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Interactions of the heart and the liver remain to be fully understood in the pathophysiology of heart failure (HF). Hepatokines are proteins synthesized and secreted from the liver and regulate systemic metabolisms of peripheral tissues. This study sought to clarify the clinical relevance of hepatokine Fetuin-A in patients with HF.We enrolled 217 participants including 187 hospitalized patients with HF and 30 control subjects who were sought with a comparable age- and sex profile and who had never had HF or structural cardiac abnormalities. First, we examined the levels of Fetuin-A and found that its levels were significantly lower in patients with HF than in the controls. Next, HF patients were categorized into four groups based on hepatic hemodynamics assessed by abdominal ultrasonography which determines liver hypoperfusion by peak systolic velocity (PSV) of the celiac artery and liver stiffness by shear wave elastography (SWE). Fetuin-A levels were significantly decreased in HF patients with liver hypoperfusion compared to those without, but were not different between HF patients with and without elevated liver stiffness. Correlation analysis revealed that circulating Fetuin-A was positively correlated with PSV of the celiac artery but not with SWE of the liver. Kaplan-Meier analysis demonstrated that HF patients with lower Fetuin-A levels were significantly associated with increased adverse outcomes including cardiac deaths and decompensated HF.Liver-derived hepatokine Fetuin-A may be a novel target involved in the cardio-hepatic interactions, as well as a useful biomarker for predicting the prognosis in patients with HF.

It has been reported that the pattern of hepatic vein (HV) waveforms determined by abdominal ultrasonography is useful for the diagnosis of hepatic fibrosis in patients with chronic liver disease. We aim to clarify the clinical implications of HV waveform patterns in patients with heart failure (HF).We measured HV waveforms in 350 HF patients, who were then classified into 3 categories based on their waveforms: those with a continuous pattern (C group); those whose V wave ran under the baseline (U group), and those with a reversed V wave (R group). We performed right-heart catheterization, and examined the rate of postdischarge cardiac events, such as cardiac death and rehospitalization due to worsening HF.The number of patients in each of the 3 HV waveform groups was as follows: C group, n = 158; U group, n = 152, and R group, n = 40. The levels of B-type natriuretic peptide (R vs C and U; 245.8 vs 111.7 and 216.6 pg/mL;Among HF patients, those with reversed V waves had higher right atrial pressure and were at higher risk of adverse prognosis.Nous avons appris que le tracé ondulatoire de la veine hépatique (VH) à l’échographie abdominale est utile au diagnostic de la fibrose hépatique chez les patients atteints d’une maladie chronique du foie. Nous avons pour objectif de clarifier les implications cliniques des tracés ondulatoires de la VH chez les patients atteints d’insuffisance cardiaque (IC).Nous avons mesuré les ondulations de la VH de 350 patients atteints d’IC et les avons ensuite classifiés en trois catégories selon leurs ondulations : ceux qui avaient un tracé continu (groupe C); ceux dont l’onde V se présentait selon les valeurs de référence (groupe U); ceux qui avaient une onde V inversée (groupe R). Nous avons réalisé un cathétérisme cardiaque droit et examiné le taux d’événements cardiaques après la sortie de l’hôpital tels que la mort d’origine cardiaque et la réhospitalisation en raison de l’aggravation de l’IC.Le nombre de patients dans chacun des trois groupes d’ondulations de la VH était réparti comme suit : groupe C, n = 158; groupe U, n = 152 et groupe R, n = 40. Les concentrations en peptides natriurétiques de type B (RChez les patients atteints d’IC, ceux qui avaient des ondes V inversées avaient une pression plus élevée de l’oreillette droite et étaient exposés à un risque plus élevé de pronostic défavorable.

We aimed to clarify clinical implications of intrarenal hemodynamics assessed by intrarenal Doppler ultrasonography (IRD) and their prognostic impacts in heart failure (HF). We performed a prospective observational study, and examined IRD and measured interlobar renal artery velocity time integral (VTI) and intrarenal venous flow (IRVF) patterns (monophasic or non-monophasic pattern) to assess intrarenal hypoperfusion and congestion in HF patients (n = 341). Seven patients were excluded in VTI analysis due to unclear imaging. The patients were divided into groups based on (A) VTI: high VTI (VTI ≥ 14.0 cm, n = 231) or low VTI (VTI

The reduced density of the autogenous bone around metal medical implants forces joint replacement patients to undergo revision surgery. The loss of bone density is caused by a significant difference in the elastic modulus between implants and autogenous bone. Various studies have attempted to reduce the elastic modulus of the implant to close the large gap in the two moduli. Porous metal is a promising material for reducing the elastic modulus of implants, but it is difficult to fabricate a closed-cell structure like bone using conventional porous metal fabrication methods. In this study, porous Ti-6Al-4V was prepared by selective laser melting, then its porosity was evaluated by X-ray computed tomography. Additionally, tensile test specimens of the porous structure were prepared and the effect of pores on the tensile properties was evaluated. Depending on the energy density, the structure of the porous body was found to form both closed- and open-cell structures. In the tensile specimens that showed the most favorable results, the elastic modulus was reduced by approximately 90%, and the tensile strength exceeded that of the annealed material. This indicates that a metal implant that has a low elastic modulus while maintaining strength can be obtained.

BackgroundIt has been recently reported that the renal venous stasis index (RVSI) assessed by renal Doppler ultrasonography provides information to stratify pulmonary hypertension that can lead to right-sided heart failure (HF). However, the clinical significance of RVSI in HF patients has not been sufficiently examined. We aimed to examine the associations of RVSI with parameters of cardiac function and right heart catheterization (RHC), as well as with prognosis, in patients with HF.MethodsWe performed renal Doppler ultrasonography, echocardiography and RHC in hospitalized patients with HF (n = 388). RVSI was calculated as follows: RVSI = (cardiac cycle time-venous flow time)/cardiac cycle time. The patients were classified to three groups based on RVSI: control group (RVSI = 0, n = 260, 67%), low RVSI group (0 < RVSI ≤ 0.21, n = 63, 16%) and high RVSI group (RVSI > 0.21, n = 65, 17%). We examined associations of RVSI with parameters of cardiac function and RHC, and followed up for cardiac events defined as cardiac death or worsening HF.ResultsThere were significant correlations of RVSI with mean right atrial pressure (mRAP; R = 0.253, P < 0.001), right atrial area (R = 0.327, P < 0.001) and inferior vena cava diameter (R = 0.327, P < 0.001), but not with cardiac index (R = −0.019, P = 0.769). During the follow-up period (median 412 days), cardiac events occurred in 60 patients. In the Kaplan–Meier analysis, the cumulative cardiac event rate increased with increasing RVSI (log-rank, P = 0.001). In the multivariate Cox proportional hazard analysis, the cardiac event rate was independently associated with RVSI (high RVSI group vs. control group: hazard ratio, 1.908; 95% confidence interval, 1.046–3.479, P = 0.035).ConclusionRVSI assessed by renal Doppler ultrasonography reflects right-sided overload and is associated with adverse prognosis in HF patients.

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP) and is associated with worse outcomes in patients with heart failure (HF). However, the relationship between shear wave dispersion (SWD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and the prognostic impact of SWD on HF patients have not been fully examined. We aimed to clarify the associations of SWD with parameters of liver function test (LFT) and right heart catheterization (RHC), as well as with cardiac events such as cardiac death and worsening HF, in patients with HF. Methods: We performed abdominal ultrasonography, LFT and RHC in HF patients (n = 195), and followed up for cardiac events. We examined associations between SWD and parameters of LFT and RHC. Results: There were significant correlations between SWD and circulating levels of direct bilirubin (R = 0.222, p = 0.002), alkaline phosphatase (R = 0.219, p = 0.002), cholinesterase (R = &minus, 0.184, p = 0.011), and 7S domain of collagen type IV (R = 0.177, p = 0.014), but not with RAP (R = 0.054, p = 0.567) or cardiac index (R = &minus, 0.015, p = 0.872). In the Kaplan&ndash, Meier analysis, cardiac event rate was significantly higher in the high SWD group (SWD &ge, 10.0 (m/s)/kHz, n = 103) than in the low SWD group (SWD &lt, 10.0 (m/s)/kHz, n = 92, log-rank, p = 0.010). In the Cox proportional hazard analysis, high SWD was associated with high cardiac event rates (hazard ratio, 2.841, 95% confidence interval, 1.234&ndash, 6.541, p = 0.014). In addition, there were no interactions between SWD and all subgroups, according to the subgroup analysis. Conclusions: SWD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

Background It has been reported that liver stiffness assessed by transient elastography are correlated with right atrial pressure, which is associated with worse outcome in patients with heart failure (HF). We aimed to clarify clinical implications of hepatic hemodynamic evaluation (liver congestion and hypoperfusion) by abdominal ultrasonography in patients with HF. Methods and Results We performed abdominal ultrasonography, right‐heart catheterization, and echocardiography, then followed up for cardiac events such as cardiac death or worsening HF in patients with HF. Regarding liver congestion, liver stiffness assessed by shear wave elastography (SWE) of the liver was significantly correlated with right atrial pressure determined by right‐heart catheterization ( R =0.343; P R =0.291; P P =0.033). In the Cox proportional hazard analysis, high SWE and low PSV were associated with high cardiac event rate (high SWE: hazard ratio [HR], 2.039; 95% CI, 1.131–4.290; low PSV: HR, 2.211; 95% CI, 1.199–4.449), and the combination of high SWE and low PSV was a predictor of cardiac events (HR, 4.811; 95% CI, 1.562–14.818). Conclusions Intrahepatic congestion and hypoperfusion determined by abdominal ultrasonography (liver SWE and celiac PSV) are associated with adverse prognosis in patients with HF.

Two type of partially stabilized zirconia, namely yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) and ceria-stabilized tetragonal zirconia polycrystals including aluminum oxide nanocomposite (Ce-TZP), were irradiated by nanosecond-pulsed Nd:YAG laser and the regular structure with concave and convex of each 30 μm width and 30 μm depth were prepared on both surfaces. In the case of Ce-TZP, the surface was changed to be black after laser irradiation. EDX measurement revealed the reduction of more amounts of oxygen atoms on Ce-TZP compared to Y-TZP. Laser irradiated zirconia implants were inserted into the bone defects of rat femur during 4 weeks. As a control, large grid sandblasted and acid etching (blastedHF) implant was used. Laser treatment for Y-TZP provided greater degree of bone-implant contact ratio than blastedHF treated Y-TZP (p

A substantial amount of experimental and analytical research has been carried out on the liquefaction mechanism, prediction of liquefaction, and soil improvement for liquefaction. In model tests on liquefaction phenomena, several techniques have been proposed for preparing saturated sandy ground. The vacuum method and CO2 gas have been used for saturation by many researchers. There have been few investigations that have studied the effective of this and alternative methods to achieve saturation of the sand in centrifuge model tests. In the present study, model sandy ground was prepared by three techniques and their degrees of saturation were estimated by measuring the P-wave velocity propagating through the ground. The degree of saturation of model ground was greatly influenced by the preparation technique. Further, the reliability and repeatability of centrifuge model test must be carefully examined to conduct successful tests, because the measurements are influenced even by slight differences in preparation of model ground. In the present study, a modelling of models test using three different scaled models (1110, 1/25, and 1/50) was performed to investigate the reliability of our centrifuge model test for liquefaction phenomena. The results confirmed good agreement of the measurements in all test cases.

近年, 遠心模型実験は液状化を対象とする模型実験にも多く用いられている. しかしながら, 粘性流体を用いた砂地盤の飽和度についてはあまり調べられていない. また, 液状化遠心模型実験の有効性についての研究は非常に限られている. そこで本研究では, 数種類の方法で飽和砂地盤を作製し弾性波速度からその飽和度を重力場と遠心場で調べた. 次に, Modeling of Models手法によって液状化遠心模型実験の有効性を検証した. その結果, 地盤作製方法の違いによって地盤の飽和度に少なからず差が生じ, 地盤に遠心加速度を加えることによって飽和度が幾らか上昇することが確かめられた. また, Modeling of models実験における応答加速度特性や間隙水圧特性から液状化遠心模型実験の有効性を確認できた.