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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 The presence of layered plaque is suggestive of recurrent thrombotic events. However, the impact of layered plaque detected by optical coherence tomography (OCT) on coronary inflammation and coronary flow reserve remains unclear. Purpose We aimed to investigate the association of OCT-derived layered plaque with pericoronary adipose tissue inflammation assessed by coronary computed tomography angiography (cCTA) and global coronary flow reserve (G-CFR) assessed by cardiac magnetic resonance imaging (CMR) in patients with acute coronary syndrome (ACS). Methods We investigated 88 patients with first ACS who underwent preprocedural cCTA and OCT imaging of the culprit lesion, and CMR after percutaneous coronary intervention (PCI). All patients were divided into four groups according to the OCT-derived culprit plaque characteristics: layered vs. non-layered plaque; and plaque rupture vs. plaque erosion. Coronary inflammation was assessed by the mean value of pericoronary adipose tissue (PCAT) attenuation (−190 to −30 HU) of the three major coronary vessels. G-CFR was obtained by quantifying absolute coronary sinus flow at rest and during maximum hyperemia. CCTA and CMR findings were compared between the groups. Results In a total of 88 patients, layered plaque [L] with plaque rupture [PR] was observed in 25 patients, layered plaque with plaque erosion [PE] was observed in 26 patients, non-layered plaque [NL] with PR was observed in 23 patients, and non-layered plaque with PE was observed in 14 patients, respectively. Three-vessel-PCAT attenuation value (L-PR vs. L-PE vs. NL-PR vs. NL-PE; −68.13±6.18 vs. −69.01±6.72 vs. −69.76±4.04 vs. −74.61±5.63 HU, P=0.009) and culprit vessel PCAT attenuation value (L-PR vs. L-PE vs. NL-PR vs. NL-PE; −66.39±7.38 vs. −68.94±8.06 vs. −70.01±5.76 vs. −75.45±6.60 HU, P=0.003) showed the graded difference between the four groups. G-CFR value also showed the graded difference between the four groups (L-PR vs. L-PE vs. NL-PR vs. NL-PE; 2.26 [1.80–2.87] vs. 2.24 [1.72–3.13] vs. 2.97 [2.24–3.83] vs. 3.18 [2.67–4.08], P=0.022). Conclusions The presence of layered plaque at the culprit lesion was associated with high PCATA and low G-CFR in patients with ACS. Detection of layered plaque may indicate increased pericoronary inflammation and impaired coronary flow reserve, potentially providing the risk stratification in patients with ACS. Funding Acknowledgement Type of funding sources: None.

Objectives This study sought to assess the predictors of coherence tomography (OCT) and coronary computed tomography angiographic (CCTA) findings for non-infarct-related (non-IR) territory unrecognized myocardial infarction (UMI) in patients with first non-ST-elevation acute coronary syndrome (NSTE-ACS) presentation. Background UMI detected by cardiac magnetic resonance (CMR) is associated with adverse outcomes in patients with both acute coronary syndrome and chronic coronary syndrome. However, the association between the presence of UMI and findings of multimodality coronary imaging remains unknown. Methods We investigated 69 patients with a first clinical episode of NSTE-ACS, who underwent pre-PCI 320-slice CCTA, uncomplicated urgent percutaneous coronary intervention (PCI) with OCT assessment within 48 hours of admission, and post-PCI CMR. UMI was assessed on late gadolinium enhancement (LGE-CMR) by identifying regions of hyperenhancement with an ischemic distribution pattern in non-IR territories (non-IR UMI). Results Non-IR UMI was detected in 11 patients (15.9%). ROC analysis revealed the optimal cut-off value of PCATA in culprit vessel for predicting the presence of non-IR UMI were −71.3. Lower ejection fraction, higher Gensini score, high pericoronary inflammation (>−71.3), OCT-defined culprit lesion plaque rupture (OCT-PR), and OCT-defined culprit lesion cholesterol crystal (OCT-CC) were significantly associated with the presence of non-IR UMI (Figure 1A). OCT findings are shown in Figure 1B. Patients with non-IR UMI had a higher prevalence of OCT-PR and OCT-CC than those without. Compared with patients without non-IR UMI, the prevalence of high pericoronary inflammation was higher in patients with non-IR UMI (Figure 1C). When the total cohort was divided into four groups according to the numbers of aforementioned OCT-derived risk factors and PCATA, patients with all of these UMI risk factors showed 46.2% (6/13) prevalence of non-IR UMI, whereas none of 15 patients without these factors showed non-IR UMI (Figure 1D). Conclusions When culprit lesion showed OCT-PR, OCT-CC, and high PCATA, about half of these patients are likely to have non-IR UMI. The integrated CCTA and OCT assessment may help identify the presence of non-IR UMI, potentially providing prognostic information in first NSTE-ACS patients. Funding Acknowledgement Type of funding sources: None.

Background Evidence regarding the use of pressure indices for the assessment of coronary stenoses in patients with chronic kidney disease (CKD) is scarce. Methods We assessed the relation between eGFR, FFR and resting Pd/Pa in 1147 consecutive patients (1316 vessels) included in the International Collaboration of Comprehensive Physiologic Assessment Study. We also compared FFR and Pd/Pa against a standardized cut-off of coronary flow reserve (CFR Results FFR increases as renal function worsens (beta −10.5, 95% CI −20.0 to −11.03, p=0.030), a relation that was not seen with resting Pd/Pa (beta −6.14, 95% CI −19.9 to 6.78, p=0.351). Both indices had similar diagnostic accuracies for the detection of a CFR CFR decreased linearly with deteriorating eGFR, and this was mainly driven by higher resting coronary flow in CKD patients (p=0.026), while hyperaemic coronary flow remained similar (p=0.403). IMR did not change significantly with eGFR (beta −0.02, 95% −0.09 to 0.05, p=0.557). The incidence of VOCO was higher in patients with CKD and FFR>0.80 when compared to non-CKD patients and FFR>0.80 (12.7% vs 6.90%, p=0.062). Prognosis was worse for those with CKD, negative FFR and CFR Conclusions The assessment of a given coronary stenosis in patients with CKD with either FFR or resting Pd/Pa is equivalent when compared to underlying coronary flow. In CKD, impaired CFR is caused by a state of increased resting flow. The assessment of CFR on top of standard pressure wire examination significantly improves prognostic stratification in CKD patients. Funding Acknowledgement Type of funding sources: None.

Background The frequent pathological cause of acute coronary thrombosis is plaque rupture or erosion. A previous CT angiographic study failed to discriminate OCT-defined intact fibrous cap culprit lesions (IFC lesions) from those with ruptured fibrous cap (RFC group) in patients with acute coronary syndrome (ACS) and chronic coronary syndrome. Objectives This study aimed to evaluate the diagnostic efficacy of preprocedural coronary CT imaging to identify optical coherence tomography (OCT)-defined plaque rupture or erosion at culprit lesions in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods Consecutive patients with suspected NSTE-ACS who underwent preprocedural non-contrast CT and CT angiography (CCTA) were studied. Patients with at least one lesion with more than 50% stenosis at the proximal segment on CCTA were subsequently assessed by invasive coronary angiography and OCT. ALL CT and OCT examination were performed within 24 hours from presentation. The diagnosis of intact fibrous cap or ruptured fibrous cap was made by OCT for the angiographically most severely stenosed lesion. Cases of ambiguous OCT diagnosis such as massive thrombosis or calcified nodule precluding the fibrous cap assessment were excluded from the final analysis. Results In the final analysis of 176 patients, OCT identified 87 RFC plaques and 89 IFC plaques for the culprit lesions, respectively. In IFC group, lower prevalence of diabetes mellitus (24.7% vs. 41.4%, P=0.025) and lower peak cardiac marker elevation (CPK, 159 vs. 272 U/L, P Conclusions Preprocedural comprehensive CT imaging including CAC and pericoronary adipose tissue inflammation could identify IFC or RFC culprit lesions defined by OCT. Further studies are needed to confirm our preliminary results and if CT imaging in NSTE-ACS provides prognostic information or specific therapeutic approach such as conservative therapy or non-stenting strategy before invasive angiography. 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.

Background Index of microcirculatory resistance (IMR) has been used as a clinical measure of microvascular function. Transthoracic Doppler echocardiography (TDE) can provide information on the functional status of coronary artery circulation. This study aims to assess the diagnostic value of left-anterior-descending artery (LAD) flow velocity by TDE for microvascular dysfunction. Methods Consecutive patients who were scheduled for elective percutaneous coronary intervention (PCI) for LAD lesions were prospectively enrolled in the single tertiary-care center between April 2020 and July 2021. Pre-PCI LAD diastolic peak velocity (DPV) by TDE at rest and hyperemia were measured. By invasive coronary angiography, quantitative coronary angiography and invasive wire-based physiological indices including fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were measured. Results A total of 104 patients were studied. Median FFR and IMR values were 0.70 (0.60–0.74) and 20.68 (14.92–31.69), respectively. No significant relationship was observed between FFR and IMR. The prevalence of microvascular dysfunction defined as IMR≥25 was 39.4%. Basal DPV was 25 (20–33) cm/sec, and hyperemic DPV was 51 (41–67) cm/sec. In lesions with IMR≥25, reference diameter (RD) was significantly greater [2.63 (2.22–3.19) mm vs 2.39 (2.09–2.66) mm, p=0.019], basal DPV was lower [26 (18–29) cm/sec vs 29 (22–37) cm/sec, p=0.022)] and hyperemic DPV was lower [49 (19–54) cm/sec vs 56 (42–70) cm/sec, p=0.023] compared to lesions with IMR2.84mm are independent predictors for IMR≥25 [Odds ratio: 3.08 (1.22–7.78), p=0.017; odds ratio 4.40 (1.55–12.50), p=0.005]. Conclusion Basal DPV by non-invasive pre-PCI TDE and reference diameter can predict lesions with coexisting microvascular dysfunction in LAD territory with functionally significant lesions without the need of vasodilator-induced hyperemia and a wire-based invasive physiological measurement. Funding Acknowledgement Type of funding sources: None.

The defect formation in a rod-shaped AA7003 alloy is carefully treated in the sample extruded at 10 or 20 m min−1 with their structure–property relationships. The + double fibre texture...

OBJECTIVES To evaluate the functional outcomes of patients with displaced patellar fractures treated with anterior plate constructs. DESIGN Prospective cohort and retrospective clinical and radiographic assessment. SETTING Level I Trauma Center. PATIENTS/PARTICIPANTS Between 2014 and 2018, 18 patients who underwent operative intervention for an isolated, displaced patella fracture (OTA/AO 34C1-3) with a minimum of 1-year follow-up agreed to participate in the study. The mean follow-up was 19.5 ± 6.0 months. INTERVENTION Patients were treated with 2.4 or 2.7-mm plates and supplemental screws or cerclage wires. MAIN OUTCOME MEASUREMENTS Patients were evaluated with the Short Form-36 Survey and the Knee Injury and Osteoarthritis Outcome Scores and asked about symptomatic implants. The range of motion was assessed by goniometer. RESULTS The cohort had no wound complications, infections, nonunion, loss of reduction, or implant failure. Active knee flexion was 131 ± 7 degrees. Five patients (28%) endorsed implant irritation. Only one patient (5.5%) underwent implant removal, which consisted of transverse screw removal alone. Twelve of the 14 patients (86%), who were previously employed, returned to work at 10 ± 7 weeks. All Knee Injury and Osteoarthritis Outcome Scores subscale scores and the Short Form-36 Survey scores for physical functioning, limitations due to physical health, limitations due to mental health, and social functioning were significantly lower than reference population norms (P < 0.05). CONCLUSIONS Anterior plating provides reliable fixation for displaced patellar fractures and results in a low incidence of implant irritation. However, patients who had anterior fixation for displaced patella fractures continue to exhibit functional deficits at 1-year postoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

We revisit the crossed-beam experimental results for the elastic scattering of low-energy electrons from gas-phase $$\hbox {C}_{60}$$ , with an emphasis on comparison with the results from ab initio calculations. The relevance of Vincent McKoy’s work, the SMC method, in this respect is demonstrated by our re-normalized data. This is evidenced in the DCS-energy (eV) and DCS-scattering angle ( $$\theta )$$ space, i.e., in 3D distributions, as the more comprehensive and distinctive features of electron scattering from this typically high-symmetry and large molecule of $$\hbox {C}_{60}$$ . An earlier inconsistency between the experimental data and theoretical absolute DCS values is solved, by re-normalizing the cross sections. Absolute scales are also placed on the inelastic scattering DCS of vibrational and electronic excitations, with the latter being compared with photoabsorption cross sections. In addition, some coexisting solid-state phase features, which emerged in the free molecules of $$\hbox {C}_{60}$$ , are summarized using low-energy electron spectroscopy.

We present a comprehensive revisited experimental high-resolution vacuum ultraviolet (VUV) photoabsorption spectrum of ammonia, NH, covering for the first time the full 5.4-10.8 eV energy-range, with absolute cross sections determined. The calculations on the vertical excitation energies and oscillator strengths were performed using the equation-of-motion coupled cluster method restricted to single and double excitation levels and used to help reanalyze the observed Rydberg structures in the photoabsorption spectrum. The VUV spectrum reveals several new features that are not previously reported in the literature, with particular reference to the vibrational progressions of the (D'1EX'1A1′), the (F'1EX'1A1′), and the (G'1A2X'1A1′) absorption bands. In addition, new Rydberg members have been identified in nda11a2″D'′′1A2X'1A1′, where n > 3 has not been reported before as well as in nde1a2″F'1EX'1A1′ and in nsa1 1a2″G'1A2X'1A1′. The measured absolute photoabsorption cross sections have been used to calculate the photolysis lifetime of ammonia in the Earth's atmosphere (0-50 km)., M.M. and F.F.S. acknowledge the Portuguese National Funding Agency FCT-MCTES through Grant No. PD/BD/106038/2015 and researcher position IF-FCT IF/00380/2014, respectively, and together with A.I.L. and P.L.-V. the research Grant Nos. UID/FIS/00068/2019 (CEFITEC), PTDC/FIS-AQM/31281/2017, and PTDC/FIS-AQM/31215/2017. This work was also supported by Radiation Biology and Biophysics Doctoral Training Programme (RaBBiT, Grant No. PD/00193/2012) and Grant No. UID/Multi/04378/2013 (UCIBIO). P.L.-V. also acknowledges his visiting professor position at Sophia University, Tokyo, Japan. The authors wish to acknowledge the beam time at the ISA synchrotron radiation source ASTRID2, Aarhus University, Denmark. D.D. acknowledges the support of the grants OVERSEE and CAPPA, managed by the Agence Nationale de la Recherche, Contract Numbers ANR-16-IDEX-0004 ULNE (I-SITE ULNE) and ANR-10-LABX-005 (CAPPA). D.D. also thanks the Région Hauts de France, the Ministère de l’Enseignement Supérieur et de la Recherche (CPER Climibio), and the European Fund for Regional Economic Development for their support. This work used HPC resources from GENCI-TGCC (Grant No. 2019-A0010806820) and the Centre de Ressources Informatiques (CRI) of the Université de Lille. G.G. acknowledges partial support from the Spanish Ministerio de Ciencia, Innovación y Universidades (Project No. FIS2016-80440) and CSIC (Project No. LINKA20085). This work was conducted under the support of the Ministry of Education, Culture, Sport, Science and Technology (MEXT), Japan.

We present a comprehensive revisited experimental high-resolution vacuum ultraviolet (VUV) photoabsorption spectrum of ammonia, NH

Background Previous reports showed all diastolic resting indexes tested were virtually identical to the instantaneous wave-free ratio (iFR). Although RFR has been also reported to be diagnostically equivalent to iFR, no comparisons have been reported about the prevalence and characteristics of discordance in diagnosis between diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR). Purpose This study sought to determine the coronary pressure characteristics of lesions classified as discordant between dPR and RFR in angiographically intermediate stenoses. Methods We recruited 532 patients with 668 intermediate (angiographically stenosis between 30% to 70% severity) coronary lesions undergoing FFR assessment and analyzed DICOM pressure tracings of resting state (dPR and RFR) using a fully automated off-line software algorithm in a blind fashion. Diagnostic performance of dPR and RFR was evaluated using FFR as a reference. Furthermore, we investigated similarity and difference between dPR and RFR. Results Median FFR was 0.81 with an interquartile range of 0.74 to 0.87. RFR was highly correlated to dPR (R2=0.94, p0.80 and the FFR values were significantly lower in RFR+/dPR– than in RFR-/dPR-, and significantly higher in RFR+/dPR– than in RFR+/dPR+. (P Conclusion Significant difference in FFR values was observed according to dPR/RFR agreement and disagreement. Revascularization decision making might defer according to the resting index used. Compared with RFR, lesions might be more frequently deferred when dPR was used to assess physiological significance. Acknowledgement/Funding None

Background 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 G-CFR by quantifying CSF using PC-CMR in patients with ACS treated with primary or emergent percutaneous coronary intervention (PCI). Methods The study prospectively enrolled 387 ACS patients who underwent uncomplicated primary or emergent PCI within 48 hours of symptom onset. Breath-hold PC-CMR images of CS were acquired to assess absolute CSF at rest and during maximum hyperemia within 30 days after primary PCI and revascularization of functionally significant non-culprit lesions of ACS. The association of G-CFR and baseline clinical characteristics with major adverse cardiac events (cardiac death, nonfatal myocardial infarction, late revascularization, or hospitalization for congestive heart failure) was investigated. Results In the final analysis of 366 patients (Male 294 (80.3%), mean age 65) including 233 patients (63.7%) with ST-segment elevation myocardial infarction (STEMI) and 133 patients (36.3%) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), rest and maximal hyperemic CSF and corrected G-CFR were 1.24 [0.83, 1.71] ml/min/g, 2.56 [1.87, 3.66] ml/min/g, and 2.20 [1.53, 3.17], respectively. During a median follow-up of 16 months, MACE occurred in 84 patients (cardiac death: 9, nonfatal myocardial infarction: 11, late revascularization: 59, hospitalization for congestive heart failure: 5). Cardiac event-free survival was significantly worse in patients with a corrected G-CFR Conclusions In ACS patients successfully revascularized within 48 hours of onset, G-CFR obtained by noninvasive PC-CMR provided significant prognostic information independent of infarction size and conventional risk scores.

Background Mechanical properties of chordae tendineae of mitral valve (MV) are still not fully investigated. Synchrotron-based X-ray phase tomography (XPCT) is a powerful tool to measure biological soft tissues. Recently, we have developed dynamic X-ray phase tomography (4D-XPCT) to discuss the dynamic phenomena of biological samples quantitatively and applied to chordae tendineae of MV (MVCT). Purpose This study evaluated 4-dimensional changes of MVCT and clarified structural changes of MVCT during cardiac cycles. Methods The X-ray energy for 4D XPCT was set to 20keV. The effective pixel size was 7.8μm. Fresh MVCT extracted from a pig heart were measured in the specially designed container filled with normal cold saline. MVCT installed on the sample stage was stretched and released with a continuous oscillation of 0.5Hz during a phase tomographic measurement. The amount of stretch was 400μm where a mechanical load caused by stretching was approximately 1N. In this measurement, projection images were acquired with a frame rate of 20Hz during a single sawtooth wave. Therefore, apparent frame rate of 20Hz is expected in 4D phase tomography. Cross section was determined by simple thresholding based on the density. In this case, the threshold was set to 1.018g/cm3. Results X-ray phase tomographic images of MVCT at the released (A) and stretched (B) conditions are shown in Fig. 1a. The load applied to the sample and change of the cross section obtained from tomography during stretching and releasing are shown in Fig. 1b and 1c, respectively. The diameter of chordae tendinea were changed approximately 2.5% during stretching and returned to initial diameter during releasing. Figure 1 Conclusions This result demonstrated that the 4D-XPCT had a capability to trace the detail of deformation process in the biological soft tissues during continuous oscillation. Even chordae tendinea are mainly consisted of collagen fibers, diameter of the chordae was changed according to stretching and releasing.

Background Fractional flow reserve (FFR) is the current standard for determining severity of epicardial stenosis and indication for percutaneous coronary intervention (PCI). However in practice, FFR is not enough robust to select lesions that will truly benefit from PCI. Coronary flow capacity (CFC) provides integrated information of coronary flow reserve (CFR) and coronary flow during hyperemia that is useful for identifying flow-limiting stenosis considering both epicardial and microvascular conditions. Objective We hypothesized that the effect of FFR-guided PCI would be enhanced by further consideration of CFC. This study aimed to investigate the prognostic effect of PCI according to CFC status of the stable lesions, using pressure-temperature sensor-tipped wire for FFR and CFC evaluation. Methods From a global, multicenter registry of comprehensive physiological assessment, a total of 1397 patients (1694 vessels) were enrolled. Three patients/vessels were excluded due to lost follow-up. Low CFC was defined for lesions with reduced CFR and the corresponding inverse of thermodilution-derived mean transit time under hyperemia, which represents hyperemic coronary flow. The effect of FFR-guided PCI on vessel-oriented composite outcomes (VOCO) was assessed by multivariate marginal COX proportional regression model with or without the interaction term between PCI and CFC, using the CFC definition with the CFR threshold of 2.0 (Figure: red + green area showing low CFC). Using the same model, variously defined CFC was tested to determine the optimal thresholds (Figure: red only area ∼ red + green + blue area). Results During the 5-year follow-up period, VOCO was identified for a total of 113 vessels. In the multivariate model, the HR of PCI was 0.963 (95% CI: 0.538–1.723). When the interaction was added to the model, the effect of PCI on VOCO incidence was significantly different according to CFC status (p=0.069 for interaction). The optimal criterion of CFC was made where Akaike Information Criterion of the model was minimized (CFR threshold of 2.9 for the CFC definition), where PCI had HR of 0.443 (95% CI: 0.196–0.999) and 1.521 (95% CI: 0.828–2.796) for lesions low and high CFC, respectively. CFR had no significant interaction with PCI (p=0.26). CFC Map Conclusion The effect of PCI on VOCO was significantly different according to CFC status. PCI to lesions with low CFC was prognostically beneficial. Our results suggested the potential of CFC for optimizing PCI benefit in stable lesions after FFR assessment.

Background Quantitative flow ratio (QFR) is a novel three-dimensional quantitative coronary angiography (QCA)-based computational index that can estimate fractional flow reserve (FFR) without pharmacologically induced hyperemia or the use of a pressure wire. Purpose We aimed to evaluate the determinants of visual-functional mismatches between conventional two-dimensional QCA and QFR. Methods A total of 504 de novo intermediate-to-severe lesions from 504 patients with stable angina who underwent angiographical and physiological assessments were analyzed. All lesions were divided into four groups based on the significance of visual (QCA-diameter stenosis [DS] >50% and ≤50%) and functional (QFR Results Among 504 lesions, 153 lesions (30.4%) showed concordantly negative (DS ≤50% and QFR >0.80) and 170 lesions (33.7%) showed concordantly positive (DS >50% and QFR ≤0.80) visual and functional assessments. Among 181 lesions (35.9%) with discordant results, 75 lesions (14.9%) showed a mismatch (DS >50% and QFR >0.80) and 106 lesions (21.0%) showed a reverse mismatch (DS ≤50% and QFR ≤0.80), respectively. Reverse mismatch was associated with smaller reference diameter (odds ratio [OR] 0.561; P=0.036), greater DS (OR 1.039, P=0.013), lower coronary flow reserve (CFR) (OR 0.571, P Conclusions There was a high prevalence of visual-functional mismatches between QCA-DS and QFR, and CFR was an important functional factor of mismatches. Our results suggested the difference between predictors of reported visual-functional mismatches of QCA/FFR and those of QCA/QFR.

Background The fractional flow reserve (FFR) becomes a standard practice for revascularization decision-making in evaluating the functional significance of angiographically intermediate epicardial coronary stenosis. The quantitative flow ratio (QFR) is a novel method for rapid computational estimation of FFR without pressure wire and hyperemic induction. FFR has been reported to be associated with not only epicardial stenosis but also subtended myocardial mass (Vsub). In contrast, the relationship between QFR and Vsub has not been clarified. Purpose We sought to examine if subtended myocardial mass (Vsub) assessed by coronary computed tomography showed a significant relationship with QFR in comparison with FFR. Methods and results We performed a post-hoc analysis of 152 territories (LAD 116, RCA 25 and LCX 11 lesions) with angiographically intermediate-to-severe stenosis in 152 patients who underwent FFR assessment. The median FFR and QFR values were 0.76 (0.64–0.84) and 0.76 (0.72–0.83), respectively. The median diameter stenosis (%DS) and minimum lumen diameter (MLD) were 54.5 (43.9–64.2) and 1.2 (0.9–1.6), respectively. In total, 123 (80.9%) and 29 (19.1%) lesions showed concordant and discordant FFR and QFR functional classifications, respectively. The ability of Vsub/MLD2 to discriminate lesions with FFR≤0.80 and QFR≤0.80 was assessed compared with QCA data. FFR values were associated with Vsub (R=0.37, P Conclusions Subtended cardiac mass volume derived from CT segmentation improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions when FFR used as a reference standard, whereas QFR showed non-significant relationship with subtended cardiac mass.

Background Studies of sex differences in fractional flow reserve (FFR) measurements have shown that in comparison with men, angiographic lesions of similar visual severity are less likely to be ischemia producing in women. Gender specific differences may influence revascularization decision making and prognosis after deferred revascularization following FFR measurement. Purpose This study sought to investigate the gender difference in long-term prognosis of patients of deferred revascularization following FFR assessment. Methods A total of 879 patients (879 vessels) with deferred revascularization with FFR >0.75 who underwent FFR and CFR measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long-term outcomes were assessed in 649 men and 230 women by the patient-oriented composite outcome (POCO, a composite of any death, any myocardial infarction [MI], and any revascularization). We applied inverse-probability weighting (IPW) based on propensity scores to account for differences at baseline between women and men (age, hypertension, hyperlipidemia, diabetes mellitus, lesion location, clinical status, FFR, Reference diameter, Diameter stenosis, lesion length). The median follow-up duration was 1855 days (745–1855 days). Results Median FFR values were 0.88 (0.83–0.93) in men and 0.89 (0.85–0.94) in women, respectively. The occurrences of POCO were significantly high in men compared with that in women (10.5% vs 4.2%, P=0.007). Kaplan–Meier analysis revealed that women had a significantly lower risk of POCO (χ2=7.2, P=0.007). Multivariate COX regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of POCO. After applying IPW, the hazard ratio of male for POCO was 2.20 (95% confidence interval: 1.12 to 4.33, P=0.023). Conclusion This large multinational study reveals that long-term outcome differs between women and men in favour of women after FFR-guided revascularization deferral. Acknowledgement/Funding None

We investigated the effects of molecular weight distribution (molecular weight and dispersity) and developer on the sensitivity and resolution of ZEP series (Zeon Corporation). ZEP520A, ZEP7000, and ZEP530A(under development) are scission-type polymer resists composed of the same structural unit with different molecular weight and dispersity. The sensitivities of ZEP530A (narrow dispersity) and ZEP7000 (high molecular weight) are approximately same and lower than ZEP520A (standard). The resolution of ZEP530A was the highest among the ZEP series.

Accepted: 2016-03-02, 資料番号: SA1150325000

© 2018 IOP Publishing Ltd. The central (Nc) and terminal (Nt) nitrogen K-shell photoelectron spectra (PESs) of N2O molecules have been measured in the σ shape resonance energy region at temperatures of ∼300 and ∼630 K. Estimating vibrational populations based on the Boltzmann distribution at these temperatures, PESs of vibrationally ground and bending-excited levels in the initial electronic ground state were extracted. Vibrationally integrated partial cross sections and asymmetry parameters for ionization from vibrationally ground and bending-excited levels were obtained as a function of the incident photon energy by integrating PESs over the vibrational levels of the core-hole states. In Ncphotoionization, the shape resonance from the bending-excited level was found to be shifted to the lower photon energy side and to become narrower than that from the ground vibrational level. In Ntphotoionization from the bending-excited level, the downward shift of the resonance is more significant than that in Ncionization. These experimental findings are qualitatively consistent with theoretical predictions and suggest that the shape resonance associated with the Ntcore hole is more sensitive to the bending angle of the initial state than is the shape resonance associated with the Nccore hole. The asymmetry parameters for photoionization from the bending-excited level, however, showed almost the same behavior as those from the ground vibrational level for both K-shell photoionization channels and in the photon energy range studied here.

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 24 month embargo from date of publication (Jan 2018) in accordance with the publisher’s archiving policy, The current contribution constitutes the third and final part of our trilogy of papers on electron attachment reactions of the group IV tetrahalides; XY4 (X = C, Si, Ge and Y = F, Cl, Br). In this context we extend our previous studies on XF4 and XBr4 and report results for electron attachment to the tetrachlorides: CCl4, SiCl4 and GeCl4 in the incident electron energy range from about 0 to 10 eV. At the same time we give a summary of the currently available literature on electron interactions with those latter compounds. Upon electron attachment the formation of Cl−, XCl3−, XCl2− and Cl2− is observed from all the tetrachlorides, and additionally the molecular anion SiCl4− is observed from SiCl4. The main DEA contributions are observed through narrow, threshold peaks (at 0 eV) and we attribute these features to single particle resonances associated with the a1 symmetry LUMOs of those compounds. Contributions from another low-lying resonance, which we assign as a 2T2 shape resonance associated with the t2 symmetry LUMO+1, is also observed in the ion yield curves for all the tetrachlorides. The energy of the peak position of those contributions varies in the range from about 1 to 2 eV, depending on the compound and the fragment formed. In addition to these low energy contributions, higher energy, fairly broad, features are observed for all the tetrachlorides. These contributions exhibit a peak in the energy range between 5 and 8 eV, again depending on the compound and the fragment formed. Further to the experimental data, we report DFT and coupled cluster calculations on the thermochemical thresholds for the individual fragments as well as the respective bond dissociation energies and electron affinities. These calculated values are compared with the experimental appearance energies and literature values, where they are available.

The authors analyzed 330 consecutive Weber B distal fibula fractures that occurred during a 3-year period and were treated with either a contoured locking plate or a conventional one-third tubular plate to compare the cost and failure rates of the 2 constructs. The primary outcomes were failure of the distal fibular implant and loss of reduction. Secondary outcomes were surgical wound infection requiring surgical debridement and/or removal of the fibular implant, and removal of the fibular plate for persistent implant-related symptoms. No failure of the fibular plates or distal fibular fixation occurred in either group. A total of 5 patients required surgical revision of syndesmotic fixation within 4 weeks of the index surgery. Of these patients, 1 was in the contoured locking plate group and 4 were in the one-third tubular plate group ( P =.610). The rate of deep infection requiring surgical debridement and/or implant removal was 6.2% in the contoured locking plate group and 1.4% in the one-third tubular plate group ( P =.017). The rate of lateral implant removal for either infection or symptomatic implant was 9.3% in the contoured locking plate group and 2.3% in the one-third tubular plate group ( P =.005). A typical contoured locking plate construct costs $800 more than a comparable one-third tubular plate construct. Based on a calculated estimate of 60,000 locking plates used annually in the United States, this difference translates to a potential avoided annual cost of $50 million nationally. This study demonstrates that it is possible to treat Weber B distal fibula fractures with one-third tubular plates at a substantially lower cost than that of contoured locking plates without increasing complications. [ Orthopedics. 2017; 40(6):e1024–e1029.]