Objective: Pulmonary vein isolation (PVI) has been widely used for the treatments of paroxysmal atrial fibrillation (PAF); however, AF recurrence remains a significant challenge. We evaluated ...relation between autonomic nervous activity and AF recurrence using heart rate variability (HRV) and deceleration and acceleration capacity (DC/AC) analyses. Methods: High-resolution Holter electrocardiogram was performed in 56 PAF patients pre- and 3 and 6 months post-PVI by cryoballoon. HRV and DC/AC analysis data were compared between the non-recurrence and recurrence groups. Results: AF recurrence occurred in 10 cases. Total heart beats and maximum heart rate significantly decreased and minimum heart rate increased only in the non-recurrence group post-PVI. In HRV analysis, root mean square successive difference (RMSSD), low-frequency components (LF), high frequency components (HF) and LF/HF significantly decreased only in the non-recurrence group at both 3 and 6 months post-PVI; in contrast, significant decreases in RMSSD, LF and HF were observed in the recurrence group only at 6 months. In DC/AC analysis, DC significantly decreased in both groups post-PVI; in contrast, AC increased only in the non-recurrence group, resulting in significantly greater AC/DC ratio in the recurrence group at 3 months post-PVI. Conclusions: To prevent AF recurrence after PVI, it is important not only to reduce vagosympathetic overall activity but also to minimize imbalance between vagosympathetic reflex responses.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the urinary albumin-to-creatinine ratio (UACR) in patients with elevated levels of albuminuria in the presence or absence of heart failure ...(HF) or type 2 diabetes mellitus (T2D). However, these effects have not yet been reported in the presence of both HF and T2D. This lack of evidence prompted us to conduct a clinical trial on the effects of dapagliflozin on UACR in patients with HF and T2D.
DAPPER is a multicentre, randomised, open-labeled, parallel-group, standard treatment-controlled trial that enrolled patients at 18 medical facilities in Japan. Eligible participants with both HF and T2D and aged between 20 and 85 years were randomly assigned to a dapagliflozin or control (anti-diabetic drugs other than SGLT 2 inhibitors) group with a 1:1 allocation. The primary outcome was changes in UACR from baseline after a two-year observation, and secondary endpoints were cardiovascular (CV) events and parameters related to HF. This trial was registered with the UMIN-CTR registry, UMIN000025102 and the Japan Registry of Clinical Trials, jRCTs051180135.
Between 12 May 2017 and 31 March 2020, 294 patients were randomly assigned to the dapagliflozin group (n = 146) or control group (n = 148). The mean age of patients was 72.1 years and 29% were female. The mean glycated hemoglobin value was 6.9%, mean NT-proBNP was 429.1 pg/mL, mean estimated GFR was 65.7 mL/min/1.73 m2, and median UACR was 25.0 (8.8–74.6) mg/g Cr in the dapagliflozin group and 25.6 (8.2–95.0) mg/g Cr in the control group. Of the 146 patients in the dapagliflozin group, 122 completed the study, and 107 (87.7%) were taking 5 mg of dapagliflozin daily at the end of the observation period. The primary outcome did not significantly differ between the dapagliflozin and control groups. Among the secondary endpoints, the mean decrease in left ventricular end-diastolic dimensions as one of the echocardiographic parameters was larger in the dapagliflozin group than in the control group. The composite endpoint, defined as CV death or hospitalisation for CV events, hospitalisation for HF events, hospitalisation for all causes, and an additional change in prescriptions for heart failure in a two-year observation, was less frequent in the dapagliflozin group than in the control group.
Although dapagliflozin at a dose of 5 mg daily did not reduce urinary albumin excretion in patients with HF and T2D from that in the controls, our findings suggest that dapagliflozin decreased CV events and suppressed left ventricular remodeling.
AstraZeneca KK, Ono Pharmaceutical Co., Ltd.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background: Cardiac radiotherapy using stereotactic body radiation therapy (SBRT) has attracted attention as a minimally invasive treatment for refractory ventricular tachycardia. However, a ...standardized protocol and software program for determining the irradiation target have not been established. Here, we report the first preclinical stereotactic radioregulation antiarrhythmic therapy trial in Japan, focused on the target-setting process.Methods and Results: From 2019 onwards, 3 patients (age range 60–91 years) presenting with ischemic or non-ischemic cardiomyopathy were enrolled. Two patients were extremely serious and urgent, and were followed up for 6 and 30 months. To determine the irradiation targets, we aggregated electrophysiological, structural, and functional data and reflected them in an American Heart Association 17-segment model, as per the current recommendations. However, in all 3 patients, invasive electrophysiological study, phase-contrast computed tomography, and magnetic resonance imaging could not be performed; therefore, electrophysiological and structural information was limited. As alternatives, high-resolution ambulatory electrocardiography and nuclear medicine studies were useful in assessing arrhythmic substrates; however, concerns regarding test weighting and multiple scoring remain. Risks to surrounding organs were fully taken into account.Conclusions: In patients requiring cardiac SBRT, the information needed for target planning is sometimes limited to minimally invasive tests. Although there are issues to be resolved, this is a promising option for the life-saving treatment of patients in critical situations.
Pulmonary vein isolation (PVI) has been widely used for the treatments of paroxysmal atrial fibrillation (PAF); however, AF recurrence remains a significant challenge. We evaluated relation between ...autonomic nervous activity and AF recurrence using heart rate variability (HRV) and deceleration and acceleration capacity (DC/AC) analyses.
High-resolution Holter electrocardiogram was performed in 56 PAF patients pre- and 3 and 6 months post-PVI by cryoballoon. HRV and DC/AC analysis data were compared between the non-recurrence and recurrence groups.
AF recurrence occurred in 10 cases. Total heart beats and maximum heart rate significantly decreased and minimum heart rate increased only in the non-recurrence group post-PVI. In HRV analysis, root mean square successive difference (RMSSD), low-frequency components (LF), high frequency components (HF) and LF/HF significantly decreased only in the non-recurrence group at both 3 and 6 months post-PVI; in contrast, significant decreases in RMSSD, LF and HF were observed in the recurrence group only at 6 months. In DC/AC analysis, DC significantly decreased in both groups post-PVI; in contrast, AC increased only in the non-recurrence group, resulting in significantly greater AC/DC ratio in the recurrence group at 3 months post-PVI.
To prevent AF recurrence after PVI, it is important not only to reduce vagosympathetic overall activity but also to minimize imbalance between vagosympathetic reflex responses.
Photocatalytic activity is determined by the transport property of photoexcited carriers from the interior to the surface of photocatalysts. Because the carrier dynamics is influenced by a space ...charge layer (SCL) in the subsurface region, an understanding of the effect of the potential barrier of the SCL on the carrier behavior is essential. Here we have investigated the relaxation time of the photoexcited carriers on single-crystal anatase and rutile TiO2 surfaces by time-resolved photoelectron spectroscopy and found that carrier recombination, taking a nanosecond time scale at room temperature, is strongly influenced by the barrier height of the SCL. Under the flat-band condition, which is realized in nanometer-sized photocatalysts, the carriers have a longer lifetime on the anatase surface than the rutile one, naturally explaining the higher photocatalytic activity for anatase than rutile.
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IJS, KILJ, NUK, PNG, UL, UM
Pump–probe time-resolved X-ray photoelectron spectroscopy measurements have been carried out to comparatively assess the relaxation process of the photoexcited states on pristine and Ar+-sputtered ...TiO2(110) surfaces and a TiO2(011)-2 × 1 surface, on which the accumulation-type space charge layers are developed. Ultraviolet laser irradiation induces a surface photovoltage (SPV) of around 0.1 eV. The SPV relaxation time on pristine TiO2(110) is determined to be approximately 100 ns and is doubled on the sputtered surface. In contrast, a much shorter time of 1 ns is observed on TiO2(011)-2 × 1. The difference in the relaxation time on the two TiO2(110) surfaces is explained by differences in the O vacancy density on the surface as well as the barrier height of the surface potential for the photoexcited holes. A large hole capture cross section of a state characteristic of TiO2(011)-2 × 1 is, on the other hand, responsible for the fast SPV relaxation on this surface.
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Time-resolved soft X-ray photoelectron spectroscopy is utilized to determine an energy level alignment and the photoexcited carrier dynamics at a C60/TiO2(110) interface. The interface electronic ...structure is characterized by a type II junction, which favors an injection of photoexcited electrons from C60 to TiO2. Ultraviolet (UV) laser pulse irradiation induces transient shifts of both C 1s and Ti 2p core levels towards the higher binding energies. These energy shifts are caused by a laser-induced charge transfer between the C60 layer and the TiO2(110) surface. Upon UV absorption, valence electrons of C60 are promoted to unoccupied levels, followed by a resonant transfer to TiO2, leaving C60 in a cationized state. On the TiO2(110) side, the electrons are injected into the conduction band to raise the carrier density so that downward bending of the TiO2 band is induced. The UV-excited states of C60 and TiO2 have sufficiently longer lifetime than the lifetime of the electron–hole pairs in solid C60. The C60/TiO2(110) interface is, thus, proved to be efficient for separating the electron–hole pairs generated within the C60 layer.
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•Carrier dynamics at the C60/TiO2(110) interface is investigated by TRPES.•The energy level alighment at the interface is characterized by a type II junction.•UV irradiation leads to cationization of C60 and downward bending of the TiO2 band.•A swift electron transfer from C60 to TiO2 suppresses the electron–hole recombination.•The C60/TiO2 composite is probed to be a promissin material for solar cells.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
