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Objectives The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study [AFIRE]; UMIN000016612 , NCT02642419 )

The electron spin resonance (ESR) method was used to measure the superoxide dismutase (SOD) activity in synovial fluids from the knee joints of 73 patients with rheumatoid arthritis (RA), and the results were compared with those of 50 patients with osteoarthritis (OA) and posttraumatic arthritis (PA). The SOD activity in RA and OA knee joint fluids was higher than in the control patients with PA. Patients with moderate RA (grade III or IV according to Larsen's classification of rheumatoid knee radiographs) showed higher SOD activities in joint fluids than patients with early (grade I or II) and terminal (grade V) stages of RA. Our results suggest that the SOD activity in joint fluids is a valid index of articular destruction and repair.

Laurel and Eriksson published the first report indicating that alpha 1-antitrypsin deficiency predisposed patients to the development of Chronic Obstructive Pulmonary Disease (COPD). For the purpose of early detection, disturbances of pulmonary function in alpha 1-antitrypsin mild deficiency cases (PiMZ) were compared with those of normal cases (PiMM) in caucasian Americans. The marked results are as follows. 1) Parameters of flow-volume curves were more disturbed in PiMZ cases than in PiMM cases. 2) Volumes of isoflow are specially different between PiMZ and PiMM cases. 3) Mechanical properties, like lung work of breathing, were larger in PiMZ cases than in PiMM cases.

Levels of soluble IL-2 receptor in sera of 18 patients with sarcoidosis were measured by a sandwich ELISA method established by the authors and were found to be significantly higher than those in sera of normal subjects. Levels of soluble IL-2 receptor in sera of sarcoidosis cases of bilateral hilar lymphadenopathy (BHL) were significantly higher than those in sera of sarcoidosis cases without BHL. In patients with sarcoidosis, levels of soluble IL-2 receptor did not differ in relation to the presence or absence of ocular lesions, or in relation to positive or negative response to protein purified derivative of tuberculosis (PPD).

For clinical laboratory data to be used effectively in wide areas of clinical medicine, it must be stored in proper database systems. Moreover, the system must be installed in the hospital information system for easy access by the hospital staff in their routine activities. From this standpoint we have developed a clinical test relational database system at Hiroshima University Hospital, which provides the functions of easy on-line retrieval and statistical analysis. We have also improved the functions to incorporate fuzzy query processing based on the theory of fuzzy sets. This system enables us to use natural linguistic representation and leads to a medical knowledge-base.

A case of a 62-year-old man with a large pericardial effusion is presented. He developed clinical signs of cardiac tamponade. Two-dimensional echocardiography revealed collapse of the right ventricle in early diastole and inversion of the free wall of both atria in systole. Pulsed Doppler echocardiography demonstrated an abnormally increased respiratory variation in transvalvular blood flow velocities. Expiration caused an increase in the flow velocities across the mitral and aortic valves, and a decrease in the flow velocity across the tricuspid valve. The exaggerated respiratory variations in transvalvular flow velocities suggest that Doppler evaluation may be a valuable adjunct in the diagnosis of cardiac tamponade.

Using pulsed Doppler echocardiography, the left atrial pre-ejection period (LAPEP) and left atrial ejection time (LAET) were studied in relation to left atrial loading and acute left ventricular pressure loading conditions in 17 patients with various heart diseases. LAPEP was defined as the time interval from the onset of a right atrial pacing pulse to the upstroke in the atrial contraction phase on the mitral flow velocity pattern; LAET was defined as the duration of left ventricular filling due to atrial contraction. 1. LAPEP did not correlate significantly with mean pulmonary capillary wedge pressure (mPCWP) indicating preload for the left atrium, nor with left ventricular end-diastolic pressure (LVEDP) indicating afterload for the left atrium. There were significant inverse correlations of LAET with mPCWP (r = -0.72) and with LVEDP (r = -0.75). 2. LAPEP, LAET and LAPEP/LAET correlated significantly with the ratio of the peak velocity in the atrial contraction phase and to that in the rapid filling phase (r = -0.62, -0.50 and -0.59, respectively). There was a significant inverse correlation of LAPEP/LAET with the left ventricular ejection fraction (r = -0.62). 3. When left ventricular systolic pressure became elevated by 25% of its basal value at a constant right atrial pacing rate, LAPEP decreased from 110 +/- 21 msec to 103 +/- 22 msec (p less than 0.05), LAET increased from 123 +/- 33 msec to 129 +/- 24 msec and LAPEP/LAET decreased from 0.95 +/- 0.37 to 0.84 +/- 0.32 (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The present study clarified the clinical significance of the suction signal--regurgitant signal near the mitral valve in the left ventricle--as obtained by two-dimensional color Doppler echocardiography in patients with mitral regurgitation. The study population consisted of 39 patients with various heart diseases having mitral regurgitation. The presence of a mitral regurgitant signal was determined not only in the left atrium but in the left ventricle using the long-axis view, four-chamber view, and short-axis view. 1. The suction signal was observed in 17 cases; on the posteromedial commissure side in four; the central portion in seven; the anterolateral commissure side in five and the mitral aneurysm portion in one. The site of the suction signal indicated the mitral regurgitant orifice and was useful for identifying the regurgitant orifice particularly in cases with prolapse of the commissural scallop. 2. Left ventriculography was performed in 18 cases and the severity of mitral regurgitation was grade III/IV or IV/IV in seven of eight cases with suction signals and was grade II/IV in the remaining one, while it was grade II/IV or I/IV in all ten cases without the signal. Sensitivity was then 100% and specificity was 91% in diagnosing III/IV or greater regurgitation according to the presence of the suction signal. The left atrial jet distance, width and area in the 17 cases with suction signals were significantly greater than those of 22 cases without the signal (3.3 +/- 1.0 vs 1.9 +/- 0.7 cm, 1.4 +/- 0.7 vs 0.8 +/- 0.4 cm, and 4.2 +/- 2.8 vs 1.3 +/- 1.3 cm2, respectively). Thus, the suction signal in the left ventricle in mitral regurgitation provided useful information concerning not only the identification of a regurgitant orifice, but the grade of mitral regurgitation, as well.

A monoclonal antibody (MoAb) H229(IgGl) was obtained by fusion between SP2/0, mouse myeloma cell line and spleen cells from BC3Fl mice immunized with HEL, a erythroleukemia cell line. MoAb H229 precipitated a 55 kilodalton(KD) molecule in reduced condition. It reacted with platelets and megakaryocytes, but not with monocytes, granulocytes, lymphocytes, thymocytes, red blood cells (RBC), colony-forming units-granulocyte/monocyte (CFU-GM), and burst forming units- erythroid (BFU-E). These findings suggest that MoAb H229 reacts with platelets specifically. However, MoAb H229 did not inhibit platelet aggregation induced by ristocetin, ADP, epinephrine and collagen.