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Recent reports have revealed that patients who experienced early rehospitalization for heart failure (HF) had worse prognoses in terms of all-cause and cardiovascular deaths as compared to those who did not. However, precipitating factors for early rehospitalization for HF remain unknown. In this study, we assessed the precipitating factors for early rehospitalization and their impact in patients with HF.We consecutively included 242 patients (mean age: 80.4 years, females: 46.3%) with a history of rehospitalization for HF. They were divided into 2 groups: the early rehospitalization group (71 patients who were readmitted within 3 months of discharge) and the late rehospitalization group (171 patients who were readmitted after more than 3 months following discharge). During the mean follow-up period of 1,144 days (range: 857-1,417 days), 121 patients (50.0%) died. Kaplan-Meier analysis revealed that patients in the early rehospitalization group had worse prognosis (all-cause death and cardiovascular death) than those in the late rehospitalization group (log-rank p0.001). As the major precipitating factor for rehospitalization, poor compliance with the doctor's instructions on fluid and physical activity restrictions (determined by the patients or their families admittance of non-compliance with the instructions given at the time of discharge) was higher in the early rehospitalization group than in the late rehospitalization group [poor compliance with fluid restriction: 19.7% vs. 7.6% (p = 0.006), poor compliance with physical activity restriction: 21.1% vs. 9.4% (p = 0.013)].We concluded that early hospital readmission in patients with HF was associated with higher mortality rates. Compared to late rehospitalization, precipitating factors for early rehospitalization were more strongly dependent on the self-care behaviors of the patients. A more effective approach, such as multidisciplinary intervention, is essential to prevent early hospital readmission and subsequent poor prognosis.

A sigmoid septum is a state of angulation between the basal interventricular septum and the ascending aorta. Although considered to have no clinical importance, it may cause left ventricular outflow tract obstruction (LVOTO) in a hypercontractile state. Percutaneous transluminal septal myocardial ablation (PTSMA) is a catheter-based therapy aimed at improving drug-refractory symptoms in patients with hypertrophic obstructive cardiomyopathy. Few studies have reported the use of PTSMA for patients with LVOTO caused by sigmoid septum. We present a successful case of a 71-year-old female patient who presented with a long history of exertional dyspnea. The presence of a sigmoid septum was revealed on echocardiography. At rest, the left ventricular outflow tract pressure gradient was low and there were no signs of systolic anterior motion (SAM) of the mitral valve; however, during Valsalva maneuver, the gradient increased significantly, and SAM could be seen. We successfully performed PTSMA, resulting in a significant lowering of the pressure gradient and disappearance of SAM. The patient’s symptoms dramatically improved by the following day.

A 58-year-old woman with pallor on her left hand due to chronic hemodialysis presented with a recent intractable skin ulcer on her left 3rd finger; the skin perfusion pressure (SPP) was 19 mmHg. Preoperative angiography revealed an occluded proximal left radial artery, no communication between the ulnar and superficial palmar arteries, several collaterals from the left ulnar to the radial artery, and no visualization of the finger arteries. Successful endovascular therapy to the occluded radial artery increased flow to the arteriovenous fistula (AVF), but not to the fingertips. Slightly compressing the AVF augmented the flow and wound blush at the wound sites on the 3rd fingertip, leading to a diagnosis of hemodialysis access-induced distal ischemia (HAIDI). Surgical AVF banding with intra-operative SPP monitoring improved the SPP to 34 mmHg, leading to complete wound healing over 1 month with a preserved AVF. We performed a bilateral temporal artery biopsy and diagnosed giant cell arteritis. As the angiographic wound blush at wound sites is reportedly an important factor for wound healing, angiography with AVF manual compression is essential to diagnose HAIDI and evaluate the blood flow for wound healing.

Highlights • The treatment of patients for lung cancer with vertebral body invasion remains challenging. • We reported a case that total vertebrectomy (Th2) and dissection subclavian artery for lung cancer invading spine and subclavian artery. • We experienced complete resected one case that tumor location and invading was very complicated., Introduction Surgery for primary lung cancer invading the spine remains challenging. Here, we present a case of superior sulcus tumor (SST) with vertebral invasion, successfully resected with total vertebrectomy (Th2) and dissection of involved apical chest wall and the subclavian artery (SCA). Presentation of case A 62-year-old man was referred with the diagnosis of lung squamous cell carcinoma originating from left upper lobe (clinical stage IIIA/T4N0M0) involving the thoracic vertebrae (Th2) as well as the apical chest wall including three ribs (1st, 2nd and 3rd) and SCA. After induction concurrent chemo-radiotherapy, we achieved complete resection by three-step surgical procedures as follows: first, the anterior portion of involved chest wall including SCA was dissected through the trans-manubrial approach (TMA); next, the posterior portion of involved chest wall including ribs was dissected and left upper lobectomy with nodal dissection was performed through posterolateral thoracotomy; finally, total vertebrectomy (Th2) was performed through posterior mid-line approach. Discussion This tumor was existence of anterior and posterior position in pulmonary apex region. So that, it is very important for complete resecting this complicated tumor to work out operation’s strategy. Conclusion Surgery may be indicated for SST invading the spine, when complete resection is expected.

Highlights • We experienced a case of bleeding after thoracic surgery be induced by rivaroxaban, which is a new anticoagulant. • This case provided important lessons for the usage of perioperative new anticoagulants, such as revaroxaban, which do not need monitoring. • Revaroxaban dose not have the monitoring of blood coagulant system and the antagonist., Introduction Postoperative pulmonary embolism (PE) is the one of the most important complications after thoracic surgery. This complicatin after the surgery is often treated by new anticoaglant drug, such as rivaroxaban, which dose not need to the monitoring of blood coaglation system. We experienced postoperative bleeding case during anticoaglant therapy using rivaroxaban. Presentation of case The patient underwent a right upper lobectomy with lung and chest wall resection for lung cancer. On postoperative day (POD) 10, we started to use rivaroxaban to treat the deep vein thrombosis (DVT). Four days after starting the rivaroxaban treatment, severe surgical site hemorrhage occurred, which led to the need for the infusion of concentrated red cells (CRC). After stopping the rivaroxaban, the thoracic bleeding ceased. Because the event occurred so long after the surgery, and because the bleeding stopped after withdrawal of treatment, we believe that rivaroxaban induced the thoracic bleeding. Conclusion Some reports in the field of orthopedics (Turpie et al., 2009) have noted that rivarxaban is effective to prevent postoperative DVT. However, there were few reports that invied the attention to postoperative bleeding be induced by rivarxaban. Thus, we describe this case in order to alert clinicians to the potential bleeding risks associated with the admistration of rivaroxaban postoperatively.

Culprit lesions of acute coronary syndrome (ACS) can be classified into plaque rupture (PR), erosion, or calcified nodule (CN). However, clinical characteristics and morphological plaque features remain unknown. Four hundred and forty-three ACS patients who underwent pre-intervention optical

Detailed mechanisms of potent and rapid antiplatelet inhibition with new-generation P2Y12 receptor inhibitor, prasugrel, has not been demonstrated. We aimed to compare the effect of prasugrel and clopidogrel on the acute phase changes of intra-stent tissue (IST) in acute coronary syndrome (ACS)

Cancer/testis antigens (CT antigens) are thought to be suitable targets for antigen-specific immunotherapy, because of the cancer-specific expression except for the testis among various normal tissues and no-expression of HLA class I in the testis. In the present study, the expressions of CT antigens (MAGE-A3, MAGE-A4, NY-ESO-1 and KK-LC-1) in non-small cell lung cancer (NSCLC) were analyzed by RT-PCR. The subjects were 239 patients with NSCLC who underwent surgery from 2001 to 2005 in our department. The expression rates of MAGE-A3, MAGE-A4, NY-ESO-1 and KK-LC-1 were 23.8%, 20.1%, 10.5% and 32.6% in patients with NSCLC, respectively. MAGE-A4 was expressed more frequently in male (25.3%) than in female (10.6%) (p0.01). The positive proportion of MAGE-A4 was higher in stages II-IV (30.6%) than in stage I (12.8%) (p0.01). Both of MAGE-A3 and MAGE-A4 were expressed more frequently in squamous cell carcinoma than in adenocarcinoma (p0.01). Such tendency was not observed among NY-ESO-1 and KK-LC-1 expression. KK-LC-1 was expressed in 32.1% of patients with adenocarcinoma and in 36.5% of patients with squamous cell carcinoma. Patients with positive MAGE-A4 expression showed significantly poorer overall survival than those without MAGE-A4 expression (p=0.013), and such effect on survival was also observed, when the analysis was limited to patients at stage I (p=0.0037). Expression of MAGE-A3, NY-ESO-1 or KK-LC-1 did not affect survival of patients with NSCLC significantly, however, expression of at least one of such CT antigens negatively affect survival of patients with NSCLC (p=0.045).

Neoatherosclerosis is the major cause of late-phase target lesion revascularization (TLR) after stent implantation. We assessed the effect of lipid-lowering therapy with rosuvastatin 10 mg/day and eicosapentaenoic acid (EPA) 1800 mg/day on in-stent neoatherosclerosis using optical coherence

Summary Background The role of the HLA phenotype in cancer prognosis has been frequently discussed. We previously reported the correlation between HLA alleles and the postoperative prognosis of 204 patients with non-small cell lung cancer (NSCLC). The present study was based on 695 patients with NSCLC to confirm these correlations. Methods We evaluated the medical records of 695 NSCLC patients who underwent surgical resection. The serological typing of HLA class I was performed using a microcytotoxicity test of lymphocytes or PCR-sequence-specific oligonucleotides (PCR-SSO), and the correlation between the HLA alleles and the clinicopathological features was analyzed. The survival curves were calculated, and then a comparison of the survival curves was carried out. Results The HLA-A2 positive(A2(+)) group at stage I showed a more unfavorable prognosis than HLA-A2(−) group in overall survival. At stage II + III, the HLA-A24(+) group had a poorer prognosis than the HLA-A24(−) group, and the HLA-B52(+) group showed unfavorable prognosis. Multivariate analysis demonstrated that HLA-A2 at stage I and HLA-A24 at stage II + III were the independent factors that affected the survival period. Conclusions The expression of HLA-A2 was considered as one of the unfavorable prognostic factors in the NSCLC patients at stage I. HLA-A24(+) group showed a significant unfavorable prognosis at stage II + III. These results suggested that HLA-A2 and HLA-A24 could be the prognostic factors in patients with NSCLC according to the state of advancement of the disease.

Invariance principle states that a scaled simple random walk converges to the standard Brownian motion. In this article, we present a discrete time stochastic process, which reflects a microstructure of market dynamics, and prove a convergence to a scaling limit process with a drift term and a jump term. These terms are derived from a macroscopic condition on volumes traded in some time intervals. The mathematical tools for obtaining our results are Dobrushin–Hryniv theory and the method of cluster expansion developed in mathematical studies of statistical mechanics.

The clinical utility of invasive imaging guidance for percutaneous coronary intervention (PCI) has been repeatedly reported. Little is known, however, about whether the combined use of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) during PCI may offer long-term clinical

The importance of HDL functionality on coronary artery disease has been repeatedly demonstrated in recent studies. However, the association between HDL functionality and stent failure has yet to be clarified. Recently, we established a cell-free assay system to evaluate the capacity of HDL to accept

Carbon/copper-based materials with high thermal conductivity and good stability at high temperatures were developed by adding a small amount of titanium. The isotropic fine-grained nuclear grade graphite and felt type C/C composite, which were impregnated by copper (10–18 vol.%) and titanium (0.5–0.8 vol.%), provided ∼1.3 times higher thermal conductivity of 110 and 200 W/mK at 1200 K than the original carbon materials. Microstructural analyses showed that the increase of thermal conductivity is due to the formation of titanium compounds at the carbon/copper interface, and that the thermal energy would pass through both the carbon and copper. The present study indicates that addition of a small amount of a third element with a low enthalphy of alloy formation with carbon and copper will increase the thermal conductivity and the stability of carbon/copper-based materials. These carbon-based materials could be one of candidate materials for the plasma facing components of the fusion devices.

Left ventricular systolic or diastolic dysfunction may lead to elevation in pulmonary capillary wedge pressure (PCWP) during pre-balloon testing at atrial septal defect (ASD) closure, through abrupt closure of left to right shunt. However, the association between acute hemodynamic changes and

α-SrMnO3 crystallizes in the hexagonal system with unit-cell dimensions a = 5.454(1) A, c = 9.092(2)A, space group P6 3 mmc , Z = 4 . The structure was solved by the heavy-atom method; of 404 unique reflections measured by counter method, 203 that obeyed the condition |F0| ≥ 3σ (|F0|) were used in the refinement to a conventional R value of 0.043. The structure consists of four close-packed SrO3 layers in an ABAC stacking sequence along the hexagonal c axis. Oxygen octahedra containing Mn4+ are grouped into face-sharing pairs linked by corner sharing within the cubically stacked “A” layer.