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Aim The ONSTEP (Open New Simplified Totally Extraperitoneal) method is a new surgical procedure for inguinal hernia reported by Lourenço and da Costa from Portugal in 2013. We investigated the operative results and post operative course of the ONSTEP method in our department. Material & Methods Since January 2021, we performed the ONSTEP method for 36 patients who classified except for female and European Hernia Society (EHS) classification for inguinal hernia L3, and investigated patient's background, surgical procedure, and postoperative course. In addition, to investigate whether there were any differences in the simplicity and safety of this procedure between operators, we compared these points of the patients operated by Board Certified Surgeon in Gastroenterology (group A) or beginner (group B). Results The average height, weight and Body Mass Index of the patients was 165.9 cm, 60.6 kg, 22.1 respectively. The average operating time was 55.1 minutes, and the average blood loss was 7.0 g. 16 cases (44.4%) planned day surgery and performed it as planned, and the remaining 20 cases were discharged on the day after surgery as planned. Local swelling was observed in 19 patients (52.8%) one week after the operation, but all of them improved one month after the operation. All patients had no chronic pain or infection. There was no statistical difference between group A and B except for the average operating time (A: 50.3minutes, B: 69.4 minutes, p = 0.001). Conclusions The ONSTEP method is simple, highly safe, and expected to reduce chronic pain.

Although hypochloremia is strongly associated with adverse prognosis in acute heart failure (AHF), it is unknown whether incorporating hypochloremia into the preexisting risk model improves the model performance. We calculated the Get With The Guidelines-Heart Failure (GWTG-HF) risk score in 1,428 patients with AHF (derivation cohort) and developed 2 risk scores incorporating brain natriuretic peptide (BNP) into the GWTG-HF risk score (GWTG-BNP risk score) and incorporating both BNP and hypochloremia (GWTG-BNP-Cl risk score). Hypochloremia was defined as

Background Hereditary transthyretin-mediated (hATTR) amyloidosis, also known as ATTRv amyloidosis, is a rapidly progressive, multisystem disease. Orthostatic hypotension, due to autonomic neuropathy, is a common yet hard-to-treat disease manifestation in patients with hATTR amyloidosis. Fatigue, muscle weakness, and deterioration in cardiac function further exacerbate orthostatic symptoms. Efficacy of RNAi therapeutics patisiran and vutrisiran was assessed in patients with hATTR amyloidosis with polyneuropathy across the APOLLO (NCT01960348), Global Open-Label Extension (OLE) (NCT02510261), and HELIOS-A (NCT03759379) studies, respectively. Purpose Evaluate the quantitative effect of patisiran and vutrisiran on orthostatic hypotension in patients with hATTR amyloidosis with polyneuropathy. Methods In APOLLO, patients were randomised 2:1 to patisiran 0.3 mg/kg or placebo, IV q3w. Patients who completed APOLLO (APOLLO-placebo, APOLLO-patisiran) were eligible to enrol into the ongoing Global OLE (patisiran 0.3 mg/kg IV q3w). In HELIOS-A, patients were randomised 3:1 to vutrisiran (25 mg SC q3m) or patisiran (0.3 mg/kg IV q3w; reference group). Primary endpoint for APOLLO and HELIOS-A was change from baseline in the modified Neuropathy Impairment Score+7 (mNIS+7) vs APOLLO placebo at M18 (APOLLO) and M9 (HELIOS-A). Orthostatic hypotension was evaluated using the postural blood pressure (PBP) component of mNIS+7, calculated as the mean of 2 supine readings of systolic BP [SBP, mmHg] taken 15 min apart minus the lowest SBP upon standing at 1, 3, and 5 min. A smaller reduction in observed SBP between supine and upright readings indicated an improved PBP. Results APOLLO enrolled 225 patients (placebo, n=77; patisiran, n=148), Global OLE 211 and HELIOS-A 164 (vutrisiran, n=122; patisiran, n=42). At baseline, the severity of orthostatic hypotension was similar between within-study treatment arms in APOLLO and HELIOS-A. In APOLLO, patisiran-treated patients showed PBP improvement or stabilization from baseline to M18 (mean [SD] change in SBP: baseline, −17.6 [19.4]; M18, −13.5 [16.8]) and was maintained at Global OLE 36m (−13.4 [15.6]). In contrast, placebo-treated patients in APOLLO had an increased change in PBP over 18m (baseline, −17.5 [16.5]; M18, −20.4 [16.9]); their PBP improved after patisiran initiation (Global OLE 36m, −16.6 [18.1]). In HELIOS-A, stabilization in PBP was observed in the vutrisiran arm (baseline, −11.2 [14.0], M18, −11.7 [14.6]). In the smaller patisiran arm, while the change in PBP increased, the value remained in the normal range (baseline, −11.6 [17.2]; M18, −14.2 [15.5]). Patisiran and vutrisiran have acceptable safety profiles. Conclusions PBP analyses quantify the benefits of RNAi therapeutics patisiran and vutrisiran on autonomic function in patients with hATTR amyloidosis with polyneuropathy. The increase in change in PBP to a symptomatic range without treatment indicates the importance of early intervention. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Alnylam Pharmaceuticals

Background Although risk stratification is important in patients with acute heart failure (AHF) to predict patient prognosis, pre-existing risk models have not often been used due to its complexity. Recently, machine learning methods have been presented as an alternative approach to analyzing the predictive probability of large clinical datasets. Purpose The aim of this study is to develop a user-friendly risk score developed by one of machine learning methods and compare the performance of the new risk score to the existing conventional risk models. Methods A machine-learning-based risk model was developed using least absolute shrinkage and selection operator (LASSO) regression by identifying predictors of in-hospital mortality in the derivation cohort (REALITY-AHF) and externally validating and comparing its performance with two pre-existing risk models: the Get With The Guidelines risk score incorporating brain natriuretic peptide and hypochloremia (GWTG-BNP-Cl-RS) and the acute decompensated heart failure national registry (ADHERE) risk model. Results In-hospital deaths in the derivation and validation (NARA-HF) cohorts were 76 (5.1%) and 61 (4.9%), respectively. The risk score comprised four variables (systolic blood pressure, blood urea nitrogen, serum chloride, and C-reactive protein) and was developed according to the results of the LASSO regression weighting the coefficient for selected variables using a logistic regression model (4V-RS). Even though 4V-RS comprised fewer variables, In the validation cohort, it showed a higher area under the receiver operating characteristic curve (AUC) than the ADHERE risk model (AUC, 0.783 vs. 0.740; P=0.059) and a significant improvement in net reclassification (0.359; 95% CI, 0.10–0.67; p=0.006). 4V-RS performed similarly to GWTG-BNP-Cl-RS in terms of discrimination (AUC, 0.783 vs. 0.759; p=0.426) and net reclassification (0.176; 95% CI, −0.08–0.43; p=0.178). Conclusions The 4V-RS model comprising only four readily available data points at the time of admission performed similarly to the more complex pre-existing risk model in patients with AHF. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cardiovascular Research Fund

Background In heart failure with reduced ejection fraction (HFrEF), drugs including angiotensin-converting enzyme inhibitors (ACEi)/ angiotensin receptor blockers (ARB), beta-blockers, and mineralocorticoid receptor antagonists (MRA) have been shown to have robust survival benefits. However, these guideline-recommended therapies remain underutilized in clinical practice. Frailty is common in HFrEF and may lead to underprescription of life-saving therapy. Purpose We aimed to investigate the association between physical frailty and the use of evidence-based pharmacological therapy for HFrEF, and the impact of this on prognosis Methods The FLAGSHIP study included patients hospitalized for acute HF and data on physical frailty were collected prospectively. Of the total 3,272 patients registered in the FLAGSHIP study, 1,041 HFrEF patients (70 years; 73% male) with left ventricular ejection fraction ≤40% were analyzed and were divided into 4 groups by severity of frailty: category I (n=371) [least frail], II (n=275), III (n=224), and IV (n=171) [most frail]. Results An ACEi/ARB was prescribed in 76% of category I and 53% of category IV patients; for a beta-blocker these proportions were 94% and 76%, respectively; for an MRA they were 55% and 46%, respectively. The proportion of patients using receiving all 3 drugs decreased as frailty increased, with approximately twice the rate of use of triple therapy in category I patients (40.2%) compared to category IV patients (23.4%) [p Conclusions Prescription of guideline-recommended therapy decreased as the severity of frailty increased in patients with HFrEF. Sub-optimal medical therapy was associated with a worse outcome and underprescription of guideline-recommended therapy may contribute to the poor prognosis associated with frailty. An effective strategy is needed to improve the medical treatment of frail patients with HFrEF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study issupported by a Grant-in-Aid for Scientifi c Research (A) from the Japan Society for the Promotion of Science (16H01862). ToruKondo receives grants from the Uehara Memorial Foundation and the Japanese Heart Failure Society Tsuchiya Foundation forthe research activities at the University of Glasgow.

The present research aimed to investigate the effect of ethylene on the physiological and molecular responses of the cut roses, Rosa hybrida L. Two cut rose cultivars (‘Amada +’ and ‘Brillante’) with different ethylene sensitivity were treated by 10 ppm exogenous ethylene for 24 h under identical vase life room conditions at partially open stage. The cultivars were then examined at both partially and fully open stage by gas chromatography, UV/Vis spectroscopy, and qRT-PCR. The cultivar with high sensitivity had lower total protein contents and showed higher ethylene production and antioxidant activity. Either exogenously applied ethylene or endogenously produced one resulted in increased antioxidant activity and decreased total protein contents. This observation is possibly because of enhanced free radical generation and protease activation with ethylene-induced flower opening and senescence. The qRT-PCR analysis showed a significant increase in the expression of ethylene signal transduction genes (RhETR1,3 and RhCTR1,2) of the treated cultivars with high sensitivity at commercial stage. However, there was a significant up-regulation of the RhETR1,3 genes in the cultivars with low sensitivity at fully-open stage. The ethylene induced responses were found highly dependent on the cultivar ability in both ethylene synthesis and perception.

Funding Acknowledgements Type of funding sources: None. Background The HATCH score is employed as a risk assessment tool for atrial fibrillation (AF) development. However, the impact of the HATCH score on the long-term adverse outcomes in patients with acute heart failure (AHF) is unknown. Aimes To investigate the clinical value of the HATCH score in AHF. Methods From a multicenter AHF registry, we retrospectively evaluated 1,543 consecutive patients admitted with AHF (median age, 78 [69–85] years; 42.3% women) from 2012 to 2019. These patients were divided into five groups based on their HATCH score at admission (scores 0, 1, 2, 3, and 4–7). The correlation between the HATCH score and composite outcome, including all-cause mortality and re-hospitalization due to HF, was analyzed using Kaplan-Meier and Cox proportional-hazard analyses. Results The median HATCH score was 2 [1-3]. During the follow-up period (median, 16.8 months), the composite endpoint occurred in 691 patients (44.8%), including 416 (27%) patients who died and 455 (29.5%) patients requiring re-hospitalizations due to HF. The Kaplan-Meier analysis showed a significant increase in the composite endpoint with increasing HATCH score (log-rank, p Conclusions The HATCH score is an independent predictor of adverse outcomes in patients with AHF. Abstract Figure. Kaplan-Meier analysis for outcome

Background The spleen is an important organ that stores blood, releases erythrocytes or monocytes, and destroys no-longer-needed platelets. It can reserve 20–30% of the total blood volume, and its size is reduced in hypovolemic shock. However, the clinical significance of the spleen size in patients with heart failure (HF) remains unclear. Purpose The purpose of this study was to investigate the relationship between spleen size, hemodynamic parameters, and prognosis in patients with HF. Methods A total of 219 patients with clinically stable HF were enrolled. All patients underwent right heart catheterisation and computed tomography. The spleen size was measured using computed tomography volumetry. In addition, spleen volume was assessed using the spleen volume index (SVI), corrected for body surface area. Cardiac events were composite endpoints of cardiac death, hospitalisation for worsening HF, fatal arrhythmias, implantation of cardiac devices, implantation of left ventricular assist devices, and unexpected percutaneous coronary intervention or cardiac surgery. Spearman's rank correlation coefficient was used to examine the relationship between spleen volume and hemodynamic parameters. Multivariate Cox hazard regression models were used to investigate whether SVI was an independent determinant of cardiac events. Results Of the 219 patients (median age, 54 [interquartile range] 46–64 years), 145 (66%) were males. The median (interquartile range) spleen volume and SVI was 118.0 (91.5–156.0) mL and 67.8 (54.9–87.2) mL/m2, respectively. SVI was positively correlated with cardiac output (r=0.269, P Conclusion The spleen size may affect the prognosis in patients with HF, reflecting haemodynamics, including systemic circulating blood volume status and sympathetic nerve activity. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Background Left ventricular reverse remodeling (LVRR) is an important predictor for a good prognosis in patients with dilated cardiomyopathy (DCM). Previous reports indicated the pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) ratio as a predictor of adverse outcomes in heart failure patients. However, the impact of the PAD/AoD ratio for predicting LVRR in patients with DCM is unknown. Aim The aim of this study is to investigate the association between PAD/AoD ratio and LVRR in patients with DCM. Methods From a prospective study, clinically stable DCM patients who were investigated the LVRR on echocardiography and underwent CT at baseline were enrolled. LVRR is defined as left ventricular (LV) ejection fraction increase of 10% and a decrease in indexed LV end-diastolic diameter of 10% compared to those at baseline. PAD and AoD data was collected with nonenhanced computed tomography images at baseline. Results In sixty-nine patients (mean age 50.0±13.3 years), the mean LV ejection fraction was 29.8%, and mean LV end-diastolic dimension was 64.5mm, and both of which data was no significant difference between patients with or without LVRR. LVRR was observed in 23 (33.3%) patients. The PAD/AoD ratio was significantly lower in patients with LVRR than without LVRR (81.4% vs. 92.4%, p=0.003). By ROC analysis, the best cut-off for the detection of LVRR was found for a PAD/AoD ratio of 0.9. From multivariate analyses, PAD/AoD ratio was identified as a significant predictor of LVRR. After a median follow-up duration of 2.5 years, the DCM patients with PAD/AoD≥0.9 revealed a significant higher cardiac event than those with PAD/AoD Conclusions The PAD/AoD ratio is useful for predicting LVRR in patients with DCM. The DCM patients with high PAD/AoD ratio had a poor long-term outcome. Funding Acknowledgement Type of funding sources: None. ROC curve for LVRR predictionKaplan-Meier survival curves

Background Autotaxin (ATX) has been reported to promote myocardial inflammation and subsequent cardiac remodeling through lysophosphatidic acid (LPA) production. However, the prognostic impact of ATX has not been clarified in dilated cardiomyopathy (DCM). Purpose We aimed to investigate the prognostic impact of ATX in patients with DCM. Methods We enrolled 104 DCM patients (49.8 years, 76 males). The subjects underwent blood sampling, echocardiography, cardiac catheterization, and endomyocardial biopsy. Gender differences in serum ATX levels have been reported, thus we divided the subjects into two groups using median serum ATX levels for men and women: High-ATX group and Low-ATX group. All patients were followed up by expert cardiologists. The cardiac event was defined as a composite of cardiac death and hospitalization for worsening heart failure. Results Eighty-nine percent of the subjects were classified as New York Heart Association functional class I or II. Female patients had higher serum ATX levels than male patients, with median values of 257.0 ng/mL and 203.5 ng/mL, respectively (Figure A). The average left ventricular ejection fraction and brain natriuretic peptide levels were 30.6% and 122.5 pg/mL. In survival analysis, cumulative event-free probability was significantly lower in High ATX group (p=0.007, Figure B). In Cox proportional hazards analysis, High-ATX was one of the independent predictors of composite cardiac events (Hazards Ratio, 2.575; p=0.043). On the other hand, high sensitive C-reactive protein and collagen volume fraction in myocardial samples were not significant predictors. Conclusion High serum ATX level was associated with poor prognosis in patients with DCM. Funding Acknowledgement Type of funding sources: None. Gender difference in autotaxin levelsSurvival analysis of cardiac events

We report here hourly variations of Mg/Ca, Sr/Ca and Ba/Ca ratios in a Mediterranean mussel shell (Mytilus galloprovincialis) collected at the Otsuchi bay, on the Pacific coast of northeastern Japan. This bivalve was living in the intertidal zone, where such organisms are known to form a daily or bidaily growth line comprised of abundant organic matter. Mg/Ca ratios of the inner surface of the outer shell layer, corresponding to the most recent date, show cyclic changes at 25-90 mm intervals, while no valuable variations are observed in Sr/Ca and Ba/Ca ratios. High Mg/Ca ratios were probably established when the bivalve was located at low tide with a reduced supply of Ca from seawater. Immediately following the great tsunami induced by the 2011 Tohoku earthquake, Mg/Ca enrichment occurred, up to 10 times that of normal low tide, while apparent Ba/Ca enrichment was observed for only a few days following the event, implementing a proxy of the past tsunami. Following the tsunami, periodic peaks and troughs in Mg/Ca continued, perhaps due to a biological memory effect as an endogenous clock.

Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB. © 2021 Elsevier Inc. and Journal of Cardiac Failure. [Published by Elsevier Inc.] All rights reserved.

Bowel wall enhancement on CT imaging is considered one of the useful features for the prediction of the presence of irreversible ischemic change in patients with small bowel obstruction. However, the applicability of CT imaging in patients with incarcerated hernias has not been investigated in detail. The aim of this retrospective study was to evaluate the feasibility of preoperative CT findings for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.Included in this study were 76 patients who underwent surgery for preoperatively diagnosed incarcerated hernias containing small bowel (27 inguinal hernias, 37 femoral hernias and 12 obturator hernias) at our hospital between January 2011 and June 2020. The preoperative clinicoradiological features were compared between the groups, and predictors for intestinal resection were evaluated.Nineteen patients required intestinal resection (Resection group), and the other 57 patients did not require intestinal resection (Nonresection group). Multivariate analyses revealed that age ≥ 80 years (p = 0.018, odds ratio = 6.604) and the absence of bowel wall enhancement (p = 0.032, odds ratio = 51.200) were independent predictors for intestinal resection. In resected specimens, all patients with an absence of bowel wall enhancement on preoperative enhanced CT had ischemic changes extending beyond the muscularis propria.Preoperative enhancement CT yields useful information for the prediction of the presence of irreversible ischemic change in patients with incarcerated hernias containing small bowel.

Background Fulminant myocarditis (FM) is a form of acute myocarditis characterized by severe left ventricular (LV) dysfunction requiring inotropes and/or mechanical circulatory support. Based on a retrospective single-center study published in 2000, patients with FM were considered to have better outcomes than those affected by acute non-fulminant myocarditis (NFM) presenting with LV systolic dysfunction (LVSD). Recently, this tenet was challenged, though substantial disagreement still exists. Purpose Aim of the present study is to provide additional evidence on the outcome of FM and to ascertain if patient stratification based on the main histologic subtypes can provide additional prognostic information. Methods Two hundred and twenty patients (median age 42 years, 46.3% female) with histologically proven acute myocarditis (onset of symptoms Results Patients with FM (N=165) had significantly higher rates of cardiac death and HTx compared with those with NFM (N=55), both at 60 days (28.0% vs. 1.8%, p=0.0001) and at 7-year follow up (47.7% vs. 10.4%, p Outcome of FM vs NFM Conclusions The results of this international registry confirm that patients with FM have higher rates of cardiac death and HTx both in the short and long-term compared with patients with NFM. Furthermore, we provide evidence that the histologic subtype of FM carries independent prognostic value, highlighting the need for timely endomyocardial biopsy in this condition. Acknowledgement/Funding None

Background Coronary artery disease is a major cause of heart failure (HF). Urgent coronary angiography (CAG) is recommended for patients with acute HF (AHF) complicated with acute coronary syndrome (ACS); however, clinical usefulness of in-hospital CAG in AHF patients without ACS remains unknown. Purpose To investigate the association between in-hospital CAG and all-cause mortality at 1-year after hospital discharge and effects of medications at discharge on this association. Methods From the REALITY-AHF study, 1344 patients hospitalized with AHF were enrolled in this study and followed up for 1-year after hospital discharge. Results In-hospital CAG was undergone in 511 patients (38%). CAG group had a significantly lower 1-year mortality compared with non-CAG group (unadjusted hazard ratio [HR]; 0.30, 95%-confidence interval [CI] 0.21–0.43, P CAG results, medications and mortality Conclusions In patients hospitalized with AHF, in-hospital CAG was associated with increased evidence based medications at discharge and a better long-term survival. Aspirin and statins at discharge might improve outcomes in AHF patients with multivessel disease. Acknowledgement/Funding This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.

Background Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated. Methods The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality. Results Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p Conclusion Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF. Acknowledgement/Funding This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.

Background and purpose Fluorine-18-flurodeoxyglucose positron emission computed tomography (18FDG-PET CT) is the sole but time-consuming and expensive examination assessing active inflammatory myocardium noninvasively in patients with cardiac sarcoidosis (CS). Though immunosuppression is used to treat CS, little is known about the cardiac biomarkers for determining therapeutic effect to immunosuppression therapy other than 18FDG-PET. Methods From Aug 2016, we prospectively enrolled 50 sarcoidosis patients with positively accumulated of FDG in the heart. The initial dose of prednisolone was 30mg/day, wherefrom the dose was tapered down 5mg/month until 6 months. After 6 months, follow-up 18FDG-PET was performed. Using 18FDG-PET images, we calculated total lesion glycolysis (TLG; SUVmeam x metabolic volume) and compared it to various cardiac markers. Non-responder was defined as TLG reduction rate Results In 50 CS patients, 41 patients had serial 18FDG-PET before and 6 months after immunosuppression therapy. 18FDG-PET images were acquired following 7 day's carbohydrate limitation and after at least 18-h fasting (mean free fatty acid level right before 18FDG-PET acquisition was 1.03 mEq/L). The mean age and plasma brain natriuretic peptide (BNP) level were 61.9 years old, 184 pg/mL at baseline, respectively. Because of immunosuppression therapy, TLG was significantly reduced from 195.3 (38.6–339.6) to 1.1 (0.01–7.37), p Figure 1 Conclusions 1) By immunosuppression therapy using prednisolone for CS, about 85% patients showed significant reduction of increased myocardial FDG accumulation. 2) The sustained high level of serum TnT at post 6 months therapy indicates persistent inflammation of sarcoidosis in the heart, which could be an expedient marker for determining therapeutic effect.

Background Myofibroblasts, which are activated fibroblasts, play an important role in interstitial fibrosis in non-ischemic dilated cardiomyopathy (NIDCM). Recently, human epididymal body protein 4 (HE4) has attracted attention as a marker specific to myofibroblasts. However, the prognostic impact of HE-4 on cardiovascular events in NIDCM patients has not been reported. Purposes The purpose of this study was to investigate the impact of circulating serum HE4 on the prognosis in patients with NIDCM. Methods Forty-four NIDCM patients underwent echocardiography, laboratory measurements, cardiac catheterization, and endomyocardial biopsy within one week under stable heart failure condition. Patients with cancer were excluded from this study. We collected blood samples from peripheral vain, ascending aorta, and coronary sinus during cardiac catheterization and measured serum HE4 level. They were divided into two groups at the median of HE4 level: High-HE4 group (HE4 >69 pmol/L); n=22, Low-HE4 group (HE4 Results The mean age, left ventricular ejection fraction (LVEF), and plasma brain natriuretic peptide level were 56 years, 32%, and 205 pg/mL. Between two groups, there were no significant differences in age, gender, LVEF, left ventricular end-diastolic diameter, cardiac index, and pulmonary capillary wedge pressure. However, estimated glomerular filtration rate was significantly lower in the High-HE4 group (p=0.025). Kaplan-Meier survival analysis revealed that the High-HE group had a higher rate of cardiac composite event (p=0.011, see Figure). However, as for the pathological analysis, not only the peripheral HE4 level but also HE4 value subtracting coronary sinus from ascending aorta did not significantly correlate with collagen volume fraction in biopsy samples. Circulating HE4 level and prognosis Conclusion Elevated circulating HE4 is associcated with poor prognosis in ambulatory patients with NIDCM.

SummaryPresent knowledge of the structure and function of platelet glycocalicin is reviewed. Glycocalicin (M,. 150,000) is a glycoprotein component of the outer surface of intact platelets which is released in soluble form following platelet homogenization. Glycocalicin has been purified and shown to inhibit platelet aggregation induced by thrombin or by ristocetin. Thrombin binding activity is associated with the peptide “tail” of the molecule (Mr 45,000), the macroglycopeptide portion (Mr 120,000) being without effect. Glycocalicin and membrane-bound glycoprotein I have been shown to be functionally and immunologically identical. Studies with platelets modified by chymotrypsin, and with platelets from patients with Bemard-Soulier disease and an ill-defined bleeding abnormality show that the amount of thrombin bound is proportional to the total amount of glycocalicin and glycoprotein I present. These results support the concept of a single class of binding site for thrombin in platelets.

Grapiprant is an analgesic and anti-inflammatory drug in the piprant class that was approved in March 2016 by FDA's Center for Veterinary Medicine for the control of pain and inflammation associated with osteoarthritis (OA) in dogs. Grapiprant functions as a selective antagonist of the EP4 receptor, one of the four prostaglandin E2 (PGE2) receptor subtypes. The EP4 receptor mediates PGE2-elicited nociception, and grapiprant has been shown to decrease pain in several rat inflammatory pain models. It was also effective in reducing pain associated with OA in humans, providing evidence for its mechanism of action in these species. The estimated canine efficacy dose of between 1.3 and 1.7 mg/kg, p.o. with a methylcellulose suspension, once a day, was predicted based on calculations from comparative affinity of grapiprant to the dog, rat, and human EP4 receptors, serum protein binding, effective doses defined in rat models of pain and inflammation, and human clinical studies. The results of this study guided the doses to be tested in the pilot study and demonstrated the usefulness of the efficacy dose prediction method. The approved commercial tablet dose of grapiprant is 2 mg/kg once a day for the control of pain and inflammation associated with OA in dogs.

Quartz grains from the Ries impact structure containing shock-induced microstructures were investigated using Scanning Electron Microscopy in cathodoluminescence (SEM-CL), secondary electron (SEM-SE) and back-scattered electron (SEM-BSE) modes as well as Mott–Seitz analysis. The purpose of this study is to evaluate the mechanism by which CL detects Planar Deformation Features (PDFs) in quartz, which is one of the most important indicators of shock metamorphism in rock-forming minerals. PDFs are micron-scale features not easily identified using optical microscopy or scanning electron microscopy. The CL spectrum of PDFs in quartz that has suffered relatively high shock pressure shows no or a relatively weak emission band at around 385 nm, whereas an emission band with a maximum near 650 nm is observed independent of shock pressure. Thus, the ~385 nm intensity in shocked quartz demonstrates a tendency to decrease with increasing shock metamorphic stage, whereas the 650 nm band remains fairly constant. The re...

The feasibility and potential advantages of laparoscopic diagnosis and repair of incarcerated obturator hernia (OH) is debated. The aim of this retrospective study was to compare short-term complications comparing laparoscopic to open repair of OH. A total of 29 preoperatively diagnosed patients underwent surgery for a preoperatively diagnosed OH between January 2006 and July 2017. The patients were divided into a laparoscopic group (11 patients underwent laparoscopic repair; 8 without and 3 with intestinal resection) and an open group (18 patients who underwent open repair; 9 without and 9 with intestinal resection).The outcomes were compared between groups. A risk factor analysis for postoperative complications was performed. The incidence of postoperative complications was fewer in the laparoscopic group [9.0% vs. 61.1%; (p

An absolute total cross-section for electron scattering from O2 is obtained in the energy range from 20 eV down to 16 meV with a very narrow electron energy width of 7 meV, using the threshold-photoelectron source employing synchrotron radiation. The total cross-section obtained in the present study generally agrees well with those obtained in previous experimental works in the energy region where the previous experimental total cross-sections agree with each other. At lower energies, several features are found, including the very large contribution of the resonance to the total cross-section. The resonance energies and the resonance widths of the individual vibrational states of the resonance are determined from the analysis of the measured absolute total cross-section. The resonance width of the resonance of O2 is found to be much narrower than the value estimated from previous high-resolution experiments and theoretical calculations.

The 16C nucleus has been investigated by the neutron knockout reaction of 17C on a liquid hydrogen target. Applying the invariant mass method in inverse kinematics and γ-ray spectroscopy, the energy spectrum was reconstructed by triple-coincidence measurement, in which neutrons, charged fragments, and γ rays from the decay of the reaction residue (16C*) were detected. A peak at 0.47 MeV was observed in the invariant mass spectrum in coincidence with a peak at 0.74 MeV in the γ-ray spectrum, which indicates the presence of an unbound state with an excitation energy of 5.46 MeV. Comparison of the experimental cross section with the value derived by a theoretical calculation provided evidence that the spin-parity of this state is 2−.

In this paper, we propose a coaxial-fed circular dipole array in a borehole (CFCAB) for directional borehole radar and present a design method for the CFCAB. In the CFCAB, a circular dipole array is arranged around a conducting cylinder. When a wave is incident on the antenna, we may divide the signals received at the antenna into two components. One is caused by the waves arriving at the antenna directly, and the other is due to the waves scattered at the conducting cylinder. We proposed a criterion to quantify the influence of the conducting cylinder on the radar measurement. We show results of experiments in air and in granite to examine the validity of the criterion. Making use of the criterion, we designed and built the directional borehole radar system with the CFCAB working at around 200 MHz. Conducting the field experiments in granite, we confirmed that the CFCAB can estimate the directions of arrival waves on the time-frequency plane, as we expected with the criterion.

The timing of partial melting and the pressure–temperature ( P–T ) paths in the High Himalayan Crystalline Sequence (HHCS) in far-eastern Nepal has been investigated using zircon chronology, rare earth element (REE) compositions, and P–T pseudosection analysis. Zircon from migmatites formed during Himalayan thermal events displays inherited magmatic core overgrown by two generations of metamorphic rims. The new rims are distinguished on the basis of their Tertiary ages, low MREE contents, and low Th/U ratios. The inner zircon rims from Sil + Grt + Bt + Kfs + Pl + Qtz and Ky + Sil + Grt + Bt + Ms + Pl + Qtz migmatites at different structural level of the HHCS display ages of c. 33–28 Ma (Early Oligocene) and c. 21–18 Ma (Early Miocene): these rims are characterized by flat MREE to HREE patterns and were overgrown by partial melt through muscovite dehydration melting under the stability of garnet, which occurred at P = c. 7–10 kbar and T = c. 730–780 °C, and at P = c. 8–14 kbar and T = c. 720–770 °C, respectively. The outer zircon rims are relatively enriched in HREE with respect to the inner rims and were overgrown at c. 27–23 Ma (Late Oligocene) and at c. 18–16 Ma (Early Miocene) during melt crystallization accompanying breakdown of garnet at P = c. 4–7 kbar and T = c. 650–725 °C. Early Miocene Ms–Bt leucogranites with two successively overgrown zircon rims at c. 18.3 ± 0.3 Ma and c. 16.3 ± 0.2 Ma were intruded into Early Oligocene migmatite hosts. Microstructural observations and the corresponding P–T conditions associated with the two generations of zircon rims indicate that the Early Oligocene and Early Miocene migmatites show relatively isobaric and nearly isothermal P–T paths during exhumation, respectively. The inferences are consistent with higher average cooling rates for the Early Miocene ( c. 30–40 °C/My) than the Early Oligocene ( c. 15–25 °C/My) migmatites, inferred from peak- T conditions and FT ( c. 6 Ma for both migmatites) and U–Pb zircon ages. The P–T–t paths of the two migmatites indicate that burial of the Early Miocene migmatites has been coeval with exhumation of the Early Oligocene migmatites, implying the formation of large-scale thrust within the HHCS.

We discovered superconductivity in BaCu x Si2- x (0.2 ≤ x ≤ 0.6) with the maximum T c of 3 K. The synthesized samples have AlB2-type structure. We measured the physical properties of BaCu0.3Si1.7 in the superconducting state as functions of temperature and magnetic field. Magnetization vs. magnetic field ( M – H ) curves show typical type-II superconducting behavior. Superconducting parameters H c1(0), H c2(0), λ(0), ξ(0), and κ GL are determined to be about 20 Oe, 22 kOe, 570 nm, 12 nm, and 48, respectively. Lattice constants a and c and the T c value depend on Cu concentration, x , T c decreases with increasing x .

Shocked quartz grains from the Ries impact structure containing planar microstructures such as Planar Deformation Features (PDFs) were characterized by using micro-Raman spectroscopy. Raman spectrum of shocked quartz shows several bands with an intense peak at 459 cm−1. Low intensity of broad Raman bands near 495 and 800 cm−1, which indicate the presence of silica glass, were detected in the PDFs. 2D Raman mapping of the shocked quartz grain shows various distribution patterns of the integrated intensity of A1 Raman band at 459 cm−1 and thus reveal a difference of crystallinity in shocked quartz. The shift and peak broadening of Raman bands to a lower wave number (459 cm−1) may be due to the degree of disordering in tetrahedral sites affected by shock pressure. The results show distinct changes of the Raman properties of quartz with shock pressure and point to a possible use of this method for the identification and characterization of Planar Deformation Features in quartz.

A Gamow–Teller (GT) transition from the drip-line nucleus 14Be to 14B was studied via the ( p , n ) reaction in inverse kinematics using a secondary 14Be beam at 69 MeV/nucleon. The invariant mass method is employed to reconstruct the energy spectrum. A peak is observed at an excitation energy of 1.27(2) MeV in 14B, together with bumps at 2.08 and 4.06(5) MeV. The observed forward peaking of the state at 1.27 MeV and a good description for the differential cross section, obtained with a DWBA calculation provide support for the 1 + assignment to this state. By extrapolating the cross section to zero momentum transfer the GT-transition strength is deduced. The value is found to compare well with that reported in a β-delayed neutron emission study.

An experimental study for the unbound nucleus 13Be has been performed by means of the invariant mass method via the one-neutron removal reaction H 1 ( Be 14 , Be 12 + n ) . A resonance has been observed at 0.51(1) MeV in the relative energy ( E rel ) spectrum of the Be 12 + n system. The transverse momentum distribution of the Be 12 + n system as well as the resonance width of 0.45(3) MeV gives evidence for the p-wave nature of the resonance. A d-wave resonance has also been observed at 2.39(5) MeV in the E rel spectrum. The observation of the low-lying p-wave resonance indicates the disappearance of the N = 8 magicity in the vicinity of the neutron drip line region.

ESR Dating of Marine Barite in Chimneys Deposited from Hydrothermal Vents Electron Spin Resonance (ESR) dating of marine barite in chimneys deposited from hydrothermal vents was attempted to determine the time since hydrothermal activity occurred. In this study, we used Barite (BaSO4) precipitated in icroenvironments in the chimneys deposited from the hydrothermal vents at the Archaean site in South Mariana spreading centre (12°56.4'N, 143°37.9'E) and at Hakurei site in the Izena caldron (27°15'N, 127°04'E) for ESR measurements. ESR spectrum of marine barite is characterized by an electron-type centre with g values of 2.0034, 2.0022 and 1.9995 attributed to SO3 -. The signal intensity increased with gamma ray dose. The dose rates of hydrothermal chimneys from the Archaean site and from the Hakurei site were calculated using a model that assumed a grain size and that incorporation of radionuclides after 226Ra in U series into the chimney, and assuming the efficiency of the defect formation by alpha particles to be the same as that for OSL. The ESR ages were estimated to be 470 years old for barite from the Archaean site and 5670 years old for one from the Hakurei site, although there is a considerable difference between the present ESR ages and the 210Pb/226Ra disequilibrium ages previously reported.

We carried out the β‐decay spectroscopy on 24Si in order to investigate a change in configuration in the wave function induced by Thomas‐Ehrman shift from a perspective of mirror asymmetry of B(GT). We observed two β transitions to low‐lying bound states in 24Al for the first time. In this proceeding, the B(GT) of 24Si is compared with that of the mirror nucleus 24Ne, and the mirror asymmetry of B(GT) is determined. Then the origin of the B(GT) asymmetry is discussed through the comparison with theoretical calculations.