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We present a mathematical short review on non-Abelian discrete groups that could be used as reference introduction to the actual flavor models proposed to account for the observed flavor structure of quarks and leptons. For the practical purpose of flavor model building, we present group-theoretical aspects of S3, S4, A4, D4, Δ(27) and Δ(54). [ABSTRACT FROM AUTHOR]

An extra-axial nodule in the cerebello-medullary fissure is described, occurring in a 27-year-old-woman. MRI and CT scans revealed the lesion was a non-enhanced round mass, which was associated with mild atrophy of the surrounding cerebellum, but with no perifocal edema. In the surgical observation, the mass was white, elastic and hard, well demarcated and localized in the cerebello-medullary fissure. Histologically, the lesion was composed of astrocytes and collagen-producing fibroblasts with no anaplasia. These findings suggested that the lesion was hamartomatous, but not neoplastic. This type of gliofibrous nodule has not been previously reported. [ABSTRACT FROM AUTHOR]

The clinicopathological features of three cases with a cranial vault tumor as the initial manifestation of malignant lymphoma are described. Two of them (involving a 47-year-old female and a 53-year-old female) were primary cranial vault lymphoma. Another case (a 50-year-old male) was revealed to have multiple tumors in the cranial vault, right iliac bone and spleen at the first admission examination. All of the cranial vault tumors, which were painless and rapidly growing, invaded the muscle and dura mater from the skull, but not the subdural space or the outside of the superficial fascia. Histological diagnosis of the three cranial vault tumors was non-Hodgkin diffuse large lymphoma. Moreover, the expression pattern of the lymphocytic cell markers, which were examined by immunohistochemistry, was identical; LCA(+), CD20/cy(+), CD79a(+), CD45RO(-), VS38c(-) and CD30(-) indicated that the tumors were B-cell origin without plasmacytic differentiation. [ABSTRACT FROM AUTHOR]

Sustainable removal of per- and polyfluoroalkyl substances (PFAS) from landfill leachate remains a pressing global challenge. To develop an effective PFAS removal technology that utilizes nature-based solutions, we considered a planting unit comprised of a microbial carrier (foamed glass) and Typha domingensis. This study evaluated the possibility of removing PFAS from landfill leachate using a planting unit through a pot experiment. The planting unit effectively removed various short- and long-chain PFAS from the landfill leachate, including perfluorocarboxylic acids (PFCAs [C4-C10]), perfluorosulfonic acids (PFSAs [C4, C6, and C8]), fluorotelomer carboxylic acids (FTCAs [5:3 and 7:3]), and 6:2 fluorotelomer sulfonic acid (FTS), with initial concentrations of 43-9100 ng L -1 , achieving a removal efficiency of 53-83% in 21 d. Mass balance analysis indicated that the contribution of accumulation on foamed glass and plant adsorption and uptake played no major role in the removal of PFCAs (C4-C9), PFSAs (C4), and FTCAs (5:3 and 7:3), and that other removal processes played a key role. Although not the most effective removal process, the contribution of accumulation on foamed glass tended to be more notable in the removal of longer-chain PFCAs. In addition, plant adsorption and uptake showed that longer-chain PFCAs were more likely to remain in roots, whereas shorter-chain PFCAs were more likely to be transferred to aboveground plant part. On the other hand, 6:2 FTS removal occurred primarily due to accumulation on foamed glass. These results suggest that differences in the physicochemical properties of PFAS affect removal mechanisms. This study provides valuable insights into development of environmentally friendly technologies capable of removing a variety of short- and long-chain PFAS., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yuka Ogata, Hidenori Matsukami, Hiroyuki Ishimori has patent ペル及びポリフルオロアルキル化合物の除去方法 (in Japanease) pending to National Institute for Environmental Studies. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Adsorption parameters such as the distribution coefficient are required to predict the release behavior of contaminants using advection-dispersion models. However, for potentially contaminant-releasing materials (PCMs) such as dredged sludge and coal ash, these parameters cannot be obtained by conventional adsorption tests. This study developed a method to determine adsorption parameters for PCMs from a set of batch tests conducted in parallel as a function of the liquid-solid ratio (LS-parallel test). This LS-parallel test was performed on sandy soil derived from marine sediment using liquid-solid ratios from 1 to 300 L/kg. The water-contact time was also changed from 10 min to 28 d to elucidate the kinetics or equilibrium of contaminants released from the sample. Adsorption parameters were successfully obtained if the substance was under adsorption control. A column percolation test was performed to confirm the effectiveness of the obtained parameters. Good agreements were observed for SO 4 2- and B, but discrepancies remained for other substances such as F - and As suggesting that improvements are necessary in both the LS-parallel test procedure and the advection-dispersion model.

Corals of the family Acroporidae are key structural components of reefs that support the most diverse marine ecosystems. Due to increasing anthropogenic stresses, coral reefs are in decline. Along the coast of Okinawa, Japan, three different color morphs of Acropora tenuis have been recognized for decades. These include brown (N morph), yellow green (G), and purple (P) forms. The tips of axial polyps of each morph exhibit specific fluorescence spectra. This attribute is inherited asexually, and color morphs do not change seasonally. In Okinawa Prefecture, during the summer of 2017, N and P morphs experienced bleaching, in which many N morphs died. Dinoflagellates (Symbiodiniaceae) are essential partners of scleractinian corals, and photosynthetic activity of symbionts was reduced in N and P morphs. In contrast, G morphs successfully withstood the stress. Examination of the clade and type of Symbiodiniaceae indicated that the three color-morphs host similar sets of Clade-C symbionts, suggesting that beaching of N and P morphs is unlikely attributable to differences in the clade of Symbiodiniaceae the color morphs hosted. Fluorescent proteins play pivotal roles in physiological regulation of corals. Since the A. tenuis genome has been decoded, we identified five genes for green fluorescent proteins (GFPs), two for cyan fluorescent proteins (CFPs), three for red fluorescent proteins (RFPs), and seven genes for chromoprotein (ChrP). A summer survey of gene expression profiles under outdoor aquarium conditions demonstrated that (a) expression of CFP and REP was quite low during the summer in all three morphs, (b) P morphs expressed higher levels of ChrP than N and G morphs, (c) both N and G morphs expressed GFP more highly than P morphs, and (d) GFP expression in N morphs was reduced during summer whereas G morphs maintained high levels of GFP expression throughout the summer. Although further studies are required to understand the biological significance of these color morphs of A. tenuis, our results suggest that thermal stress resistance is modified by genetic mechanisms that coincidentally lead to diversification of color morphs of this coral., (© The Author(s) 2021. Published by Oxford University Press on behalf of Genetics Society of America.)

The behaviour of carbon dioxide (CO 2 ) and methane (CH 4 ) emissions at the surface and below the soil cover in an industrial waste landfill under anaerobic operating conditions was evaluated for six years. This landfill contained gypsum board waste and incineration ash - a practice currently allowed because of a change in Japanese regulations. The CO 2 and CH 4 fluxes decreased throughout the six years of the survey. Almost all of the survey points exhibited fractions of CH 4 in landfill gas emissions of <0.5 (mean values: 0.0-0.1 [surface], 0.0-0.3 [subsurface]) under anaerobic conditions. In addition, a relatively high first-order reaction rate constant for the landfill gas emissions (0.3 year -1 ) was observed. The landfill leachate showed a relatively high sulphate ion (SO 4 2- ) concentration, although other environmental conditions, such as the pH, oxidation-reduction potential and ammonium concentration, were not at levels that could have inhibited CH 4 production. These findings suggest that the low fractions could have been related to the lower amounts of CH 4 generation caused by competition between methanogens and sulphate-reducing bacteria (SRB). Therefore, SRB could play a major role in the degradation of organic carbon in the landfill.

Accelerated atherosclerosis in prolonged maintenance hemodialysis (HD) has been recognized; however, whether HD duration is associated with poor clinical outcome in HD patients with coronary artery disease (CAD) after drug-eluting stent (DES) implantation is unknown. We evaluated the impact of HD duration on clinical outcomes in HD patients with CAD after DES implantation. Between April 2007 and December 2012, 168 angina pectoris patients (320 de novo lesions) on HD were treated with DES. Major adverse cardiovascular events (MACE) and target lesion revascularization (TLR) were investigated at 3 years according to the HD duration (≤ 3 years, 83 patients; >3 years, 85 patients). The incidence of MACE was significantly higher in the long HD duration group (25.3 vs. 50.6 %; P = 0.001). Especially, sudden cardiac death (SCD) was significantly higher in the long HD duration group (3.6 vs. 16.5 %; P = 0.006). On the other hand, the rates of TLR were similar between the two groups (12.0 vs. 14.1 %; P = 0.69). Cox's proportional hazard analysis revealed that HD duration (HR 1.08 per year, 95 % CI 1.03-1.13, P = 0.002), β-blocker use (0.28, 0.17-0.46, P < 0.001), and diabetes mellitus (2.10, 1.23-3.56, P = 0.007) were independent predictors of MACE. Longer HD duration did not affect TLR; however, SCD was significantly higher in the long HD duration group.

Aim: The optimal fractional flow reserve (FFR) measurement method for superficial femoral artery (SFA) lesions remains to be established. We clarified the optimal measuring procedure for FFR for SFA lesions and investigated the necessary dose of papaverine for inducing maximal hyperemia in SFA lesions., Methods: Forty-eight patients with SFA lesions who underwent measurement of peripheral FFR (pFFR: distal mean pressure divided by proximal mean pressure) after endovascular treatment by the contralateral femoral crossover approach were prospectively enrolled. In the pFFR measurement, a guide sheath was placed on top of the common iliac bifurcation and pressure equalization was performed. After advancing the pressure wire distal to the SFA lesion, sequential papaverine administration selectively to the affected common iliac artery was performed., Results: There were no symptoms, electrocardiogram changes, and significant pressure drops at the guide sheath tip with increasing papaverine dose. pFFR changes following 20, 30, and 40 mg of papaverine were 0.87±0.10, 0.84±0.10, and 0.84±0.10, respectively (P＜0.001). Although not significantly different, pFFR decreased more in several patients at 30 mg of papaverine than at 20 mg. The pFFR at 40 mg of papaverine was almost similar to that at 30 mg of papaverine. The necessary papaverine dose was not changed according to sex and number of run-off vessels., Conclusions: The contralateral femoral crossover approach is useful in FFR measurement for SFA lesions, and maximal hyperemia is induced by 30 mg of papaverine.

Objective: Wound severity is assessed mainly by the Rutherford classification for critical limb ischemia (CLI) with tissue loss. The Rutherford classification is based on the extent of tissue loss; however, its classification criteria are ambiguous and do not include information regarding wound depth. We investigated the effects of wound depth on clinical outcomes in CLI with tissue loss after endovascular treatment (EVT)., Methods: Between April 2007 and August 2013, we enrolled 210 consecutive patients (247 limbs) who received EVT for CLI with tissue loss. In the limbs examined, 271 individual wounds existed. We evaluated wound depth using the University of Texas grade (grade 1: superficial wound not involving the tendon, capsule, or bone, n = 97; grade 2: wound penetrating the tendon or capsule, n = 124; and grade 3: wound penetrating the bone or joint, n = 50). We also investigated the wound healing rate at 12 months and limb salvage and major amputation-free survival rates 3 years after EVT., Results: The wound healing rates at 12 months in Texas 1, 2, and 3 were 88%, 48%, and 24%, respectively (log-rank P < .001). The limb salvage and major amputation-free survival rates at 3 years were lower in deep wounds than in shallow wounds (limb salvage rates: 98%, 82%, and 67%, respectively; P < .001; major amputation-free survival rates: 78%, 52%, and 42%, respectively; P < .001). In only minor tissue loss, the wound healing rates at 12 months and the limb salvage and major amputation-free survival rates at 3 years were stratified according to wound depth (wound healing rates: 92% in Texas 1 and 51% in Texas 2 or 3; P < .001; limb salvage rates: 99% in Texas 1 and 86% in Texas 2 or 3; P = .001; major amputation-free survival rates: 79% in Texas 1 and 57% in Texas 2 or 3; P = .001). In only major tissue loss, deep wounds also caused poor outcomes compared with shallow wounds (wound healing rates: 70% in Texas 1 and 36% in Texas 2 or 3; P = .019; limb salvage rates: 94% in Texas 1 and 73% in Texas 2 or 3; P = .050; major amputation-free survival rates: 75% in Texas 1 and 45% in Texas 2 or 3; P = .039)., Conclusions: Wound depth is an important indicator of wound status and affects the clinical outcomes of CLI with tissue loss., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Very late stent thrombosis (VLST) is a catastrophic complication after implantation of a drug-eluting stent (DES). It has been reported that VLST is associated with pathological changes, which often include late acquired incomplete stent apposition (LAISA) with thrombus formation. In addition, the vascular response to the stent (evaginations, neointimal growth, and thrombosis) and the incidence of LAISA are reported to vary among the different types of DES. We experienced a patient with cardiogenic shock induced by simultaneous VLST of both the left anterior descending artery (LAD) and the left circumflex artery (LCX) at 3 years after implantation of two sirolimus-eluting stents. Intravascular ultrasound (IVUS) showed LAISA of both arteries. A paclitaxel-eluting stent, which had been implanted in the right coronary artery 3 years earlier, did not show such a finding. IVUS revealed "different vascular reactions" to "different types of DES" in this patient.

Purpose: To investigate the relationship between postprocedure intravascular ultrasound (IVUS) findings and restenosis after placement of drug-eluting stents (DES) for femoropopliteal lesions., Methods: Between July 2012 and May 2013, DES were placed in 64 patients with 88 de novo femoropopliteal lesions. In 40 patients (mean age 74.2±9.4 years; 27 men), DES were placed in 50 lesions under IVUS guidance, and restenosis was monitored for 1 year. All patients were symptomatic (Rutherford 2-6), and 17 patients (43%) suffered from critical limb ischemia. IVUS findings after stenting were compared for patients with vs without restenosis, which was defined as a peak systolic velocity ratio >2.4 on duplex ultrasonography or >50% diameter stenosis on angiography., Results: Ten patients (14 lesions) developed restenosis, while 30 patients (36 lesions) did not. There were no significant differences in the frequency of diabetes or dialysis between the 2 groups. Female patients were predominant in the restenosis group (p<0.003). There were no significant differences of the percentage of TransAtlantic Inter-Society Consensus C/D lesions or stent edge dissection. Multivariate analysis indicated that cilostazol use [odds ratio (OR) 0.13; p=0.046], distal lumen cross-sectional area (CSA) (OR 0.86; p=0.035), and axial symmetry index (OR 0.60; p=0.045) were independent predictors of restenosis. Using receiver operator characteristic analysis, the best cutoff values of the distal lumen CSA and axial symmetry index for predicting restenosis were 17.1 cm(2) and 0.6, respectively., Conclusion: IVUS guidance of DES placement in femoropopliteal lesions can offer useful predictors of restenosis at 1 year. The utility of distal lumen CSA and the axial symmetry index in the prediction of restenosis after femoropopliteal DES placement should be confirmed in a larger cohort., (© The Author(s) 2015.)

Objective: Critical limb ischemia (CLI) patients with tissue loss have been recognized to have a poor survival rate. In this study, we aimed to determine whether the prognosis of CLI patients with tissue loss improves after complete wound healing is achieved by endovascular therapy., Methods: We treated 187 CLI patients with tissue loss by endovascular therapy from April 2007 to December 2012. Among these patients, 113 patients who achieved complete wound healing were enrolled. The primary end point was survival rate at 3 years. The secondary end points were limb salvage rate and recurrence rate of CLI at 3 years., Results: The mean follow-up period after achievement of complete wound healing was 32 ± 18 months. At 1 year, 2 years, and 3 years, the survival rates were 86%, 79%, and 74%; the limb salvage rates were 100%, 100%, and 100%; the recurrence rates of CLI were 2%, 6%, and 9%, respectively. On multivariate Cox proportional hazard analysis, age >75 years (hazard ratio, 3.18; 95% confidence interval, 1.23-8.24; P = .017) and nonambulatory status (hazard ratio, 2.46; 95% confidence interval, 1.08-5.65; P = .035) were identified as independent predictors of death for CLI patients with tissue loss even after complete wound healing was achieved. The Kaplan-Meier curve for the overall survival rate at 3 years showed that CLI patients of older age (>75 years) had a significantly decreased survival rate compared with CLI patients of younger age (≤75 years) (58% vs 87%; log-rank test, P < .001). In addition, nonambulatory CLI patients had a significantly poor survival rate relative to ambulatory CLI patients (40% vs 93%; log-rank test, P < .001)., Conclusions: The overall survival rate of CLI patients was acceptable and the recurrence rate of CLI was extremely low once complete wound healing was achieved. Nonambulatory status and age >75 years can serve as predictors of death even after complete wound healing is achieved., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the predictors of non-healing in patients with critical limb ischemia (CLI) after successful endovascular therapy (EVT)., Background: Occasionally, wound healing in patients with CLI and tissue loss cannot be achieved even after successful EVT. Patient's co-morbidities, vascular anatomy, wound features, and interventional strategies/outcomes are associated with the probability of wound healing., Methods: Between April 2007 and October 2012, 182 patients with CLI (220 limbs) with tissue loss were treated with EVT in our institute. Of these, 164 individual wounds (130 patients, 149 limbs) out of 243 individual wounds were successfully treated. Successful EVT was defined as revascularization by achieving visible blood flow to the wounds, as evaluated by digital subtraction angiography performed just after EVT. A Cox proportional hazards model was used to analyze predictors associated with wound healing., Results: The mean follow-up period was 23±18 months. The wound healing rates were 40.2%, 57.3%, 62.2%, and 70.7% at 3, 6, 9, and 12 months, respectively. Multivariate Cox proportional hazards analysis revealed that insulin use [hazard ratio (HR), 0.541; 95% confidence interval (CI), 0.329-0.890; P=0.016], dependence on hemodialysis [HR, 0.429; 95% CI, 0.272-0.678; P<0.001], and major tissue loss [HR, 0.460; 95% CI, 0.294-0.720; P=0.001] were independent predictors of non-healing after successful EVT., Conclusions: Insulin use, dependence on hemodialysis, and major tissue loss were independent predictors of non-healing after successful EVT., (© 2014 Wiley Periodicals, Inc.)

Purpose: To develop a scoring system to predict wound healing in critical limb ischemia (CLI) patients treated with endovascular therapy (EVT)., Methods: Between July 2007 and January 2013, 184 patients (118 men; mean age 73.0 years) with CLI (217 limbs) and tissue loss underwent EVT. From this cohort 236 separate wounds were divided into development (n = 118) and validation (n = 118) groups. Predictors of wound healing were identified using multivariable analysis. Each predictor was assigned a score based on its regression coefficient, and total scores were calculated, ranging from 0 to 1 for low risk up to ≥ 4 for high risk of a nonhealing wound. The performance of the scoring system in the prediction of wound healing was evaluated by calculating the area under the receiver operating characteristics (ROC) curve., Results: By multivariable analysis, a University of Texas grade ≥ 2 (HR 0.524, 95% CI 0.288-0.951, p = 0.034), an infected wound (HR 0.497, 95% CI 0.276-0.894, p = 0.020), dependence on hemodialysis (HR 0.459, 95% CI 0.259-0.814, p = 0.008), no visible blood flow to the wound (HR 0.343, 95% CI 0.146-0.802, p = 0.014), and major tissue loss (HR 0.322, 95% CI 0.165-0.630, p = 0.001) predicted a non-healing wound. The 1-year rates of wound healing in the low-, intermediate-, and high-risk groups were 94.6%, 67.6%, and 9.1%, respectively, in the development group (p < 0.001) and 92.3%, 70.5%, and 31.3%, respectively, in the validation sample (p < 0.001). The area under the ROC curve was 0.922 in the development group and 0.808 in the validation sample., Conclusion: This scoring system reliably predicts wound healing in CLI patients after endovascular revascularization and is potentially helpful in deciding if additional adjuncts or revascularization should be considered., (© The Author(s) 2015.)

Entrapment of nondeflated balloon is a rare complication of percutaneous coronary intervention. Sometimes it has hazardous potentials for the patient. We experienced a rare complication of percutaneous coronary intervention (PCI) caused by a defective balloon. We reported this experience and simple bailout technique.

Purpose: To examine the effectiveness of vascular elastography (VE) for the assessment of totally occluded lower limb arteries prior to endovascular treatment (EVT)., Methods: Of 812 consecutive patients who underwent EVT between April 2010 and April 2012, VE was used to evaluate the hardness of chronic total occlusions of the femoropopliteal segment prior to EVT in 65 consecutive patients (48 men; mean 73.9 years, range 63-86). Elastograms of the CTOs proximally and distally were scored using a 5-point scale, and outcomes in limbs with hard lesions (VE score 0-2) were compared to those with soft lesions (VE score 3-4) according to lesion length. The interventionists who performed the endovascular procedures were not informed of the VE score results., Results: CTO characteristics could be evaluated in all cases. A VE score ≤2 was found in 14 of the 23 lesions <150 mm in length. A flexible guidewire was sufficient for recanalization in more of the soft lesions than in the hard lesions [6/9 vs. 2/14, respectively]. In 39 lesions >150 mm, a VE score of 3 was recorded in most lesions proximally, while lesions distally were hard in many cases (VE score 1 or 2). A flexible guidewire alone was sufficient in many soft CTOs (8/13, p<0.01). In 16 cases, hard calcified plaque was indicated by difficulty in penetrating the lesion even with a stiff guidewire; all these cases had a VE score of 1 or 2. A retrograde approach was required only in hard CTOs (p<0.01). The procedure time was significantly longer for the hard lesion group (152.9±63.2 vs. 87.0±29.8 minutes, p=0.001). In 11 in-stent occlusions, only VE scores of 3 (n=4) or 4 (n=7) were recorded, indicating soft thrombus, which was aspirated under distal protection in 7 cases., Conclusion: VE may be a useful method for determining the hardness of CTO lesions noninvasively before endovascular therapy, providing information that can help plan the procedure.

To evaluate the 2-year results obtained with self-expandable stent for chronic total occlusion (CTO) of the iliac artery, a retrospective study was performed of patients who underwent endovascular therapy (EVT) for chronic iliac artery CTO who presented from April 2007 to September 2012. 82 patients with 86 occluded iliac arteries underwent successful recanalization and stenting with a self-expandable stent. The primary equivalence end point was a composite of restenosis, mortality, target vessel revascularization, and limb salvage rates. Patients were followed up with the presence of a palpable femoral artery pulse, resolution of symptoms, and noninvasive vascular laboratory testing reviewed at 1, 3, and 6 months after EVT and then were evaluated at 6-month intervals. In patients who gave consent, repeat angiography was done in sixty-one of 86 lesions (70.1 %) for follow-up. The mean follow-up was at 27.6 ± 17.8 months (range 3-60 months). All stents were placed in the true lumen under intravascular ultrasound (IVUS) guidance. There were no cases of peripheral embolization or iliac artery rupture after the procedure. The ankle-brachial index increased significantly from 0.55 ± 0.19 to 0.88 ± 0.17 (P < 0.001). The primary patency rate was 96.5 % at 2 years. The MLD immediately after the procedure was 5.10 ± 0.26 mm and increased significantly to 5.40 ± 0.28 mm at the period of follow-up angiography. The 2-year outcome of endovascular therapy with self-expandable stents for CTO of the iliac artery had an acceptable result.

Background: The differences in wound healing according to wound location remain unclear., Methods and Results: Between April 2007 and October 2011, 138 patients (166 limbs) with critical limb ischemia with tissue loss were treated with endovascular treatment. On these limbs, 177 individual wounds were identified on the foot and were evaluated for wound healing rates and time to healing according to their locations. Wound locations were divided into 3 groups: group T (Toe wounds, n=112), group H (Heel wounds, n=25), and group E (Extensive wounds extending onto the fore- or mid-foot along with dorsum or plantar surfaces, n=40). The mean follow-up period was 23±19 months. At 3, 6, 9, and 12 months, wound healing rates were 51%, 64%, 75%, and 75%, respectively, in group T; 12%, 36%, 36%, and 52%, respectively, in group H; and 0%, 5%, 8%, and 13%, respectively, in group E. The median time to healing was 64 days (interquartile range 25-156 days) in group T, 168 days (interquartile range 123-316 days) in group H, and 267 days (interquartile range 177-316 days) in group E (P=0.038)., Conclusions: Extensive wounds extending onto the fore- or mid-foot along with dorsum or plantar surfaces were the most difficult type of wound to heal.

Objective: 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., Background: Complex SFA lesions involving the femoral bifurcation (FB) was mostly treated surgically, and the role played by endovascular procedures is uncertain., Methods: 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., Results: 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%; P < 0.01) 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)., Conclusions: 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., (Copyright © 2012 Wiley Periodicals, Inc.)

Advances in coronary intervention have increased the opportunity to intervene on complex lesions, resulting in an increase in PCI-related complication, including coronary artery perforation. However, treatment options for coronary perforation are limited, with delivery of devices to complex lesions being problematic. Balloon hemostasis is the usual bailout method, despite the risk of myocardial ischemia. In this report, we describe an over-the-wire balloon method to treat a patient with coronary perforation. Ischemia was avoided by injecting autologous blood through the catheter, while hemostasis was achieved by prolonged balloon inflation. This new technique is applicable when a perfusion balloon is not indicated.

Objective: We reviewed the technical changes and results achieved with the retrograde approach since we introduced it 7 years ago., Subjects and Methods: The subjects were 1,268 patients who were treated for CTO between January 2004 and December 2010. They were investigated with respect to the success rate, the frequency of employing the retrograde approach and its outcome, and other factors., Results: The retrograde approach was employed in ∼30% of chronic total occlusion (CTO) patients (n = 281) and the retrograde guidewire success rate was 81.1%. The kissing wire technique was substituted for the retrograde approach in 126 of the 281 patients, with antegrade crossing of a guidewire being successful in 88 of them (70%). The retrograde approach was combined with the CART and reverse controlled antegrade retrograde tracking (CART) techniques in 22 and 21 patients, respectively. Among 83 patients treated with Corsair catheters, crossing of the CTO was achieved in 63. The overall procedural success rate was 79.7% (224 patients). Complications of the retrograde approach included collateral channel dissection (2.1%), channel perforation (1.7%), CTO perforation (1.7%), and donor artery occlusion (1.1%)., Conclusion: The success rate and safety of the retrograde approach are both satisfactory if the appropriate devices and techniques are selected., (Copyright © 2012 Wiley Periodicals, Inc.)

An 80-year-old woman was admitted to our emergency department with ongoing dyspnea for 2 weeks. The patient was immediately intubated endotracheally because of the hypoxia with flush pulmonary edema. Electrocardiogram showed ST depression and echocardiogram showed hypokinesis of anterior left ventricular wall with poor systolic function. Also her cardiac enzymes were elevated, emergency coronary angiogram was performed from radial artery because both femoral arteries were not fully palpable. Coronary angiogram showed three vessels disease including chronic total occlusion of right coronary artery and left main bifurcation lesion. Also blood flow of left anterior descending coronary artery was delayed. Acute coronary syndrome was the cause of acute heart failure and revascularization was needed but aortography revealed total occlusion of infrarenal aorta. Patient was relatively hemodynamically stable; we planned treating total occlusion of infrarenal aorta with endovascular therapy to maintain a rout for cardiopulmonary support system. With bi-directional approach from both femoral artery and left brachial artery, occlusion site with heavy calcification was finally passed through by guide wire from retrograde approach. After pull-through technique, self-expanding nitinol stent was implanted after pre dilation with small balloon. Considering her EURO score, supposed perioperative mortality was high, percutaneous coronary intervention was performed. A 7 fr sheath was inserted from right femoral artery and intra-aortic balloon pump was inserted from left femoral artery. Sirolimus-eluting stent was implanted to left circumflex artery and also from ostium of left main to mid left anterior descending coronary artery after using an atherectomy device. After successful revascularization, patient became hemodynamically stable and weaning off the respirator was successful. Reporting case achieved successful revascularization to severe coronary artery disease after endovascular recanalization with infrarenal aortic occlusion.

Background:  Stent deployment across side branch (SB) ostium is common in daily practice. The present study investigated the natural history of SBs jailed by drug-eluting stents (DES)., Methods:  The thrombolysis in myocardial infarction (TIMI) flow grades of 271 consecutive SBs jailed by DES in 196 patients was assessed immediately after the procedure and at 9 months of follow-up. Patients receiving any SB intervention were excluded., Results: Of 271 jailed SBs, occlusion occurred in 6.27% and deterioration of flow occurred in 6.27% immediately after stenting. In patients with these SB changes, periprocedural myocardial infarction was more likely than in those without (10.0% vs. 1.8%, P = 0.017), while there was no increase of cardiac death or life-threatening complications such as stent thrombosis and Q-wave myocardial infarction (Q MI) during follow-up. At 9 months, angiography showed that one-third of the initially obstructed SBs were still occluded. In contrast, flow was maintained in almost all (98.6%) SBs with early TIMI flow grade 3 and there was no delayed occlusion of these branches. Multiple regression analysis showed that lesion complexity (Medina bifurcation class, calcification, and preprocedural TIMI grade 2 flow in the SB) and technical factors (jailing by overlapping stents) were related to SB occlusion or flow deterioration., Conclusions:  Jailed SBs showing good flow after stenting had a favorable angiographic and clinical outcome after 9 months of follow-up. However, preprocedural lesion complexity and technical factors should be considered to avoid SB occlusion/flow deterioration associated with periprocedural myocardial infarction., (©2011, Wiley Periodicals, Inc.)

To investigate the long-term outcome of Percutaneous transluminal intervention (PCI) for chronic total occlusion (CTO). The subjects were 606 patients (1,145 lesions) who were treated for CTO between January 1996 and December 2003 at our institution. Among them, 436 patients with early success and confirmed patency at the CTO by follow-up coronary angiography after 6 months were classified as the patent group (Group P), while 170 patients without early success or with occlusion on follow-up angiography were classified as the occluded group (Group O). In April 2006 (mean: 660 ± 602 days), the outcome of CTO was investigated and the major adverse cardiac events (MACE)-free rate was calculated. Multivariate analysis was performed to identify determinants of death. The early success rate was 76.4% before 2003 when Conquest guidewires were not available. However, it subsequently showed significant improvement to 89%. The cumulative survival rate was significantly higher for Group P (92%) than for Group O (64%) and the MACE-free rate (free from, death, bypass surgery, myocardial infarction, and revascularization) showed a similar trend. The cumulative survival rate of patients without myocardial viability in the territory of the vessel with CTO was significantly higher for Group P (88%) than for Group O (55%). The outcome was significantly worse for patients with occlusion of other vessels (90%) than for patients without additional occlusion (42%). It was significantly better when the left ventricular ejection fraction (LVEF) was ≥40% than when the LVEF was ≤40% (90 vs. 68%). Multivariate analysis identified occluded CTO, other vessel occlusion, low ejection fraction (EF), unimproved EF, and old age as determinants of death from CTO. If early success is obtained and patency is maintained, the long-term outcome after PCI for CTO is significantly better than when failure occurs Occluded CTO, other vessel occlusion, low EF, unimproved EF, and old age are important determinants of the outcome.

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.

Sirolimus-eluting stent (SES) is established to be effective in reducing restenosis. Repeat revascularization, however, is still required in up to 5-8% of patients. In this study, we analyzed clinical and angiographic variables that might be related with SES re-restenosis and variables related with re-restenosis after repeat SES implantation for SES restenosis. We also assessed clinical outcomes at 2-year follow-up after percutaneous coronary intervention (PCI) for SES restenosis. Repeat revascularization for SES restenosis was performed in 113 patients with 140 lesions. Of the 140 lesions, follow-up coronary angiography (CAG) was performed on 117 lesions (101 patients) and revealed 46 SES re-restenotic and 71 non-re-restenotic lesions. In multivariate analysis, SES-in-SES-strategy and reference diameter before the second PCI were independent predictors of re-restenosis after PCI for SES restenosis. However, the reference diameter was the only independent predictor of re-restenosis after SES-in-SES. Major adverse cardiac events (MACE) at 2 years were found in 44 patients (43.5%), and target lesion revascularization (TLR) was performed in 33.7% of patients after SES restenosis. In conclusion, the incidence of MACE and TLR was relatively high in patients with SES restenosis, but the placement of another SES on larger-diameter vessels may be an effective strategy for the second PCI.