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We compared the single motor unit (SMU) activity between movements with a premotion silent period (PMSP) and without PMSP in EMG. Fourteen SMUs in the gastrocnemius muscle and 6 SMUs in the soleus muscle were recorded from 5 volunteers during isometric plantar flexion. Tonically firing SMUs failed to fire just before the onset of a rapid contraction with PMSP more frequently than without PMSP. SMUs tended to fire within 10 msec (the gastrocnemius SMUs) or 20 msec (the soleus SMUs) from the onset of the phasic EMG discharge when PMSP occurred. In a rapid contraction without PMSP, the initial firing of SMUs occurred with longer latency than that in a rapid contraction with PMSP. The latency of the initial SMU firing in a rapid contraction related to the preceding time of the last SMU firing during a sustained contraction to the onset of the phasic EMG discharge. When the preceding firing was long enough, the latency distributed around 10 msec. On the other hand, for shorter preceding times, the latency lengthened with shortening of the preceding time. It is suggested that the PMSP makes the preceding time long and increases the susceptibility of motor units to the descending command at the initiation of a rapid contraction.

To investigate the 5-year patency rates and predictors of restenosis after self-expanding nitinol stent implantation for chronic total occlusion (CTO) in superficial femoral and proximal popliteal artery (SFPA) lesions.Outcomes and long-term patency rates after self-expanding nitinol stent for CTO in the SFPA lesions have not been clarified.From January 2004 to December 2009, 861 serial arteriosclerosis obliterans patients, 1,017 limbs, underwent endovascular therapy with implantation of a self-expanding nitinol stent for SFPA lesions at four institutions in Japan. Of the cohort, 352 patients, 383 limbs, had self-expanding nitinol stents implanted for CTOs in the SFPA and were followed for 5 years. We retrospectively investigated patency rate and multivariate predictors associated with restenosis.Mean age was 72 ± 9 years and 31% were female patients. In total, 58% of the patients had diabetes mellitus and 25% were patients with critical limb ischemia. Occluded length was 194 ± 89 mm, mean total stent length was 198 ± 7 mm, and mean stent diameter was 7.1 ± 0.9 mm. Five-year primary and secondary patency rates were 51.8 and 79.5%, respectively, and the rates of freedom from bypass surgery, major or minor amputation, and all-cause death were 96.1, 96.2, and 78.4%, respectively. Female gender (odds ratio, 1.95; P = 0.0051) and mean stent diameter (odds ratio, 0.77; P = 0.0324) were factors strongly associated with restenosis.Women and patients requiring small stents failed to maintain primary patency when treated with self-expanding nitinol stents for CTO lesions in the SFPA. Although primary patency was low, the secondary patency rate was acceptable.

To (1) compare the outcome of self-expandable stents with versus without jailed deep femoral artery (DFA) for proximal superficial femoral artery (SFA) lesions, and to (2) ascertain the fate of jailed DFA.Complex SFA lesions involving the femoral bifurcation (FB) was mostly treated surgically, and the role played by endovascular procedures is uncertain.We retrospectively identified 104 consecutive, de novo lesions involving the SFA ostium, stented between April 2005 and September 2010. Depending on the proximal stent edge location, the sample was divided between 60 distal common femoral artery (CFA) stenting with jailed DFA and 44 ostial SFA stenting without jailed DFA. The FB was the segment beginning in the distal CFA, 10 mm proximal to the DFA ostium and ending in the SFA and 10 mm distal to the carina. Stented CFA lesions proximal to the FB were excluded. The bifurcation was classified as patent when free of restenosis and repeat revascularization.The overall 12-month bifurcation and primary patency rates were 72.5% and 52.0%, respectively. Predictors of loss of bifurcation patency were ostial SFA stenting and a small stent in the FB. Bifurcation patency (83.3% vs. 56.3%; P0.01) and primary patency of the SFA (56.2% vs. 37.5%; P = 0.088) were higher after distal CFA than after ostial SFA stenting. In 95.7% of distal CFA and 100% of ostial SFA stenting, DFA remained patent at 12-month follow-up (P = 0.237).The 12-month fate of jailed DFA after distal CFA stenting was acceptable, and the bifurcation patency rate was higher than after ostial SFA stenting.

Percutaneous coronary intervention was performed for chronic total occlusion (CTO) of the right coronary artery (RCA) in a 55-year-old man. CT coronary angiography (CTCA) with a 64-slice scanner showed a large calcified plaque at the entrance to the CTO. A stent that had been implanted at the RCA ostium 10 years earlier was angled toward a side branch, suggesting that the guidewire would not reach the true lumen via the antegrade approach. Therefore, we attempted the retrograde approach via a septal collateral with the kissing wire technique. However, the guidewire failed to cross the CTO because of obstruction by the implanted stent. We next attempted the controlled antegrade and retrograde subintimal tracking technique and 2 stents were successfully deployed. In this patient, CTCA provided useful information for management of a difficult CTO.

Percutaneous coronary intervention (PCI) was performed for a chronic total occlusion (CTO) of the right coronary artery (RCA) in a 77-year-old male patient. A guidewire could not be passed through the vessel using the antegrade approach, so we tried the retrograde approach via a collateral septal channel. A Fielder FC guidewire (Asahi Intecc Co. Ltd., Aichi, Japan) was passed through the septal channel, and a Corsair catheter (Asahi Intecc) was advanced to the distal side of the CTO in the RCA. However, the guidewire could not be advanced from the false lumen to the true lumen using the kissing-wire technique (KWT) or the reverse controlled antegrade retrograde tracking (CART) technique. Therefore, we retracted the Corsair channel dilator for a #4PD and tried to advance the antegrade Conquest Pro guidewire (Asahi Intecc) from a straight subintimal site into the retrograde channel dilator catheter. After several attempts, the antegrade Conquest guidewire successfully entered the retrograde channel dilator catheter. Subsequently, a Cypher stent (Cordis Corp., Miami Lakes, Florida) was successfully placed. The "rendezvous in coronary" technique was useful for this CTO patient, in whom it was difficult to advance a guidewire into the true lumen by the KWT and CART techniques during the retrograde approach.

The retrograde approach via native channels, mainly septal collaterals, has now become routine. However even after retrograde advancement of a catheter through a collateral channel, it is sometimes difficult to guide the catheter from a false lumen into the true lumen. We experienced 3 patients in whom the site for retrograde guidewire re-entry site from the chronic total occlusion was unclear, and intravascular ultrasound (IVUS) was useful for identifying the re-entry site. Here we report on this new technique, in which IVUS guides the retrograde guidewire to its re-entry site.

To evaluate 6-month clinical outcomes after below-the-knee (BTK) angioplasty for critical limb ischemia (CLI) in patients on hemodialysis (HD). Subjects were 69 serial patients (81 limbs, 123 vessels) who underwent percutaneous transluminal angioplasty (PTA) for primary treatment of infrapopliteal lesions in CLI from June 2004 to December 2008. Subjects were classified into two groups for the comparative study of clinical outcomes: the patients on HD: the HD group (35 patients, 45 limbs, 71 vessels, 66 ± 11 years) and the patients not on HD: the non-HD group (34 patients, 36 limbs, 52 vessels, 69 ± 9 years). A non-randomized retrospective comparative study was conducted to obtain clinical outcomes at 6 months. In clinical results at 6 months, a higher percentage of tendency toward repeat PTA for the treated leg in the HD group (28.9 vs. 11.1%, p = 0.059), but it was not statistically significant. There was no significant difference in the rate of major amputation (11.1 vs. 5.5%) between the two groups. However, the percentage of repeat PTA performed twice or more times (13.3 vs. 0%, p = 0.031) and all-cause mortality (17.1 vs. 0%, p = 0.012) in the HD group was significantly higher than in the non-HD group. The HD group had a significantly lower rate of freedom from all-cause mortality, major amputation, or repeat PTA in the 6-month follow-up compared to the non-HD group, with the HD group 51.4% and the non-HD group 85.3% (logrank test p = 0.003). Although there are more HD patients requiring repeat revascularization compared to the general population, the 6-month outcomes of limb salvage after BTK angioplasty for CLI in HD patients were not significantly different from the general population.

急性心筋梗塞に対する急性期治療の進歩は目覚ましいものがある。しかし,急性期心室性不整脈の発生頻度はいまだ高率で,とくにsecondary VTなどのポンプ失調に伴う不整脈の予後は不良とされている。今回われわれは急性心筋梗塞130例のうち,発症24時間以内にLown分類2以下の心室性不整脈を呈した88例をA群,Lown分類3以上の心室性不整脈を呈した42例をB群とし,その臨床像,予後につき比較検討した。平均年齢はA群64.3歳,B群66.7歳,性別はA群男性69例,女性19例,B群男性26例,女性16例であった。CCU入室中の完全房室ブロック合併はA群9%, B群26.2%,ショック合併はA群10.2%, B群64.3%,入院時Forrester 3以上のポンプ失調合併はA群4.5%, B群19.1%とそれぞれB群はA群に比し有意に高率を示した。入院中のcardiac eventの発生頻度は心不全がA群6.8%, B群30.9%,重度不整脈がA群19.3%, B群52.4%,死亡がA群5.7%, B群57.1%とそれぞれB群はA群に比し有意に高率を示した。入院中死亡のA群5例,B群24例の死因についてはA群で心不全・心破裂が80%を占めるのに比し,B群ではVT・Vfが21%を占めた。また,入院中死亡29例中,入院時Killip 4以上のポンプ失調合併は75.9%と高率であった。一方,A群71例,B群15例の最長3年での長期予後では,cardiac event (AMI, UAP, heart failure, death)の発生頻度に両群間に差異はなかった。Kaplan-Meier法を用いた生存曲線では,退院直前の生存率はA群94.3%, B群42.8%とB群はA群に比し有意に低率であった。しかし,退院後では両群間に差異はなかった。以上より,急性期重度不整脈は急性期死亡と関連があり,そのほとんどはポンプ失調に伴うもので急性期重度不整脈とポンプ失調は相互に悪影響し,予後不良の要因と思われた。

Objectives : Skin potential responses (SPRs) to target and non-target stimuli in letter recognition tasks were studied to evaluate their potential as communication channels for individuals with severe motor disability. Methods : SPRs were recorded from the palm or sole of 5 subjects with cerebral palsy and 6 healthy subjects. Subjects discriminated target letters from non-target ones in a random sequence of single letters. In Task 1, subjects made a behavioral response upon presentation of the target. In Task 2, the target letters were presented as ‘go’ or ‘nogo’ signals. Results : For target letters, irrespective of behavioral requirements (‘go’ or ‘nogo’), skin potential waves frequently occurred with latency consistent with the sympathetic skin response (SSR) latency, and were regarded as SPRs evoked by target stimuli. In Task 1, the occurrence rate of the SPR was 47% for target, and 4% for non-target stimuli. In Task 2, the SPR occurred in 34% of ‘go’ target, 29% of ‘nogo’ target, and 2% of non-target stimuli. Conclusions : SPRs with SSR latency are potentially useful in controlling signals of communication tools for individuals with severe motor disability.

Objectives. After conventional balloon angioplasty (PTCA) for acute myocardial infarction in 77 patients (77 lesions), we used myocardial fractional flow reserve (FFR(myo)) to assess the endpoint of percutaneous coronary intervention (PCI) and to determine whether adjunctive stenting was required. Of these, a total of 37 lesions with FFRor = 0.94 after PTCA received no further treatment (FFR-PTCA group), while the remaining 40 lesions (FFR0.94) underwent adjunctive stenting (FFR-stent group). A further 78 patients (78 lesions) comprised the control group; these patients underwent direct stenting without FFR measurement (stent-only group). The restenosis rate at 14-day discharge (mean time to discharge) was 5.1% in the two groups treated with FFR guidance (FFR-PTCA and FFR-stent), but was 0% in the control group (p = ns). There were no significant differences in reocclusion rates between the FFR-guided patients (1.7%) and the controls (0%). There was no incidence of in-hospital mortality or reinfarction in any of the groups. The number of balloons used (mean, 1.3 0.6 balloons for FFR patients versus 1.8 0.5 balloons for control patients) and the total cost of hospitalization and treatment ($16,213 versus $19,730 in U.S. currency; 1,945,571 998,726 yen versus 2,367,656 538,444 yen in Japanese currency) were both higher in the control group. Long-term survival rates were comparable in the two groups. These findings indicate that FFR guidance for PCI of acute myocardial infarction is a useful, low-cost technique that results in similar clinical outcomes as primary stenting.

The aim of this study was to evaluate the effectiveness of cutting balloon angioplasty (CBA) in small vessels < 3.0 mm in diameter. Included were 166 patients (175 lesions) treated with CBA (CBA group), and 215 patients (240 lesions) were treated with plain old balloon angioplasty (POBA group). No differences were observed in patient backgrounds or lesion characteristics between the two groups. Procedural success rates were similar: 98.3% (CBA) versus 95.8% (POBA). Coronary dissection rates were also similar: 7.4% in the CBA versus 5.8% in the POBA group. Severe dissections (types E and F) occurred in 2.5% of cases in the POBA group, whereas there was none observed in the CBA group. In-hospital complications occurred in 3.3% in the POBA group, and in only 0.6% in the CBA group. The restenosis rate was 37.5% (CBA group) versus 48.1% (POBA group); and in vessels < 2.75 mm, restenosis was significantly lower in the CBA group than in the POBA group (36.9% vs 62.7%, P < 0.05). CBA may be a useful therapeutic strategy for small vessels, given the absence of severe coronary dissection and the significantly lower rate of restenosis compared to POBA.

(1) To delineate the cortical and spinal excitability during the pre-movement silent period (PMSP), the motor-evoked potentials (MEPs) and H-reflexes were measured for 0-150 ms prior to rapid voluntary movements of 11 healthy subjects. The appearance of PMSP was judged from the electromyogram of the agonist muscle at each rapid movement and the differences of MEPs or H-reflex between the movement which PMSP appeared (PMSP MEPs or PMSP H-reflex) and the movement which did not appear (non-PMSP MEPs or non-PMSP H-reflex) were compared. (2) The mean amplitudes of the PMSP MEPs in the flexor carpi radialis were significantly smaller than the non-PMSP MEPs, whereas the mean amplitude of the PMSP H-reflex was not significantly different from the non-PMSP H-reflex. (3) In the soleus muscle, the change in MEPs and H-reflexes was examined at three periods for 0-150 ms before the rapid movements. The mean amplitudes of PMSP MEPs for the -150- to -100-ms period and for the -50- to -5-ms period were significantly smaller than those of non-PMSP MEPs. On the other hand, the differences of the mean amplitudes between PMSP H-reflex and non-PMSP H-reflex at the three periods were not significant. (4) These findings suggested that the cortical sensitivity to the TMS was decreased during PMSP though the spinal inhibitory mechanisms assess by H-reflex was not altered during the PMSP and that the EMG pause of the PMSP originates not at the spinal level but at the cortical level. The data support the hypothesis that PMSP is preprogrammed in the preparation and initiation process of the voluntary movements aimed at reinforcement of the performance of the subsequent ballistic movements.

Presence of stent fracture (SF) after sirolimus-eluting stent (SES) implantation has reported to be associated with an increased risk of adverse events and those are previously reported. But little is known about the outcomes after re-intervention for SES restenosis lesion with SF. From April 2007

Rotational atherectomy (RA) followed by first-generation drug-eluting stent (DES) have favorable result compared with bare-metal stent in severe calcified lesion. However, the efficacy of second-generation DES implantation after RA remains unclear. Between April 2008 and December 2012, 116 patients

A coronary flow reserve (CFR) of 2.0 has been advocated as the endpoint for coronary intervention therapy. Experience shows, however, that CFR does indeed exceed 2.0 in many cases poststenting, while remaining below 2.0 in others. In this study, we assessed the clinical characteristics and IVUS findings of patients whose CFR remained below 2.0 after stent implantation, specifically 16 patients with CFR below 2.0 (22 lesions, 64 ± 9 years, 4 female), and 102 patients with CFR above 2.0 (112 lesions, mean age 66 ± 11 years, 22 female). Patient population comprised patients selected for retrospective study, but participants were selected on the basis of matching patient and lesion characteristics. The IVUS findings showed that incidence of calcified lesions and post-PTCA dissection of hard plaque were higher among patients with CFR < 2.0. Further, IVUS-obtained vascular measurements showed post-PTCA area stenosis to be 58.7 ± 15.2% in the CFR < 2.0 group, and 45.3 ± 12.5% among CFR ≥ 2.0 patients (P < 0.05). These findings indicate that patients with diffuse calcified lesions or high post-PTCA % area stenosis, as determined by IVUS, are more likely to have lower CFR after stenting. Cathet Cardiovasc Intervent 2001;52:420–424. © 2001 Wiley-Liss, Inc.

The aim of this study is to determine the recruitment pattern among individual vasoconstrictor neurons under the baroreceptor-mediated influence in man. Spikes of single vasoconstrictor units were detected from microneurograms with a template-matching method. A total of 39 single vasoconstrictor units were detected. Single vasoconstrictor units were different from each other in their susceptibility to be activated in response to changes in the R-R interval or blood pressure. The units with higher firing probability had a shorter threshold R-R interval and a higher threshold diastolic blood pressure than units with lower firing probability. In sympathetic responses consisting of only one spike (single-spike responses), units with a lower threshold frequently appeared and units with a higher threshold joined mull-spike responses. The units with a short threshold R-R interval tended to have a long inhibitory latency from R wave, suggesting low conduction velocity. The correlation between firing probability and firing threshold and that between appearance in single-spike response and multi-spike response suggest a hierarchical manner of recruitment of vasoconstrictor units. For beat-to-beat responses, however, some deviation from the hierarchical recruitment was also observed.

Although recent guideline show expanded indication of endovascular therapy (EVT) for superficial femoral and proximal popliteal artery (SFPA) lesion, only secondary patency rate after self-expanding nitinol stent implantation is comparable for vein-graft bypass. Long-term outcomes are necessary for

Background: Since a popliteal artery is located at the joint site, there is a possibility of stent fracture. As there is also a possiblity of vascular anastomosis when bypassing, the area is referred as non-stenting zone. Furthermore, Asians frequently sit with their knees bent deeply, and there is not much evidence. Here, we have evaluated the clinical results of 18 months of endovascular treatment for popliteal artery. Methods: A non-randomized, retrospective study was adopted at our hospital. Endovascular treatment was performed on 132 limbs (106 patients) with popliteal arteries from April 2007 until December2011. The age range was 72.5 10 years, including 84 limbs (63.6%) exhibiting critical limb ischemia. Artery patency was evaluated via angiography or vascular ultrasound. Have examined the technical success, primary patency, secondary patency.(follow up term 18.4 months) Results: 125 limbs (94.6%) were successful procedures, and stents were used for the 16 limbs (12.1%). The primary patency rate was 76% and secondary patency rete was 95%. Exacerbation of ischemia due to the procedure has not been observed. Conclusion: The results of endovascular treatment in the area of endovascular popliteal artery for the 12 months were within the acceptable range.

Background: Since a popliteal artery is located at the joint site, there is a possibility of stent fracture. As there is also a possiblity of vascular anastomosis when bypassing, the area is referred as non-stenting zone. Furthermore, Asians frequently sit with their knees bent deeply, and there is not much evidence. Here, we have evaluated the clinical results of 18 months of endovascular treatment for popliteal artery. Methods: A non-randomized, retrospective study was adopted at our hospital. Endovascular treatment was performed on 132 limbs (106 patients) with popliteal arteries from April 2007 until December2011. The age range was 72.5 10 years, including 84 limbs (63.6%) exhibiting critical limb ischemia. Artery patency was evaluated via angiography or vascular ultrasound. Have examined the technical success, primary patency, secondary patency.(follow up term 18.4 months) Results: 125 limbs (94.6%) were successful procedures, and stents were used for the 16 limbs (12.1%). The primary patency rate was 76% and secondary patency rete was 95%. Exacerbation of ischemia due to the procedure has not been observed. Conclusion: The results of endovascular treatment in the area of endovascular popliteal artery for the 12 months were within the acceptable range.

Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 ±11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.