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Francisco Bandeira,1 Merce Morral,2 Daniel Elies,2,3 Sergio Eguiza,2 Spyridoula Souki,2 Felicidad Manero,2 Jose L Güell2–4 1Cornea and External Disease Department, Federal University of São Paulo, São Paulo, Brazil; 2Cornea and Refractive Surgery Unit, Instituto Microcirugia Ocular, Barcelona, Spain; 3European School for Advanced Studies in Ophthalmology (ESASO), Lugano, Switzerland; 4Ophthalmology, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain Synopsis: Transitional toric intraocular lens (IOL) was developed to improve refractive outcomes in cataract surgery. We report refractive, vectorial outcomes, and stability of spherical equivalent over 12 months after implantation of this IOL.Purpose: To evaluate visual and refractive outcomes of a transitional conic toric intraocular lens (IOL) (Precizon®) for the correction of corneal astigmatism in patients undergoing cataract surgery.Setting: The Ocular Microsurgery Institute (IMO), a private practice in Barcelona, Spain.Design: This is a retrospective, non-randomized study.Methods: Retrospective chart review of 156 patients with preoperative regular corneal astigmatism >0.75 diopters (D) who underwent consecutive phacoemulsification and Precizon toric IOL implantation between January 2014 and December 2015 was performed. Two groups were divided according to attempted residual refraction: group 1 with emmetropia and group 2 with mild myopia for monovision. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were analyzed preoperatively and 3, 6, and 12 months postoperatively.Results: Precizon toric IOL was implanted in 97 eyes of 61 patients. Six months postoperatively, none of the eyes lost any line of CDVA. In all, 98% of the eyes were within ±1.00 D of attempted spherical correction. The mean preoperative keratometric cylinder was 1.92 ± 1.04 D (range 0.75–6.78), and the mean postoperative refractive cylinder was 0.77 ± 0.50 D (range 0–2.25), with 81% of the eyes with ≤1.00 D of residual cylinder. Two IOLs required realignment due to intraoperative positioning error. Eleven eyes required enhancement with corneal refractive surgery.Conclusion: Preexisting regular corneal astigmatism was effectively and safely corrected by the implantation of the transitional conic toric IOL in patients undergoing cataract surgery. Keywords: corneal astigmatism, refractive astigmatism, keratometry, cataract surgery, toric intraocular lens, biometry, phacoemulsification

Background: Atrial fibrillation (AF) may cause cerebral and systemic embolism. An increased D-dimer level indicates hyperactivation of secondary fibrinolysis, resulting in predilection for thrombosis. To clarify the differential effects of anticoagulation therapy, we compared the D-dimer levels in peripheral and left atrial (LA) blood of atrial fibrillation patients scheduled for ablation., Methods: We analyzed 141 patients with non-valvular AF (dabigatran, n = 30; apixaban, n = 47; edoxaban, n = 64; mean age: 68 years, male: 60%). Peripheral venous blood and LA blood was collected before pulmonary vein isolation. We examined the laboratory and echocardiographic parameters., Results: After adjusting for baseline characteristics, D-dimer level in the LA was significantly higher in patients treated with edoxaban than that in those on apixaban (0.77 ± 0.05 vs. 0.60 ± 0.05 μg/mL, P = 0.047), although there were no significant differences in peripheral D-dimer levels. We classified the D-dimer value of the LA into a normal group (< 0.9) and a high value group (≥ 1.0); the peripheral prothrombin fragment F1 + 2 level (odds ratio [OR] 1.012; 95% confidence interval [CI]: 1.003-1.022; P = 0.008) and left ventricular ejection fraction (LVEF) (OR, 0.947; 95% CI, 0.910-0.986; P = 0.008) were potential predictors of high LA D-dimer levels., Conclusions: In apixaban-treated patients, the D-dimer level in the left atrium was lower than in edoxaban-treated patients on the day of ablation, suggesting that the anticoagulant effect of apixaban on the left atrium is better than that of edoxaban in patients with AF., (© 2021. The Author(s).)

Purpose: To compare intracameral and topical mydriatics and anesthetics in cataract surgery., Setting: Institute of Ocular Microsurgery, Barcelona, Spain., Design: Phase IV, open-label, randomized, single-center study., Methods: Patients were randomized in a 1:1 ratio to receive intracameral mydriatic-anesthetic (Mydrane/Fydrane) and anesthetic eyedrops or control (topical eyedrops only). The other treatment was administered for the second cataract surgery. Assessments were performed at presurgery and immediately postsurgery, at 12 to 36 hours postsurgery (day 1), and 7 days postsurgery. The primary endpoint was the change from baseline in corneal/conjunctival surface staining. The secondary endpoints included assessments of epithelial alterations, point-spread function, ocular surface disease index, conjunctival hyperemia, vision breakup time, ocular symptoms/signs, adverse events (AEs), corrected distance visual acuity, intraocular pressure, patient/investigator satisfaction, and procedure time., Results: A total of 50 patients undergoing sequential cataract surgery in both eyes were included. Baseline assessments were similar in each group. The difference between Fydrane and control groups for the change from baseline at day 1 in corneal and conjunctival surface staining was not statistically significant. For Fydrane, postoperative epithelial alterations were fewer at day 1 (P < .005), folliculopapillary reaction was less frequent (P < .05), some ocular symptoms were less frequent and milder (P < .05), length of procedure was shorter (P < .001), and patient and investigator satisfaction were better (P < .05). There were few AEs in both groups., Conclusions: Fydrane reduced ocular surface damage by decreasing corneal epithelial and conjunctival toxicity with faster recovery of surface integrity compared with topical eyedrops, improved patient and investigator satisfaction, and reduced procedure time., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

We investigate the control of flow direction around a water vapor bubble using the thermoplasmonic effect of a gold nanoisland film (GNF) under laser irradiation with multiple spots. By focusing a laser spot on the GNF immersed in degassed water, a water vapor bubble with a diameter of ~10 μm is generated. Simultaneously, a sub laser spot was focused next to the bubble to yield a temperature gradient in the direction parallel to the GNF surface. Consequently, rapid flow was generated around the bubble, whose flow direction was dependent on the power of the sub laser spot. The observed flow was well-described using a stokeslet; the latter contained components normal and parallel to the GNF surface and was set to 10 μm above the GNF. This technique allows us to apply a significant force on the microfluid at the vicinity of the wall in the direction parallel to the wall surface, where the flow speed is generally suppressed by viscosity. It is expected to be useful for microfluidic pumping and microfluidic thermal management.

Vacuum-assisted closure(VAC) therapy is mainly used for tissue defects. VAC therapy can remove exudate that could impair the healing process. We applied VAC therapy in patients considered at high risk of surgical site infection who underwent cardiovascular surgery via standard median sternotomy. Risk factors included advanced heart failure, obesity, diabetes mellitus, steroid administration, immunosuppressant administration, and chronic renal failure, etc. VAC therapy was used in 134 patients. Only 3 of these patients (2.2%) developed surgical site infection caused by Staphylococcus epidermidis;2 patients fully recovered after prolonged VAC therapy for 2 weeks, and the other required an additional sternal fixation after the sternal wires were removed for wound infection control. No patient developed infective mediastinitis. Prophylactic VAC therapy can reduce postoperative wound infection in high risk patients undergoing open heart surgery via full sternotomy.

The orientation of nanomaterials with an anisotropic nature such as nanoscrolls is very important for realizing their efficient and sophisticated functions in devices, including nanostructured electrodes in artificial photosynthetic cells. In this study, we successfully synthesized a nanoscroll by intercalation of a cationic polyfluorinated surfactant into the interlayer spaces of layered niobate and successfully controlled its orientation by applying an external magnetic field in water. The exfoliated niobate nanosheets were efficiently rolled-up to form nanoscrolls, which have a fine layered structure (d020 = 3.64 nm), by mixing with heptafluorobutanoylaminoethylhexadecyldimethylammonium bromide (C3F-S) in water, whereas the corresponding hydrocarbon analogue (C3H-S) did not form nanoscrolls. The synthetic yield for the purified and isolated nanoscrolls from the nanosheets was estimated to be 62% by weight. It was confirmed by atomic force microscopy (AFM) that most of the niobate nanosheets (98%) were converted to nanoscrolls. An external magnetic field was applied to the nanoscrolls to force them to align. After the magnetic treatment, the orientation of the nanoscrolls was investigated by small angle X-ray scattering (SAXS) and transmission electron microscopy (TEM). The non-uniform ring distribution of the SAXS patterns indicates that the nanoscrolls dispersed in water were aligned well on applying the magnetic field. The long axis of the nanoscroll was oriented in the direction of the applied field and long nanoscrolls were aligned more efficiently. When the intercalated C3F-S molecules were removed from the nanoscrolls by treating with an acid, the resultant nanoscrolls did not exhibit magnetic alignment, strongly suggesting that C3F-S plays an important role in the orientation control of the nanoscrolls by the magnetic field.

The renal localization of gallium-67 or gallium-68 ((67/68)Ga)-labeled low molecular weight (LMW) probes such as peptides and antibody fragments constitutes a problem in targeted imaging. Wu et al. previously showed that (67)Ga-labeled S-2-(4-isothiocyanatobenzyl)-1,4,7-triazacyclononane-1,4,7-triacetic acid (SCN-Bz-NOTA)-conjugated methionine ((67)Ga-NOTA-Met) was rapidly excreted from the kidney in urine following lysosomal proteolysis of the parental (67)Ga-NOTA-Bz-SCN-disulfide-stabilized Fv fragment (Bioconjugate Chem., (1997) 8, 365-369). In the present study, a new (67/68)Ga-labeling reagent for LMW probes that liberates (67/68)Ga-NOTA-Met was designed, synthesized, and evaluated using longer-lived (67)Ga in order to reduce renal radioactivity levels. We employed a methionine-isoleucine (MI) dipeptide bond as the cleavable linkage. The amine residue of MI was coupled with SCN-Bz-NOTA for (67)Ga-labeling, while the carboxylic acid residue of MI was derivatized to maleimide for antibody conjugation in order to synthesize NOTA-MI-Mal. A Fab fragment of the anti-Her2 antibody was thiolated with iminothiolane, and NOTA-MI-Mal was conjugated with the antibody fragment by maleimide-thiol chemistry. The Fab fragment was also conjugated with SCN-Bz-NOTA (NOTA-Fab) for comparison. (67)Ga-NOTA-MI-Fab was obtained at radiochemical yields of over 95% and was stable in murine serum for 24 h. In the biodistribution study using normal mice, (67)Ga-NOTA-MI-Fab registered significantly lower renal radioactivity levels from 1 to 6 h postinjection than those of (67)Ga-NOTA-Fab. An analysis of urine samples obtained 6 h after the injection of (67)Ga-NOTA-MI-Fab showed that the majority of radioactivity was excreted as (67)Ga-NOTA-Met. In the biodistribution study using tumor-bearing mice, the tumor to kidney ratios of (67)Ga-NOTA-MI-Fab were 4 times higher (6 h postinjection) than those of (67)Ga-NOTA-Fab. Although further studies including the structure of radiometabolites and/or cleavable linkages are required, the results of the present study indicate that the current chemical design is applicable to the development of (67)Ga-labeled Fabs for low renal radioactivity levels.

Pilocytic astrocytoma (PA) is a neoplasia which is considered as a grade I astrocytoma by the World Health Organization (WHO). Its most common location is the cerebellum and it develops during the first two decades of life. Prognosis is mostly excellent if gross-total resection can be achieved, with 10-year survival rates of up to 95%. In rare cases, however, the patient has a bad outcome. Our aims were to retrospectively describe the clinicopathological features of 32 PAs, and identify factors that may be associated with aggressive behavior. The study included 21 males and 11 females with a median age of 10.5 years. Tumors demonstrated predilection for infratentorial location (74.9%), especially the cerebellum (59.3%), followed by cerebral ventricles (15.6%), supratentorial location (12.5%) and optic pathway (3.12%). Gross total resection was achieved in 14 tumors only. On histopathology, moderate cellularity (68.7%), microcystic changes (71.9%), Rosenthal fibers (62.5%) and eosinophilic granular bodies (53.2%) were present in the majority of cases. Atypia was present in 62.5% of cases, while endothelial proliferation and necrosis was noted in 3 and 2 cases, respectively. Median follow-up for all patients was 24 months. Four patients died in the postoperative period, one of whom was 62-year-old men and two others had brainstem location or invasion. Recurrence was observed in a 56-year-old patient whom first tumor was locally invasive. The patient died after the second surgery and anaplastic features was found in the recurrent tumor without previous radiotherapy. PA is a benign tumor, but some clinicopathological factors, such as partial resection, brainstem location and adult age have a worse prognosis., (Copyright © 2012 Elsevier B.V. All rights reserved.)

A 47-year-old female with a history of untreated hypertension and diabetes mellitus was referred because of a left ventricular echocardiographic mass with congestive heart failure. At the time of admission, she had already had a cardio-embolic stroke with loss of recent memory and slight paralysis of the right upper arm. It was difficult to distinguish between thrombus and tumor. However, her clinical condition required surgical resection as soon as possible. We performed cardiac CT to evaluate the coronary arteries and to scan the mass at the left ventricular apex. This CT evaluation revealed another mass at the left atrial appendage. Thus, these two masses were highly suggestive of thrombi. Subemergency surgical resection of the two masses and a part of the myocardium at the left ventricular apex was successfully performed. The pathological results showed that both the mass in the left ventricular apex and the mass in the left atrial appendage were thrombi, and the myocardial disarray confirmed the echocardiographic diagnosis as hypertrophic cardiomyopathy.

Background: The purpose of this study was to analyze the effect of valsartan on abnormal adipocyte metabolism and prothrombotic state in hypertensive patients with metabolic syndrome (MetS)., Methods and Results: We conducted a multicenter, prospective, randomized, parallel-group controlled trial in 150 hypertensive patients with MetS. They were randomly assigned to receive either 80-160 mg valsartan per day (valsartan group, n=79) or other conventional treatment without a renin-angiotensin system (RAS) inhibitor (non-RAS inhibitor group, n=71). After 1 year, there were no significant differences between the 2 groups in the changes in systolic and diastolic blood pressures (valsartan: 153±15/86±15 to 138±16/77±12 mmHg; non-RAS inhibitor: 150±14/82±15 to 137±15/76±10 mmHg). There was a significant difference in the change in the levels of plasminogen activator inhibitor-1 (PAI-1) between the 2 groups after 1 year (valsartan: 3.7±3.2 ng/ml; non-RAS inhibitor: 5.8±3.3 ng/ml, P=0.04). There was no significant difference between groups in the change in the concentration of adiponectin after 1 year (valsartan: 0.3±0.4 µg/ml; non-RAS inhibitor: 0.9±0.4 µg/ml, P=0.22). The animal study showed aortic PAI-1 protein expression was reduced in double knockout mice of angiotensin II type 1a receptor and apolipoprotein E (apoE) compared with the apoE knockout mice., Conclusions: Valsartan reduced plasma PAI-1 levels compared to non-RAS inhibitor in hypertensive patients with MetS, which suggests it may be useful for improving fibrinolytic function.

Objectives: The aim of this study was to determine whether 64-slice multidetector computed tomography (MDCT) can differentiate coronary reperfusion with Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 from TIMI flow grade ≤ 2 after ST-segment elevation myocardial infarction (STEMI)., Background: Multidetector computed tomography has become a popular modality for noninvasive coronary artery imaging. Recently, 64-slice MDCT has been applied to evaluate coronary arteries in acute coronary artery disease., Methods: The presence or absence of distal reperfusion in infarct-related arteries (IRA) was visualized with 64-slice MDCT during the acute phase in 87 non-high-risk patients after STEMI. To differentiate TIMI flow grade 3 from TIMI flow grade 2, we calculated the computed tomography (CT) number ratio by dividing the CT number of the contrast-enhanced coronary lumen at the most distal IRA by that at the proximal site to the culprit lesion in patients with reperfusion on MDCT. The MDCT findings were compared with TIMI flow grade with invasive coronary angiography (ICA) performed 20 ± 5 min later., Results: According to ICA, 58 patients had TIMI flow grade 0 or 1, 17 had TIMI flow grade 2, and 12 had TIMI flow grade 3, whereas distal reperfusion was evident on MDCT in 28 of the 29 patients with TIMI flow grade ≥ 2 and absent in 55 of the 58 with TIMI flow grade ≤ 1. The CT number ratio was significantly higher in TIMI flow grade 3 than in TIMI flow grade ≤ 2 (0.64 ± 0.11 vs. 0.37 ± 0.12; p < 0.0001). The sensitivity, specificity, and accuracy of a diagnosis of TIMI flow grade 3 on the basis of a CT number ratio of ≥ 0.54 that was an optimal cutoff value determined by receiver-operator characteristic curve analysis were 92%, 97%, and 97%, respectively., Conclusions: Visualization of the IRA by 64-slice MDCT enables noninvasive differentiation of angiographic TIMI flow grade 3 from TIMI flow grade ≤ 2 coronary reperfusion during the acute phase in patients with STEMI., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to test the hypothesis that the maximal temperature (Tmax) site, as measured by thermal wire, coincides with the culprit plaque by intravascular ultrasound (IVUS) in patients with acute myocardial infarction (AMI)., Background: Subsequent thrombosis developing to the proximal region from the site of plaque rupture or erosion can potentially complicate the ability of coronary angiography to identify the accurate culprit plaque in patients with coronary total occlusion., Methods: In 45 consecutive patients with a first anterior AMI, the Tmax site by thermal wire and the culprit plaque by IVUS were evaluated in the left anterior descending coronary artery (LAD)., Results: Twenty-five patients had LAD total occlusion, and the remaining 20 had LAD reperfusion. In both groups of patients, the Tmax site was significantly more distal to the angiographically most stenotic site or occlusive site (reperfusion: mean distance [MD] = 1.1 mm distal, 95% confidence interval [CI] 0.3 to 1.9 mm, p = 0.01; total occlusion: MD = 8.8 mm distal, 95% CI 8.0 to 9.6 mm, p < 0.0001). The culprit plaques by IVUS approximately coincided with those by angiography or thermal wire in patients with reperfusion. However, the angiographic occlusive site was significantly more proximal to the culprit plaque by IVUS (MD = 9.2 mm, 95% CI 7.9 to 10.6 mm, p < 0.0001), but the Tmax site coincided with the culprit plaque by IVUS (MD = 0.3 mm distal, 95% CI 0.3 mm proximal to 1.0 mm distal, p = 0.293) in patients with total occlusion., Conclusions: Temperature measurement of coronary plaque enables accurate localization of the culprit plaque in AMI with coronary total occlusion.

Background: The estimation of coronary reperfusion in acute myocardial infarction (AMI) is important. The left ventricular (LV) Tei index is a noninvasive and sensitive parameter expressing overall LV function. We hypothesized that patients without good coronary reperfusion have worse LV function with a higher or worse Tei index compared to those with good reperfusion., Methods and Results: In 85 patients with first anteroseptal AMI, without other cardiac lesions such as prior myocardial infarction, LV hypertrophy or valvular disease, the Tei index was measured using Doppler echocardiography immediately after patients' arrival to the hospital, and the Thrombolysis in Myocardial Infarction (TIMI) grade was evaluated through subsequent coronary angiography. The Tei index was significantly greater in patients who did not have TIMI score of 3 compared to those with a TIMI of 3 (0.60+/-0.13 vs 0.46+/-0.06, p<0.0001). A Tei index >0.50 as the criteria for the absence of TIMI 3 had the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 75, 86, 94, 54 and 78%, respectively., Conclusion: An increased Tei index suggests the absence of adequate coronary reperfusion in patients with first anterior AMI without other lesion.

Background: This study was designed to determine the utility of transthoracic Doppler echocardiography (TTDE) in evaluating angiographic Thrombolysis in Myocardial Infarction (TIMI) frame count as a quantitative index of coronary reperfusion in patients with anterior acute myocardial infarction (AMI) before mechanical reperfusion., Methods and Results: Color and pulsed TTDE was performed to evaluate distal left anterior descending coronary artery (LAD) reperfusion in 56 consecutive patients with a first anterior AMI before coronary intervention, and these findings were compared with the corrected TIMI frame count (cTFC) by subsequent angiography. Twenty-four of the 56 patients had LAD reperfusion (TIMI 2 or 3) by angiography. Visual antegrade distal LAD flow by color TTDE was detected in 21 of these 24 patients. In the 21 patients, diastolic peak velocity of the distal LAD flow by pulsed TTDE showed a significant correlation with cTFC by angiography (r = -0.74, p < 0.001). The diagnosis of high risk with angiographic cTFC >40 by distal LAD peak velocity <21 cm/s using TTDE had a sensitivity, specificity, and accuracy of 82%, 93%, and 91%, respectively., Conclusion: TTDE enables noninvasive and quantitative evaluation of distal LAD reperfusion in patients with anterior AMI in the acute phase before mechanical reperfusion.

The Rice varieties Araure 4 (A4) and Fonaiap 2000 (F2000) were grown in the glasshouse under natural sunlight and subjected to drought at heading. The drought induced changes in chlorophyll a fluorescence parameters, pigment composition, D1 contents and carbohydrate accumulation were investigated. Drought decreased phiPS II, FV'/FM' and qP, and increased qN in both varieties. F2000 had larger values of phiPS II and FV'/FM' at a lower RWC than A4. With the onset of drought only A4 increased the xanthophyll cycle pool, F2000 remaining constant throughout the drought cycle. Irrigated plants of A4 had a Larger de-epoxidation state (DEPS) of the xanthophyll cycle than F2000. A 40% increase in DEPS was induced by drought in both varieties but in A4 it was attained at a larger RWC than in F2000. Drought increased glucose and fructose contents of leaves 8-fold in A4 and 3-fold in F2000. Contrarily, sucrose contents decreased with drought but the effects were larger in A4 than in F2000. Sugars accumulation preceded and was proportional to the decrease in PS II activity elicited by drought in both varieties. In F2000 a decrease in D1 content smaller than 20% occurred at 70% of RWC, whereas droughted plants of A4 had lost 80% of D1 protein at 77% of RWC. Our data show that drought severely affected PS II activity and its main regulatory mechanisms in rice. There are genotypic differences in the response of PS II activity to drought that could be exploited as traits for selection to drought tolerance. There is a possible link between the drought-induced sugars accumulation in the flag leaf and the response of PS II to water deficit.

The aim of this study is to determine whether human herpesvirus 6 (HHV-6) and HHV-7 might play an important role in causing interstitial pneumonia in patients who have not undergone transplantation. HHV-6 and HHV-7 DNAs were quantitated by real-time polymerase chain reaction (PCR) in paraffin embedded lung tissues collected from 24 patients having the disease. Control tissues (without fibrosis) were also collected from 19 of the 24 patients. Statistical analysis was carried out by the Wilcoxon signed rank test or the Mann-Whitney U-test. HHV-6 DNA was detected in 3 (12.5%) of the 24 target tissues and 3 (15.8%) of the 19 control tissues, respectively. In contrast, HHV-7 DNA was detected in 19 (79.2%) of the 24 target tissues and 11 (57.9%) of the 19 control tissues. Neither HHV-6 DNA load (P = 0.6395) nor HHV-7 DNA load (P = 0.5966) in target tissues differed between males and females. Neither HHV-6 DNA load (P = 0.9589) nor HHV-7 DNA load (P = 0.7419) in target tissues differed between cases with and without underlying collagen disease. While HHV-6 DNA load did not differ between the target and control tissues (P > 0.9999), the HHV-7 DNA load was significantly higher in the target tissue than in the control tissue (P = 0.0298). This study suggests that HHV-7 may play an important role in causing interstitial pneumonia in patients who are not transplant recipients., (Copyright 2005 Wiley-Liss, Inc.)

Background: Tei index has been proposed as a noninvasive and simple index that enables the evaluation of global left ventricular (LV) function and prediction of patient prognosis. However, its use to predict complications with acute myocardial infarction (AMI) is not fully investigated. Therefore, the purpose of this study was to investigate whether or not LV Tei index allows noninvasive prediction of complications with AMI., Methods: In all, 80 consecutive patients with anteroseptal AMI were enrolled. LV Tei index was measured at the time of admission as (a - b)/ b , where a is the interval between cessation and onset of mitral filling flow and interval b is the aortic flow ejection time. Subsequent complications including cardiac death, shock, congestive heart failure, ventricular tachycardia/fibrillation, paroxysmal atrial fibrillation/flutter, advanced atrioventricular block requiring pacing, pericardial effusion, and LV aneurysm during the 30 days after the onset of AMI were prospectively evaluated and compared with the initial Tei index at admission., Results: Complications developed in 31 of 80 (39%) patients with AMI. The Tei index was significantly increased for patients with complications compared with those without them (0.69 +/- 0.16 vs 0.50 +/- 0.11, P < .0001). When Tei index > or = 0.59 was used for the criteria, the sensitivity, specificity, and overall accuracy to predict subsequent complications were 77%, 86%, and 85%, respectively., Conclusion: In patients with anteroseptal AMI, LV Tei index at arrival to the hospital in the acute phase allows noninvasive prediction of subsequent complications.

The reliability of varicella-zoster virus (VZV) loop-mediated isothermal amplification (LAMP) was evaluated for rapid diagnosis of viral infection. VZV-specific primers only amplified VZV DNA; no LAMP products were observed in reactions performed with other viral DNA templates. The specificity of this method was confirmed by two independent determinations, agarose gel electrophoresis and a turbidity assay. The sensitivity of VZV LAMP, determined by agarose gel electrophoresis, were 500 copies/tube. Detection using the turbidity assay, however, gave a sensitivity of 1,000 copies/tube. After these initial validation studies, reliability of VZV LAMP was evaluated for the detection of viral DNA in clinical specimens. Thirty-two swab samples collected from patients with vesicular skin eruptions were tested for VZV DNA. VZV was confirmed in sample numbers 10-32 by VZV real-time PCR, a previously established technique. VZV LAMP products were detected using turbidity from samples 13 to 32 (sensitivity; 87.0%, specificity; 100%, positive predictive value; 100%, negative predictive value; 75%). Although low levels of VZV DNA could be detected in the three samples exhibiting divergent results (samples numbers 10-12), no VZV LAMP product was detected in these samples, indicating a higher detection limit for this assay. Requirement of a DNA extraction step in the VZV LAMP method was examined in next experiment. The turbidity assay detected a VZV LAMP product in all of the 20 positive swab samples (samples numbers 13-32), regardless of DNA extraction., (2004 Wiley-Liss, Inc.)

Background: Transthoracic Doppler echocardiography (TTDE) enables evaluation of distal left anterior descending coronary artery (LAD) flow. The purpose of this study was to test whether TTDE can differentiate coronary reperfusion with Thrombolysis in Myocardial Infarction (TIMI) grade 3 from TIMI grade < or =2 in patients with anterior acute myocardial infarction (AMI)., Methods and Results: In 46 consecutive patients with a first anterior AMI in the acute phase before emergent coronary intervention, the presence of antegrade distal LAD flow and its diastolic peak velocity were evaluated by color and pulsed TTDE and compared with TIMI grades by subsequent coronary angiography performed 29+/-12 minutes later. Nineteen patients had TIMI 0 reperfusion, 4 had TIMI 1, 10 had TIMI 2, and 13 had TIMI 3. Visual antegrade distal LAD flow was present in 22 of the 46 patients. TIMI 2 and 3 reperfusions were both generally visualized by color TTDE. However, peak distal LAD flow velocity by pulsed TTDE was significantly greater in patients with TIMI 3 compared with those with TIMI 2 (40+/-10 vs 20+/-6 cm/s, P<0.0001). The diagnosis of TIMI 3 based on diastolic peak distal LAD flow velocity > or =25 cm/s by TTDE had a sensitivity, specificity, and accuracy of 77%, 94%, and 89%, respectively., Conclusions: TTDE enables noninvasive differentiation of TIMI 3 from TIMI < or =2 coronary reperfusion in patients with AMI in the acute phase before emergent coronary intervention.

The Doppler total ejection isovolume (Tei) index is useful for estimating global cardiac function. However, the relation between the right ventricular (RV) Tei index and RV infarction has not been investigated. The relation between the RV Tei index and severity of RV infarction was evaluated in 25 patients with inferior wall acute myocardial infarction (13 with and 12 without RV infarction). RV infarction was diagnosed when right atrial pressure was > or = 10 mm Hg or when right atrial pressure/pulmonary capillary wedge pressure was >0.8 by catheterization. The RV Tei index was significantly increased in patients with RV infarction compared with those without (0.53 +/- 0.15 vs 0.38 +/- 0.14, p <0.05). The RV Tei index in patients with severe RV infarction (right atrial pressure > or = 15 mm Hg) was significantly smaller compared with those with mild/moderate RV infarction (right atrial pressure <15 mm Hg) and showed no significant difference in patients with myocardial infarction but without RV infarction (0.44 +/- 0.09 vs 0.61 +/- 0.16 vs 0.38 +/- 0.14, severe RV infarction vs mild/moderate RV infarction vs no RV infarction, p <0.01). The RV Tei index is generally increased in patients with RV infarction; however, severe RV infarction can be manifested with limited or no increase in the Tei index (pseudonormalization).