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Persistent atrial fibrillation (AF) causes atrial remodeling, which causes myocardial fibrosis and micro-reentry. Fibrosis may reduce wave voltage and micro-reentry may enhance the dominant frequency (DF) of the F-wave. We investigated whether the DF predicts procedural success by the Maze procedure.In 138 consecutive patients who underwent mitral valve surgery and a modified Cox-Maze III procedure for persistent AF in Nagoya University in 2002-2018, 96 (70%) were successfully cardioverted (group S); 42 had persistent or relapsed AF after surgery (group F). Patient data were compared between the groups. Cut-off values were determined by an ROC analysis and predictors of procedural success were evaluated. The DF was obtained from the F-wave of V1 by a high-speed Fourier analysis using the CEPAS software program.Group F showed a significantly larger LA diameter, better LVEF, lower F-wave voltage, higher DF, and longer duration of AF. The cut-off values were as follows: LA diameter, 56 mm; EF, 64.5%; F-wave voltage, 0.13 mV; DF, 7.3 Hz; and duration of AF, 44 months. Each factor showed statistical significance in a univariate analysis; DF lost significance in the multivariate analysis. The higher (DF ≥ 7.3 Hz) and lower voltage group (≤ 0.13 mV) showed the worst procedural success rate (36%), while the lower DF ( 7.3 Hz) and higher voltage group ( 0.13 mV) showed a good rate (86%).The DF of the F-wave is a useful predictor of procedural success after the Maze procedure in addition to the voltage of F-wave.

The efficacy of coronary artery bypass grafting for pregnancy-related spontaneous coronary artery dissection (SCAD) is controversial, as graft occlusion due to SCAD lesion healing has been reported. Only 24 grafts in 14 cases of coronary artery bypass grafting for SCAD have been reported: 8 of the 9 arterial grafts were occluded, but 9 of the 15 vein grafts were patent. We encountered a case of coronary artery bypass grafting with left internal thoracic artery to the left antero-descending branch due to pregnancy-related SCAD. The patient’s graft revealed good patency immediately postoperatively but string signs 7 months later due to healing of SCAD lesions.

This study aimed to clarify the relationship between meteorological factors and the occurrence of aortic dissection.The study included 282 consecutive patients who were admitted to our institute with acute aortic dissection over a 10-year period. The local meteorological data over the same period were analyzed.On the days with occurrences of acute aortic dissection, there were significant differences in the following factors: the minimum and maximum temperature (p 0.0001), difference in the minimum and maximum temperature from the 10-year average, atmospheric pressure (p 0.0001), and difference in atmospheric pressure between the day of occurrence and the previous day. Cut-off values were determined by ROC curve analysis. Univariate analyses identified the following factors as significant predictors of the occurrence of acute aortic dissection: minimum temperature 4.0 °C (OR 2.42, p 0.0001), maximum temperature 15.1 °C (OR 2.23, p 0.0001), atmospheric pressure 1008.9 hPa (OR 1.75, p 0.0001), difference between the minimum temperature and 10-year average 0.3 °C, difference between the maximum temperature and 10-year average 0.44 °C; and the difference in atmospheric pressure between the day of occurrence and the previous day 0.4 hPa. However, the differences of the minimum and maximum temperatures from the 10-year average were the only factors that remained significant in the multivariate analysis. The minimum (RMeteorological factors influenced the occurrence of acute aortic dissection. In particular, a minimum temperature of 4 °C and maximum temperature difference from the 10-year average 0.44 °C was identified as strong risk factors for the occurrence of acute aortic dissection.

Immune checkpoint inhibitors(nivolumab)have been recommended as third-line chemotherapy for advanced gastric cancer(AGC)according to the Guidelines of Gastric Cancer(5th edition). Therefore, they have been used in daily clinical practice. On the other hand, the neutrophil-lymphocyte ratio(NLR)has been reported to be associated with the prognosis of cancer patients.Twenty patients treated with nivolumab for AGC between January 2018 and November 2019 were retrospectively examined.Median age of the 20 patients(18 males, 2 females)was 70 years(55- 84 years). Nivolumab was administered as second-, third-, fourth-, and fifth-line therapy in 1, 11, 7, and 1 case, respectively. The best tumor response evaluation was observed in PR 1, SD 7 and PD 10 cases. Median overall survival(OS)was 10 months, and median progression-free survival(PFS)was 3 months. No serious adverse events occurred. Compared to the NLR2.0 group, OS significantly prolonged(2.2 months vs 21.9 months)and PFS tended to prolong(1.4 months vs 6.2 months)in the NLR≤2.0 group.NLR may be an effective prognostic factor in patients with AGC receiving nivolumab treatment.

Purpose Some studies have reported a relationship between meteorological factors and the occurrence of acute aortic dissection (AAD). Nevertheless, the results of the studies are heterogeneous. Furthermore, whether the absolute values or fluctuation of meteorological factors influence the occurrence of AAD remains controversial. The aim of this study was to determine the meteorological factors associated with the occurrence of AAD. Methods Two hundred eighty-two consecutive patients (male, n = 178; female, n = 104; average age, 68 years) admitted to our hospital for AAD in the 10 years from September 1st 2008 were included in this study. One hundred fifty-seven patients had type A dissection. The correlation between the clinical data and the local meteorological data over the same period (provided by the National Meteorological Agency) was analyzed. We compared the following factors on days of AAD occurrence and non-occurrence: minimum and maximum temperature, minimum and maximum temperature difference between day of occurrence and previous day, difference between maximum and minimum temperature, atmospheric pressure and atmospheric pressure difference between day of occurrence and previous day (Δatmospheric pressure), and minimum and maximum temperature difference from climatological standard normal (CSN). Cutoff values were determined by ROC curve analyses and odds ratios (ORs) were calculated by a logistic regression analysis of meteorological factors with statistically significant differences. Results ignificant differences between the days of AAD occurrence and non-occurrence were observed for minimum and maximum temperature (p The cutoff values were as follows: minimum temperature, 4°C; maximum temperature, 15.1°C; atmospheric pressure, 1008.9hPa; Δatmospheric pressure, 0.4hPa; minimum temperature difference from CSN, 1°C; and maximum temperature difference from CSN, -0.2°C. The univariate logistic regression model showed revealed the following significant predictors of the occurrence of AAD; minimum temperature (OR2.42, p Conclusion Meteorological factors, especially a minimum temperature under 4°C strongly influenced the occurrence of AAD. A maximum temperature difference from CSN of over -0.2°C was also a significant predictor of AAD.