Search

Background: Vertigo or dizziness is a common occurrence, but it remains a challenging symptom when encountered in the emergency department (ED). A diagnostic score for stroke with high accuracy is therefore required.Methods: A single-center observational study (498 patients) was conducted. The predictor variables were derived from a multivariate logistic regression analysis with Akaike information criterion. The outcome was the occurrence of stroke. We evaluated the utility of a new diagnostic score (TriAGe+) and compared it with the ABCD2 score.Results: The cohorts included 498 patients (147 with stroke [29.4%]). Eight variables were included: triggers, atrial fibrillation, male gender, blood pressure ≥140/90 mm Hg, brainstem or cerebellar dysfunction, focal weakness or speech impairment, dizziness, and no history of vertigo or dizziness or labyrinth or vestibular disease. We derived the TriAGe+ score from these variables. In the cohort, the prevalence of stroke increased significantly using the diagnostic score: 5.9% for a score of 0-4; 9.1% for 5-7; 24.7% for 8-9; and 57.3% for 10-17. At a cutoff value of 10 points, the sensitivity of the score was 77.5%, the specificity was 72.1%, and the positive likelihood ratio was 3.2. When the cutoff was defined as 5 points, the score obtained a high sensitivity (96.6%) with a good negative likelihood ratio (.15). The new score outperformed the ABCD2 score for the occurrence of stroke (C statistic, .818 versus .726; P < .001).Conclusions: The TriAGe+ score can identify the occurrence of stroke in patients with vertigo or dizziness presenting to the ED. [ABSTRACT FROM AUTHOR]

Abstract: The latency relaxation is a small drop of tension before skeletal muscle begins to develop active tension. This phenomenon was found nearly one century ago but its origin has not been clarified. In this review, the hypotheses for its mechanism are discussed in terms of the recent experimental results using X-ray diffraction. The latency relaxation takes place almost simultaneously as the structural change of the regulatory protein troponin, an unspecified structural change of the thick filament, and increase in stiffness. It seems difficult to associate all of these with the latency relaxation by assuming a simple mechanism. [Copyright &y& Elsevier]

Various patterns of disease progression have been reported in patients with hypertrophic cardiomyopathy (HCM). HCM with left ventricular systolic dysfunction (HCM-LVSD) has been recognized as unfavorable patterns of disease progression that a certain proportion of patients with HCM-LVSD finally requires heart transplantation (HTx) or implantable continuous-flow left ventricular assist device (iLVAD) implantation. Compared with dilated cardiomyopathy (DCM), HCM-LVSD has reported to demonstrate worse prognosis. However, long-term prognosis of patients with HCM-LVSD after iLVAD implantation has not been fully elucidated. This study aimed to clarify the long-term clinical outcome of patients with HCM-LVSD after iLVAD implantation in comparison with those with DCM. The medical records of both patient with HCM-LVSD and idiopathic DCM as control group who underwent iLVAD implantation from 2011 to 2020 in our institution were reviewed. 96 patients with DCM (mean age 43.5 years, 73 males,) and 24 patients with HCM-LVSD (mean age 48.3 years, 16 males) had received iLVAD implantation (DCM: 25 centrifugal-flow and 71 axial-flow LVAD, HCM-LVSD: 10 centrifugal-flow and 14 axial-flow LVAD) with average LVAD support period of 1080 and 928 days, respectively. Although, there was no significant difference in brain natriuretic peptide (BNP) at pre LVAD implantation between both groups, BNP at 3 months post LVAD implantation in DCM group was significantly higher than that in HCM-LVSD group [88 vs 256 pg/ml, p<0.001]. In DCM group, 7 (7%) died, 38 (40%) had successful HTx, 49 (51%) are still on LVAD support and 2 were weaned from LVAD, 4 (17%) died, 7 (29%) had successful HTx, and 13 (54%) are still on LVAD support in HCM-LVSD group. There was no difference in patient survival after iLVAD implantation between two groups (94.3 % vs 95.7 % at 3 years, respectively). Despite inferior survival without LVAD, HCM-LVSD demonstrated equivalent overall survival compared with that of DCM after LVAD implantation. However, BNP at 3 months after LVAD implantation in HCM-LVSD group demonstrated higher value than that of DCM group which imply existence of persistent and progressive myocardial damage or subclinical right ventricular failure in HCM-LVSD even after LVAD implantation. [ABSTRACT FROM AUTHOR]

Abstract: Contrast enhancement by refraction was used to visualize tumours in the rabbit lung. VX2 tumour cells were intravenously injected into a rabbit. After 14 days the rabbit was euthanized and the lungs were imaged. Refraction-enhanced X-ray images were obtained with a sample-to-detector distance of 2.65–6m. The beamline BL20B2 at the SPring-8 synchrotron radiation facility was used for the experiment, with a monochromatic X-ray beam with an energy of 33.2keV. In the case of projection images, it was found that refraction did not help visualization of small tumours: the nodules did not show up with sharply defined edges. In tomography, tumours with a size of 1–10mm were clearly visualized, together with blood vessels with a diameter down to 0.4mm. These results show that refraction-enhanced imaging may be useful in human lung tomography to find small tumours. [Copyright &y& Elsevier]

Abstract: Architectural distortions, as well as clustered microcalcifications and masses, are important findings in interpreting breast cancer on mammogram. We have developed an automated detection algorithm for distorted areas based on the concentration of mammary glands in order to aid physicians with diagnosis. The purpose of this study is to suggest an improvement to our previous method to achieve higher sensitivity. The extraction method of the mammary gland was changed to employ both a shape index and curvedness so as not to be influenced by the background density from the breast thickness. The directionality of a normal of mammary gland is toward the nipple whereas that in an abnormal gland is toward another, distorted area. Normal mammary glands were eliminated by virtue of their conformation with the normal directionality. Our image database consisted of 117 cases with architectural distortions. The first-stage detection rate and the number of correct detections of ROIs were improved with our method. It was concluded that our detection method would be effective. [Copyright &y& Elsevier]

Continuous flow left ventricular device (CF-LVAD) brings a substantial survival improvement in end-staged heart failure patients. However, bleeding complications are common after CF-LVAD implantation, and in some cases a re-exploration for bleedings is needed. We investigated the incidence, timing and risk factors for a re-exploration for bleedings after CF-LVAD implantation. we retrospectively reviewed 162 consecutive patients (age 43 ± 13 years, 71% men) who underwent CF-LVAD implantation (HeartMateII 119, Jarvik2000 15, HVAD 13, EVAHEART 10, DuraHeart 5) in our center from January 2012 to June 2019. The baseline patient characteristics, peri-operative factors, post-operative platelet counts and post-operative antithrombotic therapy were retrospectively collected from the electronic medical record. During the follow up period [median 662 days, interquartile range (IQR) 364 - 1116 days], 35 (21.6%) patients experienced a re-exploration for bleedings. The median time from a CF-LVAD implantation to re-exploration for bleedings was 6 days (IQR 1 - 10 days). In multivariate logistic regression analysis, a post-operative platelet count was the independent predictor for a re-exploration for bleedings after CF-LVAD implantation (per 104/μl: odds ratio 0.82, 95% confidence interval 0.74 - 0.91, p < 0.001). Patients who experienced a re-exploration for bleedings had a significantly worse survival rate compared with patients who did not (At 4 years 73.6% vs. 90.1%, p = 0.039). A re-exploration for bleedings is prevalently needed after CF-LVAD implantation, especially in patients with low post-operative platelet counts. As bleedings requiring a re-exploration were associated with poor prognosis, the risk stratification using post-operative platelet counts may be beneficial for patients who underwent CF-LVAD implantation. [ABSTRACT FROM AUTHOR]

An extracorporeal centrifugal-flow left ventricular assist device (CF-E-LVAD) system (BR16010) was newly developed. Since implantation of the durable implantable LVAD (I-LVAD) is still controversial in patients with cardiogenic shock or refractory heart failure because of its significant inferiority of outcomes as compared with higher INTERMACS profile patients, short-term E-LVADs have been still clinically important for bridging strategy for the next definitive treatment. Our aim of this study was to evaluate the influence of the novel developed CF-E-LVAD on the clinical prognosis in patients with bridging strategy, as compared with conventional extracorporeal pulsatile flow LVAD (PF-E-LVAD). We retrospectively reviewed the medical records of 62 patients who were implanted E-LVAD as bridging strategy from April 2011 to January 2019. Six patients (9.7%) were implanted CF-E-LVAD. The clinical prognosis until 30 days after E-LVAD implantation, and the change of cardiac function and laboratory data at the early follow up were evaluated. Improvement of left ventricular ejection fraction was significantly greater in the CF-E-LVAD group than in the PF-E-LVAD group (217.9 [147.8 to 335.3] vs 38.3 [-21.7 to 128.8] %, P=0.010). Serum total bilirubin level significantly improved in CF-E-LVAD group than in the PF-E-LVAD group (-7.9 [-33.3 to 82.4] vs 68.8 [10.0 to 202.1] %, P=0.041). Although clinical courses, including death, cerebrovascular accidents and re-thoracotomy due to removal of mediastinal hematoma, were no significant difference between two groups, almost half (54.5%) in the PF-E-LVAD group was still ongoing the E-LVAD support at the 30 days post-E-LVAD implantation while only one patient (16.7%) was supported with E-LVAD in the CF-E-LVAD group. The novel developed CF-E-LVAD system might influence on the earlier recovery of cardiac function and the multiple organ failure, and lead to the earlier decision for next definitive strategy. [ABSTRACT FROM AUTHOR]

Left ventricular assist device (LVAD) has been reported to improve pulmonary hypertension (PH) due to left heart disease (PH-LHD). However, prevalence of combined post- and pre-capillary PH (Cpc-PH) in patients with PH-LHD and the impact of LVAD implantation on Cpc-PH has not been fully elucidated. This study aimed to investigate hemodynamic changes following LVAD implantation in patients with PH-LHD to assess pulmonary vascular reverse remodeling. Eighty-nine patients with advanced heart failure complicated by PH-LHD undergoing LVAD implantation who received serial right heart catheterizations at least 3 time points (before, early after, and 1-year after implantation) were retrospectively reviewed. Patients were divided into 2 groups as Cpc-PH group (n=50): pulmonary vascular resistance (PVR) > 3 Wood unit (WU) or diastolic pulmonary pressure gradient (DPG) ≥ 7 mmHg, and isolated post-capillary PH (Ipc-PH) group (n=39). Values of brain natriuretic peptide and transaminase in Cpc-PH group were higher than those in Ipc-PH group. Cpc-PH patients were consisted of 41 with PVR > 3 WU, 8 with PVR > 3 WU and DPG ≥ 7 mmHg, and 1 with DPG ≥ 7 mmHg preoperatively. Median values of PVR in both groups significantly decreased early after LVAD implantation [from 4.1 to 2.7 WU (p < 0.05) in Cpc-PH group; from 2.0 to 1.7 WU (p < 0.05) in Icp-PH group]. However, 15 patients were still found to be PVR > 3 WU (n=14) or DPG ≥ 7 mmHg (n=1) at that point. Among these 15 patients, 4 patients still remained on their PVR > 3 WU (n=3) or DPG ≥ 7 mmHg (n=1) even 1-year after LVAD implantation. PVR and DPG in these 4 patients turned to normal values at 3-year after implantation. Over half of patients with PH-LHD were complicated by Cpc-PH in our study cohort. LVAD implantation readily improved hemodynamics regardless of complication of Cpc-PH, whereas 15 patients were still found to be PVR > 3 WU or DPG ≥ 7 mmHg which should be considered as persistent Cpc-PH. We speculate that most of Cpc-PH in patients with PH-LHD might be caused by alteration of vascular tone which will be promptly relieved by substantial left ventricular unload, however a certain number of patients with Cpc-PH might develop structural remodeling of pulmonary vasculature which requires months or years to achieve pulmonary vascular reverse remodeling. [ABSTRACT FROM AUTHOR]

Abstract: We seek to establish non-invasive imaging able to detect and measure aspects of the biology and physiology of surface fluids present on airways, in order to develop novel outcome measures able to validate the success of proposed genetic or pharmaceutical therapies for cystic fibrosis (CF) airway disease. Reduction of the thin airway surface liquid (ASL) is thought to be a central pathophysiological process in CF, causing reduced mucociliary clearance that supports ongoing infection and destruction of lung and airways. Current outcome measures in animal models, or humans, are insensitive to the small changes in ASL depth that ought to accompany successful airway therapies. Using phase contrast X-ray imaging (PCXI), we have directly examined the airway surfaces in the nasal airways and tracheas of anaesthetised mice, currently to a resolution of ∼2μm. We have also achieved high resolution three-dimensional (3D) imaging of the small airways in mice using phase-contrast enhanced computed tomography (PC-CT) to elucidate the structure-function relationships produced by airway disease. As the resolution of these techniques improves they may permit non-invasive monitoring of changes in ASL depth with therapeutic intervention, and the use of 3D airway and imaging in monitoring of lung health and disease. Phase contrast imaging of airway surfaces has promise for diagnostic and monitoring options in animal models of CF, and the potential for future human airway imaging methodologies is also apparent. [Copyright &y& Elsevier]

ObjectiveCoronary arteriosclerotic heart disease frequently develops in patients with diabetes. Decreased serum high-density lipoprotein cholesterol concentration and low-density lipoprotein (LDL) particle size, accompanied by hypertriglyceridemia, are associated with the onset of atherosclerosis. We recently reported that hypertriglyceridemia was significantly improved in patients with type 2 diabetes who ingested diacylglycerol (DAG) oil. The effect on variables, including LDL particle size related to lipid metabolism, however, was not examined. The present study investigated the effects on these variables in more detail.MethodsPatients with type 2 diabetes (n = 24) were assigned to receive DAG oil or triacylglycerol oil, and a 3-mo, single-blind, controlled study was performed. Patients replaced cooking oil in their daily diet with DAG or triacylglycerol oil, and anthropometry and blood sampling were performed at monthly intervals.ResultsThere were no significant differences in calorie intake or amount of test oil ingested between groups. Waist circumference and serum triacylglycerol concentrations were significantly lower and serum concentrations of high-density lipoprotein cholesterol and apolipoprotein-AI were significantly higher in the DAG oil group than in the triacylglycerol oil group. Plasma plasminogen activator inhibitor-1 concentrations were significantly lower in the DAG oil group. LDL particle size tended to increase in the DAG oil group and was significantly larger in patients who had a small initial LDL particle size (<25.5 nm). There were no significant differences in variables related to glucose metabolism or in serum concentration of free fatty acids or total ketone bodies.ConclusionsThese results indicate that DAG oil may be useful for patients who have type 2 diabetes in the management of obesity and lipid abnormalities. [ABSTRACT FROM AUTHOR]

Cardiac allograft vasculopathy (CAV) is still a major cause of mortality in heart transplant (HTx) recipients. Risk stratification for predicting the development of CAV is needed to suppress the development of CAV. Our aim of this study is to clarify the risk factors for the development of CAV. We retrospectively reviewed consecutive 100 HTx recipients who did not have any coronary artery lesions on first coronary angiography at 5 to 12 weeks after transplantation (baseline). Donor-transmitted atherosclerosis (DA) on intravascular ultrasound (IVUS) was defined as a maximal intimal thickness of 0.5 mm or greater at baseline. Pathology diagnosis of cardiac antibody-mediated rejection (pAMR) was pathologically diagnosed on the basis of the 2013 ISHLT working formulation. The development of CAV included the any coronary revascularization, acute myocardial infarction and the coronary artery lesions classified ISHLT CAV 1 or 2. DA on IVUS was observed in 62 recipients regardless of no apparent lesions on angiography. pAMR was diagnosed in six recipients within 1year post-HTx. Sixteen recipients had the development of CAV, including five who underwent revascularization, one who had acute myocardial infarction and three who found the moderate lesions classified ISHLT CAV2. DA and the occurrence of pAMR within 1 year post-HTx significantly influenced on the cumulative incidence of development of CAV at a mean follow up period of 6.7±4.6 years after transplantation [Hazard ratio (HR): 5.2, 95% confidence intervals (CI):1.2-23.0, P=0.029 and HR: 7.3, 95% CI:2.0-26.7, P=0.003, respectively]. Multivariable cox proportional hazard model including DA, the occurrence of pAMR and associated variables with the development of CAV showed that DA and the occurrence of pAMR were independently associated with the development of CAV (HR: 5.4, 95%CI:1.2-24.6, P=0.028 and HR: 6.7, 95%CI:1.5-29.1, P=0.012, respectively). DA and the occurrence of pAMR within 1 year post-HTx independently influenced on the development of CAV. [ABSTRACT FROM AUTHOR]

The development of cardiac allograft vasculopathy (CAV) is known to be induced by a biphasic process involving early intimal thickening and late constrictive remodeling. However, change of intimal thickening long-term period post heart transplantation (HTx) is still unknown. Our aim of this study was to investigate the change of intimal thickening of CAV long-term period post-HTx. Intravascular ultrasound (IVUS) of coronary arteries were performed at 5 to 12 weeks after HTx (baseline) and repeated annually in all HTx recipients. And we reviewed the medical records of consecutive 102 HTx recipients who underwent serial intravascular ultrasounds from baseline to at least 1-year post HTx. 'Progressive intimal thickening on IVUS' was defined as an annual increase in maximal intimal thickness (MIT) of 0.3 mm or greater. The development of CAV included the any coronary revascularization, acute myocardial infarction and the coronary artery lesions classified ISHLT CAV 1 or 2. The progressive intimal thickening on IVUS was high incidence by 3 years post-HTx, however, was low after 3 years post-HTx (Figure 1). Also, similar trends were shown regardless of initiation of everolimus. The incidence of progressive intimal thickening on IVUS was higher in the early period than in the mid-term period (92.3% vs 25.0%, P<0.001). While, cumulative event free rate of the development of CAV was linearly decreasing until 10 years after HTx (Figure 2). This long-term serial IVUS study supported that lumen loss on CAV occurred in a biphasic process consisting of the early intimal thickening and late constrictive remodeling. These results suggest that interventions to suppress an increase in intimal thickening is earlier needed within 3 years post-HTx, and also further treatment strategy to suppress the late constrictive remodeling on CAV are required. [ABSTRACT FROM AUTHOR]