Background: Factors influencing measurements and accurate evaluation of stent apposition by optical coherence tomography (OCT) are not established. Methods and Results: Phantom models of known ...luminal sizes and lengths were evaluated by OCT under various conditions and measurements were compared with actual values. Stents implanted into phantom models were examined by OCT to validate the measurement point on the stent strut surface for accurate evaluation of stent apposition. Strut thickness was measured at 3 points (midpoint, inner and outer surfaces of the stent shadow). The precision of OCT measurements of lumen diameter and area was satisfactory when the image wire was positioned in the center, but the error and deviation were unsatisfactory when the image wire was positioned eccentrically using a low frame acquisition rate. Longitudinal OCT measurements were close to actual values under all conditions examined. Measurements from the midpoint of the stent shadow to the adjacent vessel wall surface coincided with actual stent thickness. Conclusions: Significant measurement error can occur if the image wire is positioned eccentrically with a lower frame acquisition rate than specified by the manufacturer. To accurately evaluate stent apposition, the stent surface should be measured from the center of the stent reflection. (Circ J 2009; 73: 1841-1847)
We collected HbA1c values and patient clinical information in the Hamamatsu area to investigate the state of diabetic treatment in October 2012. Since that time, several new drugs have been ...introduced, and target HbA1c values have been proposed. For comparison with 2012 another investigation was performed in October 2019. Study 1: HbA1c in outpatients. In comparison to 2012, the average HbA1c in general clinics was 6.87 % higher, while that in specialized clinics and hospitals was 7.15 % lower. Study 2: Clinical information of type 2 diabetes patients with HbA1c ≥8 %. In comparison to 2012, the average age was 4 years older in general clinics and 2 years older in specialized clinics and hospitals. In both institutions BMI decreased with aging. Similarly to 2012, patients in the higher HbA1c group were younger and had higher BMI values. In specialized clinics and hospitals, insulin therapy decreased. In both institutions the prescription of sulfonylurea decreased. Therapy with dipeptidyl-peptidase 4 inhibitors, sodium/glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists increased in both institutions. These drug therapy changes can be expected to prevent vascular complications without increasing hypoglycemia or weight gain. The treatment of obese diabetes in younger patients, and the prevention of frailty in elderly patients are future issues.
Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting ...stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (
n
= 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %,
p
< 0.001) and obesity (47 vs. 38 %,
p
= 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl,
p
< 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %,
p
= 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions.
Background
An anaphylactoid purpura affects small capillaries in the skin and other organs. Although two cases of anaphylactoid purpura exacerbated by cellulitis have been reported in Japanese ...literatures, its prognosis remains still unclear. Because cellulitis exacerbates various cutaneous inflammations, it has been speculated that cellulitis might also exacerbate cutaneous inflammation, such as vasculitis.
Findings
In this article, we report that 78-year-old woman exhibited anaphylactoid purpura, following cellulitis. We also reviewed the literature concerning about this subject.
Conclusions
This type of anaphylactoid purpura is thought to have a favorable prognosis dependent on the treatment for cellulitis.
Indocyanine green (ICG) accumulates in hepatocellular carcinoma (HCC), and tumor fluorescence can be observed under irradiation with near infrared light (NIR). This study investigated the clinical ...utility of ICG fluorescence imaging during resection of pulmonary metastases of HCC.
From April 2010 to June 2018, six patients with suspected pulmonary metastasis of HCC were enrolled prospectively. Prior to surgery, all patients underwent the ICG hepatic function test following intravenous administration of ICG (0.5 mg/kg body weight). During surgery, metastatic HCC was identified by observation of ICG fluorescence, allowing assessment of the surgical margin. Tumor fluorescence was also evaluated on cut sections.
A total of 11 metastatic HCCs were resected in six patients at nine operations. Eight lesions were removed by wedge resection and 3 lesions were managed by lobectomy. During surgery, tumor fluorescence could be confirmed through the visceral pleura in 6 out of 7 lesions treated by wedge resection, while NIR irradiation was difficult for 1 lesion. For these 6 lesions, the median distance from the tumor to the visceral pleura and the median surgical margin were 0 mm (range, 0-2 mm) and 14 mm (range, 11-17 mm), respectively. When cut sections were examined, all tumors emitted fluorescence. All lesions were histologically confirmed to be metastatic HCC.
In patients with pulmonary metastasis of HCC, ICG fluorescence imaging is useful for identifying the tumor and securing its margin when the lesion is peripheral and wedge resection is planned.
An 89-year-old woman appeared to have acute coronary syndrome at the left main trunk (LMT) complicated with severe aortic stenosis, moderate-severe mitral regurgitation, depressed left ventricular ...(LV) function, and multivessel disease. Because of sustained hypotension even under intra-aortic balloon pumping support during emergency coronary angiograhy, we performed primary percutaneous coronary intervention solely for the LMT lesion using a bare metal stent, leading to recovery from the shock state. On the second hospital day, based on our heart-team consensus, we performed aortic valve replacement and coronary artery bypass grafting surgery, and added edge-to-edge repair (Alfieri stitch) of the mitral valve, resulting in complete revascularization and dramatically improved LV function.
Deep vein thrombosis (DVT) is a major cause of pulmonary thromboembolism and sudden death. Thus, it is important to consider the pathophysiology of DVT. Recently, iron has been reported to be ...associated with thrombotic diseases. Hence, in this study, we investigate the effects of dietary iron restriction on the process of thrombus resolution in a rat model of DVT.
We induced DVT in 8-week-old male Sprague-Dawley rats by performing ligations of their inferior venae cavae. The rats were then given either a normal diet (DVT group) or an iron-restricted diet (DVT+IR group). Thrombosed inferior venae cavae were harvested at 5 days after ligation.
The iron-restricted diet reduced venous thrombus size compared to the normal diet. Intrathrombotic collagen content was diminished in the DVT+IR group compared to the DVT group. In addition, intrathrombotic gene expression and the activity of matrix metalloproteinase-9 were increased in the DVT+IR group compared to the DVT group. Furthermore, the DVT+IR group had greater intrathrombotic neovascularization as well as higher gene expression levels of urokinase-type plasminogen activator and tissue-type plasminogen activator than the DVT group. The iron-restricted diet decreased intrathrombotic superoxide production compared to the normal diet.
These results suggest that dietary iron restriction affects the process of thrombus resolution in DVT.
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