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The Academic Research Consortium (ARC) has proposed international criteria to standardize the definition of high bleeding risk (HBR) in patients undergoing percutaneous coronary intervention (PCI). In this context, Japan has also established its own guidelines, that is, the Japanese version of HBR (J-HBR) criteria. However, the J-HBR criteria have not been fully validated, especially in patients with acute myocardial infarction (MI).This bi-center registry included 1079 patients with acute MI undergoing primary PCI in a contemporary setting. Patient bleeding risks were evaluated using the ARC-HBR and J-HBR criteria. The primary endpoint was rates of major bleeding events (Bleeding Academic Research Consortium type 3 or 5) at 1 year.Of the 1079 patients, 505 (46.8%) and 563 (52.2%) met the ARC-HBR and J-HBR criteria, respectively. Patients who met the J-HBR criteria were found to have a higher rate of major bleeding events at 1 year than those who did not (12.8% vs. 3.3%, p＜0.001). When patients were scored and stratified using the J-HBR major and minor criteria, risks of major bleedings were progressively increased with the increase in the number of J-HBR criteria. In the receiver operating characteristic curve analysis, the ARC-HBR and J-HBR significantly predicted subsequent major bleedings after PCI, with ARC-HBR having greater predictive ability than J-HBR.More than half of the patients with acute MI undergoing primary PCI in Japan met the J-HBR criteria. Although the J-HBR criteria successfully identified patients who were likely to develop major bleeding events after primary PCI, the superiority of J-HBR to ARC-HBR in predicting bleeding outcomes warrants further investigation.

Apixaban is used to treat venous thromboembolism (VTE) at 10 mg twice daily (BID) for 7 days, followed by 5 mg BID without dose adjustment, and non-valvular atrial fibrillation (NVAF) at 5 mg BID or 2.5 mg BID with dose adjustment criteria (DAC) including age, body weight, and renal function. The anti-factor Xa activity (AXA), prothrombin time (PT), and activated partial thromboplastin time (APTT) in patients with VTE receiving 10 mg BID of apixaban remains unclear. Twenty-six patients (70.8±15.4 years, 10 males) with VTE receiving 10 mg BID of apixaban were enrolled. The patients were divided into two groups based on whether they met the DAC of NVAF: DAC group (n=8) and non-DAC group (n=18). Trough and peak AXA values, PT, and APTT were measured at 10 mg BID dosage and then at 5 mg BID dosage. Coagulation markers in recipients of 10 mg BID therapy were significantly higher than those of 5 mg BID recipients. A significant and strong positive correlation was observed between AXA and PT at trough and peak times. The AXA values and PT in the DAC group were significantly higher than those in the non-DAC group. No significant inter-group differences were seen in APTT. This study provides the first report of AXA distribution in VTE patients receiving 10 mg BID of apixaban. Our findings indicate that coagulation markers may differ in patients with VTE-prescribed higher doses of apixaban and a DAC may be warranted in such patients.

Limited data are available for clinical outcomes in patients who underwent urgent or emergency transcatheter aortic valve implantation (TAVI). This study investigated in-hospital and 1-year outcomes and explored prognostic covariates in urgent/emergency TAVI using nationwide registry data.Methods and Results: Among 26,775 patients who underwent TAVI between August 2013 and December 2019, 25,495 with 1-year follow-up information were analyzed in this study. Baseline and procedural characteristics, as well as clinical adverse events, were compared between the urgent/emergency and elective TAVI groups. The primary outcome was all-cause mortality within 1 year after TAVI. Multivariable Cox regression models were constructed to identify independent predictors after urgent or emergency TAVI. Urgent or emergency TAVI was performed in 578 (2.3%) patients. The Society of Thoracic Surgeons score was significantly higher in the urgent/emergency than elective TAVI group (13.3% vs. 6.0%; P0.001). Device success rate was comparable between the 2 groups. All-cause death-free survival within 1 year was lower in the urgent/emergency than elective TAVI group (77.2% vs. 92.2%; log rank P0.001). Malignancy, albumin and creatinine concentrations, ejection fraction, and mean pressure gradient were associated with 1-year mortality in the urgent/emergency TAVI group.Despite higher surgical risk and more comorbidities, the procedure was successfully performed in patients undergoing urgent/emergency TAVI, although it should be noted that prognosis was worse than for elective TAVI.

In patients with acute myocardial infarction (AMI), elevated natriuretic peptide (NP) concentrations are reportedly associated with worse clinical outcomes. This study evaluated the prognostic value of NP concentrations and in-hospital heart failure (HF) events after AMI.Methods and Results: The present bicenter registry included 600 patients with AMI undergoing percutaneous coronary intervention. HF was evaluated at 3 different time points after AMI: on admission, during hospitalization, and at the short-term follow-up at 1 month. When HF was present at each time point, 1 point was assigned to the "HF time points" (HFTP) risk scoring system; possible total scores on this system ranged from 0 to 3. The primary endpoint was a composite of all-cause death and HF rehospitalization after discharge. Among the 600 patients who survived to discharge, the primary outcome occurred in 69 (11.5%) during a mean follow-up period of 488 days. HF on admission, during hospitalization, and at the short-term follow-up were all significantly associated with subsequent clinical outcomes. Higher scores on the HFTP scoring system were related to an increased risk of the primary endpoint. Multivariable analysis indicated scores of 2 and 3 were independently associated with outcome events in a stepwise manner.Among patients with AMI, HF evaluation at different time points was useful in stratifying risks of mortality and HF rehospitalization after discharge.

Coronary flow reserve (CFR) represents entire coronary compensatory capacity. While CFR assessment is recommended to identify patients at an increased risk of cardiovascular events and coronary microvascular dysfunction, invasive CFR measurement is often technically challenging. Although not well validated yet, pressure-bounded CFR (pbCFR) has been proposed as a simple surrogate to estimate impaired CFR. In this study, we evaluated coronary physiological characteristics of low pbCFR using detailed invasive assessment. Invasive physiological assessment including resting ratio of distal coronary pressure to aortic pressure (Pd/Pa), fractional flow reserve (FFR), resting and hyperemic mean transit time, index of microcirculatory resistance (IMR), CFR, resistive reserve ratio, and microvascular resistance reserve (MRR) was performed in 107 patients in the left anterior descending coronary artery. pbCFR was calculated only with resting Pd/Pa and FFR. Patients were divided into low pbCFR and non-low pbCFR groups. Of 107 patients, 50 (46.7%) had low pbCFR. FFR (0.90 ± 0.05 vs. 0.83 ± 0.05, p 0.001), hyperemic mean transit time (0.27 ± 0.17 vs. 0.21 ± 0.12, p = 0.04), and IMR (20.4 ± 13.2 vs. 15.0 ± 9.1, p = 0.01) were significantly higher in the low pbCFR group than their counterpart. While directly measured CFR did not differ significantly (4.4 ± 2.3 vs. 5.1 ± 2.8, p = 0.18), MRR was lower in the low pbCFR group (5.4 ± 3.0 vs. 6.8 ± 3.8, p = 0.047). The rates of CFR 2.0 and IMR ≥ 25 were not significantly different between the 2 groups. In conclusion, although CFR did not differ significantly, IMR and MRR were impaired in patients with low pbCFR, suggesting pbCFR as a potential surrogate of coronary microvascular function in clinical practice.

Objective Oral diseases, including periodontitis and stomatitis, are highly prevalent worldwide and reportedly associated with the development of cardiovascular disease. Given the high rate of stomatitis in individuals wearing dentures, denture users may be at high risk of poor cardiovascular outcomes. We therefore investigated whether or not the use of dentures is associated with a poor clinical outcome in patients with acute myocardial infarction (MI). Methods This two-center retrospective observational study was conducted between January 2012 and March 2020. A total of 1046 patients with acute MI who underwent primary percutaneous coronary intervention were divided into two groups according to denture use status. The primary outcomes included ischemic events (cardiovascular death, recurrent MI, and ischemic stroke) and major bleeding (Bleeding Academic Research Consortium type 3 or 5). Results Of the 1046 patients with acute MI, 387 (37.0%) used dentures. An older age and prior MI were associated with an increased likelihood of denture use. During the mean 660-day follow-up period, ischemic and major bleeding events occurred in 169 (16.2%) and 102 (9.8%) patients, respectively. Denture use was associated with an increased risk of ischemic events, whereas no significant intergroup differences were observed in major bleeding outcomes. The results were similar among patients ≥75 years old. Conclusions More than one-third of the patients with acute MI wore dentures. Our findings suggest that denture use is significantly associated with an increased risk of ischemic events but not bleeding outcomes after acute MI.

This study aimed to compare the anthropometric and performance parameters between American football players from different high school grades and to compare their physical characteristics to the normative values for U.S. and Japanese players from previous studies. The analysis included 240 grade 10 and 11 American football players. The testing included height, body mass, broad jump, 40-yard dash, and pro-agility shuttle. The analysis was stratified by position: linemen (offensive and defensive), big skill players (fullbacks, tight ends, and linebackers), and skill players (wide receivers, running backs, and defensive backs). The only between-grade difference was body mass for linemen (Cohen’s d>0.6), with no moderate effects for all other measured variables (|d| ≦0.6). No Japanese players were better in both mass and performance measures than U.S. elite high school players. The strength and conditioning program for long-term athlete development should be established for American football players in Japan.

In elite fencers, muscle strength and muscle mass of the front leg (FL) are greater than those of the back leg (BL) due to characteristic physiological and biomechanical demands placed on each leg during fencing. However, the development of laterality in their neural and muscular components is not well-understood. The present study investigated neuromuscular characteristics of FL and BL in junior fencers. Nineteen junior fencers performed neuromuscular performance tests for FL and BL, separately. There were no significant differences in the isometric knee extension strength (MVC), unilateral vertical jump (UVJ), vastus lateralis muscle thickness (MT), or motor unit firing rate of the vastus lateralis muscle (MUFR) between FL and BL (p > 0.05). In subgroup analyses, a significantly greater MUFR in FL than BL was noted only in fencers with > 3 years of fencing experience, and significantly greater UVJ in FL than BL was observed solely in fencers with p 3 years of fencing experience, but not in those with

Recently, the impact of the lack of standard modifiable risk factors, including hypertension, diabetes, dyslipidaemia, and current smoking, has been investigated in ST-segment elevation myocardial infarction (MI). The present study aimed to evaluate clinical characteristics and prognosis of the patients with no standard risk factors in acute MI.This bi-centre registry included 1,093 patients with acute MI undergoing percutaneous coronary intervention. The participants were divided into two groups: patients having at least one of the four standard risk factors and those having none of the risk factors. The study endpoints included major adverse cardiovascular events (MACE) (death, recurrent MI, and stroke) and major bleeding events during hospitalisation. Any MACE and major bleeding events after discharge were also evaluated as an exploratory analysis.Of 1,093 patients, 64 (5.9%) had none of the four standard risk factors. The patients with no standard risk factors were likely to present with Killip class IV and cardiac arrest. The rate of in-hospital MACE was higher in patients with no risk factors than in their counterparts (25.0% vs 9.9%; p0.001), whereas the incidence of in-hospital major bleeding was not significantly different between the two groups (9.4% vs 6.7%; p=0.44). Active cancer and autoimmune/inflammatory diseases were often found in patients with no standard risk factors. After discharge, no significant differences were observed in the risks of MACE and major bleeding events between the two groups.No standard modifiable risk factors were not uncommon and were associated with poor short-term outcomes in patients with acute MI.

BACKGROUND The PARIS and CREDO-Kyoto risk scores were developed to identify patients at risks of thrombotic and bleeding events individually after percutaneous coronary intervention (PCI). However, these scores have not been well validated in different cohorts.Methods and Results:This 2-center registry enrolled 905 patients with acute myocardial infarction (MI) undergoing primary PCI. Patients were divided into 3 groups according to the PARIS and CREDO-Kyoto thrombotic and bleeding risk scores. The study endpoints included ischemic (cardiovascular death, recurrent MI, and ischemic stroke) and major bleeding events. Of 905 patients, 230 (25%) and 219 (24%) had high thrombotic and bleeding risks, respectively, with the PARIS scores, compared with 78 (9%) and 50 (6%) patients, respectively, with the CREDO-Kyoto scores. According to the 2 scores, >50% of patients with high bleeding risk had concomitant high thrombotic risk. During the mean follow-up period of 714 days, 163 (18.0%) and 95 (10.5%) patients experienced ischemic and bleeding events, respectively. Both PARIS and CREDO-Kyoto scores were significantly associated with ischemic and bleeding events after primary PCI. For ischemic events, the CREDO-Kyoto rather than PARIS thrombotic risk score had better diagnostic ability. CONCLUSIONS In the present Japanese cohort of acute MI patients undergoing contemporary primary PCI, the PARIS and CREDO-Kyoto thrombotic and bleeding risk scores were discriminative for predicting ischemic and bleeding events.

In acute myocardial infarction (MI), the prognosis has been improved, and the length of hospital stay has been shortened. In the present study, we aimed to evaluate the potential of identifying low-risk patients for early discharge after acute MI using the GRACE and CADILLAC risk scores.This bi-center registry included 797 patients with acute MI undergoing primary percutaneous coronary intervention. Patients were divided into 3 groups according to the tertiles and pre-defined thresholds of the GRACE and CADILLAC scores. The primary endpoint was a composite of in-hospital major adverse events (all-cause death, sustained ventricular arrhythmia, recurrent MI, heart failure requiring intravenous treatment, stroke, and major bleeding events).Of 797 patients, 271 (34.0%) and 316 (39.7%) had low GRACE and CADILLAC risk scores. During the hospitalization, 251 (31.5%) patients had major adverse events. Higher GRACE and CADILLAC scores were associated with longer length of stay and higher in-hospital adverse event rates. In patients with low GRACE and/or CADILLAC risk scores, 16 (5.9%) and 16 (5.1%) had in-hospital adverse events, most of which occurred within 3 days. Only 1 (0.4% and 0.3%) patient had major adverse events on day 4 or later in the low GRACE and CADILLAC risk score groups.In patients with acute MI with low GRACE and/or CADILLAC risk scores who were free from acute events within 3 days, early discharge after primary percutaneous coronary intervention may be feasible and safe.

It has been reported that Achilles tendon xanthoma (ATX), being one of the important diagnostic criteria for familial hypercholesterolemia, is independently associated with the severity of coronary artery disease (CAD). The aim of this study was to investigate plaque vulnerability in CAD patients with ATX.Patients with CAD who underwent percutaneous coronary intervention (PCI) with near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) guidance were enrolled. Soft X-ray radiography of the Achilles tendon was performed, and a maximum thickness of 9 mm or more was regarded as ATX. Using NIRS-IVUS, the degree of lipid core plaque (LCP) was evaluated by calculating the maximum value of lipid core burden index (LCBI) for any of the 4-mm segments (maxLCBIIn a total of 156 patients, 14 patients (9.0%) had ATX. MaxLCBIATX was associated with the degree of LCP in CAD patients requiring PCI. High-risk patients with lipid-rich vulnerable plaque can possibly be detected by evaluating Achilles tendon thickness.

Patients with cancer have an increased risk of cardiovascular events including myocardial infarction (MI) and vice versa, and are at high risks of ischemic and bleeding events after MI. However, short- and long-term clinical outcomes in patients with acute MI based on cancer status are not fully understood. This bi-center registry included 903 patients with acute MI undergoing primary percutaneous coronary intervention in a contemporary setting. Patients were divided into active cancer, a history of cancer, and no cancer according to the status of malignancy. Major adverse cardiovascular events (MACE), a composite of all-cause death, recurrent MI, and stroke, and major bleedings were evaluated. Of 903 patients, 49 (5.4%) and 65 (7.2%) had active cancer and a history of cancer, and 87 (9.6%) patients died during the hospitalization. In-hospital MACE was not significantly different among the 3 groups (16.3% vs 10.8% vs 10.9%, p = 0.48), whereas the rate of major bleeding events during the index hospitalization was significantly higher in patients with active cancer than their counterpart (20.4% vs 6.2% vs 5.8%, p = 0.002). After discharge, patients with active cancer had an increased risk of MACE and major bleedings compared with those with a history of cancer and no cancer during the mean follow-up period of 853 days. In conclusions, active cancer rather than a history of cancer and no cancer had significant impact on in-hospital bleeding events, and MACE and major bleedings after discharge in patients with acute MI undergoing primary percutaneous coronary intervention.

Background Recent guidelines recommend risk stratification using objective scoring systems in patients with acute coronary syndrome. In this context, the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) and GRACE (Global Registry of Acute Coronary Events) risk scores were both originally established to predict short-term mortality. However, their impact on short- and long-term clinical outcomes in a contemporary cohort of patients with acute myocardial infarction (MI) is unclear. Methods This bi-center registry included 809 patients with acute MI undergoing primary percutaneous coronary intervention. Patients were divided into three groups according to the pre-defined thresholds and tertiles of the CADILLAC and GRACE scores. The study endpoints included all-cause death and major adverse cardiovascular events (MACE) during the index hospitalization and after discharge. Results Of 809 patients, 323 (39.9%) and 255 (31.5%) had high CADILLAC and GRACE risk scores. During the index hospitalization, 61 (7.5%) patients died and 262 (32.4%) had MACE. Both CADILLAC and GRACE risk scores were associated with in-hospital mortality and MACE rates. After discharge, out of 683 patients with available follow-up information who survived to discharge, 42 (6.1%) died and 123 (18.0%) had MACE during the median follow-up period of 632 days. Significantly higher incidence of MACE in higher CADILLAC and GRACE risk scores was observed in a stepwise manner. Conclusion Both CADILLAC and GRACE risk scores were predictive for short- and long-term mortality and MACE rates in a contemporary cohort of acute MI patients undergoing primary percutaneous coronary intervention.

We determined the marker-less barbell auto-tracking accuracy using the Kanade–Lucas–Tomasi (KLT) algorithm in a digital video for two-dimensional analysis (2D-AT). The position coordinates of the barbell’s right end during multiple loads (60%–90% of one-repetition maximum) of snatch motion in eight participants were recorded using a three-dimensional motion capture system. Simultaneously, the snatch motion was recorded by a digital camera from the right side. Based on the digital video, the center of the barbell’s right end was auto-tracked using the KLT algorithm. Six barbell kinematic variables (forward, backward, and vertical displacement, peak forward, backward, and vertical velocity) were calculated. Intraclass correlation coefficient (ICC) analysis was performed to establish the agreement level between the methods. The Bland–Altman plots and regression were used to examine the agreement between the methods. ICCs of 0.999–0.971 revealed a strong agreement level between the methods. The Bland–Altman plot showed small bias (-0.001–0.001 m, -0.034 –-0.005 m/s). We considered that 2D-AT could obtain barbell position coordinates with sufficient accuracy to discriminate the difference in the lifter’s level and a successful or unsuccessful lift.

BACKGROUND Amateur wrestlers have often undergone rapid weight loss (RWL) to win their matches. On January 1, 2018, the rule of weigh-in was changed and weight category increased. The study aimed to determine the prevalence of wrestlers undergoing RWL under the new rule of morning weigh-in before the tournament and examine the relationship between the range of RWL and physical conditions. METHODS Male (N.=204) and female (N.=50) wrestlers participating in the National Wrestling Championship completed a questionnaire about weight reduction methods and their physical condition. RESULTS Among 159 participants exceeding their weight class one-week before competition, 36% of males and 44% of females exceeded their weight class by 0.0-4.9% (requiring small RWL); 30% of males and 6% of females exceeded by 5.0-10.0% (requiring large RWL), but neither males nor females were over 10.0% above required weight. In males, there was a moderate negative correlation between excess rates of body mass one-week before competition and their physical condition (r=-0.330 to -0.467, P

The purpose of this study was to clarify the physiological abilities of international-level male wrestlers compared with those of collegiate-level wrestlers. Twenty Japanese male freestyle wrestler...

Powdered samples of Erianthus were treated with anhydrous ammonia at 50–140 °C. The crystal structure of cellulose in the sample changed to cellulose III I , and its crystallite size increased with increasing temperature. Lignin content decreased with increasing temperature, while most reducing sugars, including glucose, were maintained at nearly 80%. Enzymatic hydrolysis of the ammonia-treated samples was carried out at 37 °C using a mixture of cellulase and β-glucosidase in solution. The samples treated at a higher temperature showed better enzymatic degradability. Furthermore, transverse sections of Erianthus stem were also treated with ammonia, and cell wall components and their distributions were detected with microscopic observation. By using fluorescence microscopy, it was also found that lignin content decreased with increased temperature. The immuno-labeling of pectin and β-1,3-1,4-glucan showed a change to a water-soluble form and complete removal by the ammonia treatment. However, xylan had substantial resistance to ammonia treatment.

The traditional Maule color reaction was improved by use of tris(hydroxymethyl) aminomethane-hydrochloride acid (Tris–HCl) buffer coupled with a fluorescence microscope. The purple-red color of Maule-treated hardwood was more stable with the novel treatment than with traditional treatment. In addition, Maule-treated wood samples had a characteristic fluorescence when excited with blue (460–495 nm) light. Examination of white birch (Betula platyphylla) showed that syringyl-rich and guaiacyl-rich cell walls emitted red and yellow fluorescence, respectively. Measuring the fluorescence spectra of hardwood and softwood powders after treatment with the new Maule reagents showed that hardwood powder containing syringyl lignin emitted a red fluorescence, whereas softwood powder containing guaiacyl lignin emitted a green fluorescence when excited with blue light. In conclusion, this improved technique has many advantages compared with the traditional Maule color test.

Yamashita, D, Asakura, M, Ito, Y, Yamada, S, and Yamada, Y. Physical characteristics and performance of Japanese top-level American football players. J Strength Cond Res 31(9): 2455–2461, 2017—This study aimed to compare the physical characteristics and performance between top-level nonprofessional football players in Japan and National Football League (NFL) Combine invited players and between top-level and middle-level players in Japan to determine the factors that enhance performance in international and national competitions. A total of 168 American football players (>20 years) in Japan participated in an anthropometric (height and weight) and physical (vertical jump, long jump, 40-yard dash, pro-agility shuttle, 3-cone drill, and bench press repetition test) measurement program based on the NFL Combine program to compete in the selection of candidates for the Senior World Championship. All players were categorized into 1 of the 3 position groups based on playing position: skill players, big skill players, and linemen. Japanese players were additionally categorized into selected and nonselected players for the second tryout. The NFL Combine candidates had significantly better performance than selected Japanese players on all variables except on performance related to quickness among the 3 position groups. Compared with nonselected players, selected Japanese skill players had better performance in the 40-yard dash and bench press test and big skill players had better performance in the vertical jump, broad jump, and 40-yard dash. Selected and nonselected Japanese linemen were not different in any measurements. These results showed the challenges in American football in Japan, which include not only improving physical performance of top-level players, but also increasing the number of football players with good physical performance.

Staphylococcal alpha-hemolysin (alpha-HL) is a beta-barrel pore-forming toxin (PFT) expressed by Staphylococcus aureus. alpha-HL is secreted as a water-soluble monomeric protein, which binds to target membranes and forms membrane-inserted heptameric pores. To explore the pore-forming mechanism of alpha-HL in detail, we determined the crystal structure of the alpha-HL monomer and prepore using H35A mutant and W179A/R200A mutant, respectively. Although the overall structure of the monomer was similar to that of other staphylococcal PFTs, a marked difference was observed in the N-terminal amino latch, which bent toward the prestem. Moreover, the prestem was fastened by the cap domain with a key hydrogen bond between Asp45 and Tyr118. Prepore structure showed that the transmembrane region is roughly formed with flexibility, although the upper half of the beta-barrel is formed appropriately. Structure comparison among monomer, prepore and pore revealed a series of motions, in which the N-terminal amino latch released upon oligomerization destroys its own key hydrogen bond between Asp45 Tyr118. This action initiated the protrusion of the prestem. Y118F mutant and the N-terminal truncated mutant markedly decreased in the hemolytic activity, indicating the importance of the key hydrogen bond and the N-terminal amino latch on the pore formation. Based on these observations, we proposed a dynamic molecular mechanism of pore formation for alpha-HL.