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Aims Loss of skeletal muscle mass is an important determinant associated with poor long‐term prognosis in patients with acute decompensated heart failure (ADHF). However, limited evidence is available. This study investigated the prognostic value of the psoas muscle mass index (PMI) in patients with ADHF. Methods and results A total of 210 consecutive patients aged ≥60 years with ADHF were enrolled using a prospective database between 2015 and 2017. Primary endpoint was incidence of cardiac death. Cross‐sectional psoas muscle area at the L3 vertebral level was obtained by computed tomography, and PMI was calculated by height. Reduced PMI was defined as a PMI below the 25th sex‐specific percentile. Patients were also classified by their left ventricular ejection fraction (EF) as having either heart failure with a reduced ejection fraction (HFrEF, EF more...

Objectives This study evaluated the progression of very late in-stent restenosis (VL-ISR) by analyzing four serial coronary angiography (CAG) images and its correlation with neointimal tissue characterization of the VL-ISR lesions on optical coherence tomography (OCT). Background Recently, VL-ISR is occasionally observed beyond a few years after drug-eluting stents (DESs) implantation. Methods This study analyzed 50 VL-ISR lesions after DES in which 4 serial CAGs over a period of 2 years, including at baseline procedure, 9 months after baseline procedure, 12 months before VL-ISR, and at the time of VL-ISR, were performed. Neointimal tissue characteristics by OCT were categorized as homogeneous, heterogeneous with invisible strut (Type I), heterogeneous with visible strut (Type II), speckled (Type III), or heterogeneous with sharply delineated border (Type IV). Results From the development process, 23 VL-ISRs (46%) were categorized as rapid progression and 27 (54%) as gradual progression. The five categories of neointimal tissue composition significantly differed between lesions with rapid and gradual progression. Homogeneous neointima and Type IV heterogeneous neointima were observed only in lesions with gradual progression. Moreover, most Type I heterogeneous neointima was identified in lesions with gradual progression. Instead, main neointimal tissue components of lesions with rapid progression were Type II (43%) and Type III (43%) heterogeneous neointima. Conclusion The progression rate of in-stent atherosclerotic changes is gradual, whereas organized thrombus could be associated with an increased risk of rapid neointimal growth. The two types of stenosis progression provide a new insight into the mechanism of VL-ISR development after DES implantation. more...

Objectives This study tested the hypothesis that there is no decline of coronary pressure from the proximal to the distal left anterior descending coronary artery (LAD) of humans and swine. Background In the daily clinical practice, the fractional flow reserve (FFR) in the LAD is frequently lower than that in the other arteries in the presence of a similar degree of stenosis. Methods Twenty-six patients with angiographically normal LAD were prospectively enrolled. The coronary pressure ratio (mean distal/proximal coronary pressures at hyperemia) was measured at five different positions: 12, 10, 7, and 5 cm distal from the LAD ostium, and at the ostium of the LAD. The coronary pressure measurement was further investigated in a swine model without atherosclerosis. Results The coronary pressure ratio during maximum hyperemia gradually decreased in proportion to the distance from the ostium (average: 0.85 ± 0.06 at 12 cm distal to the ostium). This finding was confirmed in swine model. The degree of the coronary pressure decrease during maximum hyperemia was similar in patients with and without evidence of minor plaque on intravascular ultrasound, however it was strongly associated with the amount of myocardium mass in the territory of the LAD. Conclusions Intracoronary pressure gradually decreases in proportion to the distance from the ostium in the LAD of humans and swine, regardless of the presence of minor atherosclerotic plaques. The degradation degree of the coronary pressure ratio during maximum hyperemia is enlarged in the presence of larger amount of myocardium mass in the territory of the LAD. more...

Objective To investigate the impact of diabetes mellitus (DM) on provisional coronary bifurcation stenting under the complete guidance of intravascular-ultrasound (IVUS). Background The efficacy of such intervention has not yet been fully elucidated in the DM patients. Methods A total of 100 DM and 139 non-DM patients in a prospective multi-center registry of IVUS-guided bifurcation stenting were compared in angiographic results at 9 months. Vessel and luminal changes during the intervention were analyzed using the IVUS. Vascular healing at the follow-up was also investigated in 23 lesions in each group using optical coherence tomography (OCT). Results No difference was detected regarding baseline reference vessel diameter and minimum lumen diameter in proximal main vessel (MV), distal MV, and side branch (SB). The rate of everolimus-eluting stent use (78.4% vs. 78.3%), final kissing inflation (60.1% vs. 49.0%), and conversion to 2-stent strategy (2.9% vs. 2.8%) were also similar. In the DM group, late loss was greater in proximal MV (DM 0.23 ± 0.29 vs. non-DM 0.16 ± 0.24 mm, P more...

Objectives This study aimed to investigate the influence of analysis interval size on optical frequency domain imaging (OFDI) assessment of stent therapy for lesions of the superficial femoral artery (SFA). Background. No consensus or validating data are available with respect to the methodology of intravascular imaging analysis for the peripheral arteries. Methods. OFDI was performed for 30 SFA lesions, during endovascular therapy and at the 6-month follow-up. Initially, lumen and stent borders were traced at 1-mm axial intervals. Volumes were calculated using a PC-based software, and the volume index (VI) was defined as the volume divided by the stent length. Two additional OFDI analyses were performed using 2-mm and 5-mm intervals, thereby reducing the number of cross-sectional image frames analyzed. Results. The mean stent length was 89.7 ± 35.2 mm. The mean difference in baseline minimum lumen area (MLA) was 0.4 mm2 between MLA values from the 1-mm and 2-mm interval analyses, and 2.2 mm2 between MLA values from the 1-mm and 5-mm interval analyses. In volumetric analysis, there were excellent correlations and good agreements for stent, lumen, and neointimal VI measurements obtained on the basis of different analysis intervals. Conclusions. Using large intervals in OFDI analyses of SFA lesions resulted in few differences in measurement variability of volumetric parameters. However, planar analysis for MLA assessment can be susceptible to high variability when large intervals are applied. © 2016 Wiley Periodicals, Inc. more...

Objectives To investigate the mechanisms of residual stenosis (RS) at side branch ostium (SBO) after final kissing balloon inflation (FKI) and clarify the impact of carina- and plaque-shifts on RS. Background Carina- and plaque-shift induce SBO compromise. FKI is an effective technique to treat this complication; however, RS often persist, and are associated with restenosis at SBO. Methods We performed serial volumetric analysis of 91 bifurcations in which crossover-stenting with FKI and pre-/post-intravascular ultrasounds (IVUS) were completed in both branches. The plaque- and carina-shifts were defined as an increase in the plaque-volume and a decrease in the vessel-volume at the SBO, respectively. RS at the SBO, defined as area stenosis >50% on IVUS, was identified in 19 lesions. Results After FKI, the plaque volume- significantly increased at the SBO, with its reduction in the proximal main vessel (MV). However, at the SBO, the volumetric lumen change correlated with vessel change (ρ = 0.690, P more...

Precision measurements of the fundamental constants are tour de force of basic metrology, where the useful information is usually beyond the last digit of the measured value. They challenge theoretical models and measurement technologies and set a network of measurement equations on which a universal system of units can be built, which stems from the most basic concepts of physics. Because of their connection with the mass unit, the Avogadro and Planck constants are on the spotlight. more...

Klinefelter's syndrome (KS) is a unique physical condition characterized by tall stature, eunuchoid body proportions, gynecomastia, and azoospermia, in addition to an extra X chromosome. In contrast to the original description, symptoms or physical findings can be extremely varied. KS is the most common chromosomal disorder, with an incidence of 1 in 500 males and is also the most commonly undiagnosed chromosomal disorder. Here, we present the case of a 26-year-old man with KS, who visited our hospital with complaints of abdominal pain and fever. On a routine physical examination, he did not differ from a normal karyotype male. Computed tomography showed extensive portal and mesenteric vein thrombosis (PMVT). It is well known that KS is frequently associated with venous thrombosis, but KS with PMVT has rarely been reported. Approximately one-third of PMVT is idiopathic, but this case suggests the possibility that undiagnosed KS is one of the causes of PMVT, as some individuals with KS are not easily distinguishable from those with the normal karyotype. more...

Objectives: We attempted to demonstrate the safety and feasibility of intravascular ultrasound (IVUS)-guided endluminal endovascular therapy for chronic total occlusion (CTO) of the iliac and/or femoropopliteal arteries using Treasure 12, a stiff guidewire for peripheral CTO of 0.018 in. in monodirectional approach setting. Background: Endovascular therapy for CTO of the iliac and femoropopliteal arteries is still technically challenging. Methods: Endovascular therapy was performed in 110 patients who were admitted to Hyogo College of Medicine Hospital with iliac and/or femoropopliteal artery disease from January 2006 to October 2007. We retrospectively analyzed the data of consecutive 47 patients who underwent the endovascular therapy by monodirectional approach for CTO lesions of the iliac and femoropopliteal arteries. From January 2006 to November 2006 (phase 1), standard technique was applied for the treatment of 21 lesions. From December 2006 to October 2007 (phase 2), IVUS-guided endovascular therapy was applied for the treatment of 31 lesions. Results: Clinical and lesion characteristics in phase 1 were not significantly different from those in phase 2. The overall initial technical success rate improved from 81% in phase 1 to 97% in phase 2. There were no significant differences in radiation exposure time between phase 1 and phase 2. Total volume of contrast material was significantly smaller in phase 2 than in phase 1 (P < 0.01). Conclusions: The IVUS-guided endovascular therapy for CTO using Treasure 12 guidewire is feasible and safe, minimizes contrast material, and has a high initial technical success rate. © 2008 Wiley-Liss, Inc. more...

The treatment of in-stent restenosis using balloon angioplasty alone often produces excellent early results, but is associated with high rate of recurrence. Previous studies have demonstrated significant tissue reintrusion shortly after the treatment of in-stent restenosis with balloon angioplasty. The study was designed to elucidate the contribution of early lumen loss 6 hr after balloon angioplasty to lumen loss at follow-up. We prospectively performed quantitative coronary angiography and intravascular ultrasound in 12 patients with in-stent restenosis before intervention, after the final procedure, 6 hr later (5.6 +/- 1.4 hr), and at follow-up (7.7 +/- 2.3 months). Compared with immediately after balloon angioplasty, by 6 hr postintervention, the minimum lumen diameter (MLD) and lumen cross-sectional area had decreased significantly (2.48 +/- 0.44 to 2.01 +/- 0.57 mm, P = 0.01, and 7.0 +/- 1.2 to 5.5 +/- 1.4 mm2, P = 0.004, respectively). Furthermore, the MLD decreased further between 6 hr postintervention and long-term follow-up (2.01 +/- 0.57 to 1.55 +/- 0.64 mm; P = 0.001). Patients who showed recurrence of restenosis at follow-up had greater early lumen loss than patients without recurrence of restenosis (0.71 +/- 0.31 vs. 0.23 +/- 0.13 mm; P = 0.006). Diffuse lesions had greater early lumen loss compared to focal lesions (0.75 +/- 0.35 vs. 0.28 +/- 0.13 mm; P = 0.008). Early lumen loss is common after the treatment of in-stent restenosis by balloon angioplasty. Within the first 6 hr postintervention, 32% +/- 29% of acute lumen gain is lost, and early lumen loss contributed to 42% +/- 18% of total lumen loss at follow-up. more...

This paper presents calculated and measured results on the loop oscillations of high-power amplifiers with several closed loop circuits using multiple FET cells, showing that the frequency of loop oscillations depends on each closed loop circuit. It is also shown in calculation and verified by experiment that the oscillation due to the imbalance of FET cells can be removed by split-cell matching methods. © 2000 Scripta Technica, Electron Comm Jpn Pt 2, 83(8): 33–42, 2000 more...

2-Bromo-3-substituted-inden-1-ones 2 reacted with L-cysteine or 2-aminobenzenethiol to produce 2,3-dihydro-5-phenylindeno[2,1-b][1,4]thiazine in moderate yield or 6-substituted-indeno[2,1-b][1,4]benzothiazines in good yield. The debrominated oxime and the phenylhydrazone of 2 were separated into their respective E- and Z-conformers by column chromatography and their E- and Z-configurations were obtained from the 1 H nmr spectra more...

2-Bromo-3-substituted-inden-1-ones 2 reacted with L-cysteine or 2-aminobenzenethiol to produce 2,3-dihydro-5-phenylindeno[2,1-b][1,4]thiazine in moderate yield or 6-substituted-indeno[2,1-b][1,4]benzothiazines in good yield. The debrominated oxime and the phenylhydrazone of 2 were separated into their respective E- and Z-conformers by column chromatography and their E- and Z-configurations were obtained from the 1 H nmr spectra more...