Search

A real-time processing system for the two-color CO2 laser interferometer on the JT-60SA has been developed for density feedback control. The system has a novel feature that can detect fringe jumps due to off-normal events, such as loss detection due to displacement of the beam axis and changes in the laser wavelengths. Because a phase change due to the JT-60SA plasma is smaller than π/2, corresponding to the line-integral electron density NL of ∼6×1019 m-2 in a short interval of 500 ns, the threshold of the fringe jump detection is decided to be π/2. Hence, off-normal events can be detected from a fringe jump, leading to the abort of the real-time feedback control. In the density feedback control of the JT-60SA plasma, the system is employed as a density monitor, with NL being successfully controlled at 16.8% ± 6.6% lower than the reference., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

Aims: This study aimed to investigate the effect of Bacillus subtilis var. natto on the susceptibility of the model host, Caenorhabditis elegans, to bacterial infection., Methods and Results: Caenorhabditis elegans worms were fed with a standard food consisting of Escherichia coli OP50 strain (control) or B. subtilis (natto) during their larval stage. The worms were then infected with pathogenic bacteria. We analyzed their survival time and RNA sequencing-based transcriptome. Upon infection with Staphylococcus aureus and Enterococcus faecalis, the survival time of B. subtilis (natto)-fed worms was longer than that of the control. Transcriptome analyses showed upregulation of genes associated with innate immunity and defense response to gram-positive bacteria in B. subtilis (natto)-fed worms., Conclusions: Bacillus subtilis (natto) conferred an increased resistance of C. elegans to gram-positive bacteria. Our findings provided insights into the molecular mechanisms underlying B. subtilis (natto)-regulated host immunity and emphasized its probiotic properties for preventing and alleviating infections caused by gram-positive bacteria., Significance and Impact of the Study: To the best of our knowledge, this is the first study to show that B. subtilis (natto) confers specific resistance against gram-positive bacteria., (© 2021 The Society for Applied Microbiology.)

An incoherent Thomson scattering diagnostic will be installed in the JT-60SA tokamak to measure electron temperature and electron density profiles. The target radial spatial resolution is 25 mm with 46 spatial channels. The accuracy in electron temperature and density is a few percent at n e = 7.5 × 10 19  m -3 , which is the expected value in the plasma core. This paper presents the designs of collection optics, fibers with their alignment system, and polychromators. The collection optics overcomes unique issues for superconducting fusion devices, i.e., limited design space, high-temperature measurements, and harsh radiation condition. When in several years the more performing plasma will generate intense nuclear radiation, the lens materials of the optics can be replaced by radiation resistant glasses without major changes in the lens holder. It will prevent transmission degradation and keep stable measurement accuracy.

A thermal image plate (TIP) using ceramic luminescence materials has been developed in order to visualize a beam spot of a CO 2 laser which is used as a light source of an interferometer developed in JT-60SA. By using CaAlSiN 3 :Eu 2+ (CASN), the TIP was developed, and its property was assessed. A CASN TIP was able to visualize the invisible CO 2 laser beam as a negative image. The beam diameter and the stability of the beam axis measurement obtained with the CASN TIP were approximately the same as that obtained with a commercial TIP. Furthermore, the time response of the CASN TIP at the best was approximately the same as that of the commercial TIP. The CASN TIP which had the highest time response was applied to the beam axis stabilizer, and then the beam axis stabilization was successfully performed in 2 h.

Background: The epidemiological patterns of musculoskeletal injuries or disorders in military personnel have not been well documented and a better understanding is required for proper preventative measures and treatment. Here, we investigated musculoskeletal injuries or disorders among members of the Japan Self-Defense Forces., Methods: All orthopedic patients (n = 22,340) who consulted to Japan Self-Defense Forces Hospitals were investigated for their type of injury or disorder, the injured body part, the mechanism, and the cause of injuries., Results: Thirty-nine percent of the cases were classified as traumatic injuries, and 61% were classified as non-traumatic disorders. Of the traumatic injury patients, the injured body part was the upper extremity in 32%, the trunk in 23%, and the lower extremities in 45% of the cases. The most common injured body location was the knee followed by the hand/finger and ankle. Exercise was the most common cause of injury, followed by traffic accident and military training. Contusions were the most common traumatic injuries, followed by sprains and fractures. Of non-traumatic disorders, the lower extremities were reported as the injured part in 43% of the disorders. Lumbar spine disorders were the most common non-traumatic disorders, followed by tendon and joint disorders., Conclusions: Over one-third of orthopedic cases among members of the Japan Self-Defense Forces are traumatic injuries, with the knee being the body part most commonly injured and exercise being the leading cause of injury.

Magnification of a polarization angle with Littrow layout gratings has been developed. High magnification with a factor of 7.7 using two gratings in Littrow layout was experimentally proved. The magnification range was investigated by calculation at a wavelength of 10.6 μm. The method can be applied for a high magnification factor >30. Larger groove numbers and smaller blaze angles are suitable for the large magnification. Statistical fluctuation of the diffracted polarization angle is compared with that of the incident polarization angle.

A tangential viewing phase contrast imaging system is being designed for the JT-60SA tokamak to investigate microturbulence. In order to obtain localized information on the turbulence, a spatial-filtering technique is applied, based on magnetic shearing. The tangential viewing geometry enhances the radial localization. The probing laser beam is injected tangentially and traverses the entire plasma region including both low and high field sides. The spatial resolution for an Internal Transport Barrier discharge is estimated at 30%-70% of the minor radius at k = 5 cm -1 , which is the typical expected wave number of ion scale turbulence such as ion temperature gradient/trapped electron mode.

Study Design: Retrospective study evaluating cranial facet joint violation (FJV) by pedicle screws., Objective: The aim of the study was to determine the incidence and risk factors of FJV following screw placement via cortical bone trajectory (CBT)., Summary of Background Data: CBT is a new minimally invasive technique for lumbar pedicle screw insertion that minimizes muscle dissection. Inserting a screw from a more caudal entry point can reduce iatrogenic damage to the cranial facet joint; however, no previous reports exist describing the incidence of FJV secondary to the CBT technique., Methods: We reviewed 202 consecutive patients who underwent lumbar pedicle screw instrumentation using CBT from October 2011 to June 2015. Postoperative CT scans were obtained to determine the degree and incidence of FJV. Clinical and imaging data were analyzed to clarify the risk factors of FJV. The detailed positions of the proximal screws were also investigated and compared between the FJV and non-FJV groups., Results: The incidence of FJV by the proximal screws was 11.8% (48/404), with no occurrence of intra-articular FJV. Multiple logistic regression analysis revealed that age >70 years, vertebral slip >10%, and adjacent facet joint degeneration (Pathria's grade 2 or 3) were independent factors significantly affecting FJV. There were statistically significant differences between the FJV and non-FJV groups in the facet-screw distance (3.2 ± 1.0 vs. 8.1 ± 2.3 mm, P < 0.01), the cranial angle (25.8 ± 6.3° vs. 29.9 ± 7.6°, P < 0.01), and the lamina-screw head distance (5.6 ± 1.6 vs. 6.4 ± 1.9 mm, P < 0.01)., Conclusion: Lumbar pedicle screw placement via CBT would reduce FJV; however, special care should be taken in patients with age >70 years, vertebral slip >10%, and facet degeneration., Level of Evidence: 3.

Little is known regarding the incidence of the shoulder instability in Japan. The aim of this study was to evaluate the incidence of traumatic shoulder instability among Japanese military cadets. A prospective cohort study was performed to capture all traumatic shoulder instability events between 2009 and 2012 among cadets in a military educational academy of the Japan Self Defense Forces. The total number of cadets in the cohort was 5,402 (average age 20.6 years). The incidence of instability events, including dislocation or subluxation, was calculated. Chronicity, demographics of participants, mechanism of injury, and athletic events were also evaluated. The incidence of traumatic dislocation was 4.1/1,000 person-years and that of subluxation was 6.1/1,000 person-years. The incidence of primary dislocation or subluxation was 5.4/1,000 person-years and that of recurrent dislocation or subluxation was 4.7/1,000 person-years. Of first dislocations or subluxations, 92% occurred during sports activities, including after-school sports activities, military training, and gym classes. In conclusion, the overall incidence of shoulder instability events among Japanese military cadets was 10.3/1,000 person-years, and was extremely high. Most shoulder instability events occurred during sports activities, and a program to prevent such injuries during sports activities is necessary for young participants., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Objective: To compare the clinical and angiographic outcomes after implantation of drug-eluting stents (DESs) in patients with coronary artery disease (CAD) with or without prior cerebral infarction., Materials and Methods: Ninety-eight consecutive patients (130 lesions) who underwent successful coronary DES implantation were prospectively classified into two groups: those with a clinical history of symptomatic cerebral infarction (cerebral infarction group, 49 patients, 69 lesions) and those without a clinical history of symptomatic cerebral infarction (noncerebral infarction group, 49 patients, 61 lesions). The primary endpoint was defined as death, nonfatal myocardial infarction, and cerebrovascular events., Results: The Kaplan-Meier method was used to create a primary endpoint curves to determine the time-dependent cumulative primary endpoint-free rate, which were compared using the log-rank test. The incidence of primary endpoints was higher in the cerebral infarction group than in the noncerebral infarction group (p = 0.0075). The Cox proportional hazards regression model for primary endpoint identified prior cerebral infarction (p = 0.0331, hazard ratio = 2.827) and patients with peripheral artery disease (p = 0.0271, hazard ratio = 2.757) as explanatory factors., Conclusion: The results showed that clinical outcomes were poorer in patients with CAD who had prior cerebral infarctions than in those who did not have infarction.

A new method to magnify a small polarization angle with brazed gratings has been developed. In the method, difference in diffraction efficiency for S and P polarization components is used. The magnification dependence on the incident angle can be small by arranging the grating in Littrow layout. A magnification with a factor ~2.7 has been demonstrated for a 10.6 μm CO2 laser beam as expected from a calculation. The method is applicable in many polarimetry fields.

A new method of plasma electron density measurement using interferometric phases (fractional fringes) of an optical frequency comb interferometer is proposed. Using the characteristics of the optical frequency comb laser, high density measurement can be achieved without fringe counting errors. Simulations show that the short wavelength and wide wavelength range of the laser source and low noise in interferometric phases measurements are effective to reduce ambiguity of measured density.

Previous studies based on coronary angiography or computed tomography coronary angiography have demonstrated a high prevalence of coronary stenosis in patients with cerebral infarction and no prior history of coronary artery disease (CAD). The purpose of the present study was to compare the coronary angiographic findings of patients with prior cerebral infarction with those of patients with no prior cerebral infarction. Consecutive patients (n = 126) who underwent a first coronary angiography for suspected CAD but had no prior history of CAD were classified into 2 groups, those with a clinical history of cerebral infarction (cerebral infarction group) and those without a clinical history of cerebral infarction (noncerebral infarction group). The incidences of diabetes mellitus, peripheral artery disease, coronary stenosis, and multivessel disease were significantly higher in the cerebral infarction group than in the noncerebral infarction group. Multiple logistic regression analysis relating to coronary stenosis identifi ed prior cerebral infarction (P = 0.0027, odds ratio = 4.414) and diabetes mellitus (P = 0.0446, odds ratio = 2.619) as explanatory factors. Thirty-four of 78 patients (44%) with coronary stenosis did not have angina symptoms. Multiple logistic regression analysis regarding the lack of angina symptoms identified motor dysfunction (modified Rankin scale ≥ 2) (P = 0.0028, odds ratio = 8.323) as an explanatory factor. The results of the present study suggest that compared with patients without cerebral infarction those with the disorder have a high prevalence of coronary stenosis, and indicate that the development of angina symptoms is influenced by the severity of motor dysfunction.

Because left ventricular (LV) diastolic dysfunction is frequently the earliest indicator of LV dysfunction in patients with heart failure, the estimation of LV diastolic function is very important. On the other hand, electrocardiography (ECG)-gated technetium (Tc) -99m tetrofosmin single-photon emission computed tomography (SPECT) has been reported to be a useful method for evaluation of LV function. The objective of this study was to examine the usefulness of ECG-gated Tc-99m tetrofosmin SPECT in terms of estimation of cardiac diastolic function. Consecutive 145 patients underwent an ECG-gated Tc-99m tetrofosmin SPECT to estimate systolic and diastolic LV function, and were compared with those evaluated by ultrasound echocardiography (UCG). LV end-diastolic volume, LV end-systolic volume, and LV ejection fraction values obtained by quantitative gated SPECT (QGS) showed significant positive linear correlations with those obtained by UCG. All 145 patients were classified into 3 groups according to diastolic function estimated by UCG. The first-third mean filling rate (1/3 MFR) and peak filling rate (PFR) that revealed the LV diastolic function of the group B (normal systolic function and mild diastolic dysfunction) patients (1.01 ± 0.35, 1.85 ± 0.57) were both significantly lower than those of the group A (normal systolic and diastolic function) patients (1.43 ± 0.37, 2.43 ± 0.56). The 1/3 MFR and PFR of the group C (moderate ~ severe systolic and diastolic dysfunction) patients (0.47 ± 0.34, 0.92 ± 0.62) were also significantly lower than those of the group A and B patients. QGS may be a useful method for the evaluation of cardiac systolic and diastolic function, especially in patients with normal systolic function and diastolic dysfunction.

We demonstrate the temporal contrast enhancement in a petawatt-class Ti:sapphire chirped-pulse amplification (CPA) laser system. An extra saturable absorber, introduced downstream after a low-gain optical parametric chirped-pulse amplification (OPCPA) preamplifier, has improved the temporal contrast in the system to 1.4×10(12) on the subnanosecond time scale at 70 TW power level. We have achieved 28 J of uncompressed broadband output energy with this system, indicating the potential for reaching peak powers near 600 TW.

Using a high-contrast (10(10):1) and high-intensity (10(21) W/cm(2)) laser pulse with the duration of 40 fs from an optical parametric chirped-pulse amplification/Ti:sapphire laser, a 40 MeV proton bunch is obtained, which is a record for laser pulse with energy less than 10 J. The efficiency for generation of protons with kinetic energy above 15 MeV is 0.1%.

Optical parametric chirped-pulse amplification (OPCPA) operation with low gain by seeding with high-energy, clean pulses is shown to significantly improve the contrast to better than 10(-10) to 10(-11) in a high-intensity Ti:sapphire laser system that is based on chirped-pulse amplification. In addition to the high-contrast broadband, high-energy output from the final amplifier is achieved with a flat-topped spatial profile of filling factor near 77%. This is the result of pump beam spatial profile homogenization with diffractive optical elements. Final pulse energies exceed 30 J, indicating capability for reaching peak powers in excess of 500 TW.

We have developed a femtosecond high-intensity laser system that combines both Ti:sapphire chirped-pulse amplification (CPA) and optical parametric CPA (OPCPA) techniques and produces more than 30 J broadband output energy, indicating the potential for achieving peak powers in excess of 500 TW. With a cleaned high-energy seeded OPCPA preamplifier as a front end in the system, for the compressed pulse without pumping the final amplifier, we found that the temporal contrast in this system exceeds 10(10) on the subnanosecond time scales, and is near 10(12) on the nanosecond time scale prior to the peak of the main femtosecond pulse. Using diffractive optical elements for beam homogenization of a 100 J level high-energy Nd:glass green pump laser in a Ti:sapphire final amplifier, we have successfully generated broadband high-energy output with a near-perfect top-hat-like intensity distribution.

A high stability electron bunch is generated by laser wakefield acceleration with the help of a colliding laser pulse. The wakefield is generated by a laser pulse; the second laser pulse collides with the first pulse at 180 degrees and at 135 degrees realizing optical injection of an electron bunch. The electron bunch has high stability and high reproducibility compared with single pulse electron generation. In the case of 180 degrees collision, special measures have been taken to prevent damage. In the case of 135 degrees collision, since the second pulse is countercrossing, it cannot damage the laser system.

Insulin resistance (IR) is now considered to be a risk factor for coronary arterial atherosclerosis and is likely to be involved in a limited endothelium-dependent vasodilatory function in peripheral circulation. We investigated whether IR impairs endothelial vasodilator function in the noninfarcted coronary artery. In 14 nondiabetic patients (10 males, 66 +/- 6 years) who were selected from 214 patients underwent IR evaluation by glucose clamp, a Doppler flow wire was used to measure coronary flow changes (percent volume flow index, %VFI) during intracoronary administration of papaverin (10 mg) and stepwise administration of acetylcholine (Ach; 1, 3, 10 microg/ml per minute) into the non-infarcted left circumflex coronary artery. Insulin resistance was comparatively evaluated by an euglycemic hyperinsulinemic glucose clamp (M value, mg/m(2) per minute) or by a 75g-oral glucose tolerance test (120-min immunoreactive insulin; 120' IRI, pmol/l). Eight patients (57%) were defined as having IR on the basis of results obtained by both the glucose clamp method (M values <167 mg/m(2) per minute) and 120' IRI (>384 pmol/l). There was no difference between papaverin-induced %VFI increases in IR and non-IR subjects (328% +/- 43% vs. 361% +/- 87%). However, IR subjects showed significantly lower Ach-induced %VFI increases in a dose-dependent manner (P < 0.05), especially when low (1 microg/ml per minute) and moderate (3 microg/ml per minute) doses of Ach were used (165% +/- 18% or 248% +/- 29% in non-IR subjects vs. 130% +/- 20% or 183% +/- 41% in IR subjects, P < 0.001, respectively). Moreover, %VFI increase at a low dose of Ach infusion significantly correlated with M values or 120' IRI ([%VFI Ach 1 microg] = 85.9 + 0.35 [M values], r = 0.58, P = 0.038; [%VFI Ach 1 microg] = 176.8 - 0.47.[120' IRI], r = -0.57, P = 0.035). Insulin resistance limits endothelium-dependent coronary vasodilation in association with the severity of IR in non-diabetic patients.

Poor clinical outcomes for hemodialysis (HD) patients compared to non-HD patients after coronary intervention have been reported. Although coronary intervention using sirolimus-eluting stents (SESs) might be expected to reduce restenosis in HD patients, little is known about the efficacy of the SESs. The purpose of the present study was to compare the clinical and angiographic outcomes of HD patients with non-HD patients after SES implantation. The study population consisted of 170 consecutive patients (234 lesions) who had undergone successful coronary SES implantation. The patients were classified into 2 groups, an HD group (18 patients, 27 lesions) and a non-HD group (152 patients, 207 lesions). The incidence of any clinical event was significantly higher in the HD group than in the non-HD group (50.0% versus 12.5%, P < 0.0001). Target lesion revascularization was necessary in 6 patients (33.3%) in the HD group and in 7 patients (4.6%) in the non-HD group (P < 0.0001). The Cox proportional-hazards regression model on cardiac events identified HD patients (P = 0.0301, hazard ratio = 2.704) as an explanatory factor. Moreover, the Cox proportional-hazards regression model on target lesion revascularization identified HD (P = 0.0004, hazard ratio = 6.921) and in-stent re-stenosis lesion (P = 0.0293, hazard ratio = 3.323) as explanatory factors. The present study suggests that compared with non-HD patients, HD patients with coronary artery disease treated by SESs have a poorer clinical outcome.

The objective of the present prospective multicenter case-control study was to investigate the long-term clinical outcome (5 years) of primary stenting compared to primary percutaneous transluminal coronary angioplasty (PTCA) without stenting (POBA) in patients with acute myocardial infarction at 7 cardiovascular centers in Hokkaido, Japan. Forty-one patients with acute myocardial infarction treated with successful primary stenting (stent group: case) and paired with 41 matched control subjects with acute myocardial infarction treated by successful primary PTCA without stenting (POBA group: control) were analyzed. After 1 year, the stent group had a lower incidence of the combined clinical endpoint (death, rehospitalization due to congestive heart failure, nonfatal myocardial infarction, repeat angioplasty, CABG, or cerebrovascular events) compared to the POBA group (17.1% versus 39.0%, P = 0.049). After 5 years, the incidences of congestive heart failure and cardiac death were the same in both groups. However, compared to the POBA group, the stent group had a lower combined clinical endpoint (34.1% versus 61.0%, P = 0.027). The Kaplan-Meier event-free survival curves of the stent group showed a significantly lower occurrence of clinical events compared to the POBA group (P = 0.0116). Multiple logistic regression analysis of clinical events identified age > or = 69 years (P = 0.0092, odds ratio = 4.179) and stenting (P = 0.0158, odds ratio = 0.279) as explanatory factors. Compared with POBA, primary stenting for acute myocardial infarction results in a better long-term clinical outcome.

The flexibility of the Multi-Link (ML) PENTA stent with platform 0.09 to 0.12-mm-thick struts and 12% to 16% metal/artery coverage was improved to facilitate safe delivery in complex coronary lesions. The present study was designed to evaluate the clinical (9-month) and angiographic (6-month) results of the ML PENTA stent in complex coronary lesions (modified American College of Cardiology/American Heart Association lesion type B2 or C) and to determine independent factors correlated with target lesion revascularization. The study population consisted of 86 consecutive patients who had undergone successful coronary ML PENTA stent implantation for coronary artery disease from May 2003 to July 2004 in our hospital. During the follow-up period, cardiac events were documented in 21 (24.4%) of the 86 patients. Target lesion revascularization was required in 16 (18.6%) of the 86 patients. Single logistic regression analysis showed that target lesion revascularization was significantly correlated with lesion length > 2.0 cm, residual percent diameter stenosis after the procedure > 20%, and multiple stents. Multiple logistic regression analysis showed that residual percent diameter stenosis after procedure > 20% (P = 0.0125, odds ratio = 11.585) was the significant explanatory factor of target lesion revascularization. The results of the present study suggest that 9-month clinical and 6-month angiographic outcomes in patients with coronary artery disease treated using the ML PENTA stent were excellent and target lesion revascularization after coronary ML PENTA stent implantation was influenced by residual percent diameter stenosis after the procedure.

A neutron scintillation detector based on a position-sensitive photomultiplier has been developed for neutron spin echo and small angle neutron scattering measurements. This photomultiplier has good spatial resolution, less than 1 mm2. The detection efficiency of gamma ray background is very low for using a thin ZnS/6LiF scintillator. The effective area of this detector is around 60 cm2.

Cardiac systolic (left ventricular ejection fraction) and diastolic (mitral inflow velocity pattern and/or mitral deceleration time) function were reported as predictors of clinical outcome or left ventricular remodeling in patients with acute myocardial infarction (AMI). Recently, a new index (Doppler-derived index combining systolic and diastolic myocardial performance; Tei index) for combined systolic and diastolic ventricular function has been reported to be a useful and convenient method for evaluation of global ventricular function. We therefore investigated the usefulness of the Tei index by echocardiography for evaluation of infarct size and clinical outcome in patients with AMI treated by successful primary angioplasty. We analyzed 10 age-matched control subjects and 43 consecutive patients with first AMI treated by successful primary angioplasty. The Tei index of the AMI patients was significantly greater than that of the control subjects (0.630 +/- 0.106 vs 0.375 +/- 0.036, P << 0.0001). Also, the Tei index showed a significant positive correlation with peak creatine kinase values and (99m)Tc-tetrofosmin scores. Moreover, multiple logistic regression analysis showed that the Tei index >>0.70 ( P = 0.0313, odds ratio = 14.14) was the only significant explanatory factor for cardiac death or developed congestive heart failure. The Tei index combining systolic and diastolic myocardial performance reflects infarct size and might be a predictor of clinical outcome in patients with AMI treated by successful primary angioplasty.

Unlabelled: Plasma brain natriuretic peptide (BNP) level and cardiac autonomic function are closely related to prognosis in patients with heart failure. However, their correlation and incremental prognostic values in human heart failure are unclear. We sought to evaluate the correlation between BNP level and cardiac sympathetic innervation assessed by (123)I-metaiodobenzylguanidine ((123)I-MIBG) and the prognostic value of combined assessment of risk factors for mortality in patients with heart failure., Methods: After conventional examinations and measurements of plasma BNP level and heart-to-mediastinum ratio (HMR) of cardiac (123)I-MIBG activity, 158 patients with heart failure were prospectively followed with an endpoint of cardiac death for 16 mo., Results: Fifteen deaths due to pump failure and 2 sudden cardiac deaths were documented. Plasma BNP level correlated with HMR significantly but not so tightly (r = 0.330, P < 0.0001). Univariate analysis identified plasma BNP level, HMR, chronic renal dysfunction, diabetes mellitus, age, and use of nitrates as significant predictors of fatal pump failure, and multivariate Cox analysis showed that plasma BNP level was the most powerful predictor of cardiac death. Patients with both plasma BNP level of > or = 172 pg/mL and late HMR of < or =1.74 had a greater annual rate of fatal pump failure than did those without (17.5%/y vs. 0%-3.9%/y, respectively). The hazard ratio of plasma BNP level (7.2) or cardiac (123)I-MIBG activity (10.1) increased to 34.4 when both variables were used, and prevalence of fatal pump failure significantly increased from 22% to 62.5% when diabetes mellitus and chronic renal dysfunction were present with a higher plasma BNP level and low cardiac (123)I-MIBG activity., Conclusion: Plasma BNP level is a stronger predictor than other risk factors for mortality in heart failure patients and is statistically significantly, but roughly, related to cardiac sympathetic nerve innervation. Impaired cardiac sympathetic nerve innervation and the presence of diabetes mellitus and chronic renal dysfunction, however, improve risk stratification of patients with heart failure and increased plasma BNP concentration.

Results of trials using the ACS Multi-Link (ML) stent, one of the new generation stents, were similar to or slightly better than those of trials using the Palmaz-Schatz (PS) stent. The purpose of this study was to compare long-term (3-year) clinical outcomes of patients with coronary artery disease treated with the ML stent to those treated with the PS stent. The present study consisted of 52 patients who underwent successful coronary ML stent implantation (ML group) and 52 matched control patients who underwent successful coronary PS stent implantation (PS group) from October 1997 to September 1999. During follow-up periods, cardiac events occurred in 11 patients (21%) in the ML group and 14 patients (27%) in the PS group, respectively (p = NS). Angiographic restenosis rates of American College of Cardiology/American Heart Association (ACC/AHA) lesion type A or B1 were 8.3% in both groups, and ACC/AHA lesion type B2 or C were 39.3% in the ML group and 35.7% in the PS group, respectively (p = NS). In addition, angiographic restenosis rates of ACC/AHA lesion type A or B1 were significantly lower than those of lesion type B2 or C in both groups. The results of the present study suggest that 6-month angiographic and 3-year clinical outcomes in patients with coronary artery disease treated by coronary stenting with the ML stent were comparable to those with the PS stent.

An isolated single coronary artery is a rare congenital anomaly and a cause of cardiac ischemia, congestive heart failure, and sudden cardiac death. Reported here are 3 cases of single coronary artery with acute myocardial infarction in which coronary stenting was performed. Also reported are the coronary blood flow patterns of the right coronary artery arising from the single left coronary artery.

Results of trials using the ACS MULTI-LINK (ML) stent, one of the new generation stents, were similar to or slightly better than those of trials using the Palmaz-Shatz stent. The purpose of this study was to evaluate relatively long-term (2 years) clinical outcomes of patients with coronary artery disease treated with the ML stent and to determine independent factors correlated with target lesion revascularization and cardiac events. The present study consisted of 82 consecutive patients who had undergone successful coronary ML stent implantation from January 1997 to December 1999. During the follow-up period, cardiac events occurred in 16 (19.5%) patients. All patients underwent follow-up angiography and 12 (14.6%) of the 82 patients underwent target lesion revascularization. Multiple logistic regression analysis showed that aggregation of risk factors (> or = 3 risk factors) (p = 0.0274, odds ratio=5.14) and percent diameter stenosis >20% (p = 0.0395, OR = 4.586) were the significant explanatory factors of target lesion revascularization. In addition, aggregation of risk factors (> or = 3 risk factors) exhibited a tendency to correlate with cardiac events (p = 0.0528) on multiple logistic regression analysis. The results of the present study suggest that target lesion revascularization after coronary ML stent implantation was influenced by aggregation of major coronary risk factors and residual percent diameter stenosis and that long-term clinical outcome is influenced by the aggregation of risk factors.

Prospective randomized trials of coronary stenting in patients with coronary artery disease have shown a reduced incidence of cardiac events. However, little is known of the late outcome of patients treated with coronary stenting. The purpose of this study was to evaluate the relatively long-term clinical outcomes (3 to 6 years) of patients treated with successful coronary stenting. The long-term clinical outcome was studied in 101 consecutive patients (78 males and 23 females) who had undergone successful coronary stent implantation for coronary artery disease in our hospital from October 1994 to September 1997. During a follow-up period of 48.9+/-9.5 months (range, 6-73 months), cardiac events were documented in 37 patients. The rate of survival free of cardiac events was 67% at 3 years. Multiple logistic regression analysis showed that ACC/AHA lesion type and residual percent diameter stenosis greater than 20% after stenting were the significant explanatory factors of adverse cardiac events. Long-term clinical outcome in patients with coronary artery disease treated with successful coronary stenting was influenced by the ACC/AHA lesion type of stented lesion and residual percent diameter stenosis after stent implantation.

It was observed that the vacuum magnetic island produced by an external error magnetic field in the large helical device shrank in the presence of plasma. This was evidenced by the disappearance of flat regions in the electron temperature profile obtained by Thomson scattering. This island behavior depended on the magnetic configuration in which the plasmas were produced.

We evaluated the diagnostic accuracy of a new method for quantitative analysis of myocardial perfusion at exercise using (99m)Tc-tetrofosmin tomographic imaging. (99m)Tc-tetrofosmin imaging of an exercise-rest sequence was performed in 30 patients with coronary artery disease (CAD) and eight age-matched control subjects. The exercise-induced myocardial count increase was calculated as the relative value (per cent increase ratio, %IR) to that at rest by correcting for physical decay for (99m)Tc and injected doses and by a subtraction technique. Exercise and rest (99m)Tc-tetrofosmin images were assessed visually and quantitatively using the per cent peak count and %IR of the myocardial count at exercise. Segments with significant coronary stenosis (diameter stenosis=75% or more) showed a significantly lower %IR than did those without significant coronary stenosis in the CAD patients (37+/-19% vs 63+/-21%, P<0.05). The diagnostic efficacy of visual analysis for detecting coronary stenosis was as follows: sensitivity, 58.1% and specificity, 81.4%. When %IR=37% was used for detecting significant coronary stenosis, sensitivity and specificity increased to 74.2% and 93.2%, respectively. Furthermore, the quantitative analysis significantly (P=0.04) improved the overall diagnostic accuracy from 73.3% to 86.7% compared to that of visual assessment. Thus, augmentation of myocardial (99m)Tc-tetrofosmin uptake at exercise is blunted in the myocardium with significant coronary stenosis. The calculation of myocardial count increase at exercise relative to that at rest can improve the diagnostic value of (99m)Tc-tetrofosmin SPECT imaging and may contribute to more accurate quantification of myocardial ischaemia and impaired tracer uptake in coronary artery disease.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital heart disease and has a high mortality rate in infancy. However, myocardial ischemia does not develop until adolescence or adulthood in about 10% of patients. Moreover, the diagnosis of ALCAPA is often difficult in cases without heart murmur or cardiac symptoms. The authors report the case of a 31-year-old man with ALCAPA. He was admitted to the hospital for evaluation of mild shortness of breath at exercise, but he had no typical chest symptoms due to myocardial ischemia or heart failure until age 31 and he had no heart murmur. Moreover, electrocardiogram did not show an old myocardial infarction or myocardial ischemia. Therefore, the authors did not suspect ALCAPA until they performed transthoracic echocardiography and exercise-stress single photon emission computed tomography (SPECT) with Tc-99m-tetrofosmin. The final diagnosis was established from the results of coronary arteriography. In the present case, a transthoracic echocardiogram showed abnormal coronary circulation, and exercise-stress SPECT revealed reversible myocardial ischemia. Transthoracic echocardiography and myocardial SPECT imaging could be a useful noninvasive tools for diagnosing the ALCAPA.

A 31-year-old man was admitted to our hospital for further evaluation of heart failure symptoms. Crow-Fukase syndrome was diagnosed on the basis of findings of polyneuropathy, hepatomegaly, monoclonal hypergammaglobulinemia, and hypertrichosis. Dipyridamole-stress thallium-201 perfusion imaging, contrast left ventriculography, and coronary angiography revealed a markedly dilated and dysfunctioning left ventricle, extensive reversible ischemia with fixed defect, and multiple coronary lesions. Histopathology of myocardial biopsy specimens demonstrated ischemia-induced myocardial necrosis. These findings suggested that ischemic cardiomyopathy, probably due to inflammatory reactions of coronary arteries in Crow-Fukase syndrome, was responsible for the heart failure symptoms and left ventricular dysfunction in this patient.

Recent large helical device experiments revealed that the transition from ion root to electron root occurred for the first time in neutral-beam-heated discharges, where no nonthermal electrons exist. The measured values of the radial electric field were found to be in qualitative agreement with those estimated by neoclassical theory. A clear reduction of ion thermal diffusivity was observed after the mode transition from ion root to electron root as predicted by neoclassical theory when the neoclassical ion loss is more dominant than the anomalous ion loss.

Despite the diagnostic efficacy of stress myocardial perfusion imaging, the correlation between the actual perfusion tracer activity and diseased state of a coronary artery has not been studied in detail. We estimated exercise-related perfusion augmentation in relation to disease states of a coronary artery in diabetic and non-diabetic patients by a newly developed quantitative technetium (Tc)-99m-tetrofosmin myocardial imaging technique. Tc-99m-tetrofosmin tomographic imaging with an exercise-rest protocol was performed in 26 stable coronary patients and in 8 age-matched controls. Percent increase (%IR) in myocardial count during symptom-limited submaximal exercise-stress was calculated in 16 non-infarcted polar map segments and in each coronary territory by a subtraction technique with corrections for physical decay and injected tracer doses, and the results were compared with those of angiographically quantified coronary diameter stenosis (%DS). Percent IR and peak heart rate during exercise showed a positive linear correlation both in coronary territories with significant stenosis (%DS > or = 75%) and in control or nonstenotic (%DS < 75%) territories. The regression line in stenotic regions was, however. significantly (p < 0.01) shifted downward compared to that in non-stenotic regions. Percent IR in stenotic regions showed a significant inverse correlation with %DS. Coronary stenosis of 75% or more was identified by a %IR cutoff value of 40% with 77% sensitivity, 70% specificity, and an accuracy of 72%. In coronary territories with a %DS of less than 75%, %IR in diabetic patients was significantly lower (46+/-15%) than that in nondiabetic patients (61+/-25%). Thus, blunted exercise-related augmentation of myocardial uptake of Tc-99m-tetrofosmin correlates with the severity of coronary narrowing and diabetic state.

Objective: To investigate whether coronary stenting limits myocardial injury and preserves left ventricular function., Design and Setting: Prospective multicentre case-control study of primary percutaneous transluminal coronary angioplasty (PTCA) with and without stenting, performed in seven cardiovascular centres., Subjects and Methods: 45 consecutive patients with acute myocardial infarction who were treated with successful primary stenting (Stent group) and did not have restenosis were paired with 45 matched control subjects with acute myocardial infarction treated by successful primary PTCA without stenting, also with no restenosis (POBA group)., Results: In comparison with the POBA group, the Stent group-especially those patients with a left anterior descending coronary artery lesion-had a smaller hypokinesis area (mean (SD): 15. 1 (20.0) v 34.4 (24.3) chords), reduced hypokinesis area/risk area (25.2 (31.9)% v 58.8 (40.1)%), and a larger ejection fraction (63.3 (10.2)% v 51.7 (11.7)%) evaluated by quantitative left ventriculography using the centerline method. In the Stent group, the correlation between risk area and hypokinesis area was significantly shifted downward. Multiple logistic regression analysis on infarct size limitation (hypokinesis area/risk area < 50%) identified preinfarction angina in all subjects and preinfarction angina and stenting in patients with left anterior descending coronary artery lesions as explanatory factors., Conclusions: Primary PTCA using a coronary stent is effective in preventing myocardial injury and restoring left ventricular function in patients with anterior acute myocardial infarction.

Left ventricular (LV) and right ventricular (RV) involvement in sarcoidosis must be firmly confirmed to determine patients' prognosis. We examined whether myocardial perfusion images using technetium-99m single photon emission computed tomography (SPECT) have a diagnostic benefit in the evaluation of biventricular involvement. Sixteen patients with sarcoidosis, aged 21-78 (54 +/- 12) years old, 5 males and 11 females, complicated with cardiac disease (cardiac sarcoidosis, n = 6) including tachyarrhythmias of ventricular origin (n = 5), atrioventricular block (n = 4), and congestive heart failure (NYHA > or = II, n = 1), were enrolled in this study. Myocardial SPECT using technetium-99m sestamibi or tetrofosmin was performed and semiquantitatively scored for comparison with 25 control subjects. Perfusion abnormalities were more frequently recognized in sarcoidosis (LV 5/16, 31% and RV 14/16, 88% vs. LV 0/25, 0% and RV 8/25, 32% in controls). LV involvement had a close correlation with atrioventricular block and with congestive heart failure, and multiple sites of RV involvement correlated with ventricular tachyarrhythmia of RV origin. Total number of defect segments were highest in cardiac sarcoidosis (18/30, 60% vs. 19/60, 32% in noncardiac sarcoidosis, and 11/150, 7% in controls, p = 0.0001), and semiquantitatively evaluated total LV and RV scores (ranging from 0 to 18) were higher than those of controls (15.1 +/- 1.8 vs. 11.4 +/- 3.0 in noncardiac sarcoidosis, and 9.0 +/- 5.0 in cardiac sarcoidosis) and exhibited a significant positive linear correlation with the RV ejection fraction (y = 19.8 + 1.83x, r = 0.786, p = 0.001). Biventricular SPECT using technetium-99m is clinically useful for the noninvasive evaluation of both ventricular involvements in sarcoidosis.

Despite the cardioprotective effect of rapid coronary reperfusion, the effects of spontaneous recanalization on myocardial viability and metabolism are unknown. We studied whether preinfarction angina affords cardioprotection when spontaneous coronary reperfusion occurred in acute infarct patients. Myocardial tomographies with thallium and I-123-labeled-beta-methyl-p-iodophenyl penta-decanoic acid (BMIPP) were performed in 27 acute myocardial infarct patients treated medically: 15 patients had preexisting angina before infarction (group A) and 12 did not (group B). Thallium and BMIPP abnormalities and regional function were quantified by a polar map and contrast ventriculography, respectively. There was no significant difference between thallium and BMIPP in the severity index in groups A and B (89 +/- 97 vs. 85 +/- 68, 97 +/- 28 vs. 95 +/- 27, respectively), and no significant difference between the groups in the thallium or BMIPP severity index. The ratio of the thallium severity index to that of BMIPP and the regional wall-motion abnormality index were identical in groups A and B. Both patient groups were divided into 2 subgroups based on the presence or absence of spontaneous coronary reperfusion: subgroups A1 and A2, and subgroups B1 and B2, respectively. There were no significant differences among the 4 subgroups in severity indexes for both tracers, the thallium/BMIPP ratio, or the asynergy score. The BMIPP severity index correlated significantly with that of thallium in all subgroups, but no significant difference between the regression lines was found. It is therefore unlikely that spontaneous coronary recanalization affords beneficial effects through preservation of myocardial viability in an ischemia-related zone, suggesting that the cardioprotective effect of preinfarction angina is a limited phenomenon in patients undergoing rapid coronary reperfusion.

Background: Although cardiac sympathetic nerve dysfunction is related to poor clinical outcome, a critical sympathetic dysfunction level for predicting cardiac death is still unclear. The current study was designed to investigate which indices derived from metaiodobenzylguanidine (MIBG) imaging have prognostic value compared with clinical and cardiac function variables, and to determine the threshold of cardiac MIBG activity for identifying patients likely to suffer cardiac death in both failing and nonfailing hearts., Methods and Results: Myocardial I-123-MIBG activity was quantified as a heart-to-mediastinum ratio in 414 consecutive patients, 173 (42%) of whom had symptomatic heart failure. After cardiac function measurements, patients were followed up with an end-point of cardiac or noncardiac death. During a mean follow-up period of 22 months, 37 cardiac deaths occurred: 23 resulted from heart failure, 9 were sudden cardiac deaths, and 5 were fatal myocardial infarctions. Multivariate analysis using the Wald chi2 and the Cox proportional hazard model revealed that late heart-to-mediastinum ratio, the use of nitrates, early heart-to-mediastinum ratio, and left ventricular ejection fraction were independent predictors of cardiac death; late heart-to-mediastinum ratio, New York Heart Association (NYHA) class, the presence of previous myocardial infarction, and age were independent predictors of heart failure and sudden cardiac death. Late heart-to-mediastinum ratio was the most powerful predictor of overall cardiac death among the variables. The Kaplan-Meier analysis showed that a late heart-to-mediastinum ratio of 1.74 or less, age greater than 60 years, the presence of myocardial infarction, and NYHA functional class 3 or 4 strongly indicated poor clinical outcomes. Furthermore, the more powerful incremental prognostic values were obtained by using MIBG imaging in combination with conventional clinical variables., Conclusions: Impaired cardiac sympathetic innervation assessed by MIBG activity has the greatest potential for predicting cardiac death and may be useful for identifying a threshold level for selecting patients at risk for death by heart failure, sudden cardiac death, and fatal myocardial infarction.