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Objective Dedicated intensive-care unit (ICU) physician staffing is associated with a reduction in ICU mortality rates in general medical and surgical ICUs. However, limited data are available on the role of intensivists in ICU for cardiac disease, especially in Japan. This study investigated the association of collaborative intensivists and cardiologist care with clinical outcomes in patients with acute myocardial infarction (AMI) admitted to the ICU. Methods This study analyzed 106 patients admitted to the ICU at Nara Prefecture General Medical Center in Nara, Japan, from April 2017 to April 2019. Eligible patients were divided into either the high-intensity ICU management group (n=51) or the low-intensity ICU management group (n=55). The primary outcome of in-hospital mortality was compared in the two groups. Results The high-intensity ICU group was found to be associated with a lower mortality rate in a multivariate analysis than the low-intensity group (7.8% vs. 16.4%; odds ratio [OR]: 0.07; 95% confidence interval [CI]: 0.01-0.54; P=0.01). There were no significant differences in the length of either the ICU stay or hospital stay or the hospital costs between the two groups. A subgroup analysis revealed that the in-hospital mortality rate was lower in the high-intensity ICU group than in the low-intensity ICU group among patients with Killip class IV (16.7% vs. 34.6%; OR, 0.08; 95% CI, 0.01-0.67; P=0.02). Conclusion The presence of dedicated intensivists in high-intensity ICU collaborating with cardiologists might reduce in-hospital mortality in patients with Killip class IV AMI who require critical care.

Background: Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence. Methods: This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion ( Conclusions: The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000039763.

Background: The efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. Methods and Results: In a multicenter, controlled trial, the CANONICAL study, we enrolled 82 HFpEF (left ventricular ejection fraction [LVEF] ≥50%) patients with type 2 diabetes (T2D) aged ≥65 years, with plasma B-type natriuretic peptide (BNP) ≥100 pg/mL or plasma N-terminal pro BNP (NT-proBNP) ≥400 pg/mL or history of HF. Patients were randomly assigned to 2 groups and were administered either the SGLT2 inhibitor canagliflozin (100 mg/day) for 24 weeks or standard therapy. The primary endpoints were changes in body weight (BW) and BNP concentrations. Mean (±SD) patient age, body mass index, and LVEF were 75.7±6.5 years, 25.0±3.6 kg/m2 and 61.5±7.6%, respectively. At 24 weeks, BW was significantly lower in the canagliflozin than standard therapy group. The extent of BNP reductions at 4 weeks was significantly greater in the canagliflozin than standard therapy group (P

It is important for the improvement of mechanical properties of quenching and partitioning (QP) steels to control the martensite transformation behavior and the stability of untransformed austenite. In this study, we evaluated the martensite transformation restart temperature (Mr) via a dilatometer during the reheat austempering pattern. This heat pattern corresponding to the typical heat treatment for QP steel involves quenching to TQ, a temperature between the martensite transformation start temperature (Ms) and the finish temperature, and austempering above Ms. In Fe-8Ni-0.2C alloy, Mr equals TQ, regardless of the progress of bainite transformation during austempering at 673 K (400 °C). In Fe-8Ni-1Si-0.2C alloy, Mr decreases parabolically from TQ with the progress of bainite transformation, and this behavior corresponds to the assumed carbon concentration by bainite transformation. These results indicate that the self-stabilization of the entire untransformed austenite during the first quench from Ms to TQ was preserved, regardless the bainite transformation. Moreover, the stabilization by the carbon concentration in untransformed austenite was added to this self-stabilization.

The carbon distribution behavior and crystal structure of as-quenched martensite in Fe-1Mn-C (C: 0.07 to 0.8 mass pct) steels were quantitatively investigated by atom probe tomography (APT) and X-ray diffraction with Rietveld analysis. APT revealed that the martensite steels contained quantities of carbon in solid solution far beyond its solubility in body-centered cubic (bcc)-Fe in all the alloys investigated; the carbon atoms were non-homogeneously distributed as carbides or aggregates on dislocations due to autotempering. Tetragonality was observed in the steels with interstitial solute carbon concentrations in the range of 0.1 to 0.7 mass pct, but was not evident below 0.1 mass pct. The appearance and disappearance of tetragonality in the low-carbon steels may be explained by the disordered bcc ↔ ordered body-centered tetragonal (bct) mechanism, considering the partial tetragonality due to the heterogeneity of the interstitial solute carbon distribution. The existence of tetragonality in the autotempered low-carbon steels can alternatively be understood by a mechanism based on the kinetic decrease of tetragonality during cooling, where the microscopic strain release is the rate-controlling process. The excess carbon solubility in the autotempered low- and medium-carbon martensite is due to the existence of tetragonal distortions, owing to the slow kinetics of the tetragonality decrease during cooling.

A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), suddenly emerged in China in 2019, spread globally and caused the present COVID-19 pandemic. Therefore, to mitigate SARS-CoV-2 infection effective measures are essential. Chlorous acid (HClO2) has been shown to be an effective antimicrobial agent. However, at present there is no experimental evidence showing that HClO2 can inactivate SARS-CoV-2. Therefore, in this study, we examined the potential of HClO2 to inactivate SARS-CoV-2 in presence or absence of organic matter and the results were compared with that of sodium hypochlorite (NaClO), another potent antimicrobial agent. When concentrated SARS-CoV-2 was incubated with 10 ppm HClO2 for 10 s, viral titre was decreased by 5 log of 50% tissue culture infective dose per mL (TCID50 ml−1). However, the same concentration of NaClO could not inactivate SARS-CoV-2 as effectively as HClO2 did even after incubation for 3 min. Furthermore, 10 ppm HClO2 also inactivated more than 4.0 log of TCID50 within 10 s in the presence of 5 % fetal bovine serum used as mixed organic matters. Our results obtained with HClO2 are more effective against SARS-CoV-2 as compared to NaClO that can be used for disinfectant against SARS-CoV-2 .

Multi structural steels exhibit high strength and good formability; however, their performance depends on the volume fraction of the secondary phase. In our previous study, ferrite + pearlite structural steel sheet showed the characteristic two-step ductile-to-brittle transition (DBT) with decreasing temperature, and the absorbed energy curve exhibited a distinct middle shelf. In this study, we evaluated the effect of pearlite volume fraction (V_P) on the DBT behavior by the Charpy impact test with sub-size specimens. For specimens without pearlite, the absorbed energy directly dropped from the upper shelf to the lower shelf with decreasing temperature. For samples with 2–3% pearlite, the absorbed energy corresponding to the transition temperature range was dispersed between the two shelves, and the transition behavior seemed to be the typical DBT behavior. When V_P was increased to 21%, the absorbed energy just above the transition-finish temperature became stable at a middle level between the two shelves; thus, the existence of a distinct middle shelf was confirmed. Although the transition-start temperature increased with increasing V_P, V_P did not affect the transition-finish temperature and the absorbed energy at the middle shelf. These results were analyzed with a simple model based on the Yoffee diagram.

Background Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition with high serum IgG4 levels affecting various organs, such as the pancreas, lacrimal and salivary glands, thyroid, kidney, and lung. Typical cardiovascular manifestations of IgG4-RD include periaortitis, coronary arteritis, and pericarditis. However, reports of IgG4-RD associated with coronary arteritis are rare. Here, we report a case of IgG4-related masses surrounding the coronary arteries. Case summary A 59-year-old man was referred to our hospital because of mediastinal masses detected by computed tomography (CT). Coronary CT angiography revealed masses surrounding the right coronary artery and the left anterior descending coronary artery. An elevated serum level of IgG4 and histological findings led to the diagnosis of IgG4-related coronary arteritis with mass formation. Coronary angiography showed numerous feeding arteries to the masses, which were demonstrated as multiple microchannels in the intravascular ultrasound (IVUS) images. Discussion IgG4-RD involving the cardiovascular system has been reported. However, coronary artery disease associated with IgG4-RD is very rare, and the mechanism of mass formation in IgG4-related coronary arteritis is unclear. In our case, within the cardiovascular system, IgG4-RD was limited to the coronary arteries, suggesting that the affected coronary arteries may provide the necessary blood supply to the mass, thus, aiding its growth. These findings were supported by the images from coronary angiography and IVUS.

Adenosine-sensitive atrial tachycardias (ATs) originating from the para-Hisian region have been reported, and the responsible mechanism is considered to be reentry. As an alternative strategy to ablation at the earliest activation site (EAS) close to the atrioventricular node, previous reports safely eliminated these ATs at the entrance of the slow conduction zone, indicated by a manifest entrainment-guided strategy, but no report has successfully ablated those ATs using the same strategy in the left atrium. We describe a case of adenosine-sensitive AT originating from the para-Hisian region that could be eliminated at a remote site from the EAS indicated by the demonstration of manifest entrainment from the high anteroseptal left atrium.

Adenosine-sensitive atrial tachycardias (ATs) originating from the para-Hisian region have been reported, and their responsible mechanism is considered to be reentry. As an alternative strategy to ablation at the earliest activaton site (EAS) close to the atrioventricular node, previous reports safely eliminated these ATs at the entrance of the SCZ, indicated by a manifest entrainment-guided strategy, but no report has successfully ablated those ATs using the same strategy in the left atrium. We described a case of adenosine-sensitive AT originating from the para-Hisian region that could be eliminated at a remote site from the EAS indicated by the demonstration of manifest entrainment from the anteroseptal LA.

The steels consisting of multi-phase structure show an advantage for their high strength and good formability. The ductile to brittle transition with decreasing temperature has been investigated by Charpy impact test with sub-size specimen for the ferrite + pearlite structure steel sheet. The transition curve of the absorbed energy showed a two-step transition behavior, and the “middle shelf” appeared clearly in the curve. The cleavage-like fracture with few dimples appeared on the fracture surface of the specimens at the middle shelf, and the plastic strain was detected just below the fracture surface. This result suggested that the fracture at the middle shelf propagates with the quasi-cleavage fracture accompanied with plastic deformation. Although the traces of fracture surface corresponded to (001), (011), and (112) bcc-iron planes, the (001) cleavage plane was not dominant for the fracture propagation path at the middle shelf.

Background The appropriate number of board-certified cardiologists (BCC) for the treatment of acute myocardial infarction (AMI) has not been thoroughly examined in Japan. This study investigated whether the number of BCC/50 cardiovascular beds affects acute outcome in AMI treatment. Methods and Results: Data on 751 board-certified teaching hospitals and 63,603 patients with AMI were obtained from the Japanese Registry Of All cardiac and vascular Diseases (JROAD) and JROAD Diagnosis Procedure Combination (JROAD-DPC) databases between 1 April 2012 and 31 March 2014. The hospitals were categorized into 3 groups based on the median number of BCC/50 cardiovascular beds: first tertile, 5.0 (IQR, 4.0-5.7); second, 8.3 (IQR, 7.4-9.8); third, 15.3 (IQR, 12.5-22.7), and the patients with AMI admitted to the categorized hospitals were compared (first tertile, 12,002 patients; second, 23,930; third, 27,671). On hierarchical logistic modeling, the adjusted OR for 30-day mortality were 0.86 (95% CI: 0.74-1.00) for the second tertile and 0.75 (95% CI: 0.65-0.88) for the third tertile. Conclusions Patients with AMI admitted to hospitals with a large number of BCC/50 cardiovascular beds had a lower 30-day mortality rate. This tendency was independent of patient and hospital characteristics. This is the first study to provide new information on the association between the number of BCC and in-hospital AMI-related mortality in Japan.

The middle shelf (MS) exhibits medium absorbed energy during a two-step ductile to brittle transition and appears clearly in a ferrite + pearlite steel sheet. The analysis involved using the electron backscattered diffraction technique and indicated that the traces of fracture surface and secondary cracks at MS and lower shelf (LS) correspond to low index crystallographic planes in bcc iron. Although the {001} cleavage plane in the ferrite grain is dominant for the fracture propagation path at LS, the traces at MS correspond to {001}, {112}, and {011} planes. The potential of fracture in the {001} plane at MS (i.e., the number of traces normalized by the number of equivalent planes) exceeds that in the {112} plane. However, the difference between the same is significantly lower than that at LS. Furthermore, the{112} and {011} planes are typical slip planes in bcc iron. This suggests that the fracture at MS propagates on the {001} plane with cleavage fracture as well as on the {112} and {011} planes with a slipping-off mechanism.

The lath martensite in steel is the basic structure which brings the high strength on many types of advanced high-strength steels (AHSSs). The properties of AHSSs depend on the strengthening mechanism of martensite. However, the mechanism is not clear because of the complex substructure of lath martensite. In this study, we evaluated the effects of solute carbon content and prior austenite grain size on the yield strength of fully lath martensite structure in low and ultra-low carbon Fe-Ni alloys. Although the grain refinement increased the strength in low-carbon alloys, it did not affect in the interstitial-free alloy. The Hall–Petch coefficient increased with the carbon content increasing, and saturated gradually. This behavior was similar to that in the ferritic steel, and more carbon content was required for the saturation in the lath martensite.

Aims Excess sodium causes the development of cardiovascular diseases in conjunction with enhancing renin-angiotensin-aldosterone system (RAAS). Natriuretic peptides are sodium regulators and prevent pathological cardiac alterations by counteracting RAAS. However, it is unknown whether natriuretic peptides inhibit the sodium effect in adverse cardiac alterations. Here, we investigated whether excess salt intake could exacerbate cardiac remodeling in mice with impaired natriuretic peptide signaling. Materials and methods Mice lacking the gene encoding the natriuretic peptide receptor, guanylyl cyclase-A (GC-A), and wild-type mice were administered with either a vehicle substance or a subpressor dose of aldosterone (100 ng/kg/min), alongside low salt (0.001% NaCl), normal salt (0.6% NaCl), or high salt diets (6.0% NaCl) for four weeks. Mice were then sacrificed and the hearts were evaluated by histology and RT-PCR. Key findings Salt load did not induce cardiac changes in vehicle and aldosterone groups in wild-type mice. On the other hand, cardiac hypertrophy and interstitial fibrosis were significantly exacerbated in a salt dependent manner in GC-A knockout (KO) mice administered aldosterone, and were associated with enhanced gene expression relevant to hypertrophy, fibrosis, and oxidative stress conditions. Of note, excess salt intake increased the expression of Sgk1, serum and glucocorticoid responsive kinase-1, in aldosterone-administered GC-A KO mice. These molecular changes were not observed in wild-type mice. Significance The results of the present study demonstrate that excess salt intake induced cardiac remodeling in conjunction with aldosterone administration in GC-A KO mice, indicating that GC-A signaling attenuated the deleterious salt effect in aldosterone-induced cardiac remodeling.

Soluble fms-like tyrosine kinase-1 (sFlt-1), an endogenous inhibitor of vascular endothelial growth factor and placental growth factor, is involved in the pathogenesis of cardiovascular disease. However, the significance of sFlt-1 in heart failure has not been fully elucidated. We found that sFlt-1 is decreased in renal failure and serves as a key molecule in atherosclerosis. In this study, we aimed to investigate the role of the decreased sFlt-1 production in heart failure, using sFlt-1 knockout mice. sFlt-1 knockout mice and wild-type mice were subjected to transverse aortic constriction and evaluated after 7 days. The sFlt-1 knockout mice had significantly higher mortality (52% versus 15%; P =0.0002) attributable to heart failure and showed greater cardiac hypertrophy (heart weight to body weight ratio, 8.95±0.45 mg/g in sFlt-1 knockout mice versus 6.60±0.32 mg/g in wild-type mice; P

Objective A high proportion of uncovered stent struts is associated with late stent thrombosis after drug-eluting stent (DES) implantation, which frequently results in myocardial infarction or death. However, the predictors of uncovered stent struts remain unknown. Here, using optical coherence tomography (OCT), we studied the baseline tissue characteristics of the target coronary segment and evaluated their influence on the neointimal coverage of the strut in the chronic phase. Methods We analyzed 118 coronary lesions treated with OCT-guided DES implantation. OCT examinations of target lesions were performed before and after DES implantation, and tissue characteristics were evaluated within 5 mm outer segment of both stent edges. At follow-up, stent strut coverage was assessed within 5 mm inner segment from each stent edge. On the basis of the proportion of uncovered stent struts in the chronic phase, target segments were divided into poorly covered (the highest quartile with % uncovered struts, n=29) and well-covered (the remaining lower quartiles with % uncovered struts, n=89) groups. Results Clinical parameters were similar between the two groups. On baseline OCT images, thin-cap fibroatheroma (TCFA) and large calcification were more frequently observed in the poorly covered group than the well-covered group (10.3 vs. 0.0%, P=0.0032, and 27.6 vs. 9.0%, P=0.017, respectively). Furthermore, multivariable analysis showed TCFA and large calcification at the proximal edge, but not at the distal edge, were predictors of uncover stent struts. Conclusion TCFA and large calcification at the proximal stent edge are strong predictors of uncovered stent struts. OCT is useful for selecting stent landing sites in terms of future occurrence of uncovered stent struts.

Foodborne disease caused by campylobacters is one of the major global problems for food safety. Infection source of Campylobacter to human is mainly through contaminated meat particularly chicken. Contamination of meat with Campylobacter usually occurs during processing at slaughterhouse and to prevent such contaminations, sodium hypochlorite is commonly used. However, it is well known that bactericidal activity of sodium hypochlorite becomes weak under organic matter rich conditions. In this study, we compared the strength of bactericidal activity of chlorous acid and sodium hypochlorite against Campylobacter jejuni and Campylobacter coli strains under organic matter rich conditions. Bactericidal activity against 5 representative C. jejuni and C. coli strains in chicken juice (an organic matter rich condition) showed that minimum concentration of chlorous acid required for complete killing of C. jejuni and C. coli cells is 200–400 ppm while that of sodium hypochlorite is 2,000 to 4,000 ppm. Similar results were obtained by using Bolton broth. Furthermore, it was observed that 400 ppm of chlorous acid but not 400 ppm of sodium hypochlorite is highly effective in killing of 25 different Campylobacter strains (12 C. jejuni and 13 C. coli strains) under the same conditions. To determine whether 400 ppm of chlorous acid treatment had killed bacterial cells or induced them into viable but non-culturable (VBNC) state, live and dead cell assay using DAPI and propidium iodide fluorescent dyes was done. Such assay clearly indicated that Campylobacter cells were indeed killed and not induced to VBNC state. Moreover, SDS-PAGE analysis of whole-cell lysates of campylobacters indicated distinct effects in protein profiles of chlorous acid but not sodium hypochlorite treated cells. The results strongly suggest that chlorous acid could efficiently kill C. jejuni and C. coli cells with much lower concentration than sodium hypochlorite and the bactericidal mechanisms of chlorous acid may be due to damages of bacterial proteins. Thus, chlorous acid could be a better disinfectant in chicken slaughtering and processing to kill campylobacters and prevent contamination.

Accumulating evidence indicates alteration of the β-adrenoceptor (AR), such as desensitization and subtype switching of its coupling G protein, plays a role in the protection against catecholamine toxicity in heart failure. However, in human takotsubo syndrome (TTS), which is associated with a surge of circulating catecholamine in the acute phase, there is no histologic evidence of β-AR alteration. The purpose of this study was to investigate the involvement of alteration of β-AR signaling in the mechanism of TTS development. Left ventricular (LV) biopsied samples from 26 patients with TTS, 19 with normal LV function, and 26 with dilated cardiomyopathy (DCM) were studied. G protein-coupled receptor kinase 2 (GRK2) and β-arrestin2, which initiate the alteration of β-AR signaling, were more abundantly expressed in the myocardium in acute-phase TTS than in those of DCM and normal control as indicated by immunohistochemistry. The percentage of cardiomyocytes that showed positive membrane staining for GRK2 and β-arrestin2 was also significantly higher in acute-phase TTS. Sequential biopsies in the recovery-phase for two patients with TTS revealed that membrane expression of GRK2 and β-arrestin2 faded over time. This study provided the first histologic evidence of the involvement of alteration of β-ARs in the development of TTS.

In order to contribute to weight reduction of car body, advanced high-strength sheet steels have been intensively investigated. A cold-rolled sheet steel of 1180 MPa grade with superior press formability and sheet steel for hot stamping with 1800 MPa of tensile strength have been developed typically. The microstructure control for those materials and some other practical properties, such as crashworthiness, antihydrogen embrittlement, and so on, will be discussed.

Upper bainite in steels has many common features with lath martensite in steels. But there are some studies that indicate that bainite transformation start temperature (Bs) is greater than T0 on steels containing high carbon content. We measured Bs on Fe–9 mass% Ni alloys containing 0.003–0.89 mass% C. In low carbon alloys, Bs is below T0, and the increasing of carbon content decreases Bs standing in a line that is parallel to T0. On the other hand, in high carbon alloys, carbon content does not affect Bs which stands around 753 K. The border between these two tendencies and Bs in high carbon alloys seem to correspond to the intersection point between the line of Bs on low carbon alloys and the calculated γ/(γ + θ) phase boundary.

Placental growth factor (PlGF) contributes to atherogenesis through vascular inflammation and plaque destabilization. High levels of PlGF may be associated with mortality and cardiovascular disease, but the relationship between PlGF level and adverse outcomes in patients with CKD is unclear. We conducted a prospective cohort study of 1351 consecutive participants with CKD enrolled in the Novel Assessment of Risk management for Atherosclerotic diseases in CKD (NARA-CKD) study between April 1, 2004, and December 31, 2011. During a median follow-up of 3 years, 199 participants died and 383 had cardiovascular events, defined as atherosclerotic disease or heart failure requiring hospitalization. In adjusted analyses, mortality and cardiovascular risk increased in each successive quartile of serum PlGF level; hazard ratios (HRs) (95% confidence intervals [95% CIs]) for mortality and cardiovascular risk, respectively, were 1.59 (0.83 to 3.16) and 1.55 (0.92 to 2.66) for the second quartile, 2.97 (1.67 to 5.59) and 3.39 (2.20 to 5.41) for the third quartile, and 3.87 (2.24 to 7.08) and 8.42 (5.54 to 13.3) for the fourth quartile. The composite end point of mortality and cardiovascular events occurred during the study period in 76.4% of patients in both the highest PlGF quartile (≥19.6 pg/ml) and the lowest eGFR tertile (

The antimicrobial activity of weakly acidified chlorous acid water (WACAW) against Staphylococcus aureus, non-pathogenic Escherichia coli, enterohemorrhagic E. coli (EHEC O157:H7), Candida albicans, and spore-forming Bacillus and Paenibacillus species was evaluated in vitro. The antiviral activity was also examined using feline calicivirus (FCV). Diluted WACAW (>100 ppm) effectively reduced the number of non-spore-forming bacteria (>4 log10 CFU reductions) within 5 min. Treatment with this sanitizer at 400 ppm for 30 min achieved>5 log10 CFU reductions in spore-forming Bacillus and Paenibacillus species while an equivalent concentration of sodium hypochlorite (NaClO) resulted in only a 0.98 and 2.72 log10 CFU reduction, respectively. The effect of this sanitizer against FCV was equivalent to that of NaClO. Immersion in WACAW (400 ppm) achieved >4 and 2.26 log10 CFU reductions in Campylobacter jejuni and EHEC, respectively, on artificially contaminated broiler carcass pieces. Finally, theantimicrobial activity of this sanitizer was shown to be maintained for at least 28 d when in contact with nonwoven fabric (100% cotton). This study showed that pH control of chlorous acid is expected to modify its antimicrobial activity and stability. WACAW is expected to have applications in various settings such as the food processing and healthcare industries.

BACKGROUND The renin-angiotensin system (RAS) is activated in heart failure (HF) as a compensatory mechanism, being related to cardiac remodeling and poor prognosis. Although RAS inhibitors are used as first-line drugs for HF, plasma renin activity (PRA) is upregulated by RAS inhibitors via a negative feedback mechanism. The clinical significance of PRA during RAS inhibitor therapy is poorly understood in acute decompensated HF (ADHF). Therefore we examined the impact of PRA in HF patients already receiving RAS inhibitors. METHODS AND RESULTS Of 611 consecutive patients with ADHF and emergency admission to hospital, we studied the impact of PRA on the prognosis of ADHF in 293 patients already receiving RAS inhibitors before admission. The patients were divided into 2 groups according to median PRA (≥ vs.

BACKGROUND Heart failure (HF) with preserved (HFpEF) left ventricular ejection fraction (LVEF) is a syndrome with complex pathophysiology. Little is known about changes in LVEF that occur over time in HFpEF patients. A fundamental clinical question about HFpEF is whether HFpEF is an early manifestation of HF with reduced LVEF (HFrEF). If so, which patients with HFpEF are likely to show a decline in LVEF to less than 50%? The aim of the present study was to examine longitudinal changes in LVEF in patients with HFpEF. METHODS AND RESULTS Among 279 consecutive HFpEF patients admitted as emergencies, we examined 100 who underwent echocardiography at least 1 year after discharge. EF >50% was used as the definition of HFpEF. During a mean duration from hospitalization to follow-up echocardiography of 31.5 months, 11% of patients had LVEF ≤50% (mildly reduced LVEF), known as mildly reduced (HFmrEF). The utility of LVEF during hospitalization to predict HFmrEF was assessed with receiver-operating characteristic curve analysis. A cutoff value of 55% had sensitivity of 90.9% and specificity of 97.7%. Logistic regression analysis indicated that LVEF ≤55% and ischemic etiology were strong predictors of progression from HFpEF to HFmrEF (odds ratio [OR] 435, 95% confidence interval [CI] 52.65-10,614, P

Background Urinary neutrophil gelatinase‐associated lipocalin (U‐ NGAL ) is an early predictor of acute kidney injury and adverse events in various diseases; however, in acute decompensated heart failure patients, its significance remains poorly understood. This study aimed to investigate the prognostic value of U‐ NGAL on the first day of admission for the occurrence of acute kidney injury and long‐term outcomes in acute decompensated heart failure patients. Methods and Results We studied 260 acute decompensated heart failure patients admitted to our department between 2011 and 2014 by measuring U‐ NGAL in 24‐hour urine samples collected on the first day of admission. Primary end points were all‐cause death, cardiovascular death, and heart failure admission. Patients were divided into 2 groups according to their median U‐ NGAL levels (32.5 μg/gCr). The high‐U‐ NGAL group had a significantly higher occurrence of acute kidney injury during hospitalization than the low‐U‐ NGAL group ( P =0.0012). Kaplan‐Meier analysis revealed that the high‐U‐ NGAL group exhibited a worse prognosis than the low‐U‐ NGAL group in all‐cause death (hazard ratio 2.07; 95% CI 1.38‐3.12, P =0.0004), cardiovascular death (hazard ratio 2.29; 95% CI 1.28‐4.24, P =0.0052), and heart failure admission (hazard ratio 1.77; 95% CI 1.13‐2.77, P =0.0119). The addition of U‐ NGAL to the estimated glomerular filtration rate significantly improved the predictive accuracy of all‐cause mortality ( P =0.0083). Conclusions In acute decompensated heart failure patients, an elevated U‐ NGAL level on the first day of admission was related to the development of clinical acute kidney injury and independently associated with poor prognosis.

Percutaneous coronary intervention (PCI)-related cardiac enzyme elevation is an independent risk factor for adverse clinical outcomes, but preprocedural predictors of this complication have not been established. This study evaluated the morphological characteristics of culprit lesions by frequency-domain optical coherence tomography (FD-OCT), and examined their predictive value for procedure-related myocardial injury in patients undergoing elective PCI.Sixty-eight patients treated by FD-OCT-guided elective PCI were studied. On the basis of the presence or absence of postprocedural plasma cardiac troponin T (cTnT) elevation, patients were divided into elevation (cTnT-E, n=25) and nonelevation (cTnT-nonE, n=43) groups. FD-OCT examinations of culprit lesions were performed before and after stent implantation, and tissue characteristics were evaluated within a 10-mm-long segment of each lesion.Clinical parameters were similar between the two groups. Stent length was significantly longer in the cTnT-E group than in the cTnT-nonE group. On baseline OCT images, thin-cap fibroatheroma and calcium deposition were more frequently observed within culprit segments of the cTnT-E group compared with the cTnT-nonE group (32.0 vs. 11.6%, P=0.043, and 72.0 vs. 46.5%, P=0.039, respectively). In addition, colocalization of these two findings was a powerful predictor of PCI-related cTnT elevation (odds ratio 8.40, 95% confidence interval 1.65-52.78, P0.01). Further, the predictive value of this colocalization was enhanced when the analysis included only spotty calcification (odds ratio 21.00, 95% confidence interval 2.65-454.22, P=0.003).FD-OCT examination showed that colocalization of thin-cap fibroatheroma and spotty calcification was a powerful predictor of PCI-related cTnT elevation. FD-OCT is useful for stratifying risk during PCI to avoid procedure-related complications.

Background: Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascular events in patients with chronic kidney disease, yet little is known about their relationship with adverse outcomes in patients on peritoneal dialysis (PD). The aim of this study was to investigate the association of PlGF and sFlt-1 with technique survival and cardiovascular events. Methods: We measured serum levels of PlGF and plasma levels of sFlt-1 in 40 PD patients at Nara Medical University. Results: PlGF and sFlt-1 levels were significantly correlated with the dialysate-to-plasma ratio of creatinine (r = 0.342, p = 0.04 and r = 0.554, p < 0.001) although PlGF and sFlt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PlGF and sFlt-1 levels were significantly higher in patients with high transport membranes compared to those without (p = 0.039 and p < 0.001, respectively). Patients with PlGF levels above the median had lower technique survival and higher incidence of cardiovascular events than patients with levels below the median, with hazard ratios of 11.9 and 7.7, respectively, in univariate Cox regression analysis. However, sFlt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively). Conclusion: Elevated PlGF and sFlt-1 are significantly associated with high transport membrane status. PlGF may be a useful predictor of technique survival and cardiovascular events in PD patients.

In this study, three different microstructures of dual-phase (DP) steel obtained by varying the intercritical annealing temperature were observed three dimensionally by a serial-sectioning method and their metrics and topological properties were quantified. The results demonstrated that martensite in DP steels has various morphologies such as layers, particles, holes, and voids. The fraction of these characteristic morphologies was examined as a function of the intercritical annealing temperature.

Aims Ablation of right-sided accessory pathways (APs) is sometimes challenging because several anatomical features of the tricuspid annulus (TA) and surrounding structures differ from those of the mitral annulus. This study investigated the electrophysiological characteristics and efficacy of a non-contact mapping (NCM) system for catheter ablation of right-sided APs. Methods and results We examined nine APs in six consecutive patients who underwent catheter ablation of right-sided APs with NCM. In Case 6, we compared NCM with contact activation mapping. Three of six patients had two APs, and one of these had previously failed ablation. We observed atrial activation during sinus rhythm or atrial pacing using a multiple-electrode array (MEA) deployed in the right atrium near the TA. Non-contact mapping identified the AP location as a peri-TA breakout point that appeared prior to or simultaneously with the delta wave onset in all APs. In Case 6 we confirmed that the peri-TA breakout identified by NCM corresponded to the earliest ventricular activation identified by contact mapping. We successfully ablated nine APs by radiofrequency (RF) energy application to the breakout sites, while one AP located just above the pole of the MEA required additional conventionally guided mapping and ablation. The mean RF duration was 189.8 ± 119.0 s. After 33.2 ± 9.4 months of follow-up, one para-hisian AP and one right lateral AP recurred, but these were successfully ablated in a second procedure using NCM. Conclusion Non-contact mapping was able to identify the location of right-sided APs accurately and quickly.