Search

Introduction: Asa part of the Hayabusa2 initial analysis [1], we analyzed eighteen Ryugu "stone" samples of 1 ~ 8 mm in size: seven stones from the 1st touch down site and eleven from the 2nd touch down site. Ryugu stones were analyzed first using X-rays. UV, visible, near-infrared mid-infrared, and mutes probes for surface reflectance spectra, internal 3D structure and element distribution [2], crystal structures, and bulk composition of light elements such as C, N, and 0. Measurements for magnetic, thermal, and physical properties mine some stones were also performed. TOF-SDIS analysis of fluid inclusions is being continued [3]. Small particles separated from some stones were ana-lyzed by IR-CT [4]. Based on 3D-CT images of individual stones, objects of interests were identified, separated by pFIE cutting, and exposed by polishing on the surface of epoxy disks. FE.EPMAJFE-SEM analysis was made on ~40 polished epoxy disks for chemical composition and textural observation [5-9]. FIB sections and small (~15 μ in diameter) fragments were separated from the polished surface and analyzed by rod, S170.1, XRF, and nano-CT. Results and discussion: Eighteen stone 2D and 3D images indicate that Ryon samples are breccias of small fragments (< ~1mm in size) of basically CI chondrite mineralogy [10]. Most of the fragments are heavily altered and consists mainly of phyllosilicates. carbonates (dolomite and brannerite), Fe sulfides and oxides, and phosphates (F-bearing hydroxyapatite); this mineralogy we call the major lithology. The mineralogy of the fragments of the major lithology shows some diversity. the abundance and shape of carbonates and phosphates differ among fragments. On the other band, some fragments in many stones are less altered and contain anhydrous silicates such as olivine and low-Ca pyroxene of typically Mr#>97 but down to Mg#~50, which we call the less-altered litbology. In the less-altered lithology, the abundance of olivine and pyroxene differs between fragments and some fragments contain them up to - 10 volti. Therefore, fragments with the less-altered lithology can be classified as CL-type thou-drite material. Most, but not all. fragments with the less-altered lithology contain only calcite as carbonate, phosphides (FeNi)3P and (Fe, Ni)2P instead of apatite. and poorly-crystallized amorphous silicates. Small (<20μm in size) type-I barred and porphyritic chondrules and CAI with spinel+hibonite-tennskite assemblages also occur. GaIS-ble ob-jects are abundant in the least-altered fragments. In summary, mineralogical and physical properties of Ryugu samples reveal incipient to advanced aqueous alteration in its parent asteroid. [ABSTRACT FROM AUTHOR]

Introduction: Initial analysis of asteroid Ryugu samples has revealed that they were mm-μm scale breccia mostly composed of aqueously altered phases (e.g., Mg-Fe phyllosilicates, carbonates) and showed remarkable similarities to CI chondrites in mineralogy and chemistry [e.g., 1,2]. Our detailed analysis of Ryugu samples has detected small amounts (<<1 vol.%) of unaltered silicates that would escape severe aqueous alteration [3]. Olivine is the most abundant (>90 vol%) phase among such unaltered silicates. Although most Ryugu olivine grains are smaller than 5 μm, they bear important information about the precursors of the parent Ryugu asteroid. In this abstract we report additional results of olivine mineralogical study of Ryugu samples, and especially compare with olivine grains in CI chondrites (Ivuna and Orgueil) to further discuss their relationship and possible common origin. Samples and Methods: Polished sections of A0026, A0055, A0063, A0106, C0002, C0023, C0025, C0033, C0040, C0046, C0055, C0076 and C0103 were analyzed using JEOL JXA-8530F FE-EPMA at Univ. of Tokyo. The quantitative analysis was performed at 12 kV accelerating voltage / 30 nA beam current (counting times at peaks: 30 sec), allowing us to obtain accurate compositions even from ~1 μm olivine grain. For comparison, polished sections of Ivuna and Orgueil with similar size to Ryugu samples (a few mm in size) were analyzed by the same method. Results: Olivine grains are present only in weakly-altered lithologies in Ryugu samples [e.g., 2]. So far we have not found olivine from Chamber A samples. Although we acquired compositions from ~200 additional olivine grains this time, the obtained compositions are basically identical to what we have already obtained [3]. Olivine compositions are clustered at Fo99 and extends to Fo44. Most olivine has 0.0-0.7 wt% MnO, and rare (<5%) LIME olivine (MnO/FeO>1 in wt%) grains are present. There is a positive correlation between Mn and Cr in olivine (MnO: 0.0-1.5 wt% vs. Cr2O3: 0.0-0.7 wt%) (Fig. 1). Most olivine grains are Ca-poor (CaO: <0.1 wt%). The comparative analysis of Ivuna and Orgueil has shown that both samples are similarly brecciated to Ryugu samples in size and mineralogy, and we found that weakly-altered lithologies contain tiny (mostly <5 μm) olivine grains. The size, texture, abundance and mineral compositions of olivine in Ivuna and Orgueil are strikingly similar to those of Ryugu olivines both in major and minor elemental compositions (Fig. 1). Discussion and Conclusion: We found identical olivine mineralogy between Ryugu samples and CI chondrites, further supporting that Ryugu samples are similar to CI chondrites [e.g., 1,2]. Although olivine has been reported in CI chondrites, the reported size is larger than 50 μm in many cases [e.g., 4]. Smaller olivine grains (<5 μm) as found in this study have not been well documented except few cases [e.g., 5]. Because the reported CI olivine composition is slightly different from our CI chondrite data [e.g., 4], there would be multiple origins for olivine in CI chondrites and Ryugu samples. In any case, the presence of small olivine grains (<5 μm) found in Ryugu and CI chondrites is important because such tiny olivine could be common precursors of these chondritic materials. [ABSTRACT FROM AUTHOR]

Introduction: The spacecraft Hayabusa2 explored C-type asteroid Ryugu and brought back representative samples of Ryugu to the Earth in 2020 [1]. We performed reflectance spectroscopy of Ryugu samples to investigate (1) spectral diversity among Ryugu samples and (2) similarities and differences between Ryugu samples and carbonaceous chondrites. These results can also be applied to spectroscopic observations performed by the spacecraft [2,3]. Sample and Analysis: We measured Visible-infrared (Vis-IR, 0.4-18 μm in wavelength) reflectance spectra of 6 and 8 coarse grains (> 1mm in size) collected from the first and second touchdown sites, respectively, and some carbonaceous chondrites. Samples were put into an air-tight cell sealed with a CaF2 or ZnSe window together with reflectance standards. All the sample handling was performed in a pure-N2 -purged glove-box to avoid atmospheric alteration of the samples. Petrological and mineralogical characterization of the samples including synchrotron X-ray computed tomography and X-ray diffraction analysis was done by other analysis groups in the Hayabusa2 initial analysis "Stone" team [e.g., 4]. IR signature of Ryugu samples compared to hydrated chondrites: All the Ryugu coarse grains have an absorption band at ~2.71 μm attributed to Mg-rich phyllosilicates and a reflectance maximum (Reststrahlen band) at ~9.8 μm suggesting saponite-bearing phyllosilicate composition. These signatures of phyllosilicates of Ryugu are similar to those of CI chondrites, which is consistent with mineralogical observations of Ryugu samples [e.g., 4]. Ryugu sample spectra show absorption features due to aliphatic compounds (3.4 μm), carbonates (e.g., ~3.4, 3.95 μm), and some samples show an absorption feature at 5.8 μm probably due to carbonyl compounds [5]. Ryugu samples show a sharper 2.7 μm band than CIs, suggesting that they contain little molecular water compared to CIs. Sulfate features are not observed in Mid-IR reflectance spectra of Ryugu unlike CIs [e.g., 6]. Tagish Lake C2-ungrouped chondrite also shows an absorption band at ~2.7 μm and Reststrahlen band at ~9.8 μm. However, IR spectral features due to carbonates are more significant in the spectra of Tagish Lake than those of Ryugu as seen in absorption bands around ~3.4 μm and a reflectance maximum at 11.2 μm [7]. CM chondrites also consist mainly of hydrated minerals, however, their spectral shapes around ~3 μm and ~10 μm are different from those of Ryugu most likely due to the different phyllosilicate composition. Vis reflectance spectra of Ryugu samples: Ryugu coarse grains have ~2-4% of reflectance in the v-band (0.55 μm) at the phase angle of 30 °, which is roughly consistent with those of hydrated carbonaceous chondrites (CI, CM, Tagish Lake, and Tarda). The reflectance spectra of CO and CV chondrites, which are dominated by anhydrous minerals and more chondrule-rich, are brighter than those of Ryugu samples. The IR spectra suggest the compositional link between Ryugu and CI chondrites, however, Vis reflectance spectra of Ryugu are not similar to CI chondrites. Low reflectance Vis spectra without a UV drop (a sudden reflectance decrease towards UV wavelengths) of Ryugu samples are not similar to unheated Orgueil but similar to Orgueil samples heated at 300-400 °C for 50 hours (or longer) in reduced conditions [8]. The causes of differences between Vis spectra of Ryugu and unheated CIs may be explained by: (1) atmospheric alteration of CIs (e.g., oxidation and water adsorption of CIs [e.g., 9]), (2) different organic composition, and (3) gentle heating experienced by Ryugu. Vis reflectance spectra of Ryugu particles show some diversity of properties (reflectance, spectral slope, and overall shapes), while IR spectra are consistent among samples. This suggests that the spectral diversity of Ryugu samples are originated from physical properties or orientations of sample surfaces rather than the compositional differences among individual particles. [ABSTRACT FROM AUTHOR]

Introduction: The successful probing, return and curation of asteroid Ryugu provides pristine sample material from the surface and subsurface of this C-type asteroid. The sampled material of the Hayabusa2 mission includes many coarse-grained fragments [1, 2]. In order to obtain the highest level of scientific output the initial study included several non-invasive and non-destructive analytical techniques. Synchrotron X-ray fluorescence computed tomography (SXRF-CT) [e.g. 3] is an ideal non-invasive analytical technique to achieve detailed in depth structural and chemical information and was applied to several mm-sized rock fragments of the asteroid Ryugu from both, surface and sub-surface samples. Here we present the first dataset on coarse grain C0033, collected at the second touchdown site. Methods: X-ray fluorescence spectroscopy experiments were performed at the P06 beamline of PETRA III (DESY, Hamburg, Germany) and at the ID15A beamline of the ESRF (Grenoble, France). The excitation energy E0 was 20.5 keV and 90 keV respectively, using Si(111) monochromator optics. The Kirkpatrick-Baez (KB) mirrorbased X-ray beam focusing provided a 0.2×0.24 µm² beam spot size at sample position during the P06 experiments, and a 0.5×0.5 µm² beam spot at sample position for the ID15A experiments. High-Energy SXRF: Every detailed SXRF analysis was started with a chemical 2D overview projection of the full volume of the mm-sized rock fragment. In case of sample C0033 an Fe-rich vein was identified. Several crosssection CT scans were performed during our subsequent study, one exactly at the height where the Fe-rich vein was observed. The cross section indicates the presence of REE-rich phases throughout the vein and confirms the vein-like nature of the Fe-enriched area. Lower-Energy SXRF: For further studies a polished section (~100 µm thick) of grain C0033 was prepared exactly at the height of the magnetite vein and was then further analysed at lower X-ray energy (20.5 keV) at PETRA III beamline P06. The Fe distribution found confirms the existence of a magnetite-rich vein. Ca and Y element maps indicate the presence of multiple apatite grains closely related to the vein. Quantification: The SXRF measurements not only provide element distribution maps but can also be quantified. In order to get better statistics small area maps and point analyses were performed. The resulting CI normalized trace element concentrations of magnetite and apatite grains located within the magnetite vein observed in C0033 show values close to CI bulk composition. All quantified measurements were acquired at PETRA III P06 beamline applying a primary beam energy of 20.5 keV. Discussion and Conclusion: The detailed SXRF study of mm-sized Ryugu rock fragments enabled the identification and localization of unique sample characteristics like the magnetite-apatite vein found in grain C0033. Veins crosscutting the sample material are compelling evidence for intense hydrous alteration on the parent body. The widespread occurrence of sulphate veins found in most CI chondrites was first interpreted as evidence for late stage lowtemperature alteration on the asteroid [e.g. 5], but later clear proof was found for the terrestrial formation of these features in almost all samples [6]. The study of rock samples sampled on the sub-surface of asteroid Ryugu now for the first time enables to study hydrous alteration processes without any terrestrial alteration. Our study shows compelling evidence for the existence of low temperature hydrous alteration veins on asteroid Ryugu. Surprisingly, the vein consists of a mixture of mostly magnetite with apatite, which is in contrast to the observation of carbonate veins found on the surface of asteroid Bennu [7]. [ABSTRACT FROM AUTHOR]

Introduction: In December 2020, the Hayabusa2 reentry capsule returned 5.4 g of material from the asteroid Ryugu. A fraction of the collected material was then examined by Initial Analysis Teams. As a part of the Mineralogy / Petrology STONE team, we received ~30 small fragments to study the 3D heterogeneity and the assembly of the different phases. Material and methods: In this study, we will present the results of a muti-analytical sequence applied to nine micrometric Ryugu fragments (ranging from 30 to 80 µm in size), coming from 3 bigger millimetric grains (A0064, C0046, and C0002). These fragments were welded with platinum on metallic needles using FIB (Focus Ion Beam) microscopes in Saclay and Lille [1]. Then, we analyzed these fragments using an IR micro-tomography setup available at the SMIS beamline of the SOLEIL synchrotron (France). Multiple configurations were used: analyses in transmission by Infrared Computed Tomography [2] (IR-CT) and analyses in reflectance by Infrared Surface Imaging [3] (IRSI). Regions of interest with peculiar spectral signatures were identified on the 3D volume and 3-µm thin-slices (~ 15 x 20 x 3 µm³) around these regions were extracted using FIB. They were finally analyzed in 2D with high-resolution IR imaging and SEM-EDX. Average composition: We will present the average IR spectra in the 2.5 - 12.5 µm range both in reflectance and transmission of the 9 small studied fragments. Several grains showed IR signatures at ~ 2.7 µm, 3.0-3.1 µm, 3.4 µm, and 3.9 µm, in a good agreement with the bands identified by NIRS3 or by MicrOmega in the JAXA curation facility [4,5], plus several mid-IR signatures of great interest, such as bands attributed to Si-O stretching in phyllosilicates, and C=O stretching in organics and carbonates. In general, the 2.7 µm feature observed in our data exhibits similar maximum position but is deeper to the one observed with NIRS3. However, we notice a variability of the composition between the 9 fragments, for instance in the intensity of the 2.7 and 3.4 µm features. Study of heterogeneity: The small fragment C0002-FO019, exhibits two regions with very different IR signatures. The difference in the position and the shape of the SiO feature could sign different lithologies affected by various degrees of aqueous alteration. In particular, some spectra show a shoulder at ~ 998 cm-1 which could be due to anhydrous silicate related to a less-altered lithology [6]. The origin of the variation of the 10 µm band (chemical composition, or structural diversity of the mineral) will be discussed. A correlation with the 2.7 µm band will also be presented. Complementary measurements performed with SEM-EDX to better constrain the mineralogy of the surface of the extracted thin-slices will be presented and we will discuss the structural diversity at the scale of ~100 nm. [ABSTRACT FROM AUTHOR]

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) and percutaneous coronary intervention (PCI) may be useful in cardiopulmonary resuscitation. However, little is known about the combination of ECMO and intra-arrest PCI. This study investigated the efficacy of rapid-response ECMO and intra-arrest PCI in patients with cardiac arrest complicated by acute coronary syndrome who were unresponsive to conventional cardiopulmonary resuscitation. METHODS AND RESULTS: This multicenter cohort study was conducted with the use of the database of ECMO in Hiroshima City, Japan. Between January 2004 and May 2011, rapid-response ECMO was performed in 86 patients with acute coronary syndrome who were unresponsive to conventional CPR. The median age of the study patients was 63 years, and 81% were male. Emergency coronary angiography was performed in 81 patients (94%), and intra-arrest PCI was performed in 61 patients (71%). The rates of return of spontaneous heartbeat, 30-day survival, and favorable neurological outcomes were 88%, 29%, and 24%, respectively. All of the patients who received intra-arrest PCI achieved return of spontaneous heartbeat. In patients who survived up to day 30, the rate of out-of-hospital cardiac arrest was lower (58% versus 28%; P=0.01), the intra-arrest PCI was higher (88% versus 70%; P=0.04), and the time interval from collapse to the initiation of ECMO was shorter (40 [25-51] versus 54 minutes [34-74 minutes]; P=0.002). CONCLUSIONS: Rapid-response ECMO plus intra-arrest PCI is feasible and associated with improved outcomes in patients who are unresponsive to conventional cardiopulmonary resuscitation. On the basis of these findings, randomized studies of intra-arrest PCI are needed. [ABSTRACT FROM AUTHOR]

Aims: This study assessed an artificial intelligence (AI) model's performance in predicting elevated brain natriuretic peptide (BNP) levels from chest radiograms and its effect on diagnostic performance among healthcare professionals., Methods and Results: Patients who underwent chest radiography and BNP testing on the same day were included. Data were sourced from two hospitals: one for model development, and the other for external testing. Two final ensemble models were developed to predict elevated BNP levels of ≥ 200 pg/mL and ≥ 100 pg/mL, respectively. Humans were evaluated to predict elevated BNP levels, followed by the same test, referring to the AI model's predictions. A total of 8390 images were collected for model creation, and 1713 images, for tests. The AI model achieved an accuracy of 0.855, precision of 0.873, sensitivity of 0.827, specificity of 0.882, f1 score of 0.850, and receiver-operating-characteristics area-under-curve of 0.929. The accuracy of the testing by 35 participants significantly improved from 0.708 ± 0.049 to 0.829 ± 0.069 ( P < 0.001) with the AI assistance (an accuracy of 0.920). Without the AI assistance, the accuracy of the veterans in the medical career was higher than that of early-career professionals (0.728 ± 0.051 vs. 0.692 ± 0.042, P = 0.030); however, with the AI assistance, the accuracy of the early-career professionals was rather higher than that of the veterans (0.851 ± 0.074 vs. 0.803 ± 0.054, P = 0.033)., Conclusion: The AI model can predict elevated BNP levels from chest radiograms and has the potential to improve human performance. The gap in utilizing new tools represents one of the emerging issues., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Extraterrestrial minerals on the surface of airless Solar System bodies undergo gradual alteration processes known as space weathering over long periods of time. The signatures of space weathering help us understand the phenomena occurring in the Solar System. However, meteorites rarely retain the signatures, making it impossible to study the space weathering processes precisely. Here, we examine samples retrieved from the asteroid Ryugu by the Hayabusa2 spacecraft and discover the presence of nonmagnetic framboids through electron holography measurements that can visualize magnetic flux. Magnetite particles, which normally provide a record of the nebular magnetic field, have lost their magnetic properties by reduction via a high-velocity (>5 km s -1 ) impact of a micrometeoroid with a diameter ranging from 2 to 20 μm after destruction of the parent body of Ryugu. Around these particles, thousands of metallic-iron nanoparticles with a vortex magnetic domain structure, which could have recorded a magnetic field in the impact event, are found. Through measuring the remanent magnetization of the iron nanoparticles, future studies are expected to elucidate the nature of the nebular/interplanetary magnetic fields after the termination of aqueous alteration in an asteroid., (© 2024. The Author(s).)

The carbonaceous asteroid Ryugu has been explored by the Hayabusa2 spacecraft to elucidate the actual nature of hydrous asteroids. Laboratory analyses revealed that the samples from Ryugu are comparable to unheated CI carbonaceous chondrites; however, reflectance spectra of Ryugu samples and CIs do not coincide. Here, we demonstrate that Ryugu sample spectra are reproduced by heating Orgueil CI chondrite at 300°C under reducing conditions, which caused dehydration of terrestrial weathering products and reduction of iron in phyllosilicates. Terrestrial weathering of CIs accounts for the spectral differences between Ryugu sample and CIs, which is more severe than space weathering that likely explains those between asteroid Ryugu and the collected samples. Previous assignments of CI chondrite parent bodies, i.e., chemically most primitive objects in the solar system, are based on the spectra of CI chondrites. This study indicates that actual spectra of CI parent bodies are much darker and flatter at ultraviolet to visible wavelengths than the spectra of CI chondrites.

In the samples collected from the asteroid Ryugu, magnetite displays natural remanent magnetization due to nebular magnetic field, whereas contemporaneously grown iron sulfide does not display stable remanent magnetization. To clarify this counterintuitive feature, we observed their nanoscale magnetic domain structures using electron holography and found that framboidal magnetites have an external magnetic field of 300 A m -1 , similar to the bulk value, and its magnetic stability was enhanced by interactions with neighboring magnetites, permitting a disk magnetic field to be recorded. Micrometer-sized pyrrhotite showed a multidomain magnetic structure that was unable to retain natural remanent magnetization over a long time due to short relaxation time of magnetic-domain-wall movement, whereas submicron-sized sulfides formed a nonmagnetic phase. These results show that both magnetite and sulfide could have formed simultaneously during the aqueous alteration in the parent body of the asteroid Ryugu., (© 2023. Springer Nature Limited.)

Chondrule-like objects and Ca-Al-rich inclusions (CAIs) are discovered in the retuned samples from asteroid Ryugu. Here we report results of oxygen isotope, mineralogical, and compositional analysis of the chondrule-like objects and CAIs. Three chondrule-like objects dominated by Mg-rich olivine are 16 O-rich and -poor with Δ 17 O (=δ 17 O - 0.52 × δ 18 O) values of ~ -23‰ and ~ -3‰, resembling what has been proposed as early generations of chondrules. The 16 O-rich objects are likely to be melted amoeboid olivine aggregates that escaped from incorporation into 16 O-poor chondrule precursor dust. Two CAIs composed of refractory minerals are 16 O-rich with Δ 17 O of ~ -23‰ and possibly as old as the oldest CAIs. The discovered objects (<30 µm) are as small as those from comets, suggesting radial transport favoring smaller objects from the inner solar nebula to the formation location of the Ryugu original parent body, which is farther from the Sun and scarce in chondrules. The transported objects may have been mostly destroyed during aqueous alteration in the Ryugu parent body., (© 2023. The Author(s).)

To decrease complications associated with the treatment of coeliac axis (CA) stenosis due to median arcuate ligament (MAL) syndrome in pancreaticoduodenectomy, we performed combined preoperative endovascular stenting and intraoperative MAL resection. This technique can secure the CA blood flow to the hepatic artery before surgery in one stage and prevent CA restenosis and stent dislocation because there is no extrinsic compression of the CA after MAL resection., (© 2021 Royal Australasian College of Surgeons.)

Study Design: Observational, anatomical, cadaveric study., Objective: We anatomically investigated the fibrous connection between the cervical nerves and the zygapophysial joint capsules., Summary of Background Data: Cervical spondylotic radiculopathy is caused by the compression of the cervical nerves as the static factor and head and neck movements as the dynamic factor. To understand the dynamic pathology of cervical spondylotic radiculopathy, the anatomic relationship between the cervical nerves and the zygapophysial joints needs to be investigated in detail., Methods: In 11 cadavers, we dissected both sides from the C5 to C7. For macroscopic examination, we observed structures connecting the cervical nerves and the zygapophysial joints in 18 cervical nerves from three cadavers. In 14 sides of eight cadavers, we histologically analyzed the fibrous structures and their attachments., Results: Macroscopically, the fibrous band connected the cranial surface of the cervical nerve to the lateral and inferior aspects of the transverse process. In four of 18 nerves, the fibrous bands were divided into two fascicles by loose connective tissues. In addition, the fibrous bands extended along the dorsal aspect of the posterior tubercle of the transverse process and attached to the zygapophysial joint capsule. Histologically, densely stained fibrous tissues overlaid the zygapophysial joint capsule and extended to the recess between the posterior tubercle and inferior articular process on the cranial vertebral body., Conclusion: We macroscopically and histologically clarified the fibrous bands connecting the cervical nerve to the zygapophysial joint capsule. The fibrous bands may help clarify the pathology of cervical spondylotic radiculopathy associated with the zygapophysial joints as dynamic factors.Level of Evidence: N/A., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Regardless of patients' baseline renal function, worsening renal function (WRF) during hospitalization is associated with poor outcomes. In individuals with acute heart failure (AHF), one predictor of WRF is an early drop in systolic blood pressure (SBP). Few studies have investigated WRF in elderly AHF patients or the influence of these patients' heart rate (HR) at admission on the relationship between an early SBP drop SBP and the AHF., Methods: We measured the SBP and HR of 245 elderly AHF inpatients (83 ± 6.0 years old, females 51%) at admission and another six times over the next 48 h. We defined 'WRF' as a serum creatinine increase ≥0.3 mg/dL by Day 5 post-admission. We calculated the 'early SBP drop' as the difference between the admission SBP value and the lowest value during the first 48 h of hospitalization., Results: There were significant differences between the 36 patients with WRF and the 209 patients without WRF: early SBP drop (51 vs. 33 mmHg, p < 0.01) and HR at admission (79 vs. 90 bpm, p < 0.05), respectively. In the multiple logistic regression analysis adjusted for the confounders, higher early SBP drop (p < 0.04) and lower HR at admission (p < 0.01) were significantly associated with WRF. No significant association was shown for the interaction term of early SBP drop × HR at admission with WRF., Conclusions: In these elderly AHF patients, exaggerated early SBP drop and lower HR at admission were significant independent predictors of WRF, and these factors were additively associated with WRF.

Earlier studies have shown that visit-to-visit blood pressure (BP) variability (VVV) served as a significant independent risk factor of stroke, specifically, in the high-risk elderly of cardiovascular disease (CVD). Although the mechanism is not clearly understood, arterial remodeling such as carotid artery, coronary artery and large aortic artery would be a strong moderator in the relationship between VVV and CVD incidence. Recent studies have provided evidence that VVV predicted the progression of arterial stiffness. While the class of antihypertensive agents is suggested to be an important determinant of VVV, long-acting calcium channel blockers use (CCBs) is associated with the reduction of VVV, and thus, is suggested to decrease the arterial stiffness. Specifically, the relationship between VVV and coronary arterial remodeling has never been reviewed until now. This article summarizes the recent literature on these topics. In the elderly hypertensives, strict BP control using CCBs could play a pivotal role in suppressing arterial stiffening via VVV reduction., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: The current study was conducted to clarify the morphology of the extraforaminal ligament (EFL) at the cervicothoracic junction and to compare the attachment of the EFL and the positional relation between the EFL and the spinal nerves, additionally to clarify the details within the connecting bundles at the cervicothoracic junction., Materials and Methods: The EFLs from the 4th cervical to the 4th thoracic vertebrae were dissected in 56 sides of 28 Japanese cadavers (11 males, 17 females). The range of age was 62.0-99.0 years. In addition, connecting bundles were analyzed by histological examination., Results: Ventral to the spinal nerve, the capsulotransverse ligament (CTL), transforaminal ligament (TFL) and the ligament between the 7th cervical vertebra and the 1st rib were attached to the transverse process and rib. The EFL ventral to the 1st thoracic nerve was not observed in all sides. Dorsal to the spinal nerve, the anterior part of the superior costotransverse ligament (ASCL) and the ligament homologous to the ASCL were attached to the transverse process and rib. The superior radiating ligament (SRL) and the ligament homologous to the SRL were identified. The connecting bundles identified between the 7th cervical and the 1st thoracic nerve were histologically confirmed to consist of nerves and vessels., Conclusions: The EFLs at the cervicothoracic junction were found to be homologous. The connecting bundles were observed between the 7th cervical and the 1st thoracic nerve. Interestingly, the 1st thoracic level alone might be a unique level at the cervicothoracic junction.

Aims: To identify the predictors of survival to discharge in adults resuscitated with extracorporeal cardiopulmonary resuscitation (ECPR) following in-hospital cardiac arrest (IHCA)., Methods: MEDLINE and ISI Web of Science were searched for eligible studies. Pooled Odds Ratio (OR) and Pooled Mean Difference (PMD) for each predictor were calculated. The quality of evidence (QOE) was evaluated according to the GRADE guidelines., Results: Eleven studies were included totalling 856 patients. Of these, 324 (37.9%) survived to discharge. Good neurological outcome (Cerebral Performance Category 1 or 2) occurred in 222/263 (84.4%) survivors. Survival was associated with significantly higher odds of an initial shockable rhythm (OR 1.65; 95% confidence interval [95%CI] 1.05-2.61; p=0.03), shorter low-flow time (PMD -17.15 [-20.90, -13.40]min; p<0.00001), lower lactate levels both immediately before ECPR start (PMD -4.12 [-6.0,-2.24]mmol/L; p<0.0001) and on ICU admission (PMD -4.13 [-6.38, -1.88]mmol/L; p<0.0003), lower SOFA score (PMD -1.71 [-2.93, -0.50]; p=0.006) and lower creatinine levels within 24h after ICU admission (PMD -0.37 [-0.54, -0.19]mg/dl; p<0.00001). No significant association was found between survival and age, gender, or cardiac vs. non-cardiac aetiology. The overall QOE was low or very low., Conclusions: In adult IHCA treated with ECPR a shockable initial rhythm, a lower low-flow time, lower blood lactate levels before ECPR start or on ICU admission, and a lower SOFA score or creatinine levels in the first 24h after ICU admission were associated with a higher likelihood of survival. These factors could help identifying patients who are eligible for ECPR., (Copyright © 2017 Elsevier B.V. All rights reserved.)

While hypertension has been shown to be a risk factor for vascular dementia, several studies have also demonstrated that hypertension also increases the risk of Alzheimer's disease (AD). Although the relationship between visit-to-visit blood pressure variability (VVV) and cognitive impairment, including AD, have been provided, the mechanisms remain poorly understood. This review paper focuses on the relationship of VVV with AD and summarizes the pathophysiology underlying that relationship, which appears to be mediated by arterial stiffness.

Transient left ventricular dysfunction in patients under emotional stress, also known as Takotsubo cardiomyopathy, has been recognized as a distinct clinical entity. Recent studies have supported the concept notion that the cardiovascular system is regulated by cortical modulation. A network consisting of the insular cortex (Ic), anterior cingulate gyrus, and amygdala plays a crucial role in the regulation of the central autonomic nervous system in relation to emotional stress such as anxiety, fear and sadness. Because the Ic is located in the region of the middle cerebral arteries, its structure tends to be exposed to a higher risk of cerebrovascular disease. Ic damage has been associated with myocardial injury, increased brain natriuretic peptide, and the incidence of Takotsubo cardiomyopathy. Because Ic damage has been associated with increased sympathetic nervous system activity, Ic damage is suggested to have a pivotal role in the pathophysiology of Takotsubo cardiomyopathy. In this review, we focus on the role of the Ic as a mediator for the cardiovascular system in relation to emotional stress, and we summarizes the current knowledge on the relationships between the Ic and Takotsubo cardiomyopathy., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Although napkin-ring sign (NRS) plaques assessed by multidetector computed tomography (MDCT) is identified as a high-risk feature, the detailed morphological features are still unknown. The purpose of this study was to elucidate the morphological features of the MDCT-assessed NRS using intravascular ultrasound (IVUS)., Methods: We evaluated 204 plaques in 193 patients with non-ST-elevation acute coronary syndrome who were diagnosed using 128-slice MDCT and were assessed using IVUS prior to coronary intervention. Morphology was compared between plaques with and without MDCT-assessed NRS. Severe IVUS-assessed attenuation was defined as an attenuation angle >180°., Results: NRS was detected in 49 lesions. MDCT-assessed plaque attenuation was lower (p<0.0001), and cross-sectional plaque areas at lesion sites, remodeling index, and the prevalence of positive remodeling were greater, in lesions with NRS (p<0.005, p<0.0001, and p<0.0001, respectively). Furthermore, the IVUS-assessed remodeling index and prevalence of severe attenuation and speckled echo appearance were significantly greater in lesions with NRS (p<0.01, p<0.0001, and p<0.0001, respectively). Using multivariate analysis, IVUS-assessed speckled echo appearance was identified as an independent predictor of MDCT-assessed NRS (odds ratio, 3.59; 95% confidence interval, 1.49-8.66; p<0.005)., Conclusion: MDCT assessment of NRS may be associated with larger heterogeneous necrotic cores and greater positive remodeling., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)