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To investigate the possibility of p-type doping of α-SrSi2, a promising as an eco-friendly thermoelectric material, the energy changes of substitutions of the Si site of α-SrSi2 by group 13 elements were evaluated using first-principles calculations. It is found that Ga doping was the most energetically favorable dopant while In is the most unfavorable. We examined the synthesis of Ga- and In-doped α-SrSi2 using the vertical Bridgeman method and investigated their thermoelectric properties. The Ga atoms were doped to α-SrSi2 successfully up to 1.0 at. %, while In atoms could not be doped as suggested by calculations. For experimental prepared Ga-doped samples, the carrier density was observed to increase with Ga doping, from 3.58 × 1019 cm−3 for undoped α-SrSi2 to 4.49 × 1020 cm−3 for a 1.0 at. % Ga-doped sample at 300 K. The temperature dependence of carrier concentrations was observed to change from negative to positive with increasing Ga content. In addition, the temperature dependence of the Seebeck coefficient was also observed to change from negative to positive with increasing Ga content. The results indicate that α-SrSi2 undergoes a semiconductor–metal transition with Ga doping. The power factor for the undoped sample was quite high, at 2.5 mW/mK2, while the sample with 0.3 at. % Ga had a value of 1.1 mW/mK2 at room temperature. [ABSTRACT FROM AUTHOR]

Purpose: The present study analyzed the outcomes of our experience with abdominal aortic aneurysm (AAA) repair over 20 years using endovascular aortic repair (EVAR) with commercially available devices or open aortic repair (OAR) and reviewed our surgical strategy for AAA. Methods: From 1999 to 2019, 1077 patients (659 OAR, 418 EVAR) underwent AAA repair. The OAR and EVAR groups were compared retrospectively, and a propensity matching analysis was performed. Results: EVAR was first introduced in 2008. Our strategy was changed to an EVAR-first strategy in 2010. Beginning in 2018, this EVAR-first strategy was changed to an OAR-first strategy. After propensity matching, the overall survival in the OAR group was significantly better than that in the EVAR group at 10 years (p = 0.006). Two late deaths due to AAA rupture were identified in the EVAR group, although there were no significant differences between the OAR and EVAR groups with regard to the freedom from AAA-related death at 10 years. The rate of freedom from aortic events at 10 years was significantly higher in the OAR group than in the EVAR group (p < 0.0001). Conclusion: The rates of freedom from AAA-related death in both the OAR and EVAR groups were favorable, and the rate of freedom from aortic events was significantly lower in the EVAR group than in the OAR group. Close long-term follow-up after EVAR is mandatory. [ABSTRACT FROM AUTHOR]

Purpose: The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. Materials and methods: Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann–Whitney U test or Fisher's exact test for the univariate analysis. Patients' characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. Results: TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). Conclusion: TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head. [ABSTRACT FROM AUTHOR]

To improve the thermoelectric (TE) performance of Mg2Si by optimizing the carrier concentration and reducing thermal conductivity, we focus on codoping Sb and Zn using theoretical and experimental methods. First-principles calculations show that Sb is a stable and controllable n-type dopant for Mg2Si, whereas Zn considerably shrinks the Mg2Si cell. We fabricate dense and high-purity polycrystalline Mg2MxSi (M = Sb, Zn; x = 0, 0.1, 0.3, and 0.5 at.%) via the all-melt process of the conventional vertical Bridgman (VB) method and examine the influence of dilute codoping of Sb and Zn on the TE properties of Mg2Si. VB-grown Mg2Si doped with 0.5 at.% Zn and Sb shows higher electrical conductivity than pure Mg2Si, achieving an increased power factor by 4.62–15.23% over that of the sintered specimen under the same doping rate at 323–873 K. Because the decreased lattice thermal conductivity of the codoped specimens nullifies the increased electronic thermal conductivity, the total thermal conductivity is similar to that of pure Mg2Si. Consequently, the dimensionless figure of merit of VB-grown Mg2Si doped with 0.5 at.% Zn and Sb reaches 0.82 at 873 K. [ABSTRACT FROM AUTHOR]

Objective: This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI). Methods: Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR). Results: The patients' mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011). Conclusions: Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods: We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results: The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion: S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization.Materials and Methods: We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients' characteristics and clinical factors were evaluated for their association with sac enlargement.Results: Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P < 0.05) was a significant predictor of sac enlargement.Conclusion: TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH).Methods: Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers.Results: Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p < 0.001).Conclusion: TAE is a technically safe and clinically effective treatment method for life-threatening SRH. CE-CT has moderate capability for accurate identification of active bleeding arteries. TAE including arteries that potentially distribute anatomic territory of the hematoma is essential. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the advantages of intraprocedural CT during adrenal venous sampling (AVS) to confirm accurate catheterization of the right adrenal vein (RAV).Materials and Methods: This single-institution study included 106 patients (mean age 52.4 years; range 28-74 years) with primary aldosteronism who performed contrast-enhanced CT (CECT) before AVS following AVS between January 2011 and March 2018. After catheterization of the RAV under fluoroscopic guidance, unenhanced CT images were obtained to confirm catheter position on unified CT angiography system. Catheter repositioning was performed when the catheter was inaccurately positioned. Venography findings were classified into two groups: (1) presumably cannulated in the RAV (presumed RAV group) and (2) obscured visualization of the RAV because of collateral vessels (obscured RAV group). Success rates of AVS were compared using Fisher's exact test.Results: The overall success of AVS was achieved in 104 patients (98.1%). Catheter was deviated into the IVC during intraprocedural CT in four patients. Fourteen patients (14.0%) required catheter repositioning by intraprocedural CT images, and accurate catheterization in the RAV was eventually accomplished. The success rate of AVS was significantly higher in the presumed RAV group (90.1% [73/81]) than that in the obscured RAV group (68.4% [13/19]) (p = 0.024). If intraprocedural CT was not acquired during AVS, the success rate of AVS would have been significantly lower (84.9% [90/106]) compared with that use of intraprocedural CT (98.1% [104/106]) (p < 0.001).Conclusions: Intraprocedural unenhanced CT by referring to the preprocedural CECT before AVS enables the confirmation of accurate catheterization of the RAV.Level Of Evidence: Level 4, case series. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA).Materials and Methods: Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications.Results: Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p < 0.001), respectively. The maximum aneurysm diameter (odds ratio (OR), 1.16; 95% confidence interval (CI), 1.01-1.34; p = 0.0362) and the number of patent lumbar arteries (OR, 2.72; 95% CI, 1.07-6.90; p = 0.0357) were predictive of persistent EL-II.Conclusions: The incidence of EL-II after EVAR using the Endurant stent graft for AAA with occluded IMA was low, but most early EL-II persisted and resulted in aneurysm enlargement. Level of Evidence Level 4, Case Series. [ABSTRACT FROM AUTHOR]

Purpose: To justify a classification system for angiographic images of uterine artery embolization (UAE) for postpartum hemorrhage (PPH) and identify new risk factors associated with failed embolization.Materials and Methods: A retrospective analysis of 63 consecutive patients who underwent UAE for severe PPH was performed. Uterine artery angiography (UA) before embolization was classified into two types: type 1 was defined as complete staining and type 2 was defined as partial staining of the uterine arteries. The clinical outcome, UA classification, and other possible factors previously reported were evaluated. Univariate and multivariate analyses were performed to determine the factors related to clinical outcomes.Results: Sixty-three patients were enrolled (type 1, 22; type 2, 41). The clinical success rates of the primary UAE session were 90.9% (20/22) for type 1 and 61.0% (25/41) for type 2 (p = 0.018). Univariate and multivariate analyses demonstrated that the only UA classification was significantly associated with primary UAE failure (p = 0.033).Conclusions: The UA classification is an independent predictive factor of the clinical success rate of the primary UAE session for PPH; thus, it is an intuitive and optimal predictor for interventional radiologists to decide whether additional therapy is necessary. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the current status of interventional radiology (IR) procedures for a type II endoleak (T2EL) in Japan, and to identify the technical aspects that affect treatment results.Materials and Methods: A retrospective survey was conducted by distributing questionnaires to 25 institutions. The eligibility criteria were endovascular aortic repair (EVAR) performed using commercial stent grafts and IR performed for T2EL between January 2007 and December 2013. Technical success was defined as disappearance of the EL on digital subtraction angiography immediately after embolization, and imaging success was defined as no EL on contrast-enhanced computed tomography within 6 months. Statistical comparisons of the number of involved branches, embolization level, embolic material, and changes in aneurysm size were made between the imaging success and imaging failure groups. The technical and imaging success rates were also compared between the initial therapy and repeat groups.Results: A total of 166 cases were investigated. Initial therapy was performed in 147 cases (88.6 %), with repeat therapy in 19 cases (11.4 %). Transcatheter arterial embolization (TAE) was used most frequently, in 161 cases (97 %), with direct puncture (DP) used in 5 cases (3 %). Both coil embolization for the branches and NBCA embolization for the sac were frequently chosen. The technical success rate was 83.2 % (TAE group), and the imaging success rate was 46.5 % (TAE + DP groups). Branch + sac embolization was performed more frequently in the imaging success group. There was no significant difference in the number of involved branches or embolic material between the imaging success and imaging failure groups. Enlargement of the aneurysm was more frequently seen in the imaging failure group. There were no significant differences in the technical success and imaging success rates between the initial therapy and repeat groups.Conclusion: This is the first report of a multi-institutional questionnaire survey of IR procedures for T2EL after EVAR in Japan that was conducted to determine the current status. Enlargement of aneurysm size after embolization was more frequently seen in the imaging failure group. It is important to embolize both branch and sac to achieve imaging success, regardless of embolic material. Long-term outcomes need to be investigated. [ABSTRACT FROM AUTHOR]

Purpose: This single-arm, multicenter, phase-II trial evaluated the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) using fine-powder cisplatin and iodized-oil suspension in patients with intermediate- and advanced-stage [Barcelona Clinic Liver Cancer (BCLC) stage-B and stage-C] hepatocellular carcinomas (HCCs). Methods: The Institutional Review Board approved this study and patients provided written informed consent. Thirty-five patients (24 men and 11 women, mean 74 ± 6 years [range 60-87 years]) with BCLC stage-B (57 %, 20/35) or stage-C (43 %, 15/35) HCCs who were not candidates for other locoregional treatments were enrolled. HAIC was performed using a suspension of fine-powder cisplatin with a maximum dose of 65 mg/m and iodized oil on demand. The primary endpoint was the response rate evaluated based on Response Evaluation Criteria in Solid Tumor (RECIST) and modified RECIST (mRECIST). Secondary endpoints were overall survival, progression-free survival, and safety. Results: The initial and best overall response rates at 4 weeks and 3 months, respectively, were 14 and 17 % based on RECIST, and 57 and 23 % based on mRECIST. The median overall and progression-free survival times were 18 and 4 months, respectively. The most frequent grade-3 or grade-4 adverse events were elevation of serum alanine (23 %) and aspartate aminotransferase (20 %), and thrombocytopenia (17 %). Conclusion: This HAIC provides promising therapeutic effects with acceptable safety to patients with intermediate-stage and advanced-stage HCCs. [ABSTRACT FROM AUTHOR]

We report three cases of hepatic artery pseudoaneurysm, which were all treated successfully using a combination of coil embolization and a side-holed 5F indwelling catheter for maintaining minimal hepatic artery blood flow with exclusion of the pseudoaneurysm. The tip of an infusion catheter was placed in the right hepatic artery and a side hole was positioned at the celiac axis. Coil embolization was then performed from the proper to the common hepatic artery using detachable coils. Hemostasis was achieved in all patients, with a final angiogram showing the hepatic arteries through the indwelling catheter. One major hepatic infarction and one focal liver abscess caused by reflux cholangitis manifested on postoperative days (PODs) 11 and 87, respectively. All patients survived and the indwelling catheter was removed on POD 136-382 without complication. [ABSTRACT FROM AUTHOR]

Purpose: To compare the results of endovascular treatment for unilateral iliac occlusion in types B and D, and confirm its validity for type D. Methods: Between 2000 and 2011, 108 patients underwent endovascular treatment for unilateral iliac occlusion. 77 were categorized as type B for occlusion of common iliac artery (CIA) or external iliac artery (EIA) and 31 were categorized as type D for occlusion of both CIA and EIA. The initial success rates, procedure time, penetration time, amount of contrast media used, complication rates, and cumulative primary patency rates were determined and compared between these groups. Results: Between type D and B groups, the initial success rates were 87.1 % (type D) and 89.6 % (type B) ( p = 0.9316). The procedure time was 137.0 ± 55.5 and 97.2 ± 47.2 min ( p < 0.05). The penetration time was 49.1 ± 40.6 and 31.6 ± 30.1 min ( p < 0.05). The amount of contrast agent used was 193.9 ± 103.1 and 156.5 ± 85.0 ml ( p = 0.0722). The complication rates were 6.5 and 3.9 % ( p = 0.8491). The cumulative primary patency rates, at 1, 3, and 5 years were 91, 85, and 85 % and 100, 96, and 93 %. Conclusion: Endovascular treatment can be indicated for unilateral occlusion of both CIA and EIA categorized as type D. [ABSTRACT FROM AUTHOR]

Purpose: To classify the renal artery (RA) anatomy based on specific requirements for endovascular renal artery denervation (RDN) in patients with drug-resistant hypertension (RH). Materials and Methods: The RA anatomy of 122 consecutive RH patients was evaluated by computed tomography angiography and classified as two types: A (main RA ≥20 mm in length and ≥4.0 mm in diameter) or B (main RA <20 mm in length or main RA <4.0 mm in diameter). The A type included three subtypes: A1 (without accessory RAs), A2 (with accessory RAs <3.0 mm in diameter), and A3 (with accessory RAs ≥3.0 mm in diameter]. A1 and A2 types were eligible for RDN with the Simplicity Flex catheter. Type B included twi subtypes based on the main RA length and diameter. Patients were accordingly classified into three eligibility categories: complete (CE; both RAs were eligible), partial (PE; one eligible RA), and noneligibility (NE; no eligible RA). Results: Bilateral A1 type was the most prevalent and was observed in 48.4 % of the patients followed by the A1/A2 type (18 %). CE, PE, and NE were observed in 69.7, 22.9, and 7.4 % of patients, respectively. The prevalence of accessory RAs was 41 %. Conclusions: Of RH patients, 30.3 % were not eligible for bilateral RDN with the current Simplicity Flex catheter. This classification provides the basis for standardized reporting to allow for pooling of results of larger patient cohorts in the future. [ABSTRACT FROM AUTHOR]

Purpose: Retrospective evaluation of intermediate-stage hepatocellular carcinoma (HCC) patient survival after undergoing chemoembolization based on the Child-Pugh score. Materials and methods: Data of intermediate-stage HCC patients undergoing chemoembolization were gathered from 43 centers in Japan. Overall survival rates were compared with Child-Pugh scores. Results: Of the 329 patients examined in this study, Child-Pugh scores were 5 (CP-5) in 136 patients (41.3 %), 6 (CP-6) in 101 patients (30.7 %), 7 (CP-7) in 58 (17.7 %), 8 (CP-8) in 22 (6.7 %), and 9 (CP-9) in 12 (3.6 %). Two-year survival rates were 77.5 % in CP-5 patients ( p = 0.047 vs. CP-6), 65.1 % in CP-6 patients ( p = 0.038 vs. CP-7), 51.3 % in CP-7 patients ( p = 0.30 vs. CP-8, p = 0.034 vs. CP-9), 50.3 % in CP-8 patients ( p = 0.0065 vs. CP-9), and 16.7 % in CP-9 patients. Two-year survival rates were 77.2 % in 139 patients meeting the 4 tumors of 7 cm criterion with Child-Pugh class A (B1) ( p < 0.0001 vs. B2), 59.5 % in 178 patients other than B1 and B3 (B2) ( p = 0.0014 vs. B3), and 16.7 % in 12 patients with Child-Pugh score 9 (B3). Conclusion: The Child-Pugh score is a useful prognostic factor to stratify intermediate-stage HCC patients. [ABSTRACT FROM AUTHOR]

Ectopic variceal hemorrhage caused by sinistral portal hypertension after splenic vein ligation during a pyloric-preserving pancreatoduodenectomy is a rare entity. We report the case of a 58-year-old man with symptoms of refractory melena. The varices could not be treated endoscopically and surgery was considered unsuitable due to severe adhesions and altered anatomy. Following clinical failure of partial splenic embolization, an alternative obliteration method by a retrograde trans-portal-venous approach was successfully performed and resolved the problem. It seems to be an effective method for ectopic variceal bleeding, especially when other interventions are unavailable or highly risky. [ABSTRACT FROM AUTHOR]

Purpose: To find a subgroup that benefits most from transarterial chemoembolization (TACE) in terms of tumor number and size and liver profile in patients with intermediate-stage hepatocellular carcinoma (HCC). Materials and methods: Data of 325 intermediate-stage HCC patients who received TACE as the initial treatment were gathered. Four tumor numbers (3-6 tumors) and five maximum tumor diameters (3-7 cm) as well as all of their combinations but one (3 tumors and 3 cm) and Child-Pugh grade were used as variables to ascertain prognostic factors. Results: The respective 1-, 3-, and 5-year overall survival rates in all patients were 86.5, 47.0, and 23.7 %, respectively. Tumor numbers of 4 ( P = 0.00145) and 5 ( P = 0.036), and tumor size of 7 cm ( P = 0.015), and 12 other combinations of tumor number and size, and Child-Pugh grade ( P = 0.0015) were identified as significant prognostic factors in univariate analysis, and 4 tumors of 7 cm ( P = 0.0008) and Child-Pugh grade ( P = 0.0036) remained significant in the stepwise Cox proportional hazard model. The overall survival was significantly better in a patient subgroup having two factors other than patient subgroups having one or no prognostic factors. Conclusion: A patient subgroup having two prognostic factors benefited most from TACE in intermediate-stage HCC patients. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to analyze the outcomes of endovascular treatment for internal iliac artery aneurysm (IIAA) at mid-term follow-up. Methods: We retrospectively analyzed 33 patients (28 males, mean age 77.4 years) who underwent endovascular treatment of 35 IIAAs (mean diameter 39.8 mm) from 2002 to 2012. We attempted to completely and selectively embolize all distal branches with permanent embolic materials, followed by proximal controls either by stent-graft placement (type 1) or coil embolization (type 2). Results: Procedural success rate was 97.1 % ( n = 34). Complete permanent distal branches embolization was achieved in 27 (79.4 %), type 1 in 24 (70.6 %), and type 2 in 10 (29.4 %) cases. During mean follow-up period of 29.1 months (range, 1.2-92.8), no IIAA-related mortality and stent/stent-graft related complications occurred. Pelvic ischemia occurred and resolved in 8 (25 %) patients. Among 32 cases followed by CT, the aneurysm diameter was stable in 18 (56.3 %), shrank in 11 (34.4 %), and enlarged in 3 (9.4 %) cases. In 22 assessed by contrast-enhanced CT, secondary endoleak occurred in 3 (13.6 %) cases and 2 required secondary interventions (2/32, 6.3 %). Type 1 procedure tends to have better mid-term outcomes. Incomplete permanent distal branches embolization was associated with enlargement and secondary intervention ( p = 0.007 and p = 0.042, respectively). The secondary intervention-free rate at 3 years in the complete and incomplete distal embolization group was 100 and 83.3 %, respectively ( p = 0.128). Conclusions: Endovascular treatment for IIAA is feasible and safe. Complete permanent distal branches embolization is important to achieve satisfactory mid-term outcomes. [ABSTRACT FROM AUTHOR]

Hemomediastinum and hemothorax due to spontaneous internal mammary artery (IMA) rupture is extremely rare, and can be a life-threatening condition. We herein present, to the best of our knowledge, the first case of spontaneous IMA rupture complicating myelodysplastic syndrome, and the first case that was successfully treated by emergency trans-arterial embolization using n-butyl cyanoacrylate. [ABSTRACT FROM AUTHOR]

A 58-year-old man was admitted to our hospital with acute anterior myocardial infarction that occurred 4 years after single sirolimus-eluting stent (SES) implantation in the left anterior descending artery. He had been undergoing continuous dual antiplatelet therapy. Emergency coronary angiography showed total thrombotic occlusion and peri-stent contrast staining at the SES site. The lesion was evaluated using intravascular ultrasound (IVUS) and optical coherence tomography (OCT) after thrombectomy. Vessel remodeling was detected on IVUS, and multiple interstrut hollows and thrombi were observed on OCT. These findings were associated with very late stent thrombosis after SES implantation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF). Methods: We retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated. Results: Stent graft placement for 11 UAFs was performed (4 men, mean age 72.8 ± 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91 %), pelvic surgery in 8 (73 %), and pelvic radiation in 5 (45 %). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55 %). In the remaining 5 (45 %), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36 %) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6 %, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9 %, respectively. Conclusion: Endovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary. [ABSTRACT FROM AUTHOR]

Isolated iliac vein injury caused by blunt pelvic trauma is a rare condition that is difficult to diagnose and often fatal. We report a case of a 52-year-old female who presented with life-threatening isolated iliac vein injury caused by blunt pelvic trauma that was successfully managed with endovascular uncovered stent placement. Although further studies are warranted to clarify the hemostatic mechanism, uncovered stent placement can be considered as an alternative treatment option to covered stent placement for life-threatening iliac vein injury when a covered stent is not rapidly available. [ABSTRACT FROM AUTHOR]

Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with "kissing"-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate retrospectively whether technical factors of hepatic arterial embolization affect the prognosis of patients with hepatocellular carcinoma (HCC). Materials and methods: Inclusion criteria of this study were the following: (1) patients received embolization as the initial treatment during 2003-2004, (2) Child A or B liver profile, (3) five or fewer HCCs with maximum diameter of 7 cm or smaller, and (4) no extrahepatic metastasis. Patient data were gathered from 43 centers. Prognostic factors were evaluated using univariate and multivariate analyses. Results: Eight hundred fifteen patients were enrolled. The 1-, 3-, 5-, and 7-year overall survival rates were 92.0 % (95 % CI 90.1-93.9), 62.9 % (95 % CI 59.3-66.6), 39.0 % (95 % CI 35.1-43.0), and 26.7 % (95 % CI 22.6-30.8) in all patients. Univariate analysis showed a Child-Pugh class-A, alpha-fetoprotein level lower than 100 ng/ml, tumor size of 3 cm or smaller, tumor number of 3 or fewer, one-lobe tumor distribution, nodular tumor type, within the Milan criteria, stage I or II, no portal venous invasion, use of iodized oil, and selective embolization were significantly better prognostic factors. In the multivariate Cox model, the benefit to survival of selective embolization remained significant (hazard ratio 0.68; 95 % CI 0.48-0.97; p = 0.033). Conclusion: Selective embolization contributes to survival in patients with HCCs. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to evaluate the safety of selective transcatheter arterial embolization (TAE) with N-butyl cyanoacrylate (NBCA) in a swine model in terms of histological changes in the pancreas. Methods: Three groups of two female swine (58-64 kg) per group underwent TAE of the dorsal pancreatic artery, under anesthesia, with 1:1, 1:4, and 1:9 mixtures of NBCA and iodized oil. Blood parameters were evaluated at days 1, 4, and 10 after TAE, after which the animals were sacrificed and pancreatic tissues were examined under light microscopy. Results: All of the animals were asymptomatic and survived for 10 days. Cone beam computed tomographic angiography revealed occlusion of the dorsal pancreatic artery and no enhancement in the embolized area. The white blood cell count and C-reactive protein level were elevated slightly on day 1 after TAE (mean ± SD: 252.7 ± 27.8 × 10/μl and 0.15 ± 0.07 mg/l, respectively), but they normalized or remained near the upper normal limit thereafter. The serum amylase and lipase levels also were elevated on day 1 (8831.7 ± 2169.2 U/l and 130 ± 53.4 U/l, respectively) but normalized thereafter. Histologically, necrosis and fibrosis were noted only in the embolized segment, and necrosis and acute inflammatory reactions were absent in the nonembolized segment. The border between both segments was well defined. Lymphocytic infiltration and foreign body reaction were noted around the embolized vessels. Conclusions: Selective TAE with NBCA in the pancreas caused localized ischemic necrosis without clinically significant pancreatitis; therefore, this procedure is tolerable in swine. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly ( p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement. [ABSTRACT FROM AUTHOR]

A 57-year-old woman with a history of diabetes mellitus underwent simultaneous pancreas-kidney transplantation. The pancreaticoduodenal graft was implanted in the right iliac fossa. The donor's portal vein was anastomosed to the recipient's inferior vena cava (IVC). Seven days after the surgery, a thrombus was detected in the graft veins. Percutaneous thrombolysis was immediately performed; however, venous congestion was still present. We therefore attempted selective embolectomy using a Fogarty Thru-Lumen Catheter. Thrombi were directed from the graft veins toward the IVC and captured in the IVC filter with complete elimination of the thrombus without any major complications. We present our technique for the successful treatment of pancreas graft thrombosis within a short time period by percutaneous selective embolectomy using a Fogarty Thru-Lumen Catheter. [ABSTRACT FROM AUTHOR]

A 61-year-old Japanese male was admitted to hospital due to severe congestive heart failure and pre-renal failure with middle aortic syndrome. The patient was successfully treated with emergent aortic angioplasty and kissing stents implantation whilst in a hemodynamically unstable state. Our experience confirms that stenosis of the descending aorta when treated with catheter intervention may be palliative, however, it was a very effective method for life threatening clinical conditions in the short and mid-term and may be an alternative to surgery. [ABSTRACT FROM AUTHOR]

We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection. [ABSTRACT FROM AUTHOR]

We report a case of lower limb ischemia secondary to type B aortic dissection, which was successfully treated with endovascular aortic fenestration and stent placement. In this case, we were not able to restore adequate flow to the ischemic limb by means of aortic balloon fenestration alone, so additional stent placement was required to buttress the true lumen and fenestra. There was no recurrence of lower limb ischemia complications during the follow-up period. Aortic balloon fenestration with stent placement seems to be a safe and effective technique to salvage an ischemic lower limb complicated by acute aortic dissection. [ABSTRACT FROM AUTHOR]

Splenic pseudoaneurysms following chronic pancreatitis can rarely become a source of life-threatening bleeding by rupturing into various regions or components, including pseudocysts, the abdominal cavity, the gastrointestinal tract, and the pancreatic duct. In such cases, prompt diagnosis and therapy are warranted. We report herein the case of a 52-year-old man in whom a splenic pseudoaneurysm ruptured into the colon via a fistula with an abscess cavity, causing massive bleeding, which was successfully managed by trans-catheter arterial embolization (TAE). [ABSTRACT FROM AUTHOR]

Background: Malignant ventricular tachyarrhythmia (VT) and sudden death are serious events in hypertrophic cardiomyopathy (HCM). However, the pathophysiology of this condition is not well understood. The objective of this study was to evaluate the relationship between cardiac sympathetic nerve activity and the occurrence of VT in HCM patients. Methods and results We studied iodine 123 metaiodobenzylguanidine scintigraphy and 24-hour ambulatory electrocardiographic monitoring in 44 HCM patients, 15 with VT (group A) and 29 without VT (group B). With planar I-123 metaiodobenzylguanidine imaging, the heart-to-mediastinum ratio for early and delayed acquisition and washout rate were calculated. Polar maps of left ventricular myocardium were divided into 20 segments, and the SD of uptake and washout rate in 20 segments were calculated as indices of regional variation. The global washout rate was significantly higher in group A than in group B (26.8 +/- 6.4% vs 17.4 +/- 5.7%, P <.0001), although other parameters including heterogeneity indices did not differ. The logistic multiple regression analysis also determined that washout rate was the most powerful predictor of VT in patients with HCM.Conclusions: The occurrence of malignant VT in HCM may be associated with global cardiac sympathetic nerve activity rather than with the heterogeneity of this activity. [ABSTRACT FROM AUTHOR]

SUMMARY: Effects of culture conditions on the lectin level by a unicellular laboratory culture of Microcystis aeruginosa M228 (freshwater cyanobacterium) were investigated. The lectin level per cell at stationary phase increased two- or fourfold by lowering the light intensity from 45 or 90 μE/m2 per s to 12 μE/m2 per s, respectively, at 25°C as measured by the enzyme-linked immunosorbent assay method. The hemagglutinating activity against rabbit erythrocytes increased in response to the lectin level. The lectin level was threefold greater at 15°C than at 25°C, and nearly ninefold greater than at 30°C. Thus, although the specific growth rate of the cyanobacterium decreased with lowering light intensity and temperature, the lectin level per cell increased significantly. When the cyanobacterium was cultured at 15°C with a light intensity of 12 μE/m2 per s, the lectin level reached the maximum near the end of exponential phase, and then decreased toward stationary phase. The level near the end of exponential phase was nearly threefold greater than that of the culture incubated at 25°C with a light intensity of 45 μE/m2 per s. These findings show that the lectin production in M. aeruginosa M228 was induced by unfavorable conditions for the cell growth. [ABSTRACT FROM AUTHOR]

There are few studies regarding the assessment of left ventricular contractile function in patients with atrial fibrillation (AF). The aim of this study was to assess the left ventricular (LV) contractile function, i.e., the end-systolic pressure-volume relation (Ees) and a recently developed LV systolic myocardial stiffness constant (Ksm), without load manipulation in AF. In an experimental study of acute AF in dogs ( n = 5), we were able to assess these indexes of the LV contractile function during acute AF, and found that the values were similar to those obtained during occlusion of the inferior vena cava (IVC) at the baseline state. During rapid ventricular pacing (140 or 160 bpm), the indices of LV contractile function increased due to the forcefrequency relation (4.56 ± 1.85, Ees baseline; 6.42 ± 2.54*+, Ees pacing; 5.15 ± 2.01 mmHg/ml, Ees AF;* P < 0.05 vs baseline,+ P < 0.05 vs. AF) (4.73 ± 0.48, Ksm baseline; 6.24 ± 1.12*+, Ksm pacing; 3.99 ± 1.14, Ksm AF;* P < 0.05 vs baseline,+ P < 0.05 vs AF). In a study of chronic clinical AF in patients without heart disease (lone AF, n = 7), the indexes of LV contractile function were preserved compared with those of control patients (CTL, n = 10) obtained during IVC occlusion; the values were decreased in patients with both AF and dilated cardiomyopathy (AFDCM, n = 5) (2.5 ± 1.1, Ees CTL; 2.4 ± 0.4, Ees lone AF; 1.1 ± 0.3 mmHg/ml*+, Ees AFDCM;* P < 0.05 vs CTL,+ P < 0.05 vs lone AF) (5.3 ± 1.8, Ksm CTL; 4.9 ± 1.6, Ksm lone AF; 2.7 ± 0.2*+, Ksm AFDCM;* P < 0.05 vs CTL,+ P < 0.05 vs lone AF). Thus, during acute AF in dogs and in chronic AF patients, LV contractile function was assessed without load manipulation. In both the acute AF dogs and the chronic lone AF patients, LV contractile function was preserved, and in the AFDCM patients it was depressed. [ABSTRACT FROM AUTHOR]

During the ventricular slow-filling period, both the left atrium and left ventricle fill passively, and their respective internal pressures equalize, becoming evenly elevated. If the diastolic chamber compliance of the left atrium is smaller than that of the left ventricle, we expect the inflowing blood to be distributed more to the left ventricle than to the left atrium during this period. We examined the magnitude of the diastolic compliance of the left atrium and the left ventricle at the end of the slow-filling period. We studied 10 patients, mostly with a mild degree of coronary artery disease, in whom hemodynamic variables were almost within normal limits. To estimate the compliance of the left atrium, we recorded the left atrial pressure directly (by the Brockenbrough technique) and determined the left atrial volume by biplane cineatriography. We determined the diastolic compliance of the left atrium from the pressure-volume relations between the nadir of the x trough and the peak of the v wave by fitting them to an exponential equation, P=b · e (P = pressure, V = volume, a, b = constants). The diastolic compliance of the left ventricle was determined from the pressure-volume relations during the ventricular slow-filling period. The compliances of the left atrium and the left ventricle at the pressure at the end of the ventricular slow-filling period were 1.60±0.41 (mean ± SD) ml · mmHg · m and 4.22±1.12, respectively. The ratio of compliance of the left ventricle to that of the left atrium was 2.60±0.71. Since the diastolic compliance of the left ventricle is 2-3 times larger than that of the left atrium, we suggest that during the slow-filling period, the interaction between the left atrial and left ventricular diastolic compliances provides preferential delivery of blood to the left ventricle and acts as a determinant of volume at the end of the slow-filling period of the left ventricle. [ABSTRACT FROM AUTHOR]

Extravascular lung water (EVLW) was quantitatively measured in 81 patients consisting of 10 subjects with normal cardiac function and 71 patients with left-sided heart diseases, usingTc-RBC as a non-diffusible indicator andTc-DTPA as a diffusible indicator in the equilibrium phase. EVLW averaged 3.0±1.4 (ml/kg, mean±SD) in subjects with normal cardiac function (n=10), 4.3±1.7 in New York Heart Association functional class I patients (n=30), 4.8±2.4 in NYHA functional class II patients (n=33) and 9.4±5.4 in NYHA functional class III (n=8) patients. EVLW was greater in NYHA class III than in normal controls or NYHA classes I or II (p < 0.01). Lung thermal volume (LTV) was also measured in 31 of the 81 patients using a double indicator dilution technique with sodium and heat. LTV averaged 6.0±1.2 (ml/kg) in normal subjects (n=4), 8.6±2.0 in NYHA functional class I patients (n=11), 9.7±3.0 in NYHA functional class II patients (n=13), and 15.9±8.2 in NYHA functional class III patients (n=3). The correlation between EVLW and LTV was significant (EVLW=0.79×LTV-72.8, r=0.80, p < 0.01). There were significant differences in EVLW/LTV ratio between NYHA class III (0.93±0.16) and NYHA class I (0.62±0.22) or class II (0.60±0.23). Thus, it was shown that EVLW was increased in left-sided heart failure and that LTV overestimated the EVLW. [ABSTRACT FROM AUTHOR]

Background: Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation: A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions: Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail. [ABSTRACT FROM AUTHOR]

We report regression of the abnormal Q waves of an inferior old myocardial infarction after an additional anterior acute myocardial infarction, and demonstrate the scintigraphic correlation and chronological course of this phenomenon. Scintigraphic findings in the present case here may contribute to an interpretation of regression of abnormal Q waves in myocardial infarction. [ABSTRACT FROM AUTHOR]

To investigate the possibility of p-type doping of α-SrSi2, a promising as an eco-friendly thermoelectric material, the energy changes of substitutions of the Si site of α-SrSi2 by group 13 elements were evaluated using first-principles calculations. It is found that Ga doping was the most energetically favorable dopant while In is the most unfavorable. We examined the synthesis of Ga- and In-doped α-SrSi2 using the vertical Bridgeman method and investigated their thermoelectric properties. The Ga atoms were doped to α-SrSi2 successfully up to 1.0 at. %, while In atoms could not be doped as suggested by calculations. For experimental prepared Ga-doped samples, the carrier density was observed to increase with Ga doping, from 3.58 × 1019 cm−3 for undoped α-SrSi2 to 4.49 × 1020 cm−3 for a 1.0 at. % Ga-doped sample at 300 K. The temperature dependence of carrier concentrations was observed to change from negative to positive with increasing Ga content. In addition, the temperature dependence of the Seebeck coefficient was also observed to change from negative to positive with increasing Ga content. The results indicate that α-SrSi2 undergoes a semiconductor–metal transition with Ga doping. The power factor for the undoped sample was quite high, at 2.5 mW/mK2, while the sample with 0.3 at. % Ga had a value of 1.1 mW/mK2 at room temperature. [ABSTRACT FROM AUTHOR]