Objectives Pulmonary hypertension (PH) is an indicator of a poor prognosis in patients with dilated cardiomyopathy. Few studies have investigated the prognostic role of PH in patients undergoing ...restrictive mitral annuloplasty (RMA) for severe functional mitral regurgitation secondary to advanced cardiomyopathy. Methods A total of 46 patients undergoing RMA were classified into 3 groups on the basis of the Doppler-derived systolic pulmonary artery pressure (PAP) at baseline. Of the 46 patients, 19 had a systolic PAP less than 40 mm Hg (mild PH group), 17 had a systolic PAP of 40 to 60 mm Hg (moderate PH group), and 10 had a systolic PAP greater than 60 mm Hg (severe PH group). Results Postoperative cardiac catheterization showed that the RMA procedure resulted in a significant reduction of the left ventricular (LV) preload and improvements in LV systolic function in all 3 groups, along with the relief of symptoms. During the follow-up period (mean, 36 ± 19 months), cardiac death occurred in 6 patients, readmission because of heart failure in 3, and fatal arrhythmia in 1. The rate of freedom from these cardiac events at 3 years was 93% ± 7%, 88% ± 8%, and 56% ± 17% in the mild, moderate, and severe PH groups ( P < .001). Serial echocardiography showed that significant LV reverse remodeling occurred in 89%, 71%, and 25% of the mild, moderate, and severe PH groups, respectively. Multivariate Cox regression analysis identified severe PH (systolic PAP > 60 mm Hg) as a significant predictor of adverse cardiac events, as well as LV remodeling after RMA. Conclusions Noninvasive assessment of preoperative PH has a prognostic value in patients undergoing RMA for severe functional mitral regurgitation secondary to advanced cardiomyopathy.
Background/AimsThe accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish ...shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. MethodsFrom April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. ResultsA total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). ConclusionsThe depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
The wearable interface has attracted attention. Since the spread of coronavirus disease 2019 has made wearing masks more frequent, we propose a mask-type interface system that can measure facial ...expressions. Since facial expressions are hidden in this system, it can be applied to services that enable hands-free operation of smartphones and other devices in public places without unnecessary concerns about the surroundings. We focused on the expansion and contraction of the mask and used multiple strain sensors to discriminate facial expressions. The advantage of using strain sensors is that they are inexpensive, disposable, lightweight, and less uncomfortable to wear. We extracted features from the data obtained by expressing facial expressions using the prototype mask, and built and evaluated expression discrimination models using six different machine learning algorithms. The results showed that the classification accuracy was over 90% for a total of 15 types of facial expressions in multiple subjects.
We investigated long-term outcomes following aortic valve replacement (AVR) in asymptomatic patients with severe aortic regurgitation (AR) and normal left ventricular (LV) function. We reviewed 268 ...patients who underwent isolated AVR for chronic severe AR from 1991 to 2010 and enrolled 162 asymptomatic patients with normal LV ejection fraction (≥50%) preoperatively. They were divided into 2 groups according to LV dimension at surgery, the early stage C group (indexed LV end-systolic diameter ≤25 mm/m2 and LV end-diastolic diameter ≤65 mm, n = 61), and late stage C group (indexed LV end-systolic diameter >25 mm/m2 and/or LV end-diastolic diameter >65 mm, n = 101). Survival was compared with that of an age- and gender-matched Japanese general population using a one-sample log-rank test. Subgroup analysis was performed for patients who survived >10 years after AVR. The mean age of all patients was 59 ± 14 years and mean follow-up period was 10 ± 5 years. Survival after AVR for the early and late stage C groups was not statistically different (P = 0.57). Furthermore, survival for both groups was not statistically different from that of the general population (early stage C, P = 0.63; late stage C, P = 0.14). However, subgroup analysis showed that survival >10 years after AVR was significantly worse for the late stage C group as compared to that of the general population (P < 0.001). Long-term survival following AVR for asymptomatic AR with normal LV ejection fraction was excellent. However, survival more than 10 years after surgery might be dependent on LV dimension at surgery.
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We aim to develop earphone type wearable devices for measuring occlusal force. In this article, we investigated the correlation between occlusal force and the movement of the ear canal as a basic ...study to estimate the occlusion force. The proposed estimation method uses the least squares method and the weighted average. We developed an experimental device for simultaneously measuring occlusal force and the movement of the ear canal. This device primarily consists of an occlusal force sensor and a wearable ear sensor, and converts analog signals from both sensors into digital signals using an analog‐to‐digital (AD) converter, then records the data as signals associated with measurement time. The experiment involved six subjects, who performed chewing of the occlusal force sensor five times, for 2 seconds. The occlusal force sensor was placed at the right second molar, with the wearable ear sensor placed on the right ear. Through the experiment, the occlusion and the ear canal movement were found to have a strong correlation. The average correlation coefficients consistently exceeded 0.89 for all subjects.
Purpose
To define the outcomes of our original simple chordal replacement technique using ePTFE sutures for mitral regurgitation.
Methods
Between January, 2004 and March, 2014, 38 patients underwent ...mitral valve repair using our chordal replacement technique for anterior leaflet prolapse. The mitral regurgitation was caused by degenerative disease in 34 patients and infective endocarditis in 4 patients.
Results
The follow-up period was 66 ± 37 months and the 5-year survival rate was 95 ± 4%. Two patients had recurrent mitral regurgitation, caused by degenerative change not associated with the procedure. The 5-year rate of freedom from recurrent mitral regurgitation was 94 ± 4%. In the late postoperative period, 15 (42%) patients had a mean pressure gradient > 5 mmHg. Stepwise logistic regression analysis showed that the use of a full ring (odds ratio 8.9; 95% confidence interval 1.2–64;
p
= 0.031) and a 26 mm annuloplasty (odds ratio 7.5; 95% confidence interval 1.1–50;
p
= 0.037) were significant independent risk factors for a mean pressure gradient > 5 mmHg.
Conclusion
The intermediate-term outcomes of our original chordal replacement technique were not inferior to those in previous reports, although a 26 mm annuloplasty was found to be associated with a higher mitral valve gradient at rest.
Although the thermal environment of buildings with thermally complex building envelopes can be predicted, comprehensive guidelines are not available for designers to implement the thermal-environment ...analysis. Therefore, this study examines the application scope of advanced thermal-analysis methods from the designers’ perspective. The results of the simple model were consistent with the experimental values, with an error of approximately 0.5°C. The analytically determined convective heat-transfer-coefficient values were within 0.3–0.5°W・m2K, and the difference in the predicted values between the results of the simplified and detailed models was minor. The convective heat transfer coefficient calculated using the reference temperature defined at the dimensionless distance y+ was more accurate than that was obtained using the general energy simulation incorporating the boundary-layer theory. Although the simplified advection rate had a maximum error of approximately 150 m3/h, it was considered acceptable. The differences amongst the zones were less than 0.59°C, which is considered minor. The results obtained by using summer advection were sufficiently accurate. Furthermore, the dew-point temperature was used to evaluate the risk of dew condensation. Specifically, the results indicated that the introduction of outside air increased the risk of condensation on the floor.
Highlights ► Epileptic discharges (EDs) in superficial layers were induced with penicillin G. ► Focal brain cooling preferentially terminated the faster frequency components of EDs. ► Frequency ...analysis demonstrated that cooling below 25 °C may be an effective treatment for epilepsy.
The timing of operation for severe chronic and asymptomatic aortic regurgitation remains problematic, though the present trend is to prefer early surgery. In this article, we review recent reports, ...mainly published after 2006, regarding indications for surgical treatment for pure chronic AR.
Abstract Background Restrictive mitral annuloplasty (RMA) can reverse left ventricular (LV) remodeling and reduce plasma B-type natriuretic peptide (BNP), a surrogate biomarker of heart failure. ...However, the relationship between reverse LV remodeling and plasma BNP changes after RMA is poorly defined. We explored the main hemodynamic factors contributing to change in plasma BNP after RMA in patients with functional mitral regurgitation (MR). Methods Twenty-four patients with moderate to severe functional MR secondary to LV systolic dysfunction ejection fraction (EF) <40% underwent 64-row multidetector computed tomography (MDCT) before and 1.4 months after RMA. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), LVEF, and regional and global end-systolic wall stress (ESS) were calculated from 3-dimensional MDCT images, with blood samples for plasma BNP measurement collected the same day. Results After RMA, LV volumes and global ESS were decreased, while LVEF improved (all p < 0.01). There were significant correlations between changes in LVEDVI and LVESVI ( r = 0.90, p < 0.0001), LVESVI and global ESS ( r = 0.54, p = 0.006), and global ESS and LVEF ( r = −0.60, p = 0.002). The median value for the plasma BNP also decreased from 597 pg/ml interquartile range (IQR), 360–934 pg/ml to 207 pg/ml (IQR, 124–271 pg/ml), in association with changes in LVEDVI ( r = 0.47, p = 0.019), LVESVI ( r = 0.56, p = 0.004), LVEF ( r = −0.60, p = 0.002), and global ESS ( r = 0.74, p < 0.0001). Multivariate regression analysis showed that global ESS change was the strongest contributor to change in natural-log-transformed plasma BNP (standardized partial regression coefficient = 0.59, p = 0.004), indicating a strong association between decrease in LV afterload and reduction in plasma BNP level after RMA. Conclusions There may be a significant association between LV reverse remodeling and plasma BNP change after RMA. Furthermore, LV end-systolic myocardial stress may be the key mechanical stimulus influencing plasma BNP after surgical correction for functional MR. Whether these favorable BNP responses and reverse remodeling can predict improved survival requires further study.
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