Prognostic Impact of No-Flow Time on 30-Day Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Who Received Extracorporeal Cardiopulmonary Resuscitation.

BACKGROUND: How the time sequence of cardiopulmonary resuscitation (CPR) procedures is related to clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. This study examined the impact of the time interval from collapse to start of CPR (no-flow time, NF time) and the time interval from start of CPR to implementation of extracorporeal CPR (ECPR) (low-flow time, LF time) on neurological outcomes.Methods and Results:During the period from 2010 to 2015, we enrolled 85 patients who received ECPR. Fourteen patients (16.5%) showed favorable 30-day neurological recovery. NF time was shorter in the favorable neurological recovery group than in the unfavorable recovery group (1.4±3.0 vs. 5.2±5.8 min, P<0.05), though combined NF+LF times were similar in the 2 groups (50.1±13.2 vs. 55.1±14.8 min, P=0.25). Multivariate logistic regression analysis indicated that pupil diameter at arrival and NF time were independently associated with favorable neurological recovery. The optimal cut-off value of NF time to predict favorable neurological recovery was 5 min (area under curve: 0.70, P<0.05; sensitivity, 85.7%; specificity, 52.1%). CONCLUSIONS: The results suggest that NF time is a better predictor than NF+LF time for neurological outcomes in OHCA patients who received ECPR, and that start of CPR within 5 min after collapse is crucial for improving neurological outcomes followed by use of ECPR.

Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function.

Which combination of clinical parameters improves the prediction of prognosis in patients with pulmonary arterial hypertension (PAH) remains unclear. We examined whether combined assessment of pulmonary vascular resistance and right ventricular function by echocardiography is useful for classifying risks in PAH. In 41 consecutive patients with PAH (mean age of 48.9 ± 17.3 years, 31 females), a 6-min walk test, pulmonary function test, and echocardiography were performed at baseline and during PAH-specific therapies. The study endpoint was defined as a composite of cardiovascular death and hospitalization for PAH and/or right ventricular failure. During a follow-up period of 9.2 ± 8.7 months, 18 patients reached the endpoint. Multivariate regression analysis showed that the ratio of tricuspid regurgitation pressure gradient to the time-velocity integral of the right ventricular outflow tract (TRPG/TVI) and tricuspid annular plane systolic excursion (TAPSE) during PAH-specific treatment were independent prognostic predictors of the endpoint. Using cutoff values indicated by receiver operating characteristic analysis, the patients were divided into four subsets. Multivariate analyses by Cox's proportional hazards model adjusted for age, sex and body mass index indicated that subset 4 (TRPG/TVI ≥ 3.89 and TAPSE ≤ 18.9 mm) had a significantly higher event risk than did subset 1 (TRPG/TVI < 3.89 and TAPSE > 18.9 mm): HR = 25.49, 95% CI 4.70-476.97, p < 0.0001. Combined assessment of TRPG/TVI and TAPSE during adequate PAH-specific therapies enables classification of risks for death and/or progressive right heart failure in PAH.

Successful Transcatheter Diagnosis and Medical Treatment of Right Atrial Involvement in IgG4-related Disease.

IgG4-related disease (IgG4-RD) is a fibro-inflammatory disorder characterized by lymphoplasmacytic infiltration of numerous IgG4-positive plasma cells, leading to fibrous thickening in the affected tissue. Typical cardiovascular manifestations of IgG4-RD are periaortitis, coronary arteritis, and pericarditis. Rare cases of myocardial involvement in IgG4-RD have been reported, but surgical resection or open biopsy was required for the diagnosis in those cases. Here, we report a case in which percutaneous transcatheter biopsy under the guidance of intracardiac echocardiography was useful for diagnosis of IgG4-RD manifested as an intracavitary right atrial mass, extending into the superior vena cava. Successful transcatheter diagnosis of myocardial involvement of IgG4-RD led to immediate favorable response to steroid therapy. Including the present case, previous IgG4-RD cases with myocardial involvement are reviewed to delineate its clinical characteristics.

Local Production of Fatty Acid-Binding Protein 4 in Epicardial/Perivascular Fat and Macrophages Is Linked to Coronary Atherosclerosis.

OBJECTIVE: Fatty acid-binding protein 4 (FABP4) is expressed in adipocytes and macrophages, and elevated circulating FABP4 level is associated with obesity-mediated metabolic phenotype. We systematically investigated roles of FABP4 in the development of coronary artery atherosclerosis. APPROACH AND RESULTS: First, by immunohistochemical analyses, we found that FABP4 was expressed in macrophages within coronary atherosclerotic plaques and epicardial/perivascular fat in autopsy cases and macrophages within thrombi covering ruptured coronary plaques in thrombectomy samples from patients with acute myocardial infarction. Second, we confirmed that FABP4 was secreted from macrophages and adipocytes cultured in vitro. Third, we investigated the effect of exogenous FABP4 on macrophages and human coronary artery-derived smooth muscle cells and endothelial cells in vitro. Treatment of the cells with recombinant FABP4 significantly increased gene expression of inflammatory markers in a dose-dependent manner. Finally, we measured serum FABP4 level in the aortic root (Ao-FABP4) and coronary sinus (CS-FABP4) of 34 patients with suspected or known coronary artery disease. Coronary stenosis score assessed by the modified Gensini score was weakly correlated with CS-FABP4 but was not correlated with Ao-FABP4. A stronger correlation (r=0.59, P<0.01) was observed for the relationship between coronary stenosis score and coronary veno-arterial difference in FABP4 level, (CS-Ao)-FABP4, indicating local production of FABP4 during coronary circulation in the heart. Multivariate analysis indicated that (CS-Ao)-FABP4 was an independent predictor of the severity of coronary stenosis after adjustment of conventional risk factors. CONCLUSIONS: FABP4 locally produced by epicardial/perivascular fat and macrophages in vascular plaques contributes to the development of coronary atherosclerosis.

Phthalimide Compounds Containing a Trifluoromethylphenyl Group and Electron-Donating Aryl Groups: Color-Tuning and Enhancement of Triboluminescence.

Trifluoromethylphenyl-substituted phthalimide derivatives favorably form triboluminescence (TL) active noncentrosymmetric crystals. Oligothienyl-, oligophenyl-, and naphthyl-substituted phthalimide derivatives were successfully developed as a series of metal free TL compounds. X-ray crystal structure analyses of bithienyl and naphthyl derivatives revealed noncentrosymmetric layer structures in the same direction. Introduction of suitable electron rich π-units such as thienyl groups enhances their photoluminescence and TL characteristics, and the colors can be also controlled in the visible region. A rigid naphthyl-substituted imide derivative exhibits extremely high TL performance.

π-Extended Pentalenes: The Revival of the Old Compound from New Standpoints.

Polycyclic conjugated systems bearing carbocyclic five-membered rings have attracted much attention due to their novel electronic properties and utility in organic electronic devices. Despite possessing a 4nπ electron periphery, dibenzopentalenes have a planar structure and are fairly stable. Thus, appropriate modifications should provide desirable electronic properties. Recently, we have discovered novel Ni-catalyzed coupling reactions that constitute a versatile new route to dibenzopentalene derivatives from readily available o-bromoethynylbenzenes. Moreover, we developed another dibenzopentalene synthesis using indenone derivatives as important intermediates. These methods are applicable to π-extended pentalene derivatives possessing various functional groups and aromatic ring systems. Among them, a dinaphthylpentalene derivative shows a high hole mobility (1.8 × 10(-3) cm(2) V(-1) s(-1) ) for an amorphous material. Furthermore, this is the first pentalene derivative that can be employed as a p-type material for organic heterojunction photovoltaic cells (PCE = 0.94%, V(OC) = 0.96 V) and as organic thin-film semiconductors.

"Ballooning" patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study.

Whether different patterns of ventricular ballooning in takotsubo cardiomyopathy (TCM) reflect differences in trigger mechanisms or clinical outcomes is unclear. Here we examined differences in the clinical characteristics of typical and atypical forms of TCM. TCM patients (n = 251) in the BOREAS Registry were enrolled for comparison of TCM with apical ballooning (type A, n = 217) and TCM with non-apical ballooning (type non-A, n = 34). The percentage of females was significantly lower in the type non-A group (58.8 vs. 75.6 %), while other demographic parameters and triggers of TCM were similar in the two groups. Rate of mid-ventricular obstruction (MVO) was lower (2.9 vs. 14.3 %) in the type non-A group than in the type A group, though left ventricular ejection fractions in the two groups were comparable. During a follow-up period of 2.6 ± 2.8 years, TCM recurred in 2.9 % of the patients and cardiac death occurred in 4.0 %. Cox proportional hazard analysis indicated that body mass index (hazard ratio [HR]: 0.75, 95 % confidence interval [CI] 0.54-0.99) and MVO (HR: 14.71, CI 1.87-304.66) were determinants of TCM recurrence and that advanced age (HR: 1.09, CI 1.02-1.17) and cardiogenic shock (HR: 4.27, CI 1.07-18.93) were significantly associated with cardiac death. In conclusion, approximately 20 % of TCM patients show non-apical left ventricular ballooning, and female sex and MVO are less frequent in this type than in apical ballooning type TCM. Low body mass index and MVO are risk factors of recurrence, and advanced age and cardiogenic shock are risk factors of cardiac death in TCM.

N-2,6-Di(isopropyl)phenyl-2-azaphenalenyl radical cations.

N-2,6-Di(isopropyl)phenyl-2-azaphenalenyl radical cations were obtained as a dark brown air-sensitive crystalline compound. The high HOMA values and the ACID calculation indicate relatively high aromatic character of a 5,8-di-tert-butyl derivative, and clean generation of a derivative without tert-butyl groups indicates that the di(isopropyl)phenyl group is sufficient for hampering the formation of the σ-dimer.

Beta-blockers and renin-angiotensin system inhibitors for Takotsubo syndrome recurrence: a network meta-analysis.

INTRODUCTION: Takotsubo syndrome (TTS) is an acute heart failure syndrome, featured by transient left ventricular systolic dysfunction. Recurrences of TTS are not infrequent and there is no standard preventive therapy. The aim of this study was to evaluate in a network meta-analysis if beta-blockers (BB) and ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs), in combination or not, can effectively prevent TTS recurrences. METHODS: We performed a systematic network meta-analysis, using MEDLINE/EMBASE and the Cochrane Central Register of Controlled Trials for clinical studies published between January 2010 and September 2022. We considered all those studies including patients receiving medical therapy with BB, ACEi/ARBs. The primary outcome was TTS recurrence. RESULTS: We identified 6 clinical studies encompassing a total of 3407 patients with TTS. At 40±10 months follow-up, TTS recurrence was reported in 160 (4.7%) out of 3407 patients. Mean age was 69.8±2 years and 394 patients (11.5%) out of 3407 were male. There were no differences in terms of TTS recurrence when comparing ACEi/ARBs versus control (OR 0.83; 95% CI 0.47 to 1.47, p=0.52); BB versus control (OR 1.01; 95% CI 0.63 to 1.61, p=0.96) and ACEi/ARBs versus BB (OR 0.88; 95% CI 0.51 to 1.53, p=0.65).Combination of BB and ACEi/ARBs was also not effective in reducing the risk of recurrence versus control (OR 0.91; 95% CI 0.58 to 1.43, p=0.68) vs ACEi/ARBs (OR 0.79; 95% CI 0.46 to 1.34, p=0.38)) and vs BB (OR 0.77; 95% CI 0.49 to 1.21, p=0.26). CONCLUSIONS: Our study did not find sufficient statistical evidence regarding combination therapy with BB and ACEi/ARBs in reduction of TTS recurrence.

Direct arylations for study of the air-stable P-heterocyclic biradical: from wide electronic tuning to characterization of the localized radicalic electrons.

We have developed methods for installing aryl substituents directly on the phosphino groups of the 1,3-diphosphacyclobutane-2,4-diyl system. The aryl substituents tuned the electronic and structural characteristics of the biradical unit both in solution and in the solid state. 1-tert-butyl-2,4-bis(2,4,6-tri-tert-butylphenyl)-1,3-diphosphacyclobuten-4-yl anion, prepared from phosphaalkyne (Mes*C≡P; Mes* = 2,4,6-tBu3C6H2) and t-butyllithium, was allowed to react with an electron-deficient N-heterocyclic reagent. The corresponding N-heteroaryl-substituted P-heterocyclic biradicals were produced via SNAr reactions. Biradicals bearing perfluorinated pyridyl substituents exhibited photoabsorption properties comparable to those of previously reported derivatives because the highest occupied and lowest unoccupied molecular orbit levels were reduced by a similar amount. In contrast, the triazine substituent reduced the band gap of the biradical unit, and the large red shift in the visible absorption and high oxidation potential were further tuned via subsequent SNAr and Negishi coupling reactions. The amino-substituted triazine structure provided a strongly electron-donating biradical chromophore, which produced unique p-type semiconducting behavior even though there was no obvious π-overlap in the crystalline state. The single-electron transfer reaction involving Mes*C≡P, phenyllithium, and iodine afforded 1,3-diphenyl-2,4-bis(2,4,6-tri-tert-butylphenyl)-1,3-diphosphacyclobutane-2,4-diyl via the intermediate P-heterocyclic monoradical. The tetraaryl-substituted symmetric biradical product was used to determine the electron density distribution from the X-ray diffraction data. The data show highly localized radicalic electrons around the skeletal carbon atoms, moderately polarized skeletal P-C bonds in the four-membered ring, and no covalent transannular interaction.

9,9-Bis[4-(N-aryl)phenyl]methylidene-xanthylidene Derivatives Displaying Mechano-, Crystallo-, and Thermochromism.

Tetraphenylethylene (TPE) derivatives bearing a xanthene moiety are of interest because they have novel optical properties. 9,9-Bis[4-(N,N-diphenylamino)phenyl] and 9,9-bis[4-(9-carbazolyl)-phenyl]methylidene-xanthylidenes 3 and 4 were synthesized using Suzuki-Miyaura coupling of 9,9-dibromomethylidene-xanthylidene with the corresponding boronic acids. Diphenylamino derivative 3 exhibits mechanochromism and mechanofluorochromism (MC and MFC) reflected in absorption and fluorescence color changes. In contrast, carbazolyl derivative 4 displays thermo- and crystallo-chromism in addition to MC and MFC in the solid state. Powder X-ray diffraction and single crystal X-ray crystallographic analysis reveal that the solid state photophysical properties of these substances are governed by conformational changes rather by the creation of planar π-conjugation extended geometries.

Synthesis, crystal structures, and properties of 6,12-diaryl-substituted indeno[1,2-b]fluorenes.

Fused polycyclic indeno[1,2-b]fluorene derivatives with aryl substituents at the 6,12-positions have been prepared as a potential antiaromatic 20π electronic system. They showed strong absorptions in the visible region and amphoteric redox properties. The quinoid-type molecular structures were revealed by X-ray crystal-structure analysis, which indicated that the bond lengths of the quinoid unit depend on the aryl substituents. Whereas nucleus-independent chemical shift NICS(1) calculations indicate the antiaromatic nature of the s-indacene core, they have higher stability than substituted acene derivatives. The derivatives with difluorophenyl or anthryl groups were stable in solution. Vapor-deposited thin films showed ambipolar carrier transportation in the field-effect transistor devices.

Delayed visceral bleeding from liver injury after cardiopulmonary resuscitation.

BACKGROUND: Visceral injury is a life-threatening complication of cardiopulmonary resuscitation (CPR); however, the clinical significance has been masked by the lethal outcome of out-of-hospital cardiac arrest (OHCA). OBJECTIVE: The objective is to share our experience of successful treatment of OHCA patients with serious, CPR-related visceral complications. CASE REPORTS: We report two cases of cardiac-origin OHCA with liver injury exacerbated by heparinization during mechanical circulatory support. Although both patients presented with delayed massive liver bleeding (intrahepatic or peritoneal) that compromised hemodynamic status, one patient was successfully treated by selective transcatheter arterial embolization and the other by a surgical procedure. CONCLUSION: Preventive measures such as careful CPR, as well as interventional or surgical repair after the early diagnosis of visceral injury, are required to improve the outcome in some cases of OHCA.

Reduction in GLP-1 secretory capacity may be a novel independent risk factor of coronary artery stenosis.

Multiple factors regulate glucagon-like peptide-1 (GLP-1) secretion, but a group of apparently healthy subjects showed blunted responses of GLP-1 secretion in our previous study. In this study, we examined whether the reduction in GLP-1 secretory capacity is associated with increased extent of coronary artery stenosis in non-diabetic patients. Non-diabetic patients who were admitted for coronary angiography without a history of coronary interventions were enrolled. Coronary artery stenosis was quantified by Gensini score (GS), and GS ≥ 10 was used as an outcome variable based on its predictive value for cardiovascular events. The patients (mean age, 66.5 ± 8.8 years; 71% males, n = 173) underwent oral 75 g-glucose tolerant tests for determination of glucose, insulin and active GLP-1 levels. The area under the curve of plasma active GLP-1 (AUC-GLP-1) was determined as an index of GLP-1 secretory capacity. AUC-GLP-1 was not correlated with fasting glucose, AUC-glucose, serum lipids or indices of insulin sensitivity. In multivariate logistic regression analysis for GS ≥ 10, AUC-GLP-1 < median, age and hypertension were selected as explanatory variables, though fasting GLP-1 level was not selected. The findings suggest that reduction in GLP-1 secretory capacity is a novel independent risk factor of coronary stenosis.

Synthesis and properties of terthiophene and bithiophene derivatives functionalized by BF2 chelation: a new type of electron acceptor based on quadrupolar structures.

Terthiophene and bithiophene derivatives functionalized by BF(2) chelation were synthesized as a new type of electron acceptor, and their properties were compared to those of bifuran and biphenyl derivatives. These new compounds are characterized by quadrupolar structures due to resonance contributors generated by BF(2) chelation. The bithiophene derivative has a strong quadrupolar character compared with the bifuran and biphenyl derivatives because their hydrolytic analyses indicated that the bithiophene moiety has a larger on-site Coulomb repulsion than the others. The terthiophene derivative has a smaller on-site Coulomb repulsion than the bithiophene derivative due to the addition of a thiophene spacer. These BF(2) complexes exhibit long-wavelength absorptions and according to measurements of ionization potentials and absorption edges they have energetically low-lying HOMOs and LUMOs. The crystal structure of the bithiophene derivative is of the herringbone type, with short F···S and F···C contacts affording dense crystal packing. n-Type semiconducting behaviour was observed in organic field-effect transistors based on these BF(2) complexes.

[Factors Affecting Nutrient Intake of Students after High School Graduation: Focusing on Changes in Diet and the Period of Solitary Living].

OBJECTIVES: In this study, we aim to establish supportive measures for sustaining a healthy diet in students and young adults after graduating from high school by examining possible factors leading to changes in their daily nutrient consumption. METHODS: A questionnaire survey was conducted among university, college, and vocational school students throughout the main island of Japan (total numbers of respondents with valid responses, 1,256) to evaluate their diets using a five-point scale. Two groups were selected based on the status of daily nutrient consumption. One group comprised 258 students who had maintained high nutrition scores (scored ≥ 4 points in all six primary food groups) since their third year in high school (maintained high-score group) and the other group comprised 250 students whose nutrition scores declined after high school (decreased-score group: scored high in the third year of high school but the scores decreased after admission to universities, colleges, and other institutes). By comparing these two groups, we investigated the possible factors affecting the decrease in nutrition scores. RESULTS: As the number of students in "the period of solitary living" and with the behavior of "skipping breakfast" increased, the proportion of students in the decreased-score group was found to increase. The eating behaviors that significantly differed between the students in the third year and those after graduating from high school were "skipping breakfast", "eating out", and "instant food intake" in the decreased-score group in both genders. CONCLUSION: Results of this study indicate that we must promote measures that address the factors affecting nutrition intake after high school graduation.

Anthraquinone derivatives affording n-type organic thin film transistors.

New anthraquinone derivatives were prepared and used as active layers of organic field-effect transistors (OFETs); these devices showed good n-type characteristics and the quinones were found to be useful for organic semiconductors in OFETs.

Massive cerebral embolism originated from ruptured infective mitral annular calcification in a chronic hemodialysis patient.

Infective endocarditis of mitral annular calcification (MAC) has been reported, however, little attention has been given to the possibility of cerebral-embolism based infective endocarditis of MAC. We report a chronic hemodialysis patient of massive cerebral embolism originated from ruptured infective MAC.

Highly Polarized Benzo[k]fluoranthene Imide Derivatives: Large Solvatofluorochromism, Dual Fluorescence and Aggregation Induced Emission Associated with Excited-State Intramolecular Charge Transfer.

The highly conjugated imides, 9-diphenyl-aminobenzo[k]fluoranthene imide and N-phenylcarbazo[2,3-k]fluoranthene imide, were produced by Buchwald-Hartwig reaction of N-octyl-9,10-dibromobenzo[k]fluoranthene imide with diphenylamine. In a similar manner, reaction of the N-ethylhexyl-9,10-dibromo derivative with carbazole leads to formation of 9-(N-carbazoyl)benzo[k]fluoranthene imide. All the benzo[k]fluoranthene imide (BFI) derivatives in solution show remarkable solvatofluorochromism. Diphenylamino and 9-(N-carbazoyl) derivatives, having twisted structures, exhibit fluorescence bands at short wavelengths in highly polar solvents, and they emit dual fluorescence in acetone. Moreover, the 9-(N-carbazoyl) derivative displays aggregation-induced emission in highly aqueous acetone solutions. The results of density functional theory calculations demonstrate that a considerable spatial separation exists between the HOMO and LUMO coefficients of the N-arylamine substituted BFIs. The results indicate that the ground-to-excited state transitions of these compounds have intramolecular charge transfer character.

Synthesis and Properties of a Decacyclene Monoimide and a Naphthalimide Derivative as Three-Dimensional Acceptor-Donor-Acceptor Systems.

A method involving the Diels-Alder (DA) cycloaddition of diacenaphtheno[1,2-b;1',2'-d]thiophenes (DATs) with N-alkylacenaphthylene-5,6-dicarboximides (AIs) was developed to synthesize decacyclene monoimides (DCMIs). The reactions generate the corresponding 1:2 adducts (BAIAs) as major products together with 1:1 adducts (the DCMIs). The molecular structure of BAIAb (N-octyl derivative) was unambiguously assigned as the bis-adduct having an endo,endo spatial disposition of the two acenaphthylene-5,6-dicarboximide moieties by using X-ray crystallographic analysis. Relative to the absorption spectrum of decacyclene triimide (DCTIa, N-2-ethylhexyl derivative), that of the analogous N-2-ethylhexyl-substituted monoadduct, DCMIa, is bathochromically shifted despite the fact that it possesses a less delocalized π-electron system. DCMIa does not fluoresce in various organic solvents, whereas DCTIa emits yellow fluorescence in CH2 Cl2 with a low quantum yield (ΦSN ). Moreover, DCMIa in CDCl3 displays concentration-dependent 1 H NMR spectroscopy behavior, which suggests that it self-aggregates with an association constant (Ka ) of (193±50) m-1 at 20 °C. Despite the presence of four bulky tert-butyl groups in DCMIa, its Ka value for aggregate formation is comparable to that of DCTIa [(495±42) m-1 ], which does not contain tert-butyl substituents. Spectroscopic studies with the bis-adduct BAIAa (N-2-ethylhexyl derivative) show that it displays remarkable solvatofluorochromism corresponding to an emission maximum shift (ΔλEM ) of 100 nm. The results of density functional theory calculations on BAIAc (N-methyl derivative) demonstrate that a considerable spatial separation exists between the HOMO and LUMO coefficient distributions, which indicates that the ground-to-excited state transition of the novel three-dimensional acceptor-donor-acceptor BAIAa system should have intramolecular charge-transfer character.