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Frailty is strongly associated with poor short- and long-term prognoses in patients who undergo transcatheter aortic valve implantation (TAVI). However, limited data are available regarding the association between frailty and late bleeding events after TAVI. Of the 2,518 patients in the Japanese multicenter TAVI registry, 1371 patients with complete data on frailty parameters were analyzed. We developed a modified Essential Frailty Toolset (EFT) using 4 frailty parameters-gait speed, Mini-Mental State Examination (MMSE), anemia, and hypoalbuminemia-that are significant predictors of late bleeding events in this cohort. The predictive value of the modified EFT for late bleeding after TAVI was assessed in comparison with other clinical variables. Late bleeding events after TAVI occurred in 80 patients (5.8%). Gait speed, MMSE, anemia, and hypoalbuminemia were significantly associated with late bleeding. A modified EFT was developed to include these parameters, which were scored from 0 to 5 points comprising the following 4 items: gait speed (0:1.5 m/s, 1: 1.5 to 0.75 m/s, 2:0.75 m/s), cognition (1: MMSE18), anemia (1: hemoglobin13 g/100 ml in men or12 g/100 ml in women), and malnutrition (1: albumin3.5 g/100 ml). Multivariate Cox regression analysis revealed that the modified EFT was an independent predictor of late bleeding (adjusted hazard ratio 1.51, 95% confidence interval [CI] 1.19 to 1.92, p0.001) In conclusion, the modified EFT was found to be a significant predictive factor for late bleeding events after TAVI. Assessment of frailty is important to predict patients with high bleeding risk after TAVI.

Summary Two Ruehmaphelenchus species were isolated from the ambrosia beetles Euwallacea kuroshio and E. interjectus, collected from Okinawa and Kagoshima, Japan, respectively. Both nematodes were successfully cultured on a lawn of the grey mould Botrytis cinerea. Morphological observation and molecular characterisation revealed that both species are undescribed; therefore, the nematodes are described herein as R. kuroshioi n. sp. and R. interjectus n. sp. Phylogenetically, both species are closely related to R. formosanus, R. fujiensis, R. digitulus and R. asiaticus. Ruehmaphelenchus kuroshioi n. sp. is characterised by a conical male and female tail, which has a terminal projection (mucron), small male spicule with a weakly-developed triangular condylus, dorsal and ventral limbs that are connected to each other by three different tissues, and clearly separated distal pairs of genital papillae (P3 and P4). However, R. kuroshioi n. sp. can be distinguished from its close relatives by a combination of male and female tail characters and its distinctive phylogenetic status. Ruehmaphelenchus interjectus n. sp. is almost identical to R. formosanus, sharing characteristic lateral spikes of the spicule; they form a well-supported phylogenetic clade. However, R. interjectus n. sp. is distinguished from R. formosanus by morphometric values and ribosomal RNA, i.e., a 6-bp difference from the ca 1.7 kb molecular sequence of the 18S ribosomal RNA of R. formosanus, which warrants independent species status.

Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort.This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding.This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events.The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.

The box-ball system (BBS), introduced by Takahashi and Satsuma in 1990, is a cellular automaton that exhibits solitonic behaviour. In this article, we study the BBS when started from a random two-sided infinite particle configuration. For such a model, Ferrari et al. recently showed the invariance in distribution of Bernoulli product measures with density strictly less than 1 2 \frac {1}{2} , and gave a soliton decomposition for invariant measures more generally. We study the BBS dynamics using the transformation of a nearest neighbour path encoding of the particle configuration given by ‘reflection in the past maximum’, which was famously shown by Pitman to connect Brownian motion and a three-dimensional Bessel process. We use this to characterise the set of configurations for which the dynamics are well-defined and reversible (i.e. can be inverted) for all times. The techniques developed to understand the deterministic dynamics are subsequently applied to study the evolution of the BBS from a random initial configuration. Specifically, we give simple sufficient conditions for random initial conditions to be invariant in distribution under the BBS dynamics, which we check in several natural examples, and also investigate the ergodicity of the relevant transformation. Furthermore, we analyse various probabilistic properties of the BBS that are commonly studied for interacting particle systems, such as the asymptotic behavior of the integrated current of particles and of a tagged particle. Finally, for Bernoulli product measures with parameter p ↑ 1 2 p\uparrow \frac 12 (which may be considered the ‘high density’ regime), the path encoding we consider has a natural scaling limit, which motivates the introduction of a new continuous version of the BBS that we believe will be of independent interest as a dynamical system.

Animals likely use a variety of strategies to solve laboratory tasks. Traditionally, combined analysis of behavioral and neural recording data across subjects employing different strategies may obscure important signals and give confusing results. Hence it is important to develop techniques that can infer strategy at the single-subject level. We analyzed an experiment in which two monkeys perform a visually cued rule-based task. From the analysis of their performance there is no indication that they used a different strategy. However, when we examined the geometry of stimulus representations in the state space of the neural activities recorded in dorsolateral prefrontal cortex, we found striking differences. Our purely neural results predict behavioral differences that we observed by analyzing the reaction times. These analyses provide strong support that the animals employed different strategies. Finally, we used a modeling study to correlate these strategies with the amount of training that the animals received.

Summary We isolated two tylenchid species belonging to the Sychnotylenchinae, Sychnotylenchus hibisci n. sp. and Neoditylenchus xiphydriae n. sp., from the bark beetle Ernoporus corpulentus and wood wasp Xiphydria ogasawarai, respectively. Sychnotylenchus hibisci n. sp. is characterised by its moderately stout body in both male and female, gubernaculum to spicule length ratio of one-third or less, crustaformeria structure composed of four columns with six large, rounded cells, and a broad female tail with a rounded terminus. The new species is closely related to S. ulmi, with which it shares body shape and gubernaculum to spicule length ratio, but is distinguished by the female tail shape and several morphometric values. Neoditylenchus xiphydriae n. sp. is characterised by its oval to leaf-shaped male bursa, male tail tip reaching the distal end of, and protruding beyond the bursa, a long post-vulval uterine sac (PUS), and a conical female tail with a narrowly rounded terminus. The species is typologically similar to N. pinophilus but is distinguished by its male spicule shape, gubernaculum to spicule length ratio, and longer PUS. Phylogenetically, the Sychnotylenchinae belongs under the Anguinidae (superfamily Sphaerularioidea) and is closely related to several Ditylenchus, Neotylenchus, Neomisticius, and Ficotylus species.

Aims: Recently, drug-eluting stents (DESs) have been widely adopted for patients on chronic hemodialysis (HD). However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after DES implantation. Methods and Results: We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after DES implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47 vs. 32%; p = 0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82 ± 0.49 vs. 0.97 ± 0.45 mm; p < 0.01), and the lesion length (LL) was increased (30.2 ± 16.1 vs. 24.4 ± 12.1 mm; p = 0.023) in lesions with ISR compared to those without ISR. The rate of rotational atherectomy use was also increased in lesions with ISR compared to those without ISR (50% vs. 25%; p < 0.01). In a multivariate analysis, the MLD before DES implantation (odds ratio [OR] = 0.50, 95% confidence interval [CI] 0.27–0.91, p = 0.024), LL (OR = 1.02, 95% CI 1.00–1.04, p = 0.030) and the use of rotational atherectomy (OR = 2.71, 95% CI 1.55–4.72, p < 0.01) were independent predictors of ISR. The incidence of ISR was similar between lesions treated with the first-generation (25.8%) and the second-generation DESs (20.4%). Conclusions: ISR was observed in 74 lesions (22.4%). A small MLD, long LL, and the use of rotational atherectomy were independent predictors of ISR after DES implantation in patients on HD. There was no significant difference in the ISR rate between the first- and the second-generation DESs.

Summary A Bursaphelenchus sp. belonging to the B. idius-group was isolated from a bark beetle, Ernoporus corpulentus, which had emerged from dead twigs of Hibiscus tiliaceus collected in Okinawa, in the subtropical region of Japan. In addition to its group-specific characters, i.e., four lateral lines in both male and female and less developed capitulum and relatively broad blade of the male spicules, the species is characterised by a relatively slender female tail with various tip shapes. Molecularly, the species is close to B. fagi and B. tiliae based on SSU and D2-D3 LSU sequences, but can be clearly distinguished from these two species. The species is described and illustrated herein as B. hibisci n. sp.

Maximal hyperemia at the time of fractional flow reserve (FFR) measurement is generally induced by vasodilators, even when hyperemia at the onset of angina symptoms is caused by exercise stress. This study was designed to evaluate whether pharmacological hyperemia could be used as a substitute for exercise-induced hyperemia during FFR measurement. Twenty-two patients with angiographically intermediate stenosis in the left anterior descending artery (LAD) were prospectively enrolled. FFR measurements were repeated in the following two conditions while the pressure-wire was positioned in the same segment; (1) during pharmacological hyperemia induced by intracoronary administration of 2 mg nicorandil, (2) immediately after isotonic hand-grip exercise for 90 s (50% of maximum voluntary contraction) followed by intracoronary administration of 2 mg nicorandil. Isotonic hand-grip exercise increased systolic blood pressure (130 ± 19 versus 150 ± 22 mmHg, p

BACKGROUND Little is known about changes in nutritional status as an index of frailty on clinical outcomes after transcatheter aortic valve replacement (TAVR). This study aimed to assess the clinical impact of serum albumin changes after TAVR. METHODS Changes in serum albumin levels from baseline to 1 year after TAVR were evaluated in 1524 patients who were classified as having hypoalbuminemia (

Aims Loss of skeletal muscle mass is an important determinant associated with poor long‐term prognosis in patients with acute decompensated heart failure (ADHF). However, limited evidence is available. This study investigated the prognostic value of the psoas muscle mass index (PMI) in patients with ADHF. Methods and results A total of 210 consecutive patients aged ≥60 years with ADHF were enrolled using a prospective database between 2015 and 2017. Primary endpoint was incidence of cardiac death. Cross‐sectional psoas muscle area at the L3 vertebral level was obtained by computed tomography, and PMI was calculated by height. Reduced PMI was defined as a PMI below the 25th sex‐specific percentile. Patients were also classified by their left ventricular ejection fraction (EF) as having either heart failure with a reduced ejection fraction (HFrEF, EF

This study evaluated whether intravascular ultrasound (IVUS) examination before rotational atherectomy (RA) can predict the optimal route of passage of the RA burr along the vessel. 30 patients with calcified lesions who underwent IVUS before and immediately after RA were enrolled. IVUS analyses were performed at the minimum lumen area (MLA) site and at 0.5 mm intervals. Each IVUS cross-section was divided into 4 quadrants around the center of the lumen, and pre- and post-RA IVUS cross-section images were merged. Of 1140 cross-sections, 498 (44%) contained debulked regions. When the guidewire and IVUS were located within the same quadrant, the debulked region were distributed within the same quadrant in 96% of cross-sections. The debulked region and the guidewire were distributed within the same quadrant in 81% and the debulked region and the IVUS in 72% of cross-sections, in case the guidewire and IVUS were located in different quadrants. When the guidewire and the IVUS was apart > 1.0 mm, the debulked regions were distributed within the same quadrant as the guidewire in 100% and the IVUS in 0% of cross-sections. The position of the guidewire rather than that of the IVUS catheter on pre-RA IVUS images could predict the course of the RA burr’s passage, especially when the guidewire and IVUS catheter were located apart from each other.

This study evaluated whether intravascular ultrasound (IVUS) images before rotational atherectomy (RA) can predict medial injury caused by RA burr passage in advance.Thirty-three patients with de-novo lesions located in the left anterior descending coronary artery (LAD) who underwent IVUS before and immediately after RA were enrolled. The spatial axes of the two matched pre- and post-RA IVUS cross-sectional images were merged. The segment was considered to have medial damage when the continuity of the intimal layer was disrupted and the medial layer was in direct contact with the lumen on post-RA IVUS.Medial injuries on post-RA IVUS were identified in seven segments of five patients. All segments with medial injury were located near the bifurcation of the LAD and the diagonal branch, and the spatial orientations of the medial injury region were mostly distributed in the lateral side with a diagonal branch take-off. The lumen area was significantly smaller in segments with medial injury than in those without medial injury (P0.01). The IVUS catheter was in contact with the healthy side of the arterial wall on pre-RA IVUS images for more than 1 mm in length in all segments with medial injury.When the guidewire and IVUS catheter are close to the healthy side of the arterial wall on pre-RA IVUS images, there is a higher risk of medial injury due to the RA procedure, especially near the bifurcation of the LAD and diagonal branch.

Classical and quantum walks on some finite paths are introduced. It is shown that these walks have explicit solutions given in terms of exceptional Krawtchouk polynomials and their properties are explored. In particular, fractional revival is shown to take place in the corresponding quantum walks., Comment: 22 pages, 4 figures

The optimal management of preexisting severe aortic stenosis (AS) in patients undergoing noncardiac surgery (non-CS) remains uncertain. This study aimed to investigate the safety and effectiveness of percutaneous aortic valve intervention (PAVI) in patients with AS before non-CS.We analyzed pooled data within a multicenter Japanese registry from 118 patients with severe AS who underwent PAVI before non-CS. Sixty patients underwent percutaneous balloon aortic valvuloplasty (BAV) and 58 patients underwent transcatheter aortic valve replacement (TAVR). The groups' baseline characteristics, perioperative complications, and 30-day mortality and midterm mortality after non-CS were compared.The postprocedural mean pressure gradient was higher in the BAV group than in the TAVR group (35.0 ± 11.5 mmHg vs. 11.5 ± 4.8 mmHg, p 0.001). The non-CS operation risk did not differ between the groups (p = 0.69). One patient in each group experienced a noncardiac death (p = 0.74), and the 30-day mortality rate after non-CS was 1.7%. Heart failure occurred in 2 patients in each group (p = 0.68). One patient in the TAVR group experienced a non-disabling stroke, and no myocardial infarctions occurred. Consequently, the combined adverse events were 5.0% and 6.9% in the 2 groups (p = 0.48). The bleeding rates during the non-CS were similar in both groups (33.3% vs. 25.9%, p = 0.25). There were no differences between the groups regarding midterm mortality (p = 0.60), whereas 53.3% of the patients in the BAV group required invasive treatment of their AS during follow-up.Among patients with severe AS, PAVI before non-CS reduces the AS severity and may contribute to procedural safety during non-CS.

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: 0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P P P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/ . Unique identifier: UMIN000020423.

Background: There is no known therapy with proven efficacy for improving clinical outcomes in elderly patients with heart failure (HF) and preserved ejection fraction (HFpEF). In this study, we aimed to evaluate the efficacy of tolvaptan (TLV) in elderly HFpEF patients. Methods: This retrospective observational study involved 100 consecutive elderly HFpEF patients hospitalized at the Nagoya Heart Center, Japan. Inclusion criteria were: (1) patients aged ≥75 years; (2) first hospitalization secondary to HF; (3) received medical therapy for HF, without invasive treatment; and (4) clinical follow-up for >6 months after discharge. The primary endpoint was rehospitalization due to worsening HF, and the secondary endpoint was worsening renal function (WRF) during hospitalization and at 6 months after discharge. Sixty background-matched HFpEF patients were divided into 2 groups: with TLV therapy (TLV (+), n = 29) and without TLV therapy (TLV (–), n = 31). In the TLV (+) group, TLV therapy was continued after discharge. Clinical outcomes of these patients were evaluated. Results: Bed rest period and length of hospital stay were significantly shorter in the TLV (+) group than in the TLV (−) group. The dose of loop diuretics, mean serum creatinine levels, and incidence of WRF development were significantly lower in the TLV (+) group. Incidence of rehospitalization was also significantly lower in the TLV (+) group (log-rank test; p = 0.018). The multivariate logistic regression analysis demonstrated that TLV therapy reduces the incidence of rehospitalization in elderly patients with HFpEF. Conclusions: TLV therapy reduced the bed rest period, length of hospital stay, and rate of rehospitalization without WRF in elderly HFpEF patients, suggesting that TLV could represent an effective therapy for this group of patients.

Although the left coronary artery (LCA) has a flow profile in that most blood flow occurs during diastole rather than systole, the right coronary artery (RCA) has a flow pattern that is less diastolic dominant. This study assessed whether coronary pressure waveforms distal to stenoses with the same fractional flow reserve (FFR) was the same between the LCA and RCA. A total of 347 vessels from 318 patients who underwent FFR measurements were included. Conventional FFR was calculated as the ratio of the mean coronary distal pressure (Pd) to the mean aortic pressure (Pa) at maximal hyperemia. The pressure drop ratios in systole (PDRsystole) and diastole (PDRdiastole) were calculated as the sum of (Pa minus Pd) divided by the sum of Pa at the intracoronary diastolic and systolic pressure phases, respectively. Analysis of covariance of the regression line of correlation between conventional FFR and PDRsystole revealed that the slope was significantly greater in the RCA than in the left anterior descending artery (LAD) and left circumflex artery (LCX) (−0.765, −0.578, and −0.589, p

The discrete Toda lattice preserves the eigenvalues of tridiagonal matrices, and convergence of dependent variables to the eigenvalues can be proved under appropriate conditions. We show that the ultradiscrete Toda lattice preserves invariant factors of a certain bidiagonal matrix over a principal ideal domain, and prove convergence of dependent variables to invariant factors using properties of box and ball system. Using this fact, we present a new method for computing the Smith normal form of a given matrix., The following article has been accepted by Journal of Mathematical Physics. After it is published, it will be found at (https://aip.scitation.org/journal/jmp). 14 pages

Background Whether optical frequency domain imaging (OFDI) images can realize pathological diagnosis of coronary atherosclerotic plaques, and whether its diagnostic accuracy of lesion types varies depending on the personal experience of the clinician caring for coronary intervention have not been elucidated. Purpose This study investigated the interobserver variability in characterizing atherosclerotic plaque types by OFDI for multiple OFDI observers with levels of different experience. Methods Three-hundred-thirty-three histological cross-sections from 21 autopsy hearts were co-registered with the corresponding OFDI images. Histological cross-sections were classified into the following 7 lesion types according to the modified AHA atherosclerosis classification by a single experienced pathologist blinded for OCT findings: adaptive intimal thickening (AIT), intimal xanthoma (IX), pathological intimal thickening (PIT), fibrous cap atheroma (FA), fibrocalcific plaque (FC), calcified nodule (CN), and healed erosion/rupture (HER). The five OFDI observers, unaware of the histological diagnosis, provided a single diagnosis for each corresponding OFDI image. The OFDI observer 1 was an expert interventional cardiologist with sufficient experience in OFDI imaging, followed by the OFDI observer 2, 3, and 4 as middle career interventional cardiologists who had completed training ten, seven, and four years. The OFDI observer 5 was a young career interventional cardiologist. The diagnostic accuracy of lesion types for each OFDI observer was determined taking histology as a gold standard. Results On histological analysis, 13% of histological cross-sections were diagnosed as AIT, 5% as IX, 23% as PIT, 25% as FA, 27% as FC, 2% as CN, and 5% as HER. The overall agreement between OFDI diagnosis and histopathologic diagnosis for OFDI observer 1 to 5 was 77%, 62%, 61%, 56%, and 46% (k values of 0.71, 0.54, 0.54, 0.45, and 0.33), respectively. Although the performance for characterizing AIT and FC was excellent and comparable among all OFDI observers, the sensitivity and positive predictive value for characterizing IX, PIT and FA varied depending on the OFDI observers' years of experience (Table). The main causes of false-positive or -negative diagnosis of FA were IX and PIT for all OFDI observers. Conclusion The diagnostic accuracy of atherosclerotic tissue properties from OFDI images correlated with the observers' years of experience, subspecialty training in coronary imaging, which suggests that the interpretation of OFDI images requires expertise and can be challenging to a less experienced reader. Table 1 Funding Acknowledgement Type of funding source: None

The accurate identification of in-stent fibroatheroma by in vivo imaging is clinically important to preventing the late catch-up phenomenon after stent deployment. This study investigated the diagnostic accuracy of optical coherence tomography (OCT) for the detection of “in-stent fibroatheroma” following stent implantation. Fifty stented coronary arteries from the 31 autopsy hearts were examined to compare OCT and histological image findings. A histological in-stent fibroatheroma was defined as a neointima containing an acellular necrotic core generated by macrophage infiltration. OCT-derived in-stent fibroatheroma comprised a heterogeneous pattern with an invisible stent strut behind the low-signal-intensity region. A total of 122 matched OCT and histology cross-sections were evaluated. Using histological findings as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value for OCT-derived in-stent fibroatheroma were 100%, 99%, 80%, and 100%, respectively. The only histological finding underlying the false-positive diagnosis of OCT-derived in-stent fibroatheroma was foam cell accumulation without a necrotic core on the neointimal surface. No false-negative diagnosis of OCT for in-stent fibroatheroma was apparent in this analysis. This study demonstrated the potential capability of OCT based on stent strut visualization behind low-signal-intensity regions to discriminate in-stent fibroatheroma from other neointimal tissues.

Background Muscle wasting is an important predictor of long‐term outcome in patients with cardiovascular disease, but the prognostic value of muscle wasting in patients with non‒ST‐segment‒elevation myocardial infarction is not established. The aim of this study is to investigate the prognostic value of muscle wasting, defined by psoas muscle mass index (PMI), in patients with non‒ST‐segment‒elevation myocardial infarction. Methods and Results A total of 132 consecutive patients with non‒ST‐segment‒elevation myocardial infarction were prospectively enrolled between 2015 and 2018. Primary end point was incidence of cardiovascular events including cardiovascular deaths, non‐fatal myocardial infarction, or non‐fatal stroke. Cross‐sectional area of the psoas muscle at the L3 vertebral level was obtained by computed tomography and PMI was calculated. The median follow‐up period was 2.4 years (interquartile range, 1.1–4.0 years). There were 45 cardiovascular events (34%) during the study periods. The optimal cutoff value of PMI to predict cardiovascular events was 772 mm 2 /m 2 , as assessed by receiver operating curve analysis. Patients with reduced PMI (PMI2 /m 2 ) had significantly higher cardiovascular events than those with preserved PMI (PMI≥772 mm 2 /m 2 ) (48% versus 21%; log‐rank test P P Conclusions Muscle wasting defined as PMI is a simple and useful objective marker to predict future cardiovascular outcome in patients with non‒ST‐segment‒elevation myocardial infarction. Registration Information URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000013445.

Background To date, there have been no data available regarding the diagnostic performance of optical frequency domain imaging (OFDI) for in vivo histological classification of atherosclerotic lesions. This study investigated whether OFDI can be used to diagnose and classify histological atherosclerotic lesions in the coronary artery by ex vivo histological examinations. Methods Three-hundred-fifteen histological cross-sections from 21 autopsy hearts were matched with the OFDI images. Histological cross-sections were classified into six categories: adaptive intimal thickening (AIT), pathological intimal thickening (PIT), fibrous cap atheroma (FA), fibrocalcific plaque (FC), calcified nodule, and healed erosion/rupture. The five observers with different years of experience in the interpretation of OFDI provided a single diagnosis for the OFDI scans of each cross-section according to the aforementioned six histological categories. The diagnostic accuracy and interobserver variability of lesion types for each OFDI observer were determined using histology as the gold standard. Results The overall agreement rates between OFDI and histopathologic diagnosis for OFDI observers 1–5 were 81%, 70%, 68%, 61%, and 50% (κ values of 0.75, 0.61, 0.58, 0.49, and 0.36), respectively. Although the diagnostic accuracy of OFDI for detecting AIT and FC was excellent for all five observers, the sensitivity, and positive predictive values of OFDI for detecting PIT and FA were low in proportion to years of experience. Conclusion The diagnostic accuracy of atherosclerotic tissue properties from OFDI scans correlated with the observers' years of experience, especially when lesions contained lipid components.

Information on early to late-phase kidney damage in patients who underwent transcatheter aortic valve replacement (TAVR) is scarce. We aimed to identify the predictive factors for late kidney injury (LKI) at 1-year and patient prognosis beyond 1-year after TAVR.We retrospectively reviewed 1,705 patients' data from the Japanese TAVR multicenter registry. Acute kidney injury (AKI) and LKI, defined as an increase of at least 0.3 mg/dL in creatinine level, a relative 50% decrease in kidney function from baseline to 48 hours and 1-year, were evaluated. The patients were categorized into the 4 groups as AKI-/LKI- (n = 1.362), AKI+/LKI- (n = 95), AKI-/LKI+ (n = 199), and AKI+/LKI+ (n = 46).The cumulative 3-year mortality rates were significantly increased across the four groups (12.5%, 15.8%, 24.6%, 25.8%, P.001). Multivariate analysis revealed that chronic kidney disease, coronary artery disease, periprocedural AKI, and heart failure-related re-admission within 1-year were significantly associated with LKI. The Cox regression analysis revealed that AKI-/LKI+ and AKI+/LKI+ were independent predictors of increased late mortality beyond 1-year after TAVR (P = .001 and P = .01).LKI was influenced by adverse cardio-renal events and was associated with increased risks of late mortality beyond 1-year after TAVR.

Objectives and background Although tissue protrusion (TP) between the stent struts after stent implantation has been implicate as a potential factor of stent failure, the incidence, natural history, and predictive factor of TP after stent implantation remains unclear. This prospective study evaluated the fate of TP after drug-eluting stent (DES) deployment using optical coherence tomography (OCT). Method and result This study analyzed TP for 42 lesions after DES in which three serial OCTs, including preprocedure, postprocedure, and 1-month after the procedure were performed. TP was classified into the five groups: (a) persistent, (b) progressive, (c) healed, (d) regressive, and (e) late-acquired. Immediately after the procedure, 100 TPs in 37 lesions (88%) were identified. Of those, 53 (53%) were persistent, 3 (3%) were progressive, 20 (20%) were healed, and 24 (24%) were regressed at 1-month follow-up. Seven TPs in five patients (13%) were observed only at 1-month follow-up (late-acquired). Conclusion In lesions with late-acquired TP, calcified nodule was identified as an underlying plaque morphology on preprocedural OCT. A serial OCT analysis found TP occurred not only immediately after DES implantation, but also 1-month after DES implantation.

Background: Recently, drug-eluting stents have been widely adopted rather than bare-metal stents in patients on chronic hemodialysis (HD) based on the extrapolation of data from patients on non-HD. However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after drug-eluting stent implantation.Methods and Results: We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after drug-eluting stent implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47% vs. 32%; P=0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82±0.49 vs. 0.97±0.45mm; PConclusion: ISR was observed in 74 lesions (22.4%). A small MLD, long LL and the use of rotational atherectomy were independent predictors of ISR after drug-eluting stent implantation in patients on HD. There was no significant difference in ISR rate between the first- and the second-generation drug-eluting stents.

Persistent goal-directed behaviours result in achievements in many fields. However, the underlying neural mechanisms of persistence and the methods that enhance the neuroplasticity underlying persistence, remain unclear. We here demonstrate that the structural properties of the frontal pole cortex (FPC) before tasks contain information that can classify Achievers and Non-achievers (goal-directed persistence) participating in three tasks that differ in time scale (hours to months) and task domains (cognitive, language, and motor learning). We also found that most Achievers exhibit experience-dependent neuroplastic changes in the FPC after completing language and motor learning tasks. Moreover, we confirmed that a coaching strategy that used subgoals modified goal-directed persistence and increased the likelihood of becoming an Achiever. Notably, we discovered that neuroplastic changes in the FPC were facilitated by the subgoal strategy, suggesting that goal-striving, using effective coaching, optimizes the FPC for goal persistence., Hosoda et al. study the neurobiological underpinnings of goal pursuit and persistence. They use MRI data and identify areas in the frontal pole cortex that could predict performance on various tasks. They also show that coaching results in neuroplastic remodeling that increases the likelihood of goal persistence.

Connections between the 1-excitation dynamics of spin lattices and quantum walks on graphs will be surveyed. Attention will be paid to perfect state transfer (PST) and fractional revival (FR) as well as to the role played by orthogonal polynomials in the study of these phenomena. Included is a discussion of the ordered Hamming scheme, its relation to multivariate Krawtchouk polynomials of the Tratnik type, the exploration of quantum walks on graphs of this association scheme and their projection to spin lattices with PST and FR.

The biorthogonal rational functions of the ${_3}F_2$ type on the uniform grid provide the simplest example of rational functions with bispectrality properties that are similar to those of classical orthogonal polynomials. These properties are described by three difference operators $X,Y,Z$ which are tridiagonal with respect to three distinct bases of the relevant finite-dimensional space. The pairwise commutators of the operators $X,Y,Z$ generate a quadratic algebra which is akin to the algebras of Askey-Wilson type attached to hypergeometric polynomials., Comment: 9 pages, to be published in Proc.Amer.Math.Soc

We define bi-infinite versions of four well-studied discrete integrable models, namely the ultra-discrete KdV equation, the discrete KdV equation, the ultra-discrete Toda equation, and the discrete Toda equation. For each equation, we show that there exists a unique solution to the initial value problem when the given data lies within a certain class, which includes the support of many shift ergodic measures. Our unified approach, which is also applicable to other integrable systems defined locally via lattice maps, involves the introduction of a path encoding (that is, a certain antiderivative) of the model configuration, for which we are able to describe the dynamics more generally than in previous work on finite size systems, periodic systems and semi-infinite systems. In particular, in each case we show that the behaviour of the system is characterized by a generalization of the classical 'Pitman's transformation' of reflection in the past maximum, which is well-known to probabilists. The picture presented here also provides a means to identify a natural 'carrier process' for configurations within the given class, and is convenient for checking that the systems we discuss are all-time reversible. Finally, we investigate links between the different systems, such as showing that bi-infinite all-time solutions for the ultra-discrete KdV (resp. Toda) equation may appear as ultra-discretizations of corresponding solutions for the discrete KdV (resp. Toda) equation.