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The implication of the shape of ST elevation in the acute phase of myocardial infarction (MI) remains unclear.We examined the relation between the shape of ST elevation and infarct size in 77 patients who had a first acute anterior MI with successful reperfusion within 6 hours from symptom onset. A 12-lead electrocardiogram was recorded immediately before reperfusion confirmed by coronary angiography. The shape of ST elevation in lead V3 was classified into 3 types: concave type (n = 24), straight type (n = 41), and convex type (n = 12). For concave type, straight type, and convex type, a median value of peak creatine kinase was 2287, 4371, and 5322 mU/mL, and left ventricular ejection fraction measured by left ventriculography at discharge (14 days after MI) was 58%, 48%, and 41% (P.05; concave type versus the other 2 types), respectively. A multivariate logistic regression model demonstrated that the concave type of ST elevation was a strong predicting factor for preserved left ventricular function (left ventricular ejection fraction/=50% at discharge; odds ratio 6.2, 95% confidence interval 1.6 to 20.8, P =.019).In patients with reperfused acute anterior MI, left ventricular function was excellent in patients with concave type, intermediate in those with straight type, and relatively poor in those with convex type ST elevation at discharge. This simple classification is useful for predicting left ventricular function at discharge.

Blood pressure (BP) values (systolic BP = Ps, diastolic BP = Pd, heart rate = HR) fluctuate widely throughout the day, and are at their lowest levels during sleep (sleep-Ps = PS0, sleep-Pd = Pd0, sleep-HR = HR0). We analyzed the relationships among these values using the Windkessel model (logarithmic gradient of diastolic pressure decay A = E/R, E = elastic modulus, R = vascular resistance). Intra-arterial BP and ECG were recorded throughout 24 hours in 23 patients with mild essential hypertension (EH) by telemetry, and EEG was monitored during the night. The waveform of each BP pulse was analyzed by computer. The dye-function method was used to obtain the cardiac output while the subjects were awake, recumbent and during slow-wave sleep on the EEG. A high correlation coefficient (r) was observed between mean BP and square root of E x square root of R during sleep (r = 0.88, p0.001). Sleep-HR was determined from the waveform that most effectively permitted peripheral blood flow. Furthermore, the simple algebraic relationships Pd not equal to phi x Pd0 and phi not equal to FI + a1(BI) + b1 (a1, b1 = constant) were observed between Pd0 and different 24 h Pd values [FI = eA(RR0-RR); BI = baroreflex index = RR x Pd(RR0 x Pd0)-1, which was significantly correlated with the baroreflex sensitivity, r = 0.79; RR0 and RR are the RR intervals in Pd0 and Pd waves]. The mean r between Pd0 x phi and the actual Pd over 24 h was 0.91 +/- 0.02 (SD). We conclude that sleep-BP and sleep-HR depend mainly on square root of E x square root of R, m [m = log(e)(Ps/Pd)] and E/R, whereas BP variability (phi) over a 24 h period is related to HR variation, the baroreflex index and E/R in mild EH patients.

Diastolic mitral regurgitation (MR) may be induced by prolonging atrioventricular (AV) delay, and a significant negative correhtion has been described between tbe critical PQ interval for the appearance of diastolic MR and pulmonary capillary wedge pressure (PCWP) in patients with DDD pacemakers. We report the relationship between the critical PQ interval for the appearance of diastolic MR and the optimal PQ interval in 11 patients (69.1 ± 12.6 years). Cardiac output (CO) and PCWP were measured by Swan-Ganz catheter and transmitral blood flow was recorded by pulsed-Doppler echocardiography. AV delay was prolonged stepwise by 0.025 seconds starting from 0.065 seconds. The pacing rate was fixed at 70 beats/min. CO was highest when the PQ interval was 0.18 ± 0.04 seconds. There was a significant positive correlation between the critical PQ interval for the appearance of diastolic MR and the PQ interval at which CO was the highest (r = 0.91, P < 0.01). The PQ interval at which CO was the highest was 0.02 ± 0.02 seconds shorter than the critical PQ interval for the appearance of diastolic MR (P < 0.05). When the PQ interval was increased by 0.025 seconds from the critical PQ interval for the appearance of diastolic MR, CO decreased from 4.3 ± 0.6 L/min to 4.1 ± 0.6 L/min and PCWP increased from 7.5 ± 6.4 mmHg to 8.5 ± 7.3 mmHg (P < 0.05). In conclusion, the critical PQ interval for the appearance of diastolic MR may represent the upper limit of the optimal PQ interval and the AV delay should be set to not exceed the critical PQ interval for the appearance of diastolic MR.

Case Report: A 37-year-old man with the wide QRS tachycardia visited to our hospital. The wide QRS tachycardia had emerged with paroxysmal Atrial fibrillation (pAf). The QRS configuration during the wide QRS tachycardia was a right bundle branch block pattern with left-axis deviation. Verapamil could terminate the wide QRS tachycardia. We diagnosed the wide QRS tachycardia verapamil-sensitive left posterior fascicular Ventricular Tachycardia (VT). Verapamil-sensitive left posterior fascicular VT had always emerged coexistence with pAf. During the electrophysiological study, verapamil-sensitive posterior fascicular VT was induced by programmed atrial stimulation. We performed segmental pulmonary vein antrum isolation during sinus rhythm. After the isolation of pulmonary veins, the radiofrequency application to the VT circuit was performed. VT could be terminated by radiofrequency application where the earliest purkinje potential preceded the onset of earliest surface QRS by 12 ms during VT. No VT was induced after the radiofrequency applications. Conclusions: This VT is the rare case of verapamil-sensitive posterior fascicular VT associated with pAf. We successfully ablated these double tachycardias.

In CFRP bonded onto steel plate, thermal stress is induced in steel plate by temperature change, due to difference in coefficients of thermal expansion between steel and CFRP. In this study, reduction technique of the thermal stress in steel plate, which is additional bonding of aluminum alloy plates, is proposed. Namely, the coefficient of thermal expansion of composite plate consisted of CFRP and aluminum plates is designed as that of steel. In this research, to verify the effectiveness of developed method, heat tests of CFRP and aluminum plates bonded onto steel plate were carried out. As a result of the tests, infinitesimal thermal stresses in steel plate with CFRP and aluminum plates were measured while large thermal stresses were measured in conventional CFRP bonded onto steel plate. Additionally, to confirm the test results, numerical analysis was also carried out.

Introduction: The high incidence of sleep disorderd breathing (SDB) in patients with congestive heart failure (CHF) is well known. We compared adaptive pressure support servo-ventilation therapy (ASV) with nocturnal oxygen therapy (N-HOT) in patient with SDB from the cardiac resynchronization therapy (CRT) candidates. Methods: Thirty patients (22 men; 69.6±8.5 years old; mean left ventricular ejection fraction 32.6±9.9%) with SDB (apnea-hypopnea index (AHI)>15) who were scheduled for CRT therapy were studied. All patients received polysomnographic evaluations before CRT therapy. After implantation of a biventricular pacemaker, patients received ASV or N-HOT therapy (non-randomised). Cardiac events (cardiac death, and hospitalization due to congestive heart failure) were analysed retrospectively. Results: Mean follow up period was 790±561 day. Mean AHI of all patients was 26.4±10.8. Kaplan-Meier survival analysis showed that there was a significant difference between ASV and N-HOT in cardiac death, and hospitalisation due to congestive heart failure event (P=0.0283). There were no significant differences between ASV and N-HOT in patients’ baseline characteristics. Conclusions: ASV is superior to N-HOT for the SDB in patients who are CRT candidates.

Recently, some research reports on the application of pre-stressed CFRP plate on steel members have been published. However, the shear and peeling stresses in adhesive at the end of CFRP plates are induced by releasing the pre-tension as well as bending moment. Therefore, in the strengthening of steel members with the pre-stressed CFRP plate, the CFRP plate tends to have debonding in the lower bending moment. In this study, to reduce the shear and peeling stresses in adhesive by releasing the pre-tension of CFRP plates, installation of non pre-stressed regions in CFRP plate was proposed. By installing the non pre-stressed regions in CFRP plate, dividing the locations of higher stresses in adhesive by releasing the pre-tension and bending moment were revealed. Additionally, the design equation of length of non pre-stressed regions was also presented.

Diastolic mitral regurgitation has been observed in patients with DDD pacemakers when the atrioventricular (AV) delay was prolonged. However, diastolic mitral regurgitation associated with first-degree AV block has not been fully studied. We examined transmitral blood flow in 24 patients with first-degree AV block and normal cardiac function (ages 35.3 +/- 17.4 years), and in nine patients with DDD pacemakers and normal cardiac function (ages 73.1 +/- 8.1 years), using pulsed Doppler echocardiography. Diastolic mitral regurgitation was observed in 19 of 24 patients with first-degree AV block. Although PQ interval was shortened from 0.32 +/- 0.06 to 0.20 +/- 0.05 seconds (P < 0.01) after 1 mg atropine sulfate IV, the interval between P wave (ECG) and the beginning of diastolic mitral regurgitation did not change, while the duration of diastolic mitral regurgitation was shortened from 0.15 +/- 0.03 to 0.05 +/- 0.03 seconds (P < 0.01). There was a significant correlation between changes in PQ interval and changes in the duration of diastolic mitral regurgitation (r = 0.92, P < 0.001). Although cardiac output (3.9 +/- 0.05 L/min) and pulmonary capillary wedge pressure (5.1 +/- 1.5 mmHg) were normal in all patients with pacemakers, diastolic mitral regurgitation was observed when the AV delay was prolonged. The critical PQ interval for the appearance of diastolic mitral regurgitation was 0.23 +/- 0.01 seconds. In patients with prolonged PQ intervals, delayed ventricular contraction following atrial contraction may be associated with mitral regurgitation in the presence of a reversed AV pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

Right-ventricular bifocal pacing (RVBF) was reported as a therapy of severe congestive heart failure. We evaluated regional wall motion by strain Doppler imaging in three patients with RVBF therapy who had conventional indication of pacemaker(70± 8 years old, mean ejection fraction 24±11%). Two dimensional SDI of the left ventricle were obtained from the apical four-chamber view during right ventricular apical pacing and RVBF pacing. Wall motion was assessed by strain of the myocardium and interval between Q-wave of surface ECG and peak of strain(QPSI) was measured in the three septal and lateral segments. Results were shown in table. RVBF pacing improves intra-ventricular contraction delay especially longitudinal dyssynchrony without improvement of left ventricle strain. View this table

Isoprothiolane was administered continuously of various doses to heifers with liver lesions induced by carbon tetrachloride, to determine the effect of the drug on blood components, enzymatic activities, and liver microsome functions. After injection of carbon tetrachloride, a decrease in the number of RBC and an increase in the number of WBC were temporarily observed, with few variations during the experiment. The content of total lipids, phospholipids and triglyceride in the plasma was higher in the animals treated with isoprothiolane of a dose of 50 or 100 mg/kg body weight than in the non-treated ones. Isoprothiolane of a dose of 50 or 100 mg/kg tended to increase the content of protein in the liver, and markedly depressed the increase of GOT, arginine, gamma-GTP and ICDH activity induced by carbon tetrachloride. Isoprothiolane did not promote the activity of the demethylase and hydroxylase in liver microsomes but it promoted the formation of cytochrome P-450 and b5 whose contents in the animals treated with isoprothiolane of a dose of 50 or 100 mg/kg were about twice as high as those in the non-treated animals. As for the composition of fatty acids in the microsomes, the content of unsaturated fatty acids such as oleic acid, linoleic acid and arachidonic acid was high in the isoprothiolane-treated heifers. Based on those observations, it is considered that isoprothiolane may alleviate the deleterious effects of carbon tetrachloride, protect the liver cells, and activate the lipid metabolism including the unsaturation of fatty acids, as well as the metabolism of protein.

郵政省のビジュアルコミュニケーション懇談会の調査研究活動の一環として, 西ドイツ, フランス, 米国の狭帯域と広帯域の映像通信開発の動向を調査した.各国別にその動向を報告し, 今後の日本に期待される方向を考察する.

Computed tomography of the liver was performed on two patients with subacute hepatitis. The CT findings included the presence of multiple regenerative nodules in the atrophied liver, shown by decreased CT attenuation. Complications due to hepatitis, such as massive ascites and splenomegaly, were also observed. The CT observations during the course of the disease suggested that the hepatic necrosis had been repaired by hypertrophy of regenerating nodules, not by an increase in the number of nodules, which ultimately gave rise to postnecrotic cirrhosis. Scintigraphy confirmed atrophy and repair of the liver. Thus, CT and scintigraphy were considered to be useful for the diagnosis of extensive hepatic necrosis and for evaluating the process of liver repair.

1. Es wurde nachgewiesen, das das Parotin die Eiweissynthese fordert, weil es Aminosaure und Harnstoff reduziert, die Turnover-Rate der RNS- und DNS-P vermehrt, den Einbau von C14-Glykokoll in das Lebereiweis beschleunigt und auf die im Eiweisstoffwechsel beteiligten Enzyme wirkt. 2. Das Parotin beschleunigt die Erholung des Gesamteiweises im Plasma nach der Plasmapherese und das Wachstum junger Ratten. 3. Das Parotin beschleunigt den Citronensaurecyclus und das P:O-Verhaltnis, d. h. die oxydative Phosphorylierung.

1. Es wurde bestatigt, das Parotin bei 7 Myasthenikern bessere Wirkungen als bei den bisher bekannten Arzneimitteln beobachtet wurde, mit Ausnahme einer Patientin, bei der die Parotininjektionen wegen des Fiebers ausgesetzt wurden.

SummaryBackgroundST-segment elevation of ≥1.0mm in the right precordial chest lead V4R (ST↑V4R) has been shown to be a reliable marker of right ventricular involvement (RVI) in inferior acute myocardial infarction (IMI). However, the impact of left ventricular posterior wall involvement (PWI) on the relation between ST↑V4R and RVI is unknown.MethodsWe studied 267 patients with recanalized IMI due to the right coronary artery (RCA) occlusion within 6h after symptom onset. A 12-lead electrocardiogram, lead V4R, and leads V7–9 were recorded on admission. RVI was defined as occlusion proximal to the first major right ventricular branch of the RCA. The perfusion territory of the RCA was assessed by angiographic distribution score, and PWI was defined as a score of ≥0.7. Patients were stratified according to the presence or absence of PWI and RVI.ResultsRVI was associated with higher peak creatine kinase and a higher rate of impaired myocardial reperfusion, defined as a myocardial blush grade of 0 or 1 after recanalization, in the presence or absence of PWI, especially the former. RVI was associated with a higher rate of ST↑V4R in the absence, but not in the presence, of PWI. ST↑V4R identified RVI with sensitivities of 34% and 96% (p

Background The effect of cardiac pacing on sleep-disordered breathing is controversial. We investigated the long-term effect of cardiac pacing on sleep disordered breathing in patients with conventional indications for permanent pacemakers Methods Subjects comprised 40 patients (29 men; mean age 69±9 years, mean left ventricle ejection fraction 69±8%, and body mass index 23.6±3.5 kg/m2) who were diagnosed with indications for permanent pacemakers (sick sinus syndrome in 23 patients, atrioventricular block in 15, and brady atrial fibrillation in 2). All patients received polysomnographic evaluations before implantation of permanent pacemakers. After implantation of permanent pacemakers, all patients received polysomnographic evaluations during use of the pacemaker settings (AAI/DDD/VVI at 70 beats per minute). Results The mean follow-up period was 35±13 months. Before implantation, the distribution of sleep-disordered breathing was as follows: 93% had apnea hypopnea index >5, 58% had apnea hypopnea index >15, and 20% had apnea hypopnea index >30. The mean apnea hypopnea index for all patients was 20±15, for those with obstructive type apnea was 4.9±5.3, and for those with central type apnea was 3.0±4.5. The mean Epworth Sleepiness Score was 5.9±4.0. No patient received continuous positive airway pressure therapy or any other therapy for sleep-disordered breathing during the follow up period. The mean apnea hypopnea index at 1 week after implantation of permanent pacemakers was 21±14 (P=0.8) and the mean apnea hypopnea index at end of follow-up was 11±7 (P Conclusion Long term cardiac pacing significantly reduces the number of episodes of sleep apnea in patients with conventional permanent pacemaker indications.

There are a significant number of marine steel structures suffering severe corrosion damage, and they are seriously in need of repair or strengthening to prevent structural failure. This study is focused on a repair technique using carbon fiber reinforced polymer (CFRP) sheet, especially, CFRP sheet bonding in the underwater environment. Underwater bonding of CFRP sheets is not yet a matured technique, and its repair performance for corroded steel structures is not fully understood. One of the issues is the effect of bond defects on the repair performance. Air bubbles are often found to be trapped in the adhesive layer. To examine an effect of bond defects on the repair performance, uniaxial loading tests are performed on thickness-reduced steel plates with CFRP strand sheets bonded by using underwater epoxy as adhesive. In total, sixteen CFRP strand sheet bonded steel plates are prepared, where test parameters are loading directions of tension and compression and the location of bond defects. The effect of bond defects on the repaired performance is examined in terms of yield strength, initial stiffness, and failure mode. As a result of experiment, it is found that two types of defects considered in this study do not affect repair performance significantly. However, when a CFRP bonded steel plate is under compression, buckling of CFRP strand sheet may control its compression strength, resulting in a smaller strength than the tensile strength., The Third Asia-Pacific Conference on FRP in Structures (APFIS2012), 2-4 February, 2012, Hokkaido University, Japan