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Abstract Aims The incidence and prognosis of symptomatic heart failure following acute myocardial infarction (AMI) in the primary percutaneous coronary intervention era have rarely been reported in the literature. This study aimed to (i) determine the incidence of heart failure admission among AMI survivors, (ii) compare 1 year outcomes between patients with heart failure admission and those without, and (iii) identify the independent risk factors associated with heart failure admission. Methods and results The Japan Acute Myocardial Infarction Registry is a prospective multicentre registry from which data on consecutively enrolled patients with AMI from 50 institutions between 2015 and 2017 were obtained. Among the 3411 patients enrolled, 3226 who survived until discharge were included in this study. The primary endpoint was all‐cause mortality. The secondary endpoints were major adverse cardiovascular events (defined as cardiovascular mortality, non‐fatal myocardial infarction, or non‐fatal cerebral infarction) and major bleeding events corresponding to Bleeding Academic Research Consortium Type 3 or 5. Clinical outcomes were compared between the patients who were and were not admitted for heart failure. Over a median follow‐up of 12 months, 124 patients (3.8%) were admitted due to heart failure. Independent risk factors for heart failure admission included older age, female sex, Killip class ≥2 on admission, left ventricular ejection fraction

Background and aims: Randomized clinical trials have demonstrated the ability of glucagon-like peptide-1 analogues (GLP-1RAs) to reduce atherosclerotic cardiovascular disease events in patients with type 2 diabetes (T2D). How GLP-1RAs modulate diabetic atherosclerosis remains to be determined yet. Methods: The OPTIMAL study was a prospective randomized controlled study to compare the efficacy of 48-week continuous glucose monitoring- and HbA1c-guided glycemic control on near infrared spectroscopty (NIRS)/intravascular ultrasound (IVUS)-derived plaque measures in 94 statin-treated patients with T2D (jRCT1052180152, UMIN000036721). Of these, 78 patients with evaluable serial NIRS/IVUS images were analyzed to compare plaque measures between those treated with (n = 16) and without GLP-1RAs (n = 72). Results: All patients received a statin, and on-treatment LDL-C levels were similar between the groups (66.9 ± 11.6 vs. 68.1 ± 23.2 mg/dL, p = 0.84). Patients receiving GLP-1RAs demonstrated a greater reduction of HbA1c [-1.0 (-1.4 to −0.5) vs. −0.4 (-0.6 to −0.2)%, p = 0.02] and were less likely to demonstrate a glucose level >180 mg/dL [-7.5 (-14.9 to −0.1) vs. 1.1 (-2.0 - 4.2)%, p = 0.04], accompanied by a significant decrease in remnant cholesterol levels [-3.8 (-6.3 to −1.3) vs. −0.1 (-0.8 - 1.1)mg/dL, p = 0.008]. On NIRS/IVUS imaging analysis, the change in percent atheroma volume did not differ between the groups (−0.9 ± 0.25 vs. −0.2 ± 0.2%, p = 0.23). However, GLP-1RA treated patients demonstrated a greater frequency of maxLCBI4mm regression (85.6 ± 0.1 vs. 42.0 ± 0.6%, p = 0.01). Multivariate analysis demonstrated that the GLP-1RA use was independently associated with maxLCBI4mm regression (odds ratio = 4.41, 95%CI = 1.19–16.30, p = 0.02). Conclusions: In statin-treated patients with T2D and CAD, GLP-1RAs produced favourable changes in lipidic plaque materials, consistent with its stabilization.

Abstract Organocatalytic ring-opening polymerization (ROP) is a versatile method for synthesizing well-defined polymers with controlled molecular weights, dispersities, and nonlinear macromolecular architectures. Despite spectacular advances in organocatalytic ROP, precision synthesis of polysiloxanes remains challenging due to the mismatch in polarity between highly polar initiators and nonpolar monomers and polymers and the difficulty in suppressing the formation of scrambling products via transetherification reactions during ROP of cyclic siloxanes. Here, we describe a binary organocatalytic ROP (BOROP) of hexamethylcyclotrisiloxane (D3) employing organic bases as catalysts and (thio)ureas as cocatalysts. The BOROP of D3 using triazabicyclodecene (TBD) and (thio)ureas generates polydimethylsiloxanes (PDMSs) with narrow dispersity (M w/M n

Summary: Background: Given the rapidly growing burden of cardiovascular disease (CVD) in Asia, this study forecasts the CVD burden and associated risk factors in Asia from 2025 to 2050. Methods: Data from the Global Burden of Disease 2019 study was used to construct regression models predicting prevalence, mortality, and disability-adjusted life years (DALYs) attributed to CVD and risk factors in Asia in the coming decades. Findings: Between 2025 and 2050, crude cardiovascular mortality is expected to rise 91.2% despite a 23.0% decrease in the age-standardised cardiovascular mortality rate (ASMR). Ischaemic heart disease (115 deaths per 100,000 population) and stroke (63 deaths per 100,000 population) will remain leading drivers of ASMR in 2050. Central Asia will have the highest ASMR (676 deaths per 100,000 population), more than three-fold that of Asia overall (186 deaths per 100,000 population), while high-income Asia sub-regions will incur an ASMR of 22 deaths per 100,000 in 2050. High systolic blood pressure will contribute the highest ASMR throughout Asia (105 deaths per 100,000 population), except in Central Asia where high fasting plasma glucose will dominate (546 deaths per 100,000 population). Interpretation: This forecast forewarns an almost doubling in crude cardiovascular mortality by 2050 in Asia, with marked heterogeneity across sub-regions. Atherosclerotic diseases will continue to dominate, while high systolic blood pressure will be the leading risk factor. Funding: This was supported by the NUHS Seed Fund (NUHSRO/2022/058/RO5+6/Seed-Mar/03), National Medical Research Council Research Training Fellowship (MH 095:003/008-303), National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme, NUHS Clinician Scientist Program (NCSP2.0/2024/NUHS/NCWS) and the CArdiovascular DiseasE National Collaborative Enterprise (CADENCE) National Clinical Translational Program (MOH-001277-01).

Organic π-conjugated radicals have recently joined the ranks of high-efficiency light-emitting materials; however, their light-emission mechanism is still a matter of debate. Here, the authors highlight a recently proposed luminescent enhancement mechanism and record-breaking efficiency of a radical organic light-emitting diode.

Communications Chemistry is pleased to introduce a Collection of articles focused on organomediated polymerization. Here, the Guest Editors highlight the themes within and look towards the future of this research field.

Vat-polymerization 3D printing (3DP) enables the high speed printing of precise and intricate 3D models, yet it inevitably produces highly crosslinked polymers that are not easily degradable or recyclable. Here, the author highlights recent work that realizes the formation of fully degradable polymers based on organocatalytic vat-ring-opening photopolymerization 3DP.

Abstract Background Retiform hemangioendothelioma (RH) is a rare, intermediate-grade vascular tumor that often arises in the trunk and extremities. The clinical and radiological features of RH remain largely unknown. Case presentation A male patient in his 70s presented with shortness of breath on exertion, and computed tomography incidentally revealed a tumor in his right breast. Positron emission tomography (PET) revealed moderate 18F-fluorodeoxyglucose (FDG) uptake in the tumor. RH was observed in the resected specimens. Three months after surgery, the patient was free of local recurrence and distant metastasis. Conclusions RH was found in the male breast and was accompanied by FDG uptake on PET. PET may be useful in diagnosing RH. Although metastasis is rare in RH, local recurrence may occur, and careful follow-up is required.

Abstract Background Although screening for coronary artery disease (CAD) using computed tomography coronary angiography in patients with stable chest pain has been reported to be beneficial, patients with chronic kidney disease (CKD) might have limited benefit due to complications of contrast agent nephropathy and decreased diagnostic accuracy as a result of coronary artery calcifications. Cardiac magnetic resonance (CMR) has emerged as a novel imaging modality for detecting coronary stenosis and high-risk coronary plaques without contrast media that is not affected by coronary artery calcification. However, the clinical use of this technology has not been robustly evaluated. Methods AQUAMARINE-CKD is an open parallel-group prospective multicenter randomized controlled trial of 524 patients with CKD at high risk for CAD estimated based on risk factor categories for a Japanese urban population (Suita score) recruited from 6 institutions. Participants will be randomized 1:1 to receive a CMR examination that includes non-contrast T1-weighted imaging and coronary magnetic angiography (CMR group) or standard examinations that include stress myocardial scintigraphy (control group). Randomization will be conducted using a web-based system. The primary outcome is a composite of cardiovascular events at 1 year after study examinations: all-cause death, death from CAD, nonfatal myocardial infarction, nonfatal ischemic stroke, and ischemia-driven unplanned coronary intervention (percutaneous coronary intervention or coronary bypass surgery). Discussion If the combination of T1-weighted imaging and coronary magnetic angiography contributes to the risk assessment of CAD in patients with CKD, this study will have major clinical implications for the management of patients with CKD at high risk for CAD. Trial registration Japan Registry of Clinical Trials (jRCT) 1,052,210,075. Registered on September 10, 2021.

We conducted the time-resolved simultaneous optical spectroscopic and photometric observations of mid-M-dwarf flare stars YZ CMi, EV Lac, and AD Leo. Spectroscopic observations were obtained using Apache Point Observatory 3.5 m and Small and Moderate Aperture Research Telescope System 1.5 m telescopes during 31 nights. Among the 41 detected flares, seven flares showed clear blue wing asymmetries in the H α line, with various correspondences in flare properties. The duration of the blue wing asymmetries range from 20 minutes to 2.5 hr, including a flare showing the shift from blue to red wing asymmetry. Blue wing asymmetries can be observed during both white-light and candidate non-white-light flares. All of the seven flares showed blue wing asymmetries also in the H β line, but there are large varieties on which other chromospheric lines showed blue wing asymmetries. One among the 7 flares was also observed with soft X-ray spectroscopy, which enabled us to estimate the flare magnetic field and length of the flare loop. The line-of-sight velocities of the blueshifted components range from –73 to –122 km s ^−1 . Assuming that the blueshifts were caused by prominence eruptions, the mass of upward-moving plasma was estimated to be 10 ^15 –10 ^19 g, which are roughly on the relation between flare energy and erupting mass expected from solar coronal mass ejections (CMEs). Although further investigations are necessary for understanding the observed various properties, these possible prominence eruptions on M-dwarfs could evolve into CMEs, assuming the similar acceleration mechanism with solar eruptions.

Abstract The purpose of this study was to investigate the occurrence rate and predictors of photodynamic therapy (PDT) induced acute exudative maculopathy (PAEM). This retrospective study included 39 eyes of 39 patients (32 males and 7 females), who were treated with initial PDT. PAEM was defined as an increase in central retinal thickness (CRT) of 15% or more measured by OCT on day 3 after PDT compared with baseline. Sixteen of 39 eyes (41%) were classified in the PAEM+ group. CRT and central choroidal thickness (CCT) were significantly increased at 3 days in the PAEM+ group and significantly decreased at 1 month after PDT in the PAEM- group. In a multiple comparison, neovascular age-related macular degeneration (nAMD) had a significantly higher incidence of PAEM compared to polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). The incidence of PAEM was lower in PCV and CSC, and higher in nAMD. BCVA at 1 month was significantly worse in the PAEM group, which may be related to visual prognosis after PDT. Since both CRT and CCT decrease at 1 month, the detection of PAEM needs to be assessed a few days after PDT.

Background Acute myocardial infarction (AMI) infrequently occurs after acute stroke. The Heart‐brain team approach has a potential to appropriately manage this poststroke cardiovascular complication. However, clinical outcomes of AMI complicating acute stroke (AMI‐CAS) with the heart‐brain team approach have not been characterized. The current study investigated cardiovascular outcomes in patients with AMI‐CAS managed by a heart‐brain team. Methods and Results We retrospectively analyzed 2390 patients with AMI at our institute (January 1, 2007–September 30, 2020). AMI‐CAS was defined as the occurrence of AMI within 14 days after acute stroke. Major adverse cerebral/cardiovascular events (cardiac‐cause death, nonfatal myocardial infarction, and nonfatal stroke) and major bleeding events were compared in subjects with AMI‐CAS and those without acute stroke. AMI‐CAS was identified in 1.6% of the subjects. Most AMI‐CASs (37/39=94.9%) presented ischemic stroke. Median duration of AMI from the onset of acute stroke was 2 days. Patients with AMI‐CAS less frequently received primary percutaneous coronary intervention (43.6% versus 84.7%; P

Polymer–polymer coupling reactions using an excess amount of chemical oxidants are wasteful. Here the authors report an electrochemical route for chain extension and topological transformations of poly(dimethylsiloxane).

We report on the chemical composition of the very metal-poor (VMP; [Fe/H] = −2.9) star LAMOST J1645+4357, which was identified as a red giant having peculiar abundance ratios by Li et al. The standard abundance analysis is carried out for this object and the well-studied metal-poor star HD 122563, which has similar atmospheric parameters. LAMOST J1645+4357 has a remarkable abundance set, highlighted by these features: (1) nitrogen is significantly enhanced ([N/Fe] = +1.4), and the total abundance of C and N is also very high ([(C+N)/Fe] = +0.9); (2) α -elements are overabundant with respect to iron, as generally found in VMP stars; (3) Ti, Sc, Co, and Zn are significantly deficient; (4) Cr and Mn are enhanced compared to most of VMP stars; and (5) Sr and Ba are deficient, and the Sr/Ba ratio ([Sr/Ba] = −1.0) is significantly lower than the value expected for the r -process. The overall abundance pattern of this object from C to Zn is well reproduced by a faint supernova model assuming spherical explosion, except for the excess of Cr and Mn, which requires enhancement of incomplete Si burning or small contributions from a Type Ia or pair-instability supernova. There remains, however, a question as to why the abundance pattern of this star is so unique among VMP stars.

Starspots and stellar flares are indicators of stellar magnetic activity. The magnetic energy stored around spots is thought to be the origin of flares, but the connection is not completely understood. To investigate the relation between spot locations deduced from light curves and the occurrence of flares therein, we perform starspot modeling for the TESS light curves of three M-dwarf flare stars, AU Mic, YZ CMi, and EV Lac, using the code implemented in Paper I. The code enables us to deduce multiple stellar/spot parameters by the adaptive parallel tempering algorithm efficiently. We find that flare occurrence frequency is not necessarily correlated with the rotation phases of the light curve for each star. The result of starspot modeling shows that any spot is always visible to the line of sight in all phases, and we suggest that this can be one of the reasons why there is no or low correlation between rotation phases and flare frequency. In addition, the amplitude and shape of the light curve for AU Mic and YZ CMi have varied in two years between different TESS cycles. The result of starspot modeling suggests that this can be explained by the variations of spot size and latitude.

Stellar coronal mass ejections (CMEs) have recently received much attention for their impacts on exoplanets and stellar evolution. Detecting prominence eruptions, the initial phase of CMEs, as the blueshifted excess component of Balmer lines is a technique to capture stellar CMEs. However, most of prominence eruptions identified thus far have been slow and less than the surface escape velocity. Therefore, whether these eruptions were developing into CMEs remained unknown. In this study, we conducted simultaneous optical photometric observations with Transiting Exoplanet Survey Satellite and optical spectroscopic observations with the 3.8 m Seimei Telescope for the RS CVn-type star V1355 Orionis that frequently produces large-scale superflares. We detected a superflare releasing 7.0 × 10 ^35 erg. In the early stage of this flare, a blueshifted excess component of H α extending its velocity up to 760–1690 km s ^−1 was observed and thought to originate from prominence eruptions. The velocity greatly exceeds the escape velocity (i.e., ∼350 km s ^−1 ), which provides important evidence that stellar prominence eruptions can develop into CMEs. Furthermore, we found that the prominence is very massive (9.5 × 10 ^18 g < M < 1.4 × 10 ^21 g). These data will clarify whether such events follow existing theories and scaling laws on solar flares and CMEs even when the energy scale far exceeds solar cases.

Active M-type stars are known to often produce superflares on the surface. Radiation from stellar (super)flares is important for exoplanet habitability, but the mechanisms are not well understood. In this paper, we report simultaneous optical spectroscopic and photometric observations of a stellar superflare on an active M dwarf, YZ Canis Minoris, with the 3.8 m Seimei telescope and the Transiting Exoplanet Survey Satellite. The flare bolometric energy is ${1.3}_{-0.6}^{+1.6}\times {10}^{34}\,\mathrm{erg}$ and the H α energy is ${3.0}_{-0.1}^{+0.1}\times {10}^{32}\,\mathrm{erg}$ . The H α emission line profile shows red asymmetry throughout the flare, with a duration of 4.6–5.1 hr. The velocity of the red asymmetry is ∼200–500 km s ^–1 and the line width of H α broadens up to 34 ± 14 Å. The redshifted velocity and line width of H α line decay more rapidly than the equivalent width, and their time evolutions are correlated with that of the white-light emission. This indicates the possibility of the white light, the H α red asymmetry, and the H α line broadening originating from nearly the same site, i.e., the dense chromospheric condensation region, heated by nonthermal electrons. On the other hand, the flux ratio of the redshifted excess components to the central components is enhanced one hr after the flare’s onset. This may be due to the main source of the red asymmetry changing to post-flare loops in the later phase of the flare.

OBJECTIVES:. To determine the characteristics of thyroid storm patients with acute decompensated heart failure who should be candidates for temporary percutaneous mechanical circulatory support in addition to beta-blocker treatment to prevent cardiogenic shock. DESIGN:. A single-center, retrospective review of treatment details and data collected from electronic medical records. SETTING:. Thyrotoxicosis complicated with acute decompensated heart failure. PATIENTS:. Eight consecutive patients who were admitted to our hospital for acute decompensated heart failure with thyroid storm between December 2011 and August 2020 were retrospectively reviewed. Of the eight patients, four were treated with percutaneous mechanical circulatory support. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Compared with thyroid storm patients who did not require percutaneous mechanical circulatory support, those who did had a significantly higher initial plasma brain natriuretic peptide level (1,231 [911–3,387] vs 447 pg/mL [243–653 pg/mL], respectively; p = 0.015), as well as a significantly larger left ventricular end-diastolic diameter (56 [54–63] vs 48 mm [38–48 mm], respectively; p = 0.029) and end-systolic diameter (50 [49–58] vs 28 mm [28–30 mm], respectively; p = 0.029) on echocardiogram. In terms of thyroid storm severity, the Burch-Wartofsky score was higher in patients with percutaneous mechanical circulatory support than in those without, although the difference was not significant. All patients survived this index admission. CONCLUSIONS:. In thyroid storm patients, the presence of a high brain natriuretic peptide level, “left ventricular dilatation,” or both may necessitate hemodynamic assessment to determine the indication of percutaneous mechanical circulatory support before beta-blocker administration.

Abstract The development of solventless system for modulating properties of network materials is imperative for the next generation sustainable technology. Utilization of photostimulation is important owing to its spatial and temporal locality, yet designing photoresponsive network materials exhibiting repeatable and dramatic change in their properties remains a challenge. Here, the authors report a photocleavable regenerative network (PRN) linked with photoresponsive hexaarylbiimidazoles (HABIs) synthesized from narrow dispersity star‐shaped poly(dimethylsiloxane)s (PDMSs) having 2,4,5‐triphenylimidazole end groups. The use of urea anion as a catalyst for ring opening polymerization (ROP) of cyclic siloxane initiated from silanols enables control of molecular weight and dispersity. The rheological measurements for the synthesized PRNs exhibit drastic changes in storage and loss moduli (G′ and G″) upon photoirradiation in the solid state (G′ > G″). This photocontrolled change in viscoelasticity with retaining solidity enables application of PRNs as a remotely‐controlled photo‐melt adhesive and photo‐scissible string. The developed PRNs will enable a wide variety of applications such as industrially important next‐generation sustainable adhesive, sealant, and reversibly‐deformable 3D printing materials with their spatially and temporally local manipulability, solventless handleability, and excellent reversibility.

Objective Although there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.Methods This single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.Results We analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p

Background: Hypertension, diabetes, dyslipidemia and smoking are established coronary risk factors for coronary heart disease in the general population. However, in Japanese patients with acute myocardial infarction (AMI), the impact of the number of coronary risk factors on in-hospital morality remains unclear. Methods: The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database. We examined the association between the number of coronary risk factors and in-hospital mortality. Results: Data were obtained from total of 20462 AMI patients (mean age, 68.8 ± 13.3 years old; 15281 men, 5181 women). The prevalence of hypertension increased with advancing age, while the prevalence of smoking decreased with advancing age. The prevalence of diabetes and dyslipidemia were highest in middle age. A majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors. Overall, the number of coronary risk factor was relatively less in older subjects and women under 50 years old. Crude in-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively. After adjusting for age and sex, there was an inverse association between the number of coronary risk factors and the in-hospital mortality (adjusted odds ratio [1.68; 95% confidence interval, 1.20–2.35] among individuals with 0 vs. 4 risk factors). Conclusion: In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors. To investigate the underlying reasons for these findings, further studies are needed.

Background: Cardiovascular diseases, including acute myocardial infarction (AMI), are leading causes of death among the Japanese, who have the longest life expectancy in the world. Over the past 50 years in Japan, the percentage of elderly individuals has increased 4-fold, from 5.7% in 1960 to 23.1% in 2010. To explore medical practices and emergency care for AMI in this aging society, the Japan Acute Myocardial Infarction Registry (JAMIR) was established as a nationwide real-world database. Methods: JAMIR conducted retrospective analysis of 20,462 AMI patients (mean age, 68.8 ± 13.3 years; 15,281 men [74.7%]) hospitalized between January 2011 and December 2013. Results: The rates of ambulance use and emergency PCI were 78.9% and 87.9%, respectively. The median door-to-balloon time was 80 min (interquartile range, 53–143 min). Overall in-hospital mortality was 8.3%, including 6.6% due to cardiac death. JAMIR included 4837 patients aged ≥80 years (23.6%). In this age group, patients who underwent PCI (79.9%) had significantly lower in-hospital mortality than those who did not (11.1% vs. 36.9%, P

The design of organic and polymeric soft materials showing isothermal reversible liquid–nonliquid conversion is challenging. Here, the authors show solvent-free repeatable molecular architectural transformation between liquid-star and non-liquid-network polymers by the cleavage and reformation of covalent bonds in the polymer chain.

Thermocouples are used to measure high temperature in process and steel industries. To measure high temperature gas, thermocouples should be inserted deeply enough; commercial specification documents recommend at least 5 times the diameter of sheath or more. This paper analyzes the effect of insertion length on thermocouple outputs in high temperature gas measurement. The theoretical evaluation is revised to include the radiation effect in the authors' previous work presented in SICE AC 2015 and compared with experimental data in a heating furnace more precisely than the work presented in SICE AC 2016.

This study is concerned with the feasibility of power generation using a pico-hydraulic turbine from sewage flowing in pipes. First, the sewage flow rate at two connection points to the Toyogawa River-Basin Sewerage, Japan, was explored for over a year to elucidate the hydraulic energy potential of the sewage. Second, the performance of the pico-hydraulic turbine was investigated via laboratory experiments that supposed the turbine to be installed in the sewage pipe at the connection points. This study indicates that the connection points have hydraulic potential that can be used for power generation throughout the year. It also demonstrates that the pico-hydraulic turbine can be usefully employed for power generation from sewage flowing in the pipe at the connection points.

As a frontier topic of soft condensed matter physics, irreversible aggregation has drawn attention for a better understanding of the complex behavior of biomaterials. In this study, we have described the synthesis of an artificial amphiphilic molecule, an alternating tetra-block-like amphiphile, which was able to diversify its aggregate structure in water. The aggregated state of its aqueous dispersion was obtained by slow evaporation of the organic solvent at room temperature, and it collapsed irreversibly at ~ 50°C. By using a cryo-transmission electron microscope and a differential scanning calorimeter, it was revealed that two types of molecular nanostructures were formed and developed into submicro- and micrometer-sized fibrils in the aggregated material.

BACKGROUND:High-sensitive cardiac troponin T (hsTnT) is a sensitive biomarker of myocardial damage and predictor of acute decompensated heart failure (ADHF). However, there is little information on changes over time in hsTnT level during ADHF management. The aim of this prospective study was to evaluate changes in hsTnT levels between admission and at discharge in patients with ADHF, and identify factors that determine such levels and their prognostic significance. METHODS AND RESULTS:We evaluated 404 ADHF patients with abnormal hsTnT levels (≥0.0135 ng/ml) on admission. The median (interquartile ranges) hsTnT levels on admission, at discharge, and percent changes in hsTnT levels were 0.038 (0.026 to 0.065), 0.032 (0.021 to 0.049) ng/ml, and -12.0 (-39.8 to 7.4) % respectively. The numbers of patients with falling (hsTnT decrease > -15%), stable (hsTnT change between -15 and +15%) and rising (hsTnT increase > +15%) hsTnT level at discharge were 190, 146, and 68, respectively. The percent change in B-type natriuretic peptide (BNP) levels was greater in the falling group, compared to the stable (p

Circulating polyunsaturated fatty acid (PUFA) levels are associated with clinical outcomes in cardiovascular diseases including coronary artery disease and chronic heart failure (HF). However, their clinical implications in acute decompensated HF (ADHF) remain unclear. The aim of this study was to investigate the clinical roles of circulating PUFAs in patients with ADHF.Circulating levels of PUFAs, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA) and dihomo-gamma linoleic acid (DGLA), were measured on admission in 685 consecutive ADHF patients. Adverse events were defined as all-cause death and worsening HF.During a median follow-up period of 560 days, 262 (38.2%) patients had adverse events. Although patients with adverse events had lower n-6 PUFA (AA + DGLA) level than those without, n-3 PUFA (EPA + DHA) level was comparable between the groups. Kaplan-Meier analyses showed that lower n-6 PUFA level on admission was significantly associated with the composite of all-cause death and worsening HF, all-cause death, cardiovascular death and worsening HF (p < 0.001, p = 0.005, p = 0.021, p = 0.019, respectively). In a multivariate Cox model, lower n-6 PUFA level was independently associated with increased risk of adverse events (HR 0.996, 95% CI: 0.993-0.999, p = 0.027).Lower n-6 but not n-3 PUFA level on admission was significantly related to worse clinical outcomes in ADHF patients. Measurement of circulating n-6 PUFA levels on admission might provide information for identifying high risk ADHF patients.

BACKGROUND: Cardiovascular events still occur at intermediate stenosis with fractional flow reserve (FFR) ≥0.81, underscoring the additional measure to evaluate this residual risk. A reduction in distal coronary artery pressure/aortic pressure (Pd/ Pa) from baseline to hyperemia (ie, change in Pd/Pa) reflects lipidic burden within vessel walls. We hypothesized that this physiological measure might stratify the risk of future cardiac events at deferrable lesions. METHODS: Lesion- (899 intermediate lesions) and patient-based (899 deferred patients) analyses in those with FFR ≥0.81 were conducted to investigate the association between change in Pd/Pa and target lesion failure (TLF) and major adverse cardiac events at 7 years, respectively. RESULTS: The occurrence of TLF and major adverse cardiac events was 6.7% and 13.4%, respectively. The incidence of target lesion--related nonfatal myocardial infarction was 0.6%. Lesions with TLF had a greater change in Pd/Pa (0.11±0.03 versus 0.09±0.04; P=0.002), larger diameter stenosis (51.0±9.2% versus 46.4±12.4%; P=0.048), and smaller FFR (0.84 [0.82--0.87] versus 0.86 [0.83--0.90]; P=0.02). Change in Pd/Pa (per 0.01 increase) predicted TLF (odds ratio, 1.16 [95% CI, 1.05--1.28]; P=0.002) and major adverse cardiac event (odds ratio, 1.08 [95% CI, 1.01--1.16]; P=0.03). Lesions with change in Pd/Pa ≥0.10 had 2.94- and 1.85-fold greater likelihood of TLF (95% CI, 1.30--6.69; P=0.01) and major adverse cardiac event (95% CI, 1.08--3.17; P=0.03), respectively. Lesions with FFR ≤0.85 had a substantially higher likelihood of TLF when there is a change in Pd/Pa ≥0.10 (12.4% versus 2.9%; hazard ratio, 3.60 [95% CI, 1.01--12.80]; P=0.04). However, change in Pd/Pa did not affect TLF risk in lesions with FFR ≥0.86 (3.8% versus 3.7%; hazard ratio, 0.56 [95% CI, 0.06--5.62]; P=0.62). CONCLUSIONS: Despite deferrable FFR values, lesions and patients with a change in Pd/Pa ≥0.10 had higher cardiovascular risk. Change in Pd/Pa might help stratify lesion- and patient-level risks of future cardiac events in those with FFR ≥0.81. GRAPHIC ABSTRACT: A graphic abstract is available for this article. [ABSTRACT FROM AUTHOR]