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In-hospital bleeding is associated with poor prognosis in patients with acute myocardial infarction (AMI). We sought to investigate whether a combination of pre-procedural blood tests could predict the incidence of in-hospital major bleeding in patients with AMI.A total of 1684 consecutive AMI patients who underwent primary percutaneous coronary intervention (PCI) were recruited and randomly divided into derivation (n = 1010) and validation (n = 674) cohorts. A risk-score model was created based on a combination of parameters assessed on routine blood tests on admission. In the derivation cohort, multivariate analysis revealed that the following 5 variables were significantly associated with in-hospital major bleeding: hemoglobin level 12 g/dL (odds ratio [OR], 3.32), white blood cell count10,000/μL (OR, 2.58), platelet count150,000/μL (OR, 2.51), albumin level 3.8 mg/dL (OR, 2.51), and estimated glomerular filtration rate 60 mL/min/1.73 mOur novel laboratory-based bleeding risk model could be useful for simple and objective prediction of in-hospital major bleeding events in patients with AMI.

An 81-year-old female was referred to our department 1 year ago due to a worsening renal function. Her manifestations met the criteria of Sjögren syndrome, suggesting renal failure likely resulting from tubulointerstitial nephritis (TIN) due to Sjögren syndrome. However, at her request, she was followed up with no further investigation or treatment. The following July, since her renal function deteriorated again, a renal biopsy was performed. Using IgM-CD138 dual staining, the renal pathology showed the infiltration of accumulated IgM-positive plasma cells within the renal insterstitium, so she was diagnosed with tubulointerstitial nephritis with IgM-positive plasma cells (IgMPC-TIN).IgMPC-TIN, proposed by Takahashi et al. in 2017, as a type of TIN, is characterized by the pathological infiltrations of IgM-positive plasma cells within the renal insterstitium and is effectively treated with corticosteroid therapy. Despite her old age, corticosteroid therapy was performed, resulting in the improvement in her renal function according to blood and urine tests and an improved pulmonary involvement, although renal dysfunction remained.Elderly patients often have multiple underlying medical conditions and take numerous medications, so differentiating renal disorders is challenging. However, a renal biopsy, even in an elderly patient, can aid in identifying the cause of renal disorders and predicting the prognosis. IgMPC-TIN is a condition in which renal function can be expected to improve if treated. It is thus important to make a diagnosis of IgMPC-TIN without overlooking and to consider proper treatment.

Low serum albumin (SA) on admission in patients with acute myocardial infarction (AMI) has been reported to be associated with adverse cardiovascular events. The relation between low SA and post-AMI bleeding events is presently unknown. We analyzed 1,724 patients with AMI enrolled in the HAGAKURE-ACS registry who underwent primary percutaneous coronary intervention from January 2014 to December 2018. To assess the influence of low SA at admission, patients were divided into 3 groups according to the albumin tertiles: the low SA group (3.8 g/100 ml), the middle SA (MSA) group (3.8 to 4.1 g/100 ml), and the normal SA (NSA) group (≥4.2 g/100 ml). The primary end point was the incidence of Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries moderate/severe bleeding. The cumulative 3-year incidence of the primary end point was significantly higher in the low SA group than in the MSA and NSA groups (30.8% and 11.9% vs 7.7%; p0.001). In the landmark analysis at 30 days, the cumulative incidences of the primary end point were also significantly higher in the low SA group than in the MSA and NSA groups, both within and beyond 30 days (20.1% and 6.1% vs 3.5%; p0.001, and 12.4% and 6.2% vs 4.5%; p0.001, respectively). After adjusting for confounders, the low SA group showed excess risk of bleeding events relative to NSA (hazard ratio 1.56; 95% confidence interval 1.06 to 2.30; p = 0.026), whereas risk of bleeding was neutral in MSA relative to NSA (hazard ratio 0.94; 95% confidence interval 0.63 to 1.34; p = 0.752). In conclusion, low SA at admission was independently associated with higher risk for bleeding events in patients with AMI undergoing percutaneous coronary intervention.

Internal mammary artery graft dissection is a rare condition and is usually caused by iatrogenic complications or mechanical stress. We experienced a case of acute myocardial infarction due to spontaneous internal mammary artery graft dissection that was triggered by emotional stress and was successfully treated by percutaneous intervention using drug-eluting stents. (Level of Difficulty: Beginner.), Graphical abstract, Internal mammary artery graft dissection is a rare condition and is usually caused by iatrogenic complications or mechanical stress. We experienced a…

High-resolution numerical simulation has been performed to study aeroacoustic noise radiated from a turbulent boundary layer at freestream Mach number Ma = 0.3, which develops on a smooth flat plate and over a small forward-facing step. Sound waves radiated from the turbulent boundary layer on the flat plate are dominant in a very-low-frequency band and have characteristics of a linear sound source. The sound waves are observed in the far-field from the boundary propagate outside of the flow region where small hydrodynamic pressure fluctuations with a significant long-wavelength appear. The instantaneous hydrodynamic pressure fields that gradually develop or decay while moving downstream with the turbulent boundary layer are associated with the evolution of various vortical structures. The characteristics of the sound wave being a linear sound source and dominant in a very-low-frequency band are similar to those of the real high-speed train. The sound waves generated from the turbulent boundary layer over the forward-facing step with a height (SH) of SH/y+ ≅ 62 are significantly larger in a full frequency band than those radiated from the turbulent boundary layer on the flat plate. Numerical results of the turbulent boundary layer over the forward-facing step with a height of SH/y+ ≅ 30 show that the sound waves are dominant in the low-frequency band, and also step-specific sound waves are generated in the high-frequency band. Further, even if the step height is SH/y+ ≅ 7.5, the sound waves unique to the small step are generated in the high-frequency band.

Background: In-hospital bleeding is associated with poor prognosis in patients with acute myocardial infarction (AMI). We sought to investigate whether a combination of pre-procedural blood tests could predict the incidence of in-hospital major bleeding in patients with AMI. Methods and Results: A total of 1684 consecutive AMI patients who underwent primary percutaneous coronary intervention (PCI) were recruited and randomly divided into derivation (n=1010) and validation (n=674) cohorts. A risk-score model was created based on a combination of parameters assessed on routine blood tests on admission. In the derivation cohort, multivariate analysis revealed that the following 5 variables were significantly associated with in-hospital major bleeding: hemoglobin level 10000/μL (OR, 2.58), platelet count < 150000/μL (OR, 2.51), albumin level < 3.8 mg/dL (OR, 2.51), and estimated glomerular filtration rate < 60 mL/min/1.73 m 2 (OR, 2.31). Zero to five points were given according to the number of these factors each patient had. Incremental risk scores were significantly associated with a higher incidence of in-hospital major bleeding in both cohorts ( P < 0.001). Receiver operating characteristic curve analysis of risk models showed adequate discrimination between patients with and without in-hospital major bleeding (derivation cohort: area under the curve [AUC], 0.807; 95% confidence interval [CI], 0.759 – 0.848; validation cohort: AUC, 0.793; 95% CI, 0.725 – 0.847). Conclusions: Our novel laboratory-based bleeding risk model could be useful for simple and objective prediction of in-hospital major bleeding events in patients with AMI

Labile zinc plays various roles in cells at low concentrations which most fluorescent probes are not able to detect. Here we report a cephem-based probe which coordinates to zinc and zinc-bound water cleaves the scaffold and releases the fluorophore. In addition, the zinc is recycled and reacts with multiple probes, amplifying the signal. This signal amplification system is useful for the detection of intracellular zinc at low concentrations and has potential for further development of probes with a similar molecular design.

Background Little is known about clinical associations between glucose fluctuations including hypoglycemia, heart rate variability (HRV), and the activity of the sympathetic nervous system (SNS) in patients with acute phase of acute coronary syndrome (ACS). This pilot study aimed to evaluate the short-term effects of glucose fluctuations on HRV and SNS activity in type 2 diabetes mellitus (T2DM) patients with recent ACS. We also examined the effect of suppressing glucose fluctuations with miglitol on these variables. Methods This prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group comparative study included 39 T2DM patients with recent ACS, who were randomly assigned to either a miglitol group (n = 19) or a control group (n = 20). After initial 24-h Holter electrocardiogram (ECG) (Day 1), miglitol was commenced and another 24-h Holter ECG (Day 2) was recorded. In addition, continuous glucose monitoring (CGM) was performed throughout the Holter ECG. Results Although frequent episodes of subclinical hypoglycemia (≤4.44 mmo/L) during CGM were observed on Day 1 in the both groups (35% of patients in the control group and 31% in the miglitol group), glucose fluctuations were decreased and the minimum glucose level was increased with substantial reduction in the episodes of subclinical hypoglycemia to 7.7% in the miglitol group on Day 2. Holter ECG showed that the mean and maximum heart rate and mean LF/HF were increased on Day 2 in the control group, and these increases were attenuated by miglitol. When divided 24-h time periods into day-time (0700–1800 h), night-time (1800–0000 h), and bed-time (0000–0700 h), we found increased SNS activity during day-time, increased maximum heart rate during night-time, and glucose fluctuations during bed-time, which were attenuated by miglitol treatment. Conclusions In T2DM patients with recent ACS, glucose fluctuations with subclinical hypoglycemia were associated with alterations of HRV and SNS activity, which were mitigated by miglitol, suggesting that these pathological relationships may be a residual therapeutic target in such patients. Trial registration Unique Trial Number, UMIN000005874 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000006929)

Ruptured aneurysms in perforating arteries are uncommon. We report a case of a basilar perforator artery aneurysm that was treated successfully using simple stenting to induce a rectifying effect without using a coil. In this case, coiling for the aneurysm was attempted initially, but it failed because of anatomical and practical problems. After placement of two stents in the basilar artery, the aneurysm was occluded completely without any neurological deficits at 100 days after the procedure. Although superselective coil embolization is ideal even in a small perforator aneurysm, simple stenting for a parent artery is a preferable treatment, especially in challenging cases for coil embolization of the aneurysmal dome.

Experimental ischemia-reperfusion models have shown that 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, statins, have cardioprotective effects. SAMIT (Statin Acute Myocardial Infarction Trial) is a multicenter prospective open randomized trial, designed to evaluate the effects of statin treatment from the earliest stage on cardioprotection in patients with acute myocardial infarction (AMI). Patients were randomly assigned to receive atorvastatin (initial dose of 40 mg at admission followed by the maintenance dose of 10 mg/day for 30 days) or not (control), and then immediately underwent percutaneous coronary intervention (PCI) for the culprit lesion. The primary endpoints were infarct size and left ventricular function. The secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE) and various biomarkers. There were no significant differences in baseline characteristics between 2 groups of the statin treatment group and the control group. The left ventricular ejection fraction increased at 6 months after the onset of AMI, compared with the baseline level in the atorvastatin group (P

This paper describes a view-based outdoor navigation method. Navigation in outdoor can be divided into two levels; the global level deals with localization and subgoal selection, while the local level deals with safe navigation in a local area. We adopt an improved version of SeqSLAM method for global-level localization, which can cope with changes of robot’s heading and speed as well as view changes using very wide-angle images and a Markov localization scheme. The global level provides the direction to move and the local level repeatedly sets subgoals with local mapping using 3D range sensors. We implemented these global and local level methods on a mobile robot and conducted on-line navigation experiments.

A purpose of this article is to describe a breakthrough technique for occlusive superficial femoral artery (SFA) recanalization: multi-site access and sheaths insertion (MUSASHI) technique. Trans-collateral retrograde approach (TCA) for SFA cannot become popular because it needs conventional (crossover or ipsilateral) approach, which might not be suitable for collateral channel tracking. An innovative MUSASHI technique has a possibility to make TCA popular. Inserting two different sheaths into SFA and profunda artery from common femoral artery, we can manipulate both antegrade and retrograde guidewires without losing their trackability and with strong system-stability. Using MUSASHI technique, TCA may become easier and safer.

Model of soft robotic fish Designing a high-performance soft robotic fish requires considering the interaction between the flexible robot structure and surrounding fluid. This paper introduces fluid-structure interaction (FSI) analysis used to enhance the hydrodynamic performance of soft robotic fish using piezoelectric fiber composite (PFC) as the propulsion actuator. The basic FSI analysis scheme for soft robotic fish is presented, then the numerical model of the actuator, robot structure, and surrounding fluid are described based on the FSI analysis scheme. The FSI analysis of the soft robotic fish is performed through these numerical models. To evaluate the effectiveness of FSI analysis, coupling simulation and experimental results are compared. We found that the calculated results of propulsive force and deformation displacement were similar to those for experiments. These results suggest that FSI analysis is useful and is applicable to evaluating propulsion characteristics of the soft robotic fish to improve performance.

Summary Background Although drug-eluting stents (DES) have considerably reduced the incidence of in-stent restenosis, late and very late stent thrombosis (ST) after DES implantation have emerged as major safety concerns. We morphologically investigated the age of DES thrombi aspirated during percutaneous coronary intervention (PCI) from patients with either late or very late ST that resulted in acute myocardial infarction (AMI). Methods and results We obtained DES thrombi during PCI from 16 consecutive patients with ST (late and very late ST, n = 4 and n = 12, respectively), who presented with AMI within 24 h of the onset of anginal symptoms. Thrombi were morphologically classified as fresh, lytic, and organized. Fresh thrombus was identified in 5 (31%) of the 16 patients and lytic thrombus was found in 3 (19%). Organized thrombus was notably found in 8 (50%) patients, of whom 5 (31%) had only the organized type and 3 (19%) had both fresh and organized thrombi. The frequency of fresh thrombus tended to be higher in patients with stent failure such as stent malapposition and fracture, but the difference did not reach significance ( p = 0.06). Conclusions Although the study group is small, about two-thirds of DES thrombi in late and very late ST were days or weeks old. These findings suggest an important discrepancy between the time of onset of the intra-stent thrombotic process and the occurrence of acute clinical symptoms, and provide further information about another potential mechanism of DES thrombosis.

Gabexate mesilate is a non-peptide protease inhibitor, developed in Japan, which is used in the treatment of acute pancreatitis and disseminated intravascular coagulation. This compound is readily hydrolyzed as it has ester bonds in its structure. It is now out of patent in Japan and there are many generic versions on the market. The crystal structure and the hydrolysate content of the branded product and nine generic versions were evaluated by X-ray diffractometry, thermal analysis and HPLC. The results showed that generic products containing mannitol as an additive had a higher content of hydrolysate as an impurity than the branded product or generic products formulated without mannitol, suggesting that the crystal structure might be altered and stability impaired in mannitol-containing drug products.

A new multiscale numerical method is developed to simulate the fluid-solid interaction. The solid motion is described by coarse grained particles which are generated by consolidation of harmonically interacting atoms, and the fluid motion is by the lattice Boltzmann method. Since the characteristic time of the fluid motion is much longer than that of the coarse grained particles, the momentum change due to the rapid collision of the coarse grained particles at the interface is accumulated over a certain time duration and then passed the fluid motion. The method is applied to an elastic rod fixed on the wall in the two dimensional Poiseuille flow. The oscillation and stress within the rod as well as the velocity and vorticity of the fluid are examined with respect to the vortex shedding at the top of the rod. Also the method is applied to the problem of fluid transfer by multiple elastic rods. It is found that the results are quite reasonable and that the present method is effective in dealing with the fluid-solid interactions.

The direct numerical simulations of turbulent flow in a rotating channel are executed, with the attention on a transient state after an onset of the rotation. Some different rotation numbers which contain 0, 0.5, 1, 2.5 and 5 are tested. To clarify a relationship between rotation numbers and the alteration of turbulence structures, we paid notice to temporal evolutions of wall friction velocities on both sides, volume-averaged velocity, kinetic energy and its production and dissipation. We found that the time evolutions of flow rates indicate non-monotonic behaviors due to the system rotation. The major reason of it is the difference in response of wall friction velocities on both walls. Moreover, we applied an analysis based on the theory of the invariants of Reynolds stress tensor to associate the status of turbulence with turbulence structures. From the result of the analysis, the three-dimensionality of turbulence is emphasized by the system rotation except for the vicinity of the wall on the pressure side. On the suction side, however, flow field indicates the feature of two-dimensionality.

Fully-developed flow in a channel subjected to the spanwise rotation was investigated by means of the direct numerical simulation (DNS). Two steps of rotation number, Roτ=1 and Roτ=2.5, and stationary condition were mainly calculated. The turbulence was enhanced in the pressure side and attenuated in the suction side by increasing the rotation number, but the change was not monotonic.Notable feature was found for the case of Roτ≈ 1 : the flow rate takes its maximum ; it fluctuated in time ; the shift of Reynolds shear stress almost teminated. For higher rotation rate, roll-cell vortices and, as a consequence, the constant-gradient in the mean velocity profile were observed. Furthermore, the log profile was evident only in the region blown from the pressure side by the roll-cell vortices. Due to these observations, it was found that the rotation number 'unity' was a turning point of the change of dominant structures : the near-wall vortices in lower rotation and the large-scale roll-cell vortices in higher.

A modified boundary condition for the distribution function in the Lattice Boltzmann method at the interface between solid and fluid that takes into account a finite mass ratio between two phases and an inelastic reflection is proposed. The new boundary condition is built into the immersed boundary method to compute the interaction between graphene and laminar flow. Numerical simulations are carried out at a Reynolds number of 40, and drag and lift acting on the graphene and its deformation are examined by changing the mass ratio and the coefficient of restitution. It is found that the amplitude of the oscillating motion of the graphene is enhanced when compared with the case of infinite mass ratio with perfect collision.

Background: In-stent restenosis (ISR) remains a persistent, unresolved issue even in the era of percutaneous coronary intervention (PCI) using drug-eluting stents. The present study compares the clinical and angiographic outcomes of using sirolimus-eluting stents (SES) for re-intervention against ISR that was originally treated with sirolimus-eluting or bare-metal (BMS) stents. Methods and Results: This prospective single-center registry investigated 179 ISR lesions in 158 consecutive patients (53 lesions in 49, and 126 in 109 patients originally treated with SES and BMS, respectively), who had undergone re-intervention with SES. The patients were clinically and angiographically followed up at 8 months after re-PCI. The incidence of re-restenosis (29 vs 12%, P