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Introduction: High shock impedance is associated with conversion failure among patients with subcutaneous implantable cardioverter defibrillators (S-ICD). Currently, there is no preoperative assessment method for predicting high shock impedance. This study aimed to examine the efficacy of chest computed tomography (CT) as a preoperative evaluation tool to assess the shock impedance of S-ICDs. Methods and Results: The amount of adipose tissue adjacent to the device and the anteroposterior diameter at the basal heart region were measured preoperatively using a chest CT. We examined the correlation between these measurements and shock impedance at the conversion test. We enrolled 43 patients with S-ICDs (age: 54±15 years, body mass index: 23±4 kg/m , PRAETORIAN score: 30–270 points, amount of adipose tissue 1250±716 cc), who underwent intraoperative conversion tests by inducing ventricular fibrillation, which was terminated with a 65 J shock. A strong concordance correlation coefficient was observed between the shock impedance and the amount of adipose tissue (r=0.616, p < 0.01) and anteroposterior diameter (r=0.645, p < 0.01). Moreover, these were identified as independent predictive factors of shock impedance (amount of adipose tissue: β=0.439, p = 0.009; anteroposterior diameter: β=0.344, p = 0.038) in the stepwise multiple regression analysis. Conclusions: Preoperative CT-measured amount of adipose tissue and basal heart anteroposterior diameter are independent predictors of shock impedance. These may provide better accuracy in identifying high shock impedance in patients with S-ICDs.

BACKGROUND The optimum cut-off value of premature atrial contraction (PAC) burden (CV-PACb) in 24-h Holter electrocardiography (24-h ECG) for predicting atrial fibrillation (AF) is debatable, with few validation data.Methods and Results:We retrospectively analyzed 61 patients already diagnosed with AF (AD-AF) and 147 patients never diagnosed with AF (ND-AF), aged ≥50 years, free of heart disease, and who had undergone 24-h ECG and transthoracic echocardiography (TTE). Receiver operating characteristic analysis demonstrated that 0.4% was the optimal CV-PACb differentiating AD-AF from ND-AF, with 69% sensitivity and 72% specificity (area under the curve [AUC] 0.72; 95% confidence interval [CI] 0.65-0.79); however, the left atrial volume index was not significant (AUC 0.60; 95% CI 0.51-0.68). To verify the CV-PACb, new propensity-matched cohorts (i.e., subjects with a PAC burden ≥0.4% and

To classify the types of hyperdense areas in the heart cavities on post-mortem CT (PMCT) and compare them according to the presence of blood clots in the heart cavities at forensic autopsy. One hundred and twelve cases with CT images taken before forensic autopsy were evaluated. The presence and shape of hyperdense areas in the right or left heart cavities were retrospectively evaluated on PMCT images and were classified into four types (block-like, cast-like, fluid level-like, and unclear). The presence of blood clots was confirmed when there were clots in the heart cavities at forensic autopsy. Of the 112 cases, 57 exhibited blood clots in the heart cavities at forensic autopsy. The hyperdense areas in the right heart cavities on PMCT in 57 cases exhibiting blood clots at forensic autopsy were classified as follows: block-like, 32; fluid level-like, 4; cast-like, 17; and unclear, 4. The sensitivity of block-like and cast-like hyperdense areas in the right heart cavities on PMCT for the presence of clots in the heart cavities at forensic autopsy was 86% (95% confidence interval [CI]: 74–94%); the corresponding specificity, PPV, and NPV were 95% (95% CI: 85–99%), 94% (95% CI: 84–99%), and 87% (95% CI: 75–94%), respectively. Block-like and cast-like hyperdense areas in the right heart cavities on PMCT predicted the presence of intracardiac blood clots at forensic autopsy. • Clinical radiologists likely have no experience of interpreting findings of blood clots on post-mortem CT (PMCT). • The appearance of blood clots on PMCT provides important clues for diagnosing the cause and process of death. • The shapes of the hyperdense areas in the heart cavities were classified into four types, and two of these types could be used to predict the presence of blood clots in the heart cavities at forensic autopsy.

The progesterone receptor (PR) plays an important role in various physiological processes, especially in the female reproductive system, and abnormalities of PR function are associated with several diseases, including some types of cancer. Non-steroidal PR ligands are of interest as candidate drugs for treatment of PR-related diseases without the serious adverse effects that may be caused by steroidal ligands. For the development of non-steroidal PR ligands, both a hydrophobic backbone and a polar functional group corresponding to the 3-carbonyl group of progesterone, which interacts with Gln725 and Arg766 of the PR-ligand binding domain, are critically important. We previously showed that carborane is a useful hydrophobic pharmacophore for PR antagonists, and in this work, we introduced the pentafluorosulfanyl (SF5) group as a novel polar functional group of carborane-based non-steroidal PR antagonists. All the synthesized SF5-containing carborane derivatives exhibited PR-antagonistic activity at micromolar or submicromolar concentration. Among them, compounds 11 are potent progesterone antagonists with submicromolar IC50 values.

Introduction: Atrial arrhythmia (AA) and left ventricular systolic dysfunction (LVSD) frequently co-exist, which loom as burgeoning public health problems. It is difficult to determine whether a tachycardia is the indicator or consequence of LVSD in patients with tachycardia and LVSD. Tachycardia mediated cardiomyopathy (TCM) raises a “chicken or egg” question. Regardless of the etiology, the patients with severe LVSD are considered as the candidate for the implantation of cardioverter defibrillator as primary prevention. It is well known that the LVSD improves after the successful treatment of AA in TCM population. However, enlarged left ventricular end-diastolic dimension (LVDd) is considered as a parameter of irreversible LVSD. Hypothesis: Enlarged LVDd could not be a predictor for irreversible LVSD in patients with AA. Methods: We assessed patients with persistent AA and heart failure (Ejection Fraction (EF) Results: Twenty-five patients with persistent AA and LVSD (23 men; mean age 63.8±9.3 years) were enrolled in this study. After restored and maintained SR, EF and left ventricular end-systolic volume (ESV) and BNP were improved in all patients respectively (EF 30.7±10.7 to 54.0±7.3%, ESV; 82.1±32.4 to 50.6±24.1ml, BNP; 379.2±237.9 to 48.0±29.7pg/ml P60mm were observed in 5 patients (25%) before the treatment. EF was normalized in patients with severe LVSD (EF Conclusions: The unnecessary device implantation could be avoided in patients with AA and severe LVSD with aggressive rhythm control therapy. Even in the patients with severe LVSD and enlarged LVDd, LVSD is reversible when AA exists.

We report a patient with occult breast cancer who underwent axillary dissection as primary surgery. The patient, a 68-yearold woman, noticed a tumor measuring approximately 3 cm in diameter, in her left axilla. Biopsy of the axillary tumor revealed adenocarcinoma. Imaging studies did not detect primary lesions in the mammary gland or other organs. The patient was diagnosed with occult breast cancer and underwent axillary dissection but did not desire mastectomy or radiation therapy. The patient was closely observed thereafter. Tamoxifen was prescribed for 5 years but left breast cancer was detected 14 years after the operation. A simple mastectomy was performed. She died of respiratory failure 1 year later. Occult breast cancer may require axillary lymph node dissection and systemic therapy. Breast preservation could be an alternative treatment if followed by adequate systemic therapy and close observation.

Solitary lung tumors after radical surgery for breast cancer often present difficulty in diagnosis and treatment. This report describes the case of a patient with a previous history of radicalsurgery for breast cancer who underwent lung surgery. Solitary pulmonary nodules should be diagnosed in patients with breast cancer, because treatments and prognoses differ between metastatic and primary tumors. At the age of 43 years, this patient underwent surgicaltreatment for breast cancer. Eighteen years later, a solitary mass was observed in the middle lobe of the right lung. Right middle lobectomy was performed using video-assisted thoracic surgery. The diagnosis was primary lung carcinoma. In case of primary lung carcinoma, radical treatment is possible through surgical resection. On the contrary, breast cancer metastasis has been known to have subtypes with characteristics that may often be different from those of the originall esions; therefore, surgicalresection helps in the reevaluation of receptor expression. Thus, early pathological diagnosis using surgical resection is useful for early diagnosis and treatment.

Purpose Methods and materials Results Conclusion Personal information and conflict of interest References, Purpose: Livor mortis is a sign that occurs following death. It is a reddish purple coloration that develops under the skin in dependent parts of the body because of gravity-induced accumulation of blood in the postmortem interval [1]. Similarly, high X-ray...

The progesterone receptor (PR) plays an important role in various physiological processes, especially in the female reproductive system, and abnormalities of PR function are associated with several diseases, including some types of cancer. Non-steroidal PR ligands are of interest as candidate drugs for treatment of PR-related diseases without the serious adverse effects that may be caused by steroidal ligands. For the development of non-steroidal PR ligands, both a hydrophobic backbone and a polar functional group corresponding to the 3-carbonyl group of progesterone, which interacts with Gln725 and Arg766 of the PR-ligand binding domain, are critically important. We previously showed that carborane is a useful hydrophobic pharmacophore for PR antagonists, and in this work, we introduced the pentafluorosulfanyl (SF

A second cohomology class of the group cohomology of the symplectomorphism group is defined for a symplectic manifold with first Chern class proportional to the class of symplectic form and with trivial first real cohomology. Some properties of it are studied. In particular, it is characterized in terms of cohomology classes of the universal symplectic fiber bundle over the classifying space of the symplectomorphism group with the discrete topology.

根口クラゲ類エビクラゲの摂餌生態を解明するために，瀬戸内海産個体を用いて吸口構造および消化管内容物の観察を行った。吸口は長径約350μm，短径約130μm の楕円形に近い形であり，このサイズクラスの動物プランクトンが捕食されると推定される。採集した7個体の内，4個体の口腕水管内から小型浮遊性カイアシ類Paracalanus parvus s.l., Oithona sp. の2種が検出された。これらの体幅は吸口のサイズと一致する。, The feeding habits of the rhizostome Netrostoma setouchianum (Kishinouye, 1902) collected from the central part of the Seto Inland Sea, Japan was examined based on observations of the structure of secondary mouths and contents in the canals and stomach. The mouths were oval, approximately 365 μm along the major axis and 130 μm along the minor axis. Small-sized planktonic copepods such as Paracalanus parvus s.l. and Oithona sp. were found in the canals and had body widths that fell well within the size of the mouths., 本研究の一部は日本学術振興会科学研究補助金（基盤研究 B25304031，代表 大塚 攻；基盤研究B26304030，代表 西川 淳）によって行われた。

BACKGROUND An adaptive cardiac resynchronization therapy (aCRT) algorithm has been described for synchronized left ventricular (LV) pacing and continuous optimization of cardiac resynchronization therapy (CRT). However, there are few algorithmic data on the effect of changes during exercise.Methods and Results:We enrolled 27 patients with availability of the aCRT algorithm. Eligible patients were manually programmed to optimal atrioventricular (AV) and interventricular (VV) delays by using echocardiograms at rest or during 2 stages of supine bicycle exercise. We compared the maximum cardiac output between manual echo-optimization and aCRT-on during each phase. After initiating exercise, the optimal AV delay progressively shortened (P

OBJECTIVES: Among children hospitalized for bronchiolitis, we examined temporal trends in the use of hypertonic saline (HTS) and the characteristics associated with receiving this treatment. METHODS: We conducted a secondary analysis of data from 2 large, multicenter prospective cohort studies that included young children hospitalized with bronchiolitis during 5 winter seasons (2008–2014). Our outcome was receipt of HTS any time during the preadmission visit or hospitalization. For comparison with the observed trends in HTS use, we conducted a PubMed literature review of studies evaluating HTS use for bronchiolitis. We classified publications according to their assessment of HTS efficacy (positive, negative, or neutral). RESULTS: Among 2709 hospitalized children, 241 (8.9%) received HTS. There was marked variability in HTS use by site (0%–91%), with use more common among children admitted to the ICU than those treated on the ward (31% vs 15%). Over the study period, administration of HTS increased from 2% during the 2008–2009 season to 27% during the 2011–2012 season, but then it decreased to 11% during the 2013–2014 season. Before 2010, the number of PubMed HTS publications ranged from 0 to 3 articles per year, with all classified as either positive or neutral. The number of positive publications increased in 2010 (n = 5), whereas negative publications peaked in 2014 (n = 4). CONCLUSIONS: Use of HTS in children hospitalized with bronchiolitis increased during the 2008 to 2012 winter seasons and then declined. These findings paralleled trends in the HTS literature, with positive articles encouraging HTS use in early years followed by a growing number of neutral and negative articles after 2012.

We evaluated prognostic factors of locoregional breast cancer recurrence in 35 patients. The average age at the time of surgery was 58.4 years(range: 32-87 years). Of the 35 patients, 7, 17, and 11 had Stage I , II and III disease, respectively. Immunohistochemically, 25 tumors were ER+, and 10 were ER-, while 6 were HER2+, 27 were HER2-, and 2 had uncertain HER2 statuses. Their median disease-free interval(DFI), which is the intervalbetween initialsurgery and locoregional recurrence, was 29.4 months(range: 1-133 months). After locoregional relapse, 13 patients underwent surgical tumor removal, and 34 received systemic treatment. The median time-to-progression(TTP)after first-line therapy for recurrent breast cancer was 12.7 months(range: 1-185 months), and the median overall survival(OS)was 70.0 months(range: 3-313 months). Univariate analysis showed that disease stage at initial surgery, triple-negative disease, DFI, and TTP significantly affected OS, whereas ER and HER2 status, surgical margin at primary surgery, lymphovascular invasion, irradiation after initial surgery, and resection of the recurrent tumor were not significant factors. Patients with factors that predict worse prognosis after locoregional recurrence should be treated carefully.

The presence of a solitary lung tumor after radical surgery for breast cancer often causes difficulty in the diagnosis and treatment. We report a patient who had previously undergone radical surgery for breast cancer, and who underwent lung surgery. When the patient was 57 years old, she underwent surgical treatment for breast cancer. Six years later, a chest radiograph revealed a solitary mass on the upper lobe of her left lung. A left upper lobectomy was performed, utilizing videoassisted thoracic surgery. The pathological diagnosis, based on hematoxylin and eosin staining, was lung metastasis from breast cancer. The immunohistological findings revealed that the tumor was positive for estrogen receptor, progesterone receptor, and GCDFP-15, and negative for TTF-1 and Napsin A. Although the original breast cancer lesion was positive for the HER2 receptor, the metastatic lung lesion was negative. It has already been reported that the subtypes can change from 1 subtype in the original lesion to another in the metastatic lesion. Adjuvant therapy was administered based on the subtype of the metastatic lesion after the surgery. Therefore, surgical resection is useful for the purpose of reevaluating HER2 receptor status, the results ofwhich can influence the postoperative adjuvant treatment. The patient is now doing well, without any evidence ofrecurrence or metastasis 15 months after surgery.

We construct crossed homomorphisms of the groups of volume preserving diffeomorphisms of closed manifolds with nontrivial first cohomology groups and give their applications to the volume flux groups. Moreover, we see that they descend to crossed homomorphisms of their isotopy groups. In the two dimensional case, we show that their restrictions to Torelli groups are the first Johnson homomorphisms.

Breast cancer is the leading form of cancer in women in Japan. Cases of elderly women with breast cancer have been increasing rapidly in Japan due to the increasing age of the population. We examined the clinicopathological features and prognosis of breast cancer patients over 80 years old to define an optimal treatment regimen. From January 2004 to October 2014, 43 primary breast cancer patients underwent surgery at the Chiba Rosai Hospital. The median age was 84 years. On pathological diagnosis, the median tumor diameter was 2.4 cm. The tumors were positive for estrogen and progesterone receptors in 30 and 26 patients, respectively. The median overall survival time was 78 months. Only lymph node metastasis was an important predictor of overall survival. It is important to appropriately treat elderly patients. However, there have been no clinical practice guidelines for the management of breast cancer in elderly individuals because of a lack of clinical trials including elderly patients. Elderly patients have other complications such as cardiovascular disease, diabetes, dementia, and pulmonary emphysema. Therefore, we need to make a clinical decision for each individual patient considering comorbidities, functional status, and clinicopathological characteristics of the tumor.

The cationic iridium complex ([Ir(cod) 2 ]OTf + rac-BINAP) efficiently catalyzed a sequential process of ortho-C―H bond functionalization, cyclization and dehydration, leading to a concise preparation of 1-methylene indene (benzofulvene) derivatives. The iridium complex operated as a catalyst in the ortho-C―H bond alkenylation of aryl ketones with alkynes and as a Lewis acid catalyst in the cyclization of the alkenylated product and the subsequent dehydration.