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Introduction: Embolus due to plaque rupture is a risk of cerebral infarction for carotid artery stenting (CAS). Female have been controversial as a risk factor for cardiovascular interventions in recent years. MMP-9 has been previously reported to be associated with acute ischemic stroke and to be a potential marker for arteriosclerosis.Therefore, this paper aimed to investigate the gender difference of embolic complications for CAS using MMP-9.Material and Methods: We analyzed 46 consecutive cases of CAS performed with distal balloon protection, including 34 males and 12 females. Serum levels of matrix metalloproteinase (MMP) -9 were measured before and after CAS. Embolic events were examined in Diffusion Weighted Imaging (DWI) on MRI the next day after CAS.Results: 13 cases (28.3%) had DWI-positive findings after CAS, and these results showed a significant gender difference (female 58.3% vs. male 17.6%, p < 0.05). Pre-CAS MMP-9 was significantly higher in females than in males (661.7 vs. 428.1 ng/ml, p < 0.05).Pre-CAS MMP-9 tended to be higher in DWI-positive cases than DWI-negative cases with no significant difference (676.9 vs. 415.0 ng/ml, p = 0.051).Conclusion: High serum MMP-9 in female have correlation with DWI positive findings after CAS. We suggest that high serum MMP-9 have a risk of cerebral infarction for CAS. Considering the results, CAS should be carefully performed, especially in female.

Herein, we describe a case of traumatic direct carotid cavernous fistula (DCCF) treated with target coil embolization using the combined transarterial and transvenous balloon-assisted technique. The patient was a 59-year-old woman who had been involved in a vehicular accident. She was admitted to the hospital due to chemosis and exophthalmos. Cerebral angiography revealed a shunt from the internal carotid artery (ICA) to the cavernous sinus (CS), which indicated DCCF. Thus, target coil embolization using the combined transarterial and transvenous balloon-assisted technique was performed. Angiography was performed 1 week after surgery to confirm the disappearance of DCCF. No recurrence was observed during the 1-year follow-up after treatment. Thus, target coil embolization using the combined transarterial and transvenous balloon-assisted technique is safe and effective for the treatment of traumatic DCCF.

The soft magnetic properties of α-Fe fine powders were investigated before and after low temperature ammonolysis together with the effect of alumina presence in the grain boundaries to clarify the contribution of these during the preparation process. The crystallite size was controlled to be approximately 50 nm and 30 nm before and after ammonolysis, respectively, by changing the preparation conditions to eliminate the effect of particle size on the magnetic properties. The ammonolysis product was a mixture of approximately 50 wt% of an α″-Fe16N2-like compound (hereafter denoted as “α″-Fe16N2”) with residual α-Fe, which had the largest magnetization among the ammonolysis products reported in our previous works. The core loss of magnetic rings made from this powder was first studied after sealing in Delrin® capsules to avoid decomposition by oxidation and the presence of humidity. The core loss was decreased to one third and the permeability was decreased to approximately 80% by the ammonolysis process, independent of the presence of alumina at the grain boundaries. The hysteresis contribution in the core loss was significantly decreased due to enhanced magnetic domain interaction in the anisotropic crystal lattice of “α″-Fe16N2”. The covalent chemical bonds of Fe-N caused the compound to be more electrically resistive and also resulted in a slight decrease of the eddy current loss contribution. Alumina precipitation at the grain boundaries caused a doubling of core loss increase and an increase of the permeability to approximately 130% because the magnetic interaction between grains was reduced by the presence of alumina in the composite products. Combing the decreased core loss by nitridation and the increased magnetic permeability by alumina precipitation will be useful to develop a new soft magnetic material.

Spontaneous retroclival subdural hematoma is rare among adults. To the best of our knowledge, only six cases have been reported. A 73-year-old man presented with sudden severe headache, diplopia, and dysarthria, with no history of trauma. Head CT revealed a retrociliary hematoma. No obvious causes of bleeding, such as cerebral aneurysms or malformations, were detected. Conservative treatment was provided to the patient. MRI showed an intraventricular hemorrhage and a space between the basilar artery and hematoma three days after onset. The hematoma almost disappeared on day 7. MRI, particularly T2-weighted sagittal MRI, is effective in localizing hematomas and confirming intraventricular hemorrhages.

Phytophagous insects are among the most diverse of the earth’s organisms, and their diversification patterns and the driving forces behind these have attracted considerable research interest. Host shifting to closely related plant species is thought to play an important role in phytophagous insect diversification, but the extent to which other interactions such as mutualistic associations affect diversification is not yet known. In this study, we reconstructed the molecular phylogeny of JapaneseStomaphisaphids and determined whether host shifting or mutualistic association with different ant species could explain diversification in this aphid genus. We analyzed 12 species ofStomaphisand grouped them into ten well-supported DNA lineages. Species in each lineage used a single or a few host plant species, but were mutualistically associated with many ant species of the genusLasius. This result suggests thatStomaphisevolutionarily diversified primarily through host plant shifts. Interestingly, the reconstructed phylogeny suggests thatStomaphishost shifts occasionally occurred between very distantly related host plant taxa (spanning up to five plant orders). The dependence ofStomaphison long-lastingLasiusant colonies situated in temperate deciduous forests whereLasiusis the dominant ant genus may have led the aphids to shift to distantly related but spatially adjacent host tree species.

High mobility group AT-hook 2 (HMGA2) is a non-histone transcriptional regulator protein. Aberrant expression of the HMGA2 gene (HMGA2) and structural rearrangement at the chromosomal region 12q14 with HMGA2 involvement have been reported in several mesenchymal tumors. We analyzed truncated and full-length HMGA2 expression in 55 cases of meningioma, the most common brain tumor of mesenchymal origin. Fluorescence in situ hybridization and 3'-rapid amplification of cDNA ends were used to investigate the possibility of gene rearrangements. Moreover, the relationship between HMGA2 expression and clinicopathological features was assessed. Compared with normal brain tissues, 95% of the meningioma tissues exhibited increased HMGA2 expression. In 14 cases, the expression of truncated HMGA2 was more than two-fold higher than that of paired full-length HMGA2. Chromosomal translocation involving the chromosomal region 12q14 was undetectable. No significant correlation was found between the Ki-67 labeling index and HMGA2 expression and between the HMGA2 expression and the clinicopathological features. The majority of the meningioma cases displayed increased HMGA2 expression, which was not attributed to the chromosomal rearrangement at the corresponding region. Similar to that in the other mesenchymal tumors, increased HMGA2 expression was not associated with tumor cell proliferation in meningiomas.

Background Neuroendovascular therapy is typically performed via the femoral artery, but there are rare cases in which a tortuous upstream angioarchitecture makes it difficult to access the intracranial circulation via this route. Methods In this case series, we describe six cases treated by surgical cut-down in the neck, with puncture of the carotid artery. Antiplatelet and anticoagulation agents were used in all cases. The indications for the technique were postsurgical thoracic aortic aneurysm (two cases), postsurgical abdominal aortic aneurysm (one case), major vessel tortuosity of the common carotid artery (two cases) and aortic arch anomaly (one case). Results The surgical cut-down technique permitted successful neuroendovascular therapy. Although one patient had a small cervical haematoma, he was treated without surgical evacuation. Conclusion Overall, our findings indicate that the surgical cut-down technique is safe and useful for patients in whom the femoral approach is unsuitable.

Transmural thermal injury (TTI), such as esophageal erosion/ulcer and periesophageal nerve injury leading to gastric hypomotility, is not rare complications associated with pulmonary vein isolation (PVI). However, the mechanism and predicting factors of TTI have not yet been fully elucidated with second-generation cryoballoon (CB) PVI. One hundred ten consecutive patients, who underwent CB PVI for atrial fibrillation and received esophagogastroduodenoscopy 2 days later, were investigated. The relationships between TTI and both clinical and anatomical parameters were examined. We measured the following parameters based on the computed tomography data: the angle of the left atrial (LA) posterior wall to the descending aorta (Ao) (LA-Ao angle); the branching angle of the left inferior pulmonary vein (LIPV) to the coronal plane (LIPV angle); and the minimum distance between the LA posterior wall and descending Ao enclosing the esophagus (LA-Ao distance). TTIs occurred in 19 patients (esophageal erosion in 2 and gastric hypomotility in 17). The patients with TTI were significantly older than those without TTI. In the anatomical parameters, the LIPV angle was larger and the LA-Ao distance was shorter in the TTI (+) group compared to the TTI (−) group. With the multivariate logistic regression analysis, the age (odds ratio [OR] 2.148, P = 0.022) and LA-Ao distance (OR 0.430, P = 0.013) were independent predictors of TTI. The occurrence of TTI in CB PVI was associated with aging, suggesting compromised periesophageal circulation, and the anatomical proximities between the LA and the descending Ao, which enclose the esophagus.

Rough set theory was proposed by Z. Pawlak in 1982. This theory can mine knowledge based on a decision rule from a database, a web base, a set, and so on. The decision rule is used for data analysis as well as calculating an unknown object. We analyzed time-series data using rough sets. Economic time-series data was predicted using decision rules. However, there are cases where an excessive number of decision rules exist, from which, it is difficult to acquire knowledge. In this paper, we propose a method to reduce the number of decision rules by merging them. Similar to how it is difficult to acquire knowledge from multiple rules, it is also difficult to acquire knowledge from rules with a large number of condition attributes. We propose a method to reduce the number of condition attributes and thereby reduce the number of rules. We analyze time-series data using this proposed method and acquire knowledge for prediction using decision rules. We use TOPIX and the yen–dollar exchange rate as knowledge-acquisition data. We propose a method to facilitate knowledge acquisition by merging rules.

Background To investigate the impact of uncontrolled blood pressure (BP) on left atrial (LA) remodeling and clinical outcome after pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). Methods One hundred and one symptomatic paroxysmal AF patients (85 males, 62.2 ± 8.4-year-old) who underwent successful PVI were classified as follows: group 1 (n = 46), no hypertension (HTN); group 2 (n = 36), HTN with controlled BP; and group 3 (n = 19), HTN with uncontrolled BP. Uncontrolled BP was defined as BP > 140/90 mm Hg. LA dimension was measured by echocardiography before and 6 months after PVI. LA wall thickness along the ablation line was measured using computed tomography prior to PVI. Cox regression analysis was performed for the prediction of recurrence. Results LA wall thickness in groups 2 and 3 was greater than that of group 1, except for the anterior right superior pulmonary vein (PV) and posterior left inferior PV. Kaplan-Meier analysis revealed a significantly higher recurrence in group 3 (52.6%). LA dimension only increased in group 3 (38.2 ± 5.6 mm to 41.3 ± 6.2 mm, P = 0.022). At the second procedure, all group 3 recurrent patients showed substrate degradation (low voltage area and/or dense scar formation) and required substrate modification. Uncontrolled BP was an independent risk factor for recurrence (hazard ratio: 2.350, P = 0.033). Conclusions HTN induced heterogeneous LA hypertrophy regardless of whether HTN was controlled. Uncontrolled BP promoted atrial remodeling, and is therefore a strong predictor for recurrence of AF after PVI.

Objectives: The uric acid (UA) level is related to cardiac events and mortality, but little is known about the clinical significance of serum UA with regard to the ventricular tachyarrhythmia (VT) risk in patients with heart failure. Methods: The present study enrolled 56 patients with ischemic and nonischemic cardiomyopathy (37 males, mean age 64.7 ± 11.1 years) who received prophylactic implantable cardioverter-defibrillator (ICD) implantation. Based on a median serum UA value, study subjects were divided into two groups: serum UA < 6.1 mg/dL (group L, n = 29) and ≥6.1 mg/dL (group H, n = 27). Echo- and electrocardiograms (QRS duration and QTc intervals) were examined in each group. Results: During the follow-up period (30 ± 8 months), 22 (39%) patients had appropriate ICD therapies for sustained VT. There was no significant difference in the electro- and echocardiographic data between both groups. However, appropriate ICD therapies were significantly higher in group H than in group L (p = 0.02). In multivariate analysis, UA was an independent predictor of appropriate ICD therapies (hazard ratio 1.826, 95% confidence interval 1.248–2.671, p = 0.002). Conclusions: Serum UA levels might be a predictor of VT, providing new aspects regarding the decision to adapt ICD implantation in patients with heart failure.

An increase in magnetic coercivity is important for the α″-Fe 16 N 2 -like compound with an enhanced magnetization from α-Fe as a new hard magnetic material. In the present study, BaFe 12 O 19 particles were coated with fine Fe 3 O 4 powder produced by hydrolysis of Fe(acac) 3 in benzyl alcohol. Smooth magnetization curves were obtained for the composite particles, suggesting they were magnetic hybrids with strong magnetic coupling between the Fe 3 O 4 coating and the BaFe 12 O 19 core particles. The Fe 3 O 4 coating layer was then nitrided by ammonolysis at 150 °C to produce a dual-phase mixture of an α″-Fe 16 N 2 -like compound, which we refer to as “α″-Fe 16 N 2 ”, and residual α-Fe. Smooth magnetization hysteresis curves were obtained for (“α″-Fe 16 N 2 ”) 0.31 (α-Fe) 0.69 /BaFe 12 O 19 particles, and a magnetic coercivity of 199 mT, compared to the value of just 65 mT for (“α″-Fe 16 N 2 ”) 0.57 (α-Fe) 0.43 powder, indicating magnetic coupling between the core and shell structures. Thus, the hybrid particles exhibited both high magnetization and coercivity.

Rough set theory was proposed by Z. Pawlak in 1982. This theory enables the mining of knowledge granules as decision rules from a database, the web, and other sources. This decision rule set can then be used for data analysis. We can apply the decision rule set to reason, estimate, evaluate, or forecast an unknown object. In this paper, rough set theory is used for the analysis of time-series data. We propose a method to acquire rules from time-series data using regression. The trend of the regression line can be used as a condition attribute. We predict the future slope of the time-series data as decision attributes. We also use merging rules to further analyze the time series data.

Aims Transmural thermal injury (TTI), such as oesophageal erosion/ulcer and perioesophageal nerve injury leading to gastric hypomotility, is an important complication associated with pulmonary vein isolation (PVI). However, a predictor of TTI concerning anatomical structures surrounding the oesophagus has not yet been fully elucidated. Therefore, we sought to identify the predisposing factors of TTI after PVI. Methods and results Consecutive 110 patients, who underwent PVI for atrial fibrillation, received oesophagogastroduodenoscopy 2 days later, were investigated. The relationships between TTI and clinical and anatomical parameters were examined. Based on the computed tomography data, we measured the angle of the left atrial (LA) posterior wall to the descending aorta (Ao) (LA-Ao angle), the branching angle of the left inferior pulmonary vein (LIPV) to the coronal plane (LIPV angle), and the minimum distance between the LA posterior wall and descending Ao enclosing the oesophagus (LA-Ao distance). Transmural thermal injuries occurred in 21 patients (oesophageal erosion in 5 and gastric hypomotility in 16). Age, gender, body mass index, LA diameter, and LA volume index in echocardiography were not associated with TTI. However, the LIPV angle was larger and the LA-Ao distance was shorter in the TTI (+) group compared to the TTI (-) group. With multivariate logistic regression analysis, the LIPV angle [odds ratio (OR): 2.144, P = 0.0031] and LA-Ao distance (OR: 0.392, P = 0.0229) were independent predictors of TTI. Conclusion The anatomical proximities of the LA posterior wall, LIPV, and descending Ao surrounding the oesophagus are strongly associated with the prevalence of TTI.

The results of preoperative embolization for skull base meningiomas were retrospectively evaluated to confirm the efficacy of this procedure. Skull base meningiomas that were treated with preoperative embolization were evaluated in 20 patients. The occluded arteries, embolic materials, treatment time, excision rate, neurologic manifestations, and complications were analyzed. The embolic material was 80% liquid, 30% coils, and 15% particles. The surgery was normally completed within 3 to 5 hours. Blood loss was normally approximately 250 mL, excluding four patients having the following conditions: malignant meningioma, a large tumor located on the medial side of the sphenoidal ridge, the petroclival tumor, and infiltrated tumor into the sigmoid sinus. The mean excision rate was 90%, achieving a Simpson grade III, but 10% were graded as Simpson grade IV. No permanent complications due to the preoperative embolization occurred. No neurologic symptoms occurred after excision. Current cerebral endovascular treatment is sophisticated, and the complication rate has markedly decreased. Although it was impossible to compare directly with or without operative embolization, preoperative embolization should be actively used as part of the treatment for this benign tumor, with better understanding of dangerous anastomosis.

Few reports exist regarding the details of ice formation on second-generation cryoballoon (CB) surface during pulmonary vein isolation (PVI). We propose a new parameter “temperature drop” in thawing phase for predicting sufficient ice formation and CB-PVI outcome. Consecutive 106 patients who underwent successful CB-PVI for atrial fibrillation (AF) were analyzed. We defined “temperature drop” as a temperature drop of more than 3 °C just after CB catheter bending. We compared the previously known parameters predicting durable PVI between PVs with or without temperature drop. Then, we compared the PVI outcome among three groups: group 1 with temperature drop in all PVs, group 2 with temperature drop in 1–3 PVs, and group 3 without temperature drop in any PV. Temperature drop was present in 206 out of 424 isolated PVs. In those, PV occlusion score was significantly higher (3.7 ± 0.5 vs. 3.5 ± 0.6, P

Glucocorticoid (GC) resistance is associated with poor response to the following chemotherapy in lymphoid malignancies, such as lymphoma and leukemia. However, it remains unclear whether GCs interfere with the cytotoxic effects of anti-cancer drugs on GC-resistant cells. In this study, we examined whether GCs affected the sensitivities to vincristine (VCR)/doxorubicin (DOX) and the expression of drug transporters in GC-resistant cells. The dexamethasone (DEX)/prednisolone (PSL)-resistant lymphoid and non-lymphoid cell lines Raji and HL60 were cultured with DEX for 7 days and then treated with VCR or DOX for 3 days. Seven days of DEX treatment increased the IC50s of both VCR and DOX in Raji cells but not in HL60 cells. The mRNA and protein expression levels of organic cation/carnitine transporter (OCTN) 2, one of the drug uptake transporters expressed in both cell lines, were decreased only in Raji cells. When Raji cells were cultured with PSL, the IC50 of DOX but not VCR increased as the expression of OCTN2 decreased. No significant increases in efflux transporter expression were induced by DEX or PSL. When siRNA against OCTN2 was introduced into Raji cells, the IC50 of DOX but not VCR increased significantly. These data suggested that both DEX and PSL decreased the sensitivity of the DEX/PSL-resistant Raji cells to DOX, a change that was at least partially due to reductions in OCTN2. Thus, the continuous usage of GCs may interfere with the effects of chemotherapy on GC-resistant lymphoid cells.

Rough Set Theory proposed in 1982 by Zdzislaw Pawlak. This theory can be data mining based on decision rules from a database, a web page, a big data, and so on. The decision rule is employed for data analysis as well as calculating an unknown object. We used rough set to analyze time-series data. We obtained prediction knowledge from time series data using decision rules. Economic time-series data was predicted using decision rules. However, when acquiring a decision rule from time series data, there are cases where the number of decision rules is very large. If the number of decision rules is very large, it is difficult to acquire knowledge. We proposed a method of merging them to reduce the number of decision rules. Similar to how it is difficult to acquire knowledge from multiple rules, it is also difficult to acquire knowledge from rules with a large number of condition attributes. Our method reduces the number of conditions attributes and thereby reduces the number of rules. However, it is not always possible to reduce rules. There are cases where the number of rules increases. In this thesis, we examine under what conditions rule reduction is possible. Change the condition attribute and verify the effect on rule reduction. We acquire knowledge using the Nikkei Stock Average. We acquire decision rule by rough set method and consider the influence on rule reduction.

In heart failure patients, exhaled acetone concentration, a noninvasive biomarker, is increased according to heart failure severity. Moreover, exhaled acetone concentration is also known to be affected by diabetes mellitus. However, there have been no reports on exhaled acetone concentration in heart failure patients with diabetes mellitus. A 77-year old man was admitted to our hospital with acute decompensated heart failure and atrioventricular block. He had controlled diabetes mellitus under insulin treatment with hemoglobin A1c of 6.5%. He underwent treatment of diuretics and permanent pacemaker implantation. His condition improved and he was discharged at Day 12. Due to the heart failure improvement, his levels of exhaled acetone concentration decreased from 1.623 ppm at admission to 0.664 ppm at discharge. This is the first report to reveal a change of exhaled acetone concentration in a diabetic patient with acute decompensated heart failure.

The relationship between insulin resistance and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) remains unclear.Drug-refractory 114 paroxysmal AF patients (89 males, 62 ± 8 years) who underwent successful PVI were enrolled. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated and a value of ≥2.5 was defined as insulin resistant. The left atrial volume index (LAVI) was measured using echocardiography before and 1 year after PVI. Tumor necrosis factor-α (TNF-α) and TGF-β1 serum levels were measured before PVI, and the left atrium (LA) conduction velocity was calculated. The patients were divided into two groups (group 1: HOMA-IR 2.5, n = 81; group 2: HOMA-IR ≥ 2.5, n = 33).The LAVI between the two groups before PVI did not significantly differ (P 0.05), nor did TNF-α (7.7 ± 2.0 vs 7.5 ± 1.0 pg/mL; P = 0.149) or TGF-β1 (28.4 ± 12.0 vs 27.6 ± 10.3 ng/mL; P = 0.757). LAVI before and 1 year after PVI in each group did not change. The conduction velocity of group 2 was slower than that of group 1 (0.7 ± 0.1 vs 1.1 ± 0.3 m/s, P 0.001). Kaplan-Meier analysis showed significantly higher AF recurrence in group 2 than that in group 1 ( P = 0.019). Cox multivariable analysis revealed that insulin resistance was an independent predictor of recurrence (hazard ratio 1.287, P = 0.004).Our results suggest that insulin resistance promotes LA electrical remodeling and might be related to AF recurrence after PVI.

We demonstrate the generation of 21 fs (1.8 optical cycle), 45-µJ, carrier-envelope phase (CEP)-stable optical pulses with an octave-spanning spectrum from 2.2 to 4.9 µm. Multi-cycle output pulses (120 fs, 149 µJ, 3.5 µm, and 300 Hz) from a KTA-based optical parametric amplifier are compressed down to the sub-two-cycle regime using YAG and Si plates. The single-shot CEP stability of the compressed pulses is measured to be 283 mrad for 500 s. This robust and compact scheme realizes a field strength of 282 MV/cm with f/11 focusing, opening a new regime of attosecond strong-field physics in solids.