The present study used data from the Japanese Committee for Stentgraft Management's national registry, which contains unique surgical data, including surgical timing, anatomic factors, and pathologic ...factors, to determine the generalized community experience with thoracic endovascular abdominal aortic repair (TEVAR).
The medical background and short-term outcomes were reviewed for patients who had undergone TEVAR for a thoracic aortic aneurysm (TAA; 14,235 cases) or aortic dissection (AD; 990 type A and 4259 type B) from 2008 to 2015. TEVAR for AD was separated from that for TAAs; only the background and short-term outcomes were evaluated. The technical outcomes of TEVAR for TAA were also evaluated. All the cases were categorized as follows: elective, urgent (within 24 hours after admission), or emergent (immediately after admission). The outcomes included in-hospital mortality and persistent stroke and paraplegia diagnosed at discharge. The number of debranching bypasses, proximal landing zone (0, 1, 2, ≥3), and zone length were included in the logistic regression analysis.
The mortality, stroke, and paraplegia rates in the TAA and AD groups were 4.4%, 4.6%, and 3.7% and 4.0%, 2.9%, and 2.8%, respectively. After analyzing the TAA cohort, we found that urgent and emergent cases were associated with all adverse outcomes. The rate of paraplegia increased drastically in the patients with stent graft coverage that extended for six or more zones. Massive atheroma was associated with stroke and paraplegia. The cumulative survival rate of the TAA group was stratified by the urgency (ie, elective, urgent, emergent; P < .001). We found that the more proximal (0, 1, and 2) the landing zone, the greater the risk of stroke. Likewise, the longer (six or more zones) the coverage, the greater the risk of paraplegia.
Urgency was strongly associated with mortality, stroke, and paraplegia, and the classification of urgent and emergent, according to the surgical timing after admission, successfully stratified the population in the long-term overall survival analysis. A proximal landing zone involving the aortic arch and debranching bypasses were associated with the occurrence of stroke, and the length of stent graft coverage for six or more zones was associated with paraplegia. Identifying these risk factors will help operators of TEVAR develop appropriate operative strategies to mitigate patient risk.
A Saturn‐like 1:1 complex composed of macrocyclic oligothiophene E‐8T7A and C60 fullerene (C60) was synthesized to investigate the interaction between macrocyclic oligothiophenes and C60 in solution ...and the solid state. Because the Saturn‐like 1:1 complex E‐8T7A⋅C60 is mainly stabilized by van der Waals interactions between C60 and the sulfur atoms of the E‐8T7A macrocycle, C60 is rather weakly incorporated inside the macro‐ring in solution. However, in the solid state the Saturn‐like 1:1 complex preferentially formed single crystals or nanostructured polymorphs. Interestingly, X‐ray analysis and theoretical calculations exhibited hindered rotation of C60 in the Saturn‐like complex due to interactions between C60 and the sulfur atoms. Furthermore, the photoinduced charge transfer (CT) interaction between E‐8T7A and C60 in solution was investigated by using femtosecond transient absorption (TA) spectroscopy. The ultrafast TA spectral changes in the photoinduced absorption bands were attributed to the CT process in the Saturn‐like structure.
Saturn's rings: The Saturn‐like 1:1 complex between C60 and the sulfur atoms of macrocyclic oligothiophene (mainly stabilized by van der Waals interactions) interacts weakly in solution; however, in the solid state this complex preferentially forms single crystals that exhibit hindered rotation of C60 in the complex due to the interactions between C60 and the surrounding sulfur atoms (see figure).
Excited‐state dynamic planarization processes play a crucial role in determining exciton size in cyclic systems, as reported for π‐conjugated linear oligomers. Herein, we report time‐resolved ...fluorescence spectra and molecular dynamics simulations of π‐conjugated cyclic oligothiophenes in which the number of subunits was chosen to show the size‐dependent dynamic planarization in the vicinity of a ring‐to‐linear behavioral turning point. Analyses on the evolution of the total fluorescence intensity and the ratio between 0–1 to 0–0 vibronic bands suggest that excitons formed in a cyclic oligothiophene composed of six subunits fully delocalize over the cyclic carbon backbone, whereas those formed in larger systems fail to achieve complete delocalization. With the aid of molecular dynamics simulations, it is shown that distorted structures unfavorable for efficient exciton delocalization are more easily populated as the size of the cyclic system increases.
Going around in circles: Excited‐state dynamic planarization processes of π‐conjugated cyclic oligothiophenes were investigated using time‐resolved fluorescence spectra and molecular dynamics simulations. Excitons formed in a cyclic oligothiophene composed of six subunits fully delocalize (“cyclic exciton”), whereas those formed in larger systems fail to achieve complete delocalization (“acyclic exciton”).
Vitreous humor (VH) is used for postmortem biochemical studies because it is well protected in an uncontaminated state even after death. The goal of this research was to investigate electrolyte ...concentrations in the VH from human eyes with and without a history of vitrectomy surgery.
We analyzed the sodium (Na), potassium (K), chloride (Cl) and magnesium (Mg) concentrations from 34 VH samples from 34 patients. Eleven samples were from eyes with a history of vitrectomy, and the remaining 23 eyes had no history of vitrectomy. The correlations of Na, K, Cl and Mg concentrations with patient age, interval between first and second vitrectomy, and lens status (history of cataract surgery) were also evaluated.
The Na, K, Cl and Mg concentrations in VH from vitrectomized eyes were 134.1 ± 7.9 mmol/L, 3.7 ± 0.2 mmol/L, 99.7 ± 6.7 mmol/L and 0.59 ± 0.09 mmol/L, respectively; all were significantly lower than the corresponding concentrations in VH from control eyes (lower by 5.0%, 11.0%, 11.7%, and 22.6%, respectively). Na, K, Cl and Mg concentrations in VH from vitrectomized eyes did not show significant correlations with patient ages or the interval between their first and second vitrectomies. There were no significant differences in Na, K, Cl and Mg concentrations in VH between phakic eyes and intraocular lens-implanted eyes.
With the increasing number of vitrectomies being performed, it is necessary to consider the history of vitrectomy when using a subject's VH in forensic examination.
In infants with ventricular septal defect (VSD) who undergo surgical intervention, body weight, along with age, is frequently thought to be the decisive predictor of morbidity and mortality after ...surgery; however, its information on quantitative risk assessment is limited.
All infants (<1 year old) with a fundamental diagnosis of VSD who underwent surgical VSD closure or pulmonary artery banding between 2012 and 2016 were identified from the Japan Cardiovascular Surgery Database Congenital Section. The outcome of interest was a composite end point of all-cause death and major complications within 30 days after surgery. We evaluated the association between body weight at surgery and composite end point using logistic regression models.
A total of 4947 cases were analyzed (median age, 125; interquartile range IQR, 79-193 days; median body weight, 4.94 IQR, 4.00-6.00 kg), including 4310 cases (87.1%) treated with surgical VSD closure and 637 (12.9%) treated with pulmonary artery banding. The surgical course was uncomplicated in 94.2% of cases, 23 (0.5%) died, and 283 (5.7%) experienced major complications. The risk of the composite end point was higher along with lower body weight (adjusted odds ratio, 1.56 for every −1 kg; 95% confidence interval, 1.30-1.88; P < .001) and plateaued at body weight of approximately >4.5 kg via smoothing spline curve. Importantly, cases with approximately <4.5 kg of body weight had higher predicted risk regardless of age.
Surgical intervention for infants with VSD was safely performed in contemporary practice; however, caution is warranted in lower body weight infants, particularly for infants with approximately <4.5 kg.
Purpose
A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk (LMT) is the most ...critical form of this pathology and its surgical repair is challenging. We conducted this single-center study to review the surgical outcomes of patients with a saccular CAA in the LMT.
Methods
Between May, 2012 and June, 2020, five patients with a saccular CAA in the LMT underwent surgery at our center. The median age at operation was 66.5 (59.7–69) years and the median diameter of the CAA was 13.0 mm (IQR 11–14 mm).
Results
The CAA was fully excluded by patch closure of the LMT orifice and direct closure of the distal LMT, supplemented by coronary artery bypass grafting with the exclusive use of arterial conduits. There was no in-hospital mortality, although one patient suffered graft spasm-related myocardial infarction with complete recovery. Post-operative angiography showed a fully excluded LMT in all patients. There was no mortality or adverse cardiac events during follow-up.
Conclusions
Our surgical policy for CAA in the LMT is feasible and safe; however, coronary blood flow is dependent on reliable bypasses.
An infant with neonatal Marfan syndrome (nMFS), a condition that is nearly always lethal during infancy, was referred to our hospital with symptoms of congestive heart failure resulting from severe ...mitral valve insufficiency. During mitral valve repair, the use of an annuloplasty ring was waived until annular dilatation was achieved after 2 palliative mitral valvuloplasty procedures. After the definitive operation, the patient's mitral valve function remained within normal limits until the last follow-up when the patient was 11 years old. To the best of our knowledge, this patient has the longest recorded survival after mitral valve repair.
All trophoblast subtypes of the placenta are derived from trophoblast stem cells (TSCs). TSCs have the capacity to self‐renew, but how the proliferation of these cells is regulated in the ...undifferentiated state has been largely unclear. We now show that the F‐box protein Skp2 regulates the proliferation of TSCs and thereby plays a pivotal role in placental development in mice on the C57BL/6 background. The placenta of Skp2−/− mouse embryos on the C57BL/6 background was smaller than that of their Skp2+/+ littermates, with the mutant embryos also manifesting intrauterine growth retardation. Although the Skp2−/− mice were born alive, most of them died before postnatal day 21, presumably as a result of placental defects. Depletion of Skp2 in TSCs cultured in the undifferentiated state resulted in a reduced rate of proliferation and arrest of the cell cycle in G1 phase, indicative of a defect in self‐renewal capacity. The cell cycle arrest apparent in Skp2‐deficient TSCs was reversed by additional ablation of the cyclin‐dependent kinase inhibitor (CKI) p57 but not by that of the CKI p27. Our results thus suggest that Skp2‐mediated degradation of p57 is an important determinant of the self‐renewal capacity of TSCs during placental development, at least in mice of certain genetic backgrounds.
Gross appearance of Skp2+/+ and Skp2−/− placentas at E15.5. Skp2−/− embryos on the C57BL/6 background had smaller placentas than did corresponding Skp2+/+ embryos.
Background: This study investigated the impact and predictive factors of concomitant significant tricuspid regurgitation (TR) and evaluated the roles of right ventricle (RV) function and the etiology ...of TR in the clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).Methods and Results: We assessed grading of TR severity, TR etiology, and RV function in pre- and post-TAVI transthoracic echocardiograms for 678 patients at Keio University School of Medicine. TR etiology was divided into 3 groups: primary TR, ventricular functional TR (FTR), and atrial FTR. The primary outcomes were all-cause and cardiovascular death. At baseline, moderate or greater TR was found in 55 (8%) patients and, after adjustment for comorbidities, was associated with increased all-cause death (hazard ratio HR 2.11; 95% confidence interval CI 1.19−3.77; P=0.011) and cardiovascular death (HR 2.29; 95% CI 1.06−4.99; P=0.036). RV dysfunction (RVD) also remained an independent predictor of cardiovascular death (HR 2.06; 95% CI 1.03−4.14; P=0.042). Among the TR etiology groups, patients with ventricular FTR had the lowest survival rate (P<0.001). Patients with persistent RVD after TAVI had a higher risk of cardiovascular death than those with a normal or recovered RV function (P<0.001).Conclusions: The etiology of TR and RV function play an important role in predicting outcomes in concomitant TR patients undergoing TAVI.
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