including PATI evaluation may provide a highly accurate information for identifying high risk lesions potentially leading to future AAA rupture. Funding Acknowledgement Type of funding source: None

Background The usefulness of computed tomography myocardial perfusion (CTP) to assess hemodynamically significant coronary artery lesions has been previously reported. However, the diagnostic value of quantitative evaluation of regional absolute coronary flow by CTP to detect microvascular dysfunction remains unknown. Purpose The aim of study is to assess the diagnostic value of preprocedural CTP to detect coexisting microvascular dysfunction with functionally significant epicardial stenosis in patients with chronic coronary syndromes. Methods and results Thirty-three chronic coronary syndrome patients with de novo single functionally significant stenosis (Fractional flow reserve [FFR] The determinants of coexistence of microvascular dysfunction and functional epicardial stenosis were determined. In invasive wire-based analysis, FFR, coronary flow reserve (CFRwire) and IMR were 0.68 (0.57–0.72), 1.61 (1.00–1.98), and 26.7 (19.3–39.4) respectively. In CTP analysis, rest and hyperemic-MBF and CFR derived from CTP (CFRCTP; calculated as hyperemic-MBF/rest-MBF) were 2.00 (1.31–2.35) ml/min/g, 4.03 (2.11–5.44) ml/min/g, and 2.09 (1.49–2.09) respectively. In the lesions with IMR>25, hyperemic-MBF was significantly lower than that in IMR25 showed area under the curve of 0.72 (0.54–0.90), sensitivity of 47% and specificity of 94%. Conclusion Quantitative assessment of absolute coronary flow by CTP may help detect coexisting microvascular dysfunction in patients with significant epicardial stenotic lesions. Funding Acknowledgement Type of funding source: None

Background Despite the reduction in late thrombotic events with newer generation coronary stents, late stent failure remains a concern following stent implantation. Neoatherosclerosis (NA) is a cause of in-stent restenosis and acute thrombotic occlusion originating from the stented segment by disruption of the in-stent atheroma. Although the clinical impact of NA at 1 year has been reported, clinical significance of NA observed at very later phase remains to be determined. We sought to investigate the association between optical coherence tomography (OCT) findings at very late phase after stenting and subsequent clinical outcomes. Methods A total of 195 patients with 316 stents (including 74 bare metal stents, 48 first-generation DES, and 194 second-generation DES) without stent failure who underwent OCT examination at >3 years (4.9 [3.9- 5.8] years) after stent implantation according to the prespecified protocol were investigated. OCT analysis included the presence of lipid-laden neointima, macrophage, malapposition, thrombus, and plaque rupture within the stents. NA was defined as having lipid-laden neointima. The criteria for the diagnosis of NA were signal-poor region in continuous flames, lipid length longer than 0.3 mm, and invisible stent strut at NA site. Quantitative OCT measurement included lipid length (LL), lipid arc, minimum lumen area (MLA) at the stented segment and minimum stent area (MSA). Major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, and clinically driven revascularization were assessed. MACE-free survival rate was compared between patients with stent showing NA (NA group) and those without NA (non-NA group). Furthermore, in per-stent basis analysis, stent failure including remote revascularization and stent thrombosis of the stent after follow-up OCT examination was assessed. Results NA was identified in 50 stents (15.8%) in 38 patients (19.5%). During the median follow-up period of 2.1 [1.0- 2.8] years after OCT examination, 15 MACEs (7.7%) were captured in the total cohort, of which stent failure was observed in 5 stents (5/316, 1.6%). In patient-based analysis, patients with NA had more frequent MACE than those without (18.0% vs 5.1%, p=0.01). Kaplan-Meier analysis revealed that significantly higher MACE rate was detected in NA group than in non-NA group (χ2=5.4, Log-rank p=0.02). In stent-based analysis, NA stents had more frequent stent failure than those without (8.0% vs 0.4%, p=0.002) Conclusions NA observed by OCT at >3 years after implantation were associated with subsequent worse clinical outcomes in both patient and stent-based analysis. NA at the very late phase after stenting might be the therapeutic target of secondary prevention and OCT examination at very late phase after stenting may help identify high risk patients of subsequent MACE. Funding Acknowledgement Type of funding source: None

Background A recent study has demonstrated that coronary spasm is associated with inflammation of peri-coronary adipose tissue (PAT) by using the combination of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (CT). PAT attenuation (FAI) on CT angiography (CTA) has been reported to reflect PAT inflammation. We sought to investigate if FAI on CTA was associated with coronary vasospasm in patients with suspected vasospastic angina (VSA). Methods A total of 88 patients who underwent CTA and acetylcholine provocation test (SPT) for suspected VSA were retrospectively investigated. FAI was assessed by the crude analysis of the mean CT attenuation value of 3 major coronary arteries on CTA. FAI was evaluated for the proximal reference diameter (FAI-Ref) and inner 2mm adipose tissue layer (FAI-2mm) from the vessel wall. Diagnosis of VSA (VSA group) was made by SPT and the subjects with negative SPT without organic coronary lesions served as non-VSA group. Association between VSA diagnosis and FAI was assessed and the predictors of VSA was explored by univariable and multivariable analyses. Results In 45 patients (51.1%), VSA was diagnosed (VSA group). There were no significant differences in baseline characteristics between the VSA and non-VSA groups. RCA-FAI was significantly higher in patients of VSA group than in non-VSA group. RCA-FAI-2mm provided significantly better diagnostic performance for VSA than RCA-FAI-Ref and LCA-derived FAI values. Furthermore, RCA-FAI-2mm showed a significant relationship with the severity of spasm evaluated by most stenotic segment diameter during SPT. (r=−0.28, p Conclusion Coronary spasm may be linked with PAT inflammation detected by CTA-derived RCA-FAI, particularly by inner PAT assessment close to the vessel wall. Representative cases for FAI analyses Funding Acknowledgement Type of funding source: None

Essentials The activated partial prothrombin time (aPTT) cannot predict the activity of emicizumab (Emi). Adjusted clot waveform analyses using a prothrombin time (PT)/aPTT initiator were developed. Activity of Emi in the co-presence of factor VIII or bypassing agents was quantified. This assay is useful for assessing coagulation potential in Emi-treated hemophilia A.Background Emicizumab is an anti-activated factor IX/FX bispecific antibody that mimics activated FVIII cofactor function. Emicizumab does not require activation by thrombin, and its effect on shortening the activated partial thromboplastin time (APTT) is much greater than that of FVIII. Therefore, the APTT has limited utility in hemophilia A (HA) patients treated with emicizumab. Aim To evaluate the global coagulation potential of emicizumab. Methods Clot waveform analysis (CWA) with prothrombin time (PT)/APTT mixed reagents was used to define hemostatic monitoring protocols in HA patients. A modified parameter, adjusted-|min1| (Ad|min1|), was developed. Maximum and minimum percentage transmittance were defined as 100% and 0% in the precoagulation and postcoagulation phases, respectively. Ad|min1| was calculated as an index of the maximum velocity of the coagulation process. Results Ad|min1| obtained with mixed-trigger reagent (PT/APTT/buffer, 1 : 15 : 135) in the presence of emicizumab optimally corresponded to the conversion rate estimated in animals; 0.2-0.4 IU dL

WOS: 000451511200001, PubMed ID: 30073913, Objective: To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. Methods: The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. Results: The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. Discussion: Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting., Bayer Pharma Plc, The authors are members of the SHIELD (Supporting Hemophilia through International Education, Learning and Development) group, an independent panel of physicians with expert interest in the treatment of haemophilia. Formation of the SHIELD group and its meetings were supported by Bayer Pharma Plc. Members received honoraria for attendance at meetings but no honoraria were paid for contributions to this manuscript. This publication and its content are solely the responsibility of the authors. Medical writing assistance was provided by Clark Health Communications under the direction of the authors and paid for by Bayer Pharma Plc.

Computed tomography (CT) for light materials such as soft biological tissues was performed using a monochromatic X-ray beam provided by a parametric X-ray radiation (PXR) source at the Laboratory for Electron Beam Research and Application (LEBRA) of Nihon University. Using a high-efficiency flat panel detector (FPD), each projection image for CT was taken with exposure times of 5 or 10 s, and 60–360 projection images in each run were obtained with total measurement time of 5 min to 1 h. CT images were obtained from the projection images using the conventional calculation method. The typical tomograms obtained had sharp outlines, which are likely attributable to the propagation-based phase contrast.

We have been developing twisted Bi-2223 multifilamentary taped wires to suppress the AC losses in perpendicular-field configuration for industrial-production process. It is confirmed that the hysteretic losses in the filamentary region can be reduced by twisting in a same manner as in situ Nb 3 Sn multifilamentary ones, while the coupling loss remains in unsatisfactory situation for commercial frequency uses. As one of practical methods for further reduction of the coupling loss, we propose an advanced multifilamentary structure of the taped wires in which an insulation layer is arranged in the central region of the tape to effectively restrict the main part of the coupling current in the perpendicular-field configuration instead of an insulation barrier around each filament that may be not usually suitable to the practical production process. We have designed and fabricated prototype wires with the proposed structure, and measured the AC loss properties in the perpendicular-field configuration. The experimental results suggest that the central insulation barrier has a function to suppress the coupling loss remarkably. We also discuss improvement in the structural design for the further reduction of the AC losses.

著者人数：13名, Accepted: 2008-08-19, 資料番号: SA1001037000

Wavelength-tunable monochromatic Parametric x-ray (PXR) was generated at the Laboratory for Electron Beam Research and Application (LEBRA) at Nihon University. Using the LEBRA-PXR, phase contrast imaging was carried out. Phase contrast images of a kitten deciduous tooth were taken by diffraction enhanced imaging (DEI) method. The results showed that LEBRA-PXR is a high coherent x-ray and is suitable for phase contrast imaging.

A cosmic dust monitor for use onboard a spacecraft is currently being developed using a piezoelectric lead zirconate titanate element (PZT). Its characteristics of the PZT sensor is studied by ground-based laboratory impact experiments using hypervelocity particles supplied by a Van de Graaff accelerator. The output signals obtained from the sensor just after the impact appeared to have a waveform that was explicitly related to the particle’s impact velocity. For velocities less than ∼6 km/s, the signal showed an oscillation pattern and the amplitude was proportional to the momentum of the impacting particle. For higher velocities, the signal gradually changed to a single waveform. The rise time of this single waveform was proportional to the particle’s velocity for velocities above ∼6 km/s. The present paper reports on results for the low velocity case and especially discusses the effect of an outer coating of the sensor with a paint, which is used to reduce heating by solar radiation.

A cosmic dust detector is currently being developed using a piezoelectric lead zirconate titanate (PZT) element. The characteristics of the multilayered detector (MD), which was composed of one hundred PZT disks, were investigated by bombarding it with hypervelocity iron particles supplied by a Van de Graaff accelerator. It was confirmed that there was a linear relationship between the signal amplitude observed from MD and the momentum of the particles. As compared with the single-layered detector (SD) that was composed of one PZT disk, it was found that the sensitivity of MD was ∼3 times higher than that of SD within the limits of the experimental conditions.

The propagation of transverse waves generated acoustically in a piezoelectric element by colliding it with hypervelocity microparticles was studied. The propagation times were measured by a set of multiple electrodes on the surface of the element. The coordinates that the particles struck were determined by combining the propagation times and the velocity of the waves. By using the position-sensitive element, significant deviations between the prior indicated and actually measured orbits were observed. The potential of the present element as part of a steering system is discussed.

The main purpose of this paper is to investigate the ultimate behavior of steel cable-stayed bridges with design variables and compare the validity and applicability of computational methods for evaluating ultimate load capacity of cable-stayed bridges. The methods considered in this paper are elastic buckling analysis, inelastic buckling analysis and nonlinear elasto-plastic analysis. Elastic buckling analysis uses a numerical eigenvalue calculation without considering geometric nonlinearities of cable-stayed bridges and the inelastic material behavior of main components. Inelastic buckling analysis uses an iterative eigenvalue calculation to consider inelastic material behavior, but cannot consider geometric nonlinearities of cable-stayed bridges. The tangent modulus concept with the column strength curve prescribed in AASHTO LRFD is used to consider inelastic buckling behavior. Detailed procedures of inelastic buckling analysis are presented and corresponding computer codes were developed. In contrast, nonlinear elasto-plastic analysis uses an incremental-iterative method and can consider both geometric nonlinearities and inelastic material behavior of a cable-stayed bridge. Proprietary software ABAQUS are used and user-subroutines are newly written to update equivalent modulus of cables to consider geometric nonlinearity due to cable sags at each increment step. Ultimate load capacities with the three analyses are evaluated for numerical models of cable-stayed bridges that have center spans of 600 m, 900 m and 1200 m with different girder depths and live load cases. The results show that inelastic buckling analysis is an effective approximation method, as a simple and fast alternative, to obtain ultimate load capacity of long span cable-stayed bridges, whereas elastic buckling analysis greatly overestimates the overall stability of cable-stayed bridges.

We have investigated epitaxial structures and physical properties of double-perovskite ${\mathrm{La}}_{2}{\mathrm{MnFeO}}_{6}$ films grown by pulsed-laser deposition. The films showed magnetic hysteresis at low temperatures regardless of the degree of Mn/Fe order and the saturation magnetization became smaller for the higher Mn/Fe-order films. The x-ray absorption and x-ray magnetic circular dichroism measurements revealed antiferromagnetic coupling between ${\mathrm{Mn}}^{3+}$ and ${\mathrm{Fe}}^{3+}$ ions, resulting in ferrimagnetism of double-perovskite ${\mathrm{La}}_{2}{\mathrm{MnFeO}}_{6}$. A band structure was established based on the synchrotron radiation photoemission and optical spectra. The optical gap ranged 1.1 eV above the valence state dominated by the Mn $3d {e}_{g}$ orbitals, which is similar to the charge-transfer insulating state in the end member compound of ${\mathrm{LaMnO}}_{3}$.

Factor (F)V is converted into its active form, FVa, by limited proteolysis. Thrombin-catalyzed activation of FV is essential for its full cofactor activation. Previously, we reported that thrombin was bound to the C2 domain in the light chain of FVIII. As FV has a similar domain structure to FVIII, we focused on the FV C2 domain as a possible binding region for thrombin. Kinetic parameters, measured by surface plasmon resonance, revealed that the K(d) values of anhydro-thrombin for FV, FVa, and the FV C2 domain were 66, 240, and 670 nmol L(-1), respectively. FV activation was increased by approximately 9-fold by the addition of thrombin. In the presence of the FV C2 domain, this increase of the FV activation was inhibited. However, FV activation was not inhibited by the addition of the FVIII C2 domain. FV was cleaved into a 105-kDa heavy chain and a 71/74-kDa light chain by thrombin-catalyzed proteolysis at Arg709, Arg1018 and Arg1545. In the presence of the FV C2 domain, the cleavage was inhibited at all sites. Proteolysis was not affected by the addition of the FVIII C2 domain. These results indicated that the FV C2 domain contains a major binding site for thrombin and that this domain is necessary for the proteolysis at all cleavage sites. Furthermore, the present results also suggested that thrombin has an independent binding site for FV different from that for FVIII.

Dynamic compaction process is analyzed by applying the boundary element method (BEM) based on Biot’s two-phase model of solid and liquid. In order to analyze mixed concrete, concrete properties at early ages are determined experimentally. Applying these properties, porepressure distribution under dynamic compaction is calculated. A feasibility of the analysis is confirmed by the compaction test. Varying the intervals between the first placement and the second, experimentally jointed beams of concrete are made and tested under bending. Analyzing BEM models of two layers, pore-pressure distributions under vibration are analyzed, taking into account the effect of placing intervals. It is demonstrated that pore-pressure distribution may not drastically change until 3 to 4 hours after placement, suggesting that the underlying layer is still responsive to vibration. Distributions of pore pressures analyzed are compared with the strengths of beams. Thus good correlation between the bending strengths of jointed beams and generation of pore pressures at the joint is confirmed. It is confirmed that low pore-pressure around the joint could result in the decrease in the bending strength, sometimes leading to nucleation of cold joints.

NGC3516 in the low flux state shows a flat energy spectrum (photon index ∼1) and an intense narrow iron line. Such spectra are also observed in other Seyfert galaxies, and a broad bump structure around 6 keV above the 'flat' power-law spectrum has been interpreted as the gravitationally red-shifted iron line, disk reflection, or cold and/or warm absorbers. However, six years if BeppoSAX observations, including our latest three ones in 2001, clearly demonstrate that energy spectra above 20 keV always exhibit steep power-laws with photon indices ∼2, and the flux changes only by a factor of 2, while the soft X-ray flux by a factor of ∼10. From this fact, using BeppoSAX and ASCA data, we have concluded that the flat spectrum results from reprocessed, and partially covered power-laws with Γ∼1.8 by warm matter nearby the central source and a cold absorber moved in the line of sight, respectively, and that the broad iron line and disk reflection components are less significant than one ever thought. Thus, the long-term spectral variations can be considered by intervening absorbers rather than changes in the accretion rate.

著者人数: 18名, 資料番号: SA1003695000

A cryogenic C-band 2.6-cell photocathode RF electron gun has been studied at Nihon University in collaboration with KEK for future use in a compact electron-accelerator based monochromatic X-ray source. The cold model cavity with an input coupler was fabricated at KEK in 2016 by ultraprecision machining and diffusion bonding techniques. The RF characteristics of the cavity obtained at cryogenic measurements have been in agreement with the result of the CST Studio simulation. The unloaded quality factor of ~73000 has been obtained at the cavity temperature of 20 K, which is 5.5 times higher than that at room temperature and consistent with the simulation taking into account the anomalous skin effect of the cavity surface resistance. The input coupling coefficient of approximately 20 at 20 K has well reproduced the design value. The shift in the accelerating n-mode resonant frequency due to the cavity temperature change from 296.65 to 20 K has been 19.02 MHz, being 0.12 MHz greater than the value based on the linear expansion coefficients for copper by NIST.

A report is presented of a patient with neonatal erythema infectiosum who developed petechiae, transient thrombocytopenia and transient cardiac failure due to transplacental transmission of human parvovirus B19 (HPV B19) infection. It is suggested that the thrombocytopenia was caused by platelet-associated IgG produced by the patient, and that the cardiac failure may have been caused by direct entry of HPV B19 into the cardiac tissue.

This study aimed to analyse occlusal force, area and pressure for individual maxillary and mandibular teeth by assessing their occlusal-supporting abilities. Ninety-nine subjects (49 men and 50 women; average age, 24·7 ± 3·4 years; range, 20-37 years) performed maximal voluntary clenching twice for 3 s in both the intercuspal position and the intercuspal position with sliding movement from edge-to-edge occlusion, with a pressure-sensitive sheet placed between the maxillary and mandibular dental arch. Occlusal force, area and pressure of individual teeth were calculated by colour development in the pressure-sensitive sheet with special analytical equipment and software. Occlusal contact condition of individual teeth was confirmed using the intra-occlusal record. All data were analysed using unpaired Student's t-test, Kruskal-Wallis test and Scheffe's test for multiple comparisons with a significance level of P

The experiments of the PXR performance carried out for the target crystals with different cutting planes have shown significant difference in the PXR property, which suggests another way to increase the PXR intensity than by increasing the electron beam current. In order to investigate the effect of the geometrical condition of the crystal surface on the PXR property, the experiments have been carried out for the target crystal with a knife-edge-shaped cut surface. For the case with symmetric Bragg geometry on the front surface and asymmetric condition on the rear surface, the rather low intensity X-ray beam has shown considerably good spatial coherence. The X-ray beam with narrow line width has made it possible to obtain X-ray absorption spectra with a high resolution. In contrast, relatively high intensity, which enabled taking an absorption image with the exposure for several tens of seconds, has been obtained for the geometry with asymmetric front surface and symmetric rear surface. This configuration, however, has raised a problem of degradation in the spatial coherence of the X-rays due to the superposition of two different X-ray beams.

The infrared free electron laser (FEL) and the parametric X‐ray radiation (PXR) developed on the basis of the 125 MeV electron linac at Nihon University have been applied to studies in a variety of scientific fields. Primary users so far are the faculty members in the university, approximately 2000 hr/year of the machine time having been dedicated to the experiments since 2004. Currently the wavelength range of the FEL served for users’ experiments covers 1500 to 6000 nm at the optical power level of 10 to 30 mJ/macropulse. Combination of the fundamental infrared FEL with BBO non‐linear optical crystals yielded higher harmonics with good conversion efficiencies, which has extended the available wavelength range as short as approximately 400 nm. The PXR generator has employed a double‐crystal system so that the monochromatic X‐ray beam is available at a fixed output port independently of the X‐ray center energy. By using a Si(111) crystal as the PXR target the energy variable monochromatic X‐ray beam from 5 to 20 keV has been successfully applied to users’ experiments. The latest work on the PXR generation using a Si(220) target crystal has demonstrated availability of the X‐ray beam with energies up to approximately 34 keV.

The association between the extent of left ventricular (LV) hypertrophy and severity of ventricular or atrial arrhythmias are examined. Two-dimensional echocardiography and 24-h Holter electrocardiography monitoring were performed in 60 patients with hypertrophic cardiomyopathy (HCM). According to the distribution of the LV hypertrophy, the patients were divided into three groups: 1. Apical hypertrophy (APH), 2. Septal hypertrophy, and 3. Extensive hypertrophy. Ventricular arrhythmias were found in 82% of the patients and supraventricular arrhythmias were detected in 70% of the patients. Lown grade III and IV arrhythmias occurred significantly more frequently in patients with extensive than with septal hypertrophy. Lown grade III to IV arrhythmias did not occur in patients with APH. Present results show a significant association between the extent of LV hypertrophy and the severity of ventricular arrhythmias in HCM.

In this work, studies on relationships of chemical compositions between fusion crust and nucleus in iron spherules are reported. More than 10% of the iron spherules which were picked out from deep sea sediment, have cores and crusts. We were able to divide three of them into cores and crusts. Each cores and crusts were analyzed individually by INAA. The core mainly consists of iron and nickel. Other trace elements, especially noble metal Au and Ir were concentrated in the core. The mechanism of core formation in the iron spherules shows us the origin of them.

The Munich Dust Counter (MDC) is a scientific experiment on board of the MUSES-A mission of Japan. It is the result of a cooperation between the Institute of Space and Astronautical Science (ISAS) of Japan and the Chair of Astronautics of the Technische Universität München (TUM) of Germany. The MDC is an impact ionization detector designed to determine mass and velocity of cosmic dust. Here a short overview over the MUSES-A mission is given to show the measurement situation of the MDC experiment. The measurement principle of the instrument together with a discussion of the scientific objectives and the design of the experiment is summarized.

The temperature recorded immediately after hypervelocity collision of microparticles comprising iron and nickel with a silver-coated piezoelectric plate was analyzed using photomultipliers of different spectral response characteristics. The conversion rate between the velocity and temperature is estimated to be ∼900 K/km∕s in the velocity range of 10–40 km/s. This rate is greater than that reported earlier.

A cosmic dust detector for use onboard a satellite is currently being developed by using piezoelectric lead zirconate titanate (PZT). The characteristics of the PZT detector have been studied by bombarding it with hypervelocity iron (Fe) particles supplied by a Van de Graaff accelerator. One central electrode and four peripheral electrodes were placed on the front surface of the PZT detector to measure the impact positions of the incident Fe particles. It was demonstrated that the point of impact on the PZT detector could be identified by using information on the time at which the first peak of the output signal obtained from each electrode appeared.

The monochromatic X‐ray source based on parametric X‐ray radiation (PXR) was developed by using the electron beam from the 125‐MeV linac at Nihon University. The X‐ray generating system consists of two silicon perfect‐crystal plates to offer a wide tunability. The system has actually been providing the energy dispersive monochromatic X‐ray beam in the region of 6 to 20 keV, using Si(111)‐plane for the target and the second crystals. Since the X‐ray beam from the PXR generator has rather high energy resolution and coherency, X‐ray absorption fine structure (XAFS) measurement and phase‐contrast imaging are possible applications of PXR. Actually, preliminary experiments on energy dispersive XAFS measurement and refraction‐contrast imaging have been successfully carried out using the PXR beam.

Phase contrast x‐ray imaging is an important technique for investigation of materials consisted of light atoms, such as soft biological tissues. The tunable monochromatic x‐ray source based on Parametric X‐ray Radiation (PXR), which was developed at Laboratory for Electron Beam Research and Application (LEBRA) in Nihon University, provides x‐rays with a high spatial coherence which is an essential property required for phase contrast imaging. In preliminary experiment, refraction contrast images for leaf tissues of a tree and animal specimen have been obtained successfully with the LEBRA‐PXR x‐rays. In the imaging system, the x‐ray that passed through the sample once reflects off the silicon perfect‐crystal x‐ray analyzer at the Bragg angle, and then enters the imaging plate. The bright‐field and the dark‐field phase contrast images have been obtained by infinitesimal rotations of the analyzer, showing the evidence of contrast reversal. Although the conventional radiograph by absorption contrast was also taken with the LEBRA‐PXR, significant differences are found between the radiograph and the phase contrast images.Phase contrast x‐ray imaging is an important technique for investigation of materials consisted of light atoms, such as soft biological tissues. The tunable monochromatic x‐ray source based on Parametric X‐ray Radiation (PXR), which was developed at Laboratory for Electron Beam Research and Application (LEBRA) in Nihon University, provides x‐rays with a high spatial coherence which is an essential property required for phase contrast imaging. In preliminary experiment, refraction contrast images for leaf tissues of a tree and animal specimen have been obtained successfully with the LEBRA‐PXR x‐rays. In the imaging system, the x‐ray that passed through the sample once reflects off the silicon perfect‐crystal x‐ray analyzer at the Bragg angle, and then enters the imaging plate. The bright‐field and the dark‐field phase contrast images have been obtained by infinitesimal rotations of the analyzer, showing the evidence of contrast reversal. Although the conventional radiograph by absorption contrast was also ...

In elderly patients with aneurysmal subarachnoid hemorrhage (SAH), complications including vasosopasm, subdural effusion, and late hydrocephalus, are liable to occur even after aneurysmal surgery. We examined prospectively the efficacy of arachnoid plasty using fibrin glue membrane during surgery of ruptured aneurysms in the elderly patients for preventing complications. The effects on the modified Rankin scale (mRS) and the Glasgow outcome scale (GOS) 3 months after SAH were noted.Total of 31 patients aged more than 70 years selected from a consecutive series of patients with aneurysmal SAH, were divided into two groups alternately, a group with arachnoid plasty (n = 16) and a control group without arachnoid plasty (n = 15). Statistical analyses were performed to assess relationships among various clinical and neuroradiological variables, especially between arachnoid plasty and occurrence of symptomatic vasospasm, subdural effusion, late hydrocephalus, or outcome such as mRS and GOS 3 months after onset.Statistical analyses revealed that arachnoid plasty were associated with late hydrocephalus and subdural effusion negatively, but with better mRS at 3 months after SAH. A tendency to be associated with less frequent symptomatic vasospasm was also noted.Arachnoid plasty using fibrin glue is suggested to be effective in preventing complications associated with SAH and aneurysmal surgery. A better outcome in the elderly patients can be achieved.