A 63-year-old man was diagnosed with hypertrophic obstructive cardiomyopathy. Echocardiography revealed asymmetrical left ventricular hypertrophy, systolic anterior movement (SAM) of mitral leaflets ...causing an outflow tract pressure gradient of 52mmHg, and moderate mitral regurgitation (MR) directed posteriorly in the left atrium. Four years later, when the patient was admitted for mild congestive heart failure, SAM and left ventricular outflow obstruction were absent, and prolapse of the posterior mitral leaflet was causing anteriorly-directed severe MR. Rupture of the chordae tendineae was responsible for the mitral prolapse and for the abolition of the outflow obstruction.
The transition metal–benzene (1:1) complexes are synthesized by laser evaporation method followed by the size and structure selection with 2-m long electrostatic hexapole field. Electric dipole ...moments of half-sandwich type binary complexes for a series of the transition metals, i.e. Ti, V, Co, and Ni, with benzene molecule were determined by measuring the focusing curves, namely the dependence of the focused beam intensity upon the hexapole field strength. It is found that the dipole moments of Ti–C
6H
6 and V–C
6H
6 are larger than the ones of Co–C
6H
6 and Ni–C
6H
6. Such large dipole moments of Ti–C
6H
6 and V–C
6H
6 can be ascribed to the strong orbital interaction due to charge transfer between the metal atom and benzene molecule.
Hyperthyroidism has been recognised as the cause of secondary pulmonary hypertension (PH). However, several studies have reported that most PH cases due to hyperthyroidism are asymptomatic and not ...severe. Here, we report the case of a woman in her 30s with symptomatic and severe PH due to hyperthyroidism. She presented with a 2-month history of dyspnoea on exertion, palpitation and lower-extremity oedema. Echocardiography showed severe PH with estimated pulmonary arterial systolic pressure (ePASP) of 62 mm Hg. The diagnostic work-up showed severe PH due to hyperthyroidism. After treatment for hyperthyroidism, improvement of thyroid function contributed to a decrease in ePASP to 30 mm Hg. Similar to the present case, PH due to hyperthyroidism generally improves with the treatment of hyperthyroidism. Therefore, we must not overlook hyperthyroidism as a cause of PH and diagnose and start treatment for PH-causing hyperthyroidism at an early stage.
Introduction: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), is superior to enalapril for chronic heart failure (CHF) with reduced ejection fraction (EF). However, its ...efficacy and safety in older Japanese patients in clinical practice are poorly understood. We aimed to investigate the efficacy and safety of ARNI compared with angiotensin receptor blocker (ARB) in older patients with CHF in real-world clinical practice. In addition, nutritional status and body composition were investigated as essential indicators of efficacy.Methods: This retrospective single-center observational study enrolled 55 consecutive older patients (aged ≥75 years) with CHF who received ARNI (n = 27) or ARB (n = 28) therapy between October 2020 and March 2021. Blood samples were collected before (baseline) and 4, 12, and 24 weeks after ARNI or ARB therapy initiation. Furthermore, echocardiography was performed before (baseline) and 24 weeks after ARNI or ARB therapy initiation. The efficacy endpoints were changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, left ventricular EF, nutritional status, and body composition changes. The controlling nutritional status (CONUT) score and geriatric nutritional risk index were investigated as nutritional status indices. The safety endpoints were symptomatic hypotension, renal function exacerbation, and hyperkalemia in patients who continued ARNI or ARB therapy for >24 weeks without additional nonpharmacological treatment.Results: There were no significant changes in NT-proBNP levels and estimated glomerular filtration rates; however, there was a significant CONUT score improvement in the ARNI group (least-squares mean difference, −1.0; 95% confidence interval, −1.4 to −0.3; p = 0.04). The initial ARNI dose could not be uptitrated in five patients (19%) due to hypotension.Conclusions: ARNI exhibited significant improvement in the nutritional status in older patients with CHF compared with ARB. However, the ARNI dose should be adjusted according to the patient's blood pressure.
Dissociative adsorption of H
2 (D
2) on Au thin films grown on an Ir{1
1
1} surface has been studied with temperature-programmed desorption using a quadrupole mass spectrometer and nuclear reaction ...analysis. Thin Au{1
1
1} films are epitaxially grown on Ir{1
1
1}, as confirmed by low-energy electron diffraction and scanning tunneling microscopy. H
2 (D
2) was dissociatively adsorbed on these Au{1
1
1} films, although it is well known that Au surfaces are noble enough not to dissociate hydrogen molecules. We propose a model to explain the unexpected high reactivity of the thin Au{1
1
1} surface, where narrowing of the s-band is responsible. Moreover, we found that H (D) atoms can be confined into the interface between the Ir surface and the Au thin film. We demonstrate how reactive Au thin films grown on an Ir surface are, and also compare the Au films with Ag films grown on Ir in order to test the validity/generality of our proposed model.
The prognostic value of bone mineral content (BMC) for the clinical outcomes of patients with coronary artery disease (CAD) remains unknown. The present study evaluated the association between BMC ...index (BMCI) and cardiovascular events between January 2020 to June 2021, in consecutive patients (n = 257) with CAD undergoing percutaneous coronary intervention (PCI) at the Nagano Municipal Hospital. BMCI was measured using bioelectrical impedance analysis and calculated as the BMC divided by height squared. Patients were classified as low (<0.918) or high BMCI (≥0.918) groups according to the receiver operating characteristics curve analysis for the primary endpoint, major adverse cardiovascular events (MACE), including cardiovascular death, spontaneous myocardial infarction, stroke, and any revascularization. During a median follow-up of 744 days, the low BMCI group (n = 152) had an increased risk of MACE compared with the high group (n = 105) (19.7
6.7%,
= .004). A low BMCI was significantly associated with MACE in the multivariable Cox and the Inverse Probability of Treatment Weighting analyses (hazard ratio: 3.16, 95% confidence interval: 1.15-8.67,
= .025). In conclusion, among patients with CAD undergoing PCI, BMCI was a predictor for cardiovascular events. Further research is required to determine whether medical interventions for BMC can improve patient prognosis.
Objective Although lowering the low-density lipoprotein cholesterol (LDL-C) levels using statins can reduce cardiovascular risk, 70% of the cardiovascular risk remains despite treatment with statins. ...Several studies have shown that elevated triglyceride (TG)-rich lipoprotein is the primary therapeutic target for reducing the residual risk. However, conventional treatment with fibrates is frequently associated with adverse drug reactions, especially in patients with chronic kidney disease (CKD), and even with a reduction in TG. Pemafibrate is a novel selective peroxisome proliferator-activated receptor α modulator (SPPARMα) with fewer side effects and greater effectiveness that can overcome these challenges. We aimed to investigate the safety and efficacy of pemafibrate in patients with CKD and herein present a real-world profile of pemafibrate. Methods Between January 2019 and January 2020, 126 consecutive patients with hyperglyceridemia from two institutions (54 patients with CKD; 43%) who received pemafibrate were enrolled in this retrospective observational study. Blood samples were collected before (baseline) and at 24 weeks after commencing pemafibrate therapy. The primary endpoint was a decrease in the serum lipid levels. The secondary endpoints were the incidence of rhabdomyolysis, hepatargy, and an exacerbation of CKD. Results All patients, including 51% of patients who were concurrently taking statins, reported significantly reduced total cholesterol, non-high-density lipoprotein-cholesterol (non-HDL-C), LDL-C, and TG, and increased HDL-C (p<0.05). The subgroup of patients with CKD showed similar results without increased HDL-C. No adverse events were observed in any patients. Conclusion Pemafibrate has a good safety profile and efficacy for treating patients with serum lipid abnormalities, including those with CKD.
Aiming at artwork restoration application, to decolor the blue‐ink stained marble stone surface was studied for finding out efficient ablation conditions with the use of Q‐switched Nd:YAG laser as ...the function of laser flux power, wavelength, and its water spray effect. The blue ink mostly consists of indigo dye which absorbs light in the visible region. The decoloration, or decolor efficiency, was evaluated by using the grayscale representation instead of the RGB method. Our experimental results show that the 532 and 355 nm wavelengths are more suitable for blue‐ink decoloration. No decoloration was observed at the 1,064 nm ablation, which is usually regarded as effective on black‐crust stained surfaces. The decolor effect of the water‐sprayed surface was found to be effective at the higher laser flux power. A photo‐absorption‐assisted laser ablation mechanism is proposed in addition to the plasma‐assisted laser ablation mechanism.
The decolorization of the blue‐ink stained marble surface was investigated for efficient ablation as a function of flux, wavelength, and its water spray effect using a Q‐switched Nd:YAG laser with the goal of restoring artwork. The wavelengths of 532 and 355 nm are more suited for decolorizing blue ink. The water‐spray effect works fine even at higher fluxes.
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