It is unclear whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) differ in their effectiveness for preventing hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).
...This retrospective cohort study analyzed an international consortium that encompassed 19 centers from 6 countries or regions composed of previously untreated CHB patients then treated with either ETV or TDF monotherapy. Those who developed HCC before antiviral treatment or within 1 year of therapy were excluded. The association between antiviral regimen and HCC risk was evaluated using competing-risk survival regression. We also applied propensity score matching (PSM) to 1:1 balance the 2 treatment cohorts. A total of 5,537 patients were eligible (n = 4,837 received ETV and n = 700 received TDF) and observed for HCC occurrence until December 23, 2018. Before PSM, the TDF cohort was significantly younger and had generally less advanced diseases.
In the unadjusted analysis, TDF was associated with a lower risk of HCC (subdistribution hazard ratio SHR, 0.45; 95% confidence interval CI, 0.26-0.79; P = 0.005). The multivariable analysis, however, found that the association between TDF and HCC no longer existed (SHR, 0.81; 95% CI, 0.42-1.56; P = 0.52) after adjustment for age, sex, country, albumin, platelet, α-fetoprotein, cirrhosis, and diabetes mellitus. Furthermore, the PSM analysis (n = 1,040) found no between-cohort differences in HCC incidences (P = 0.51) and no association between regimens (TDF or ETV) and HCC risk in the multivariable-adjusted analysis (adjusted SHR, 0.89; 95% CI, 0.41-1.92; P = 0.77).
TDF and ETV did not significantly differ in the prevention of HCC in patients with CHB.
Owing to recent advances in early reperfusion strategies, pharmacological therapy, standardized care, and the identification of vulnerable patient subsets, the prognosis of acute myocardial ...infarction has improved. However, there is still considerable room for improvement. This review article summarizes the latest evidence concerning clinical diagnosis and treatment of acute myocardial infarction.
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•With advances in diagnosis and treatment, the prognosis of acute myocardial infarction (MI) has improved.•However, there is still considerable room for further improvement.•The current review paper provides the latest evidence in the field of acute MI.
Since optical coherence tomography (OCT) was first performed in humans two decades ago, this imaging modality has been widely adopted in research on coronary atherosclerosis and adopted clinically ...for the optimization of percutaneous coronary intervention. In the past 10 years, substantial advances have been made in the understanding of in vivo vascular biology using OCT. Identification by OCT of culprit plaque pathology could potentially lead to a major shift in the management of patients with acute coronary syndromes. Detection by OCT of healed coronary plaque has been important in our understanding of the mechanisms involved in plaque destabilization and healing with the rapid progression of atherosclerosis. Accurate detection by OCT of sequelae from percutaneous coronary interventions that might be missed by angiography could improve clinical outcomes. In addition, OCT has become an essential diagnostic modality for myocardial infarction with non-obstructive coronary arteries. Insight into neoatherosclerosis from OCT could improve our understanding of the mechanisms of very late stent thrombosis. The appropriate use of OCT depends on accurate interpretation and understanding of the clinical significance of OCT findings. In this Review, we summarize the state of the art in cardiac OCT and facilitate the uniform use of this modality in coronary atherosclerosis. Contributions have been made by clinicians and investigators worldwide with extensive experience in OCT, with the aim that this document will serve as a standard reference for future research and clinical application.
Understanding electrochemical behavior of the alkaline metal cation–graphene interface in electrolyte is essential for understanding the fundamental electrochemical interface and development of ...graphene-based technologies. However, most studies have been mainly conducted based on typical electrochemical analysis and computational evaluation, and the fundamental properties of both cations and graphene at the electrified interface by the experimental approach still remain poorly understood. Here, we report comprehensive analysis of the electrochemical behavior of both alkaline metal cations and graphene using electrochemical surface X-ray diffraction (EC-SXRD) and Raman (EC-Raman) spectroscopic techniques in which the interfacial structure of cations and the charging state and mechanical strain of the graphene can be elucidated. EC-SXRD and cyclic voltammetry demonstrated electrochemically driven specific adsorption and desorption of cations on the graphene surface involved in the dehydration and hydration process. Under the cation adsorption condition, EC-Raman spectroscopy revealed that graphene becomes a highly electron doped state with lattice expansion, which is a similar feature of the potassium–graphite intercalation compound. This study provides new insight for understanding fundamental electrochemical behavior of the alkaline metal cation–graphene interface and contributes to the development of carbon-based novel applications.
Background
Late-onset biliary complications (LBC) after pancreatoduodenectomy (PD) can be serious. This study aimed to clarify the frequency and risk factors of severe LBC after PD.
Methods
We ...defined LBC as biliary complications occurring 3 months after PD and severe LBC as cases that required intensive care. A total of 318 patients who underwent PD between 2010 and 2018 with at least 1 year of postoperative follow-up were evaluated.
Results
Hospitalization for severe LBC was required in 59 patients (19%), of whom 20 had liver abscesses (6.3%); 18, acute cholangitis (5.7%); 12, biliary stones (3.8%); and 21, biliary strictures (6.6%). Interventional radiological or endoscopic treatment was required in 32 patients (10%), of whom 9 had a benign primary disease with biliary stones and/or strictures. Thirteen of the remaining 23 patients with a malignant primary disease had liver abscesses and cholangitis. Significant independent risk factors for severe LBC in patients with malignant primary disease were recurrence around the hepaticojejunostomy (odds ratio 6.5,
P
= 0.013) and chemotherapy (odds ratio 13.5,
P
< 0.001).
Conclusions
Severe LBC after PD may occur regardless of whether the primary disease is benign or malignant. The course of severe LBC differs according to the primary disease, and therefore, appropriate follow-up and optimal treatment should be recommended according to the condition of the patient and the disease state.
Metal-free carbonaceous catalysts have potential applications for oxygen evolution reaction (OER) devices because of their low-cost and abundant supply. We report that fluorine-doped carbon black is ...an active catalyst for OER. Fluorine-doped carbon black (F-KB) is simply synthesized by the pyrolysis of KETJENBLACK (KB) as carbon substrate with Nafion as fluorine precursor. As a result, the OER activity of F-KB is significantly higher than that of pristine KB in alkaline media. The OER catalytic activity of F-KB is found to be dependent on the quantity and characteristics of carbon-fluorine bonding (C-F) which can be controlled by the pyrolysis temperature. It is further found that the OER activity depends on the quantity of semi-ionic C-F bonds, but not covalent C-F bonds. This result proves the importance of carbon atoms with semi-ionic C-F bonds as the active sites for OER.
Fluorine-doped carbon has a higher electrocatalytic oxygen evolution activity than pristine carbon black in alkaline media. The activity of oxygen evolution and characteristics of carbon to fluorine bond are controlled by pyrolysis temperature of Nafion.
Objectives The aim of this study was to determine whether coronary high-intensity plaques (HIPs) visualized by noncontrast T1-weighted imaging can predict future coronary events. Background Coronary ...HIPs are associated with characteristics of vulnerable plaques, including positive remodeling, lower Hounsfield units, and ultrasound attenuation. However, it remains unclear whether the presence of HIPs is associated with increased risk for coronary events. Methods The signal intensity of coronary plaques was prospectively examined in 568 patients with suspected or known coronary artery disease (CAD) who underwent noncontrast T1-weighted imaging to determine the plaque-to-myocardium signal intensity ratio (PMR). Results During the follow-up period (median 55 months), coronary events were observed in 55 patients. Receiver-operating characteristic curve analysis identified a PMR of 1.4 as the optimal cutoff for predicting prognosis. Multivariate Cox regression analysis identified the presence of plaques with PMRs ≥1.4 as the significant independent predictor of coronary events (hazard ratio: 3.96; 95% confidence interval: 1.92 to 8.17; p < 0.001) compared with the presence of CAD (hazard ratio: 3.56; 95% confidence interval: 1.76 to 7.20; p < 0.001) and other traditional risk factors. Among the 4 groups based on PMR cutoff and the presence of CAD, coronary event–free survival was lowest in the group with PMRs ≥1.4 and CAD and highest in the group with PMRs <1.4 but no CAD. Importantly, the group with PMRs ≥1.4 and no CAD had an intermediate rate of coronary events, similar to the group with PMRs <1.4 and CAD. Conclusions HIPs identified in a noninvasive, quantitative manner are significantly associated with coronary events and may thus represent a novel predictive factor.
Electrochemical surface-enhanced Raman scattering measurements of single layer graphene provide unique information on resonant excitation induced by localized surface plasmons under controlled ...electron or hole doping. The highly confined electromagnetic field from the LSPs of the Au nanodimer structures prepared on defect-free graphene can generate holes and electrons of the electrochemical potentials beyond the limit of far-field light illumination. The electrochemical in situ SERS spectra prove nonzero wavevector excitation through the observation of normally forbidden Raman bands in graphene. The present findings point to a novel approach to breaking the limit of optoelectronic interactions and photochemical reactions of graphene and other semiconductors.
Since the treatment window of thrombolytic therapy for stroke is limited, new therapy remains to be developed. We have recently developed low-intensity pulsed ultrasound (LIPUS) therapy to improve ...cognitive dysfunction in mouse models of vascular dementia and Alzheimer's disease. Here, we further aimed to examine whether our LIPUS therapy improves neurological recovery from ischemic stroke, and if so, to elucidate the mechanisms involved. In a mouse model of middle cerebral artery occlusion (MCAO), we applied LIPUS (32 cycles, 193 mW/cm
) to the whole brain 3 times in the first week (days 1, 3, and 5) after MCAO. We evaluated neurological functions using behavioral tests and performed histological analyses. Furthermore, to elucidate how LIPUS works within the injured brain, we also tested the effects of LIPUS in endothelial nitric oxide synthase (eNOS)-deficient (eNOS
) mice. In wild-type mice, the LIPUS therapy markedly improved neurological functions in the tightrope and rotarod tests at 28 days after MCAO. Histological analyses showed that the LIPUS therapy significantly increased the numbers of CD31-positive blood vessels in the perifocal lesion and doublecortin (DCX)-positive neurons in the ischemic striatum, indicating the angio-neurogenesis effects of the therapy. Importantly, these beneficial effects of the LIPUS therapy were totally absent in eNOS
mice. No adverse effects of the LIPUS therapy were noted. These results indicate that the LIPUS therapy improves neurological functions after stroke through enhanced neuro-angiogenesis in mice in vivo in an eNOS-dependent manner, suggesting that it could a novel and non-invasive therapeutic option for stroke.
Background: With aging of the population, the economic burden associated with heart failure (HF) is expected to increase. However, little is known about the hospitalization costs associated with HF ...in Japan. Methods and Results: In this cross-sectional study, using data from The Japanese Registry of All Cardiac and Vascular Diseases (JROAD) and JROAD-Diagnosis Procedure Combination databases between 2012 and 2014, we evaluated hospitalization costs for acute cardiovascular diseases (CVDs), including HF. A total of $1,187 million/year (44% of the hospitalization costs for acute CVDs) was spent on patients with HF. We identified 273,865 patients with HF and the median cost per patient was $8,089 ($5,362–12,787) per episode. The top 1% of spenders accounted for 8% ($80 million/year), and the top 5% of spenders accounted for 22% ($229 million/year) of the entire cost associated with HF. The costs associated with HF for patients over 75 years of age accounted for 68% of the total cost. Conclusions: The costs associated with HF were higher than the hospitalization cost for any other acute CVD in Japan. Understanding how the total hospitalization cost is distributed may allow health providers to utilize limited resources more effectively for patients with HF.
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