Outcomes of left bundle branch area pacing compared to His bundle pacing and right ventricular apical pacing in Japanese patients with bradycardia.

Background: His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) emerge as better alternatives to right ventricular apical pacing (RVAP) in patients with bradycardia requiring permanent cardiac pacing. We aimed to compare the clinical outcomes of LBBAP, HBP, and RVAP in Japanese patients with bradycardia. Methods: A total of 424 patients who underwent successful pacemaker implantation (HBP, n = 53; LBBAP, n = 75; and RVAP, n = 296) were retrospectively enrolled in this study. The primary study endpoint was the cumulative incidence of heart failure hospitalization (HFH) during the follow-up. Results: The success rate for implantation was higher in the LBBAP group than in the HBP group (94.9% and 81.5%, respectively). Capture threshold increase >1V during the follow-up occurred in the HBP and RVAP groups (9.4% and 5.1%, respectively), while it did not in the LBBAP group. The cumulative incidence of HFH was significantly lower in the LBBAP group than the RVAP (adjusted hazard ratio, 0.12 [95% confidence interval: 0.02-0.86]; p = .034); it did not differ between the HBP and RVAP groups (adjusted hazard ratio, 0.48 [95% confidence interval: 0.17-1.34]; p = .16). Advanced age, mean percent right ventricular pacing (per 10% increase), left ventricular ejection fraction <50%, and RVAP were associated with HFH. Conclusions: Compared to RVAP and HBP, LBBAP appeared more feasible and effective in patients with bradycardia requiring permanent cardiac pacing.

Chitosan Hydrogels Crosslinked with Oxidized Sucrose for Antimicrobial Applications.

Oxidized sucrose (OS) reacts with amino-group-containing polysaccharides, including chitosan, without catalyst, resulting in hydrogels entirely composed of carbohydrates. The presence of imine bonds with low structural stabilities and unreacted aldehydes in the structures of these hydrogels hinder their application as biomaterials. Therefore, herein, the chitosan hydrogels (CTSGs) obtained after the crosslinking of chitosan with OS were reduced using sodium borohydride to convert imine bonds to secondary amines and aldehydes to alcohols. The structures of CTSGs were comprehensively characterized using Fourier transform infrared and 13C nuclear magnetic resonance spectroscopies, and the results implied that the degree of crosslinking (CR) depended on the OS feed amount used during CTSG preparation. The properties of CTSGs were significantly dependent on CR; with an increase in CR, the thermal stabilities and dynamic moduli of CTSGs increased, whereas their swelling properties decreased. CTSGs exhibited antimicrobial properties against the gram-negative bacterium Escherichia coli, and their performances were also dependent on CR. The results indicated the potentials of CTSGs completely based on carbohydrates as antimicrobial hydrogels for various medical and pharmaceutical applications. We believe that this study will contribute to the development of hydrogels for application in the food, medical, and pharmaceutical fields.

Preparation and characterization of carboxymethylated Aureobasidium pullulans ß-(1 → 3, 1 → 6)-glucan and its in vitro antioxidant activity.

Aureobasidium pullulans ß-(1 â†’ 3, 1 â†’ 6)-glucan (APG) has a high degree of ß-(1 â†’ 6)-glucosyl branching and a regular triple helical structure similar to that of schizophyllan. In this study, APG was carboxymethylated to different degrees of substitution (DS = 0.51, 1.0, and 2.0, denoted CMAPG 1-3, respectively) using a heterogeneous reaction. With increasing DS, the triple-helix structure drastically decreased and converted to a random coil structure in CMAPG 3. Further, aqueous solutions of CMAPG changed from pseudoplastic fluids to perfect Newtonian liquids with increasing DS, indicating that the intra- and intermolecular hydrogen bonds had been cleaved by the substituents to form a random coil structure. In addition, APG and CMAPG solutions exhibited scavenging ability against hydroxyl, organic, and sulfate radicals. It was also found that the carboxymethylation of APG drastically enhanced the organic radical scavenging ability. On the basis of the relationship between the DS and radical scavenging ability of the CMAPG samples, we believe hydroxyl and organic radicals were preferably scavenged by the donation of hydrogen atoms from the glucose rings and the methylene moieties of the carboxymethyl groups, respectively. Considering the obtained results, CMAPG and APG are expected to have applications in pharmaceuticals, functional foods, and cosmetics as antioxidant polysaccharides.

Clinical outcome for heart failure hospitalizations in patients with leadless pacemaker.

Introduction: The long-term performance of leadless pacemaker (LPM) has not been well evaluated. Methods: Between September 2017 and January 2021, 929 consecutive patients who underwent pacemaker implantation were grouped according to the types of pacemakers: LPM (LPM group, n = 368) and conventional pacemaker (PM group, n = 561). Results: The median follow-up duration was 1.7 years (interquartile range 0.8-2.6 years). Hospitalization rate for heart failure in the LPM group was 9.3%, 15.6%, and 21.6% at 1, 2, 3 years, respectively. The LPM group had a significantly higher adjusted heart failure hospitalization risk than the PM group [hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.09-2.64, p = .01]. More patients with symptomatic bradycardia caused by sinus node dysfunction (SND) in the LPM group (n = 150) were admitted to the hospital for heart failure compared to those in the PM group (n = 219) (HR 2.02, 95%CI 1.04-3.90, p = .03), whereas no significant difference was observed between the two groups in the patients with bradycardia caused by atrial fibrillation (LPM group, n = 71; PM group, n = 18) or atrioventricular block (LPM group, n = 147; PM group, n = 324). Conclusions: Patients who received LPM implantation had greater hospitalization risk for heart failure, compared to those who received conventional pacemaker implantation. The increased risk was mainly attributed to patients with SND.

Cellulose/glucomannan blends prepared from aqueous sodium hydroxide solution and their practical use as food materials.

Aqueous sodium hydroxide solution is one of the simplest and most environmentally friendly solvents of cellulose. Regenerated cellulose/glucomannan blends were prepared from an aqueous sodium hydroxide solution, and the mechanical properties and structure of the blends were investigated. In addition, the noodle-shaped blends were sensory evaluated as food materials. The blends exhibited porous structures, which corresponded with high water and oil absorption. The strength and modulus of the blends were markedly low, probably due to the highly porous structure. The viscoelastic measurement indicated that cellulose and glucomannan existed in a rubbery state under wet conditions. The blends had a good oral sensation, probably derived from the remarkable porous structure, high water content, low strength and modulus, and rubbery state in wet conditions. The sensory evaluation suggested that the noodle-shaped blends can be used as a food material with a texture similar to capellini pasta.

The Anatomical Position of Graf's Standard Plane and Its Relationship With Pelvic Morphology: A Computed Tomography-Based Study.

Objective The Graf method is the most widely used ultrasonographic method for evaluating developmental dysplasia of the hip (DDH), and it relies on a set standard plane. However, no previous reports have discussed the detailed anatomical location of the plane. The aim of this study was to evaluate the exact anatomical position of Graf's standard plane in the pelvis and to ascertain the correlation between this position and pelvic morphology in children without abnormal pelvic morphology. Methods We retrospectively assessed the pelvic CT data of 32 children (64 hips) aged three to five years without abnormal pelvic morphology and measured the pelvic winging and acetabular anteversion and coverage. We defined the coronal plane that passed through the center of the bilateral femoral head as plane A. We determined that Graf's standard plane could be approximated by rotating plane A until the outer wall of the ilium was parallel to the sagittal plane, and we defined this as plane A'. AA' was defined as the angle from plane A to plane A' on the sagittal plane. The anterior rotational angle (clockwise, viewing from the right side) was measured as the positive AA'. Moreover, we measured the pelvic rotation, acetabular anteversion, and acetabular coverage and evaluated the correlation between AA' and these morphological parameters. Results The average AA' was -8.27° and AA' had a significant correlation with acetabular anteversion (Spearman's ρ=0.40**, p<0.01). Conclusions We found that Graf's standard plane, as determined by the CT scan, tilts slightly posteriorly. This information may be useful in improving the ease of ultrasonographic examination of DDH.

Detailed Structural Characterization of Oxidized Sucrose and Its Application in the Fully Carbohydrate-Based Preparation of a Hydrogel from Carboxymethyl Chitosan.

Oxidized sucrose (OS) is a bio-based cross-linking agent with excellent biological safety and environmental non-toxicity. However, the precise structure of OS has not been elucidated owing to its structural complexity and low purity. Accordingly, in this study, complete chemical shift assignments were performed by applying various nuclear magnetic resonance techniques, which permitted the structural and quantitative characterization of the two main OS products, each of which contained four aldehyde groups. In addition, we investigated the use of OS as a cross-linking agent in the preparation of a hydrogel from carboxymethyl chitosan (CMC), one of the most popular polysaccharides for use in biomedical applications. The primary amine groups of CMC were immediately cross-linked with the aldehyde groups of OS to form hydrogels without the requirement for a catalyst. It was found that the degree of cross-linking could be easily controlled by the feed amount of OS during CMC hydrogel preparation and the final cross-linking degree affected the thermal, swelling, and rheological properties of the obtained hydrogel. The results presented in this study are therefore expected to be applicable in the preparation of fully carbohydrate-based hydrogels for medical and pharmaceutical applications.

NMR and HPLC profiling of bee pollen products from different countries.

Bee pollen, a beehive product collected from flowers by honeybees, contains over 250 biological substances, and has attracted increasing attention as a functional food. However, commercial bee pollen products are often multifloral, and samples from different countries vary significantly. There is no universal standard for objective quality assessment of bee pollen based on its chemical composition. Here, we report metabolomic analysis of 11 bee pollen samples from Spain, China, and Australia for quality control. The characteristics of the samples depend on the sucrose, nucleoside, amino acid, and flavanol concentrations. Bee pollen samples from Spain and Australia had higher sucrose and adenosine concentrations, whereas those from China had higher trigonelline, uridine, and cytidine concentrations. Interestingly, acetic acid was only detected in samples from China. These components can be used to identify the country of origin. The obtained profiles of the samples will contribute to universal standard development for bee pollen products.

Optimization of the conditions for the immobilization of glycopolypeptides on hydrophobic silica particulates and simple purification of lectin using glycopolypeptide-immobilized particulates.

Glycopolypeptide-immobilized particulates exhibit high binding selectivities and affinities for several analytes. However, to date, the conditions for the synthesis of glycopolypeptide-immobilized particulates have not been optimized and the application of these particulates as carriers for affinity chromatography has not been reported. Accordingly, herein, as a model compound for determining the optimal conditions for the immobilization of an artificial glycopolymer on hexyl-containing hybrid silica particulates (HSPs), the glycopolypeptide poly [GlcNAcß1,4GlcNAc-ß-NHCO-(CH2)5NH-/CH3(CH2)9NH-/γ-PGA] (3) containing multivalent chitobiose moieties and multivalent decyl groups with a γ-polyglutamic acid backbone was synthesized. Immobilization of 3 on HSPs under each condition was evaluated by a lectin-binding assay using wheat germ (Triticum vulgaris) agglutinin (WGA), which is an N-acetylglucosamine-binding lectin. As a result, the optimal immobilization conditions for HSPs at 25 mg/mL were obtained at dimethyl sulfoxide (DMSO) concentration of reaction solvent in the range of 1(DMSO):9(water) to 4(DMSO):6(water) and a compound 3 concentration in the range of 125 nM-1250 nM. Furthermore, the influence of the alkyl group structure introduced into glycopolypeptide for imparting hydrophobicity to it on the immobilization of glycopolypeptide on HSPs was investigated. As a result of comparing three types, poly [GlcNAcß1,4GlcNAc-ß-NHCO-(CH2)5NH-/γ-PGA] (1) with no alkyl group, poly [GlcNAcß1,4GlcNAc-ß-NHCO-(CH2)5NH-/CH3(CH2)4NH-/γ-PGA] (2) with a pentyl group, and 3 with a decyl group, 3 showed the best immobilization efficiency on HSPs. Finally, 1 mg 3-immobilized HSPs prepared under the optimum conditions adsorbed approximately 7.5 µg WGA in a structure-specific manner. We also achieved a simple WGA purification from raw wheat germ extract as a practical example using 3-immobilized HSPs. We believe that in the future, these glycopolypeptide-immobilized particulates will be used not only for the purification of plant lectins, but also as specific adsorbents for various lectins-like substances such as in vivo lectins, pathogenic viruses, and toxin proteins.

Preparation and Enzyme Degradability of Spherical and Water-Absorbent Gels from Sodium Carboxymethyl Cellulose.

To synthesize a biodegradable alternative to spherical polyacrylic acid absorbent resin, spherical hydrogel particles were prepared from carboxymethyl cellulose (CMC) dissolved in an aqueous solution, using ethylene glycol diglycidyl ether (EGDE) as a crosslinking agent. The effect of varying the initial CMC concentration and feed amount of EGDE on the shape, water absorbency, water-holding capacity, and enzyme degradability of the resultant CMC hydrogels was determined. The reaction solution was poured into fluid paraffin, and spherical hydrogel particles were obtained via the shear force from stirring. The shape and diameter of the spherical hydrogel particles in the swollen state depended on the CMC concentration. The spherical hydrogel particles obtained by increasing the amount of EGDE resulted in a decrease in absorbency. Additionally, all the spherical hydrogel particles were degraded by cellulase. Thus, spherical biodegradable hydrogel particles were prepared from CMC, and the particle size and water absorption of the hydrogel could be controlled in the range of 5-18 mm and 30-90 g·g-1 in the swollen state, respectively. As an alternative to conventional superabsorbent polymers, the spherical CMC hydrogels are likely to be useful in industrial and agricultural applications.

Dramatically Increased Binding Constant of Water-Soluble Cyclodextrin Hyperbranched Polymers: Explored with Diffusion Ordered NMR Spectroscopy (DOSY).

We report that the polymerization of cyclodextrin (CD) with epichlorohydrin (ECH) dramatically increases the binding constant of CD to vanillin, from 55 to 8.4 × 103 M-1, by approximately 100 times, as determined by diffusion ordered spectroscopy (DOSY)-1H NMR. The binding constant increased with an increase of the ECH content of the polymer, although ECH polymers without CDs showed no affinity at all, suggesting that the hydrophobicity of the ECH network outside of CDs helps to enhance the binding. This increased binding constant allows CD-ECH polymers to increase the drug loading ratio, which may be one of the most critical issues for drug delivery systems.

Reinforcing Poly(methyl methacrylate) with Bacterial Cellulose Nanofibers Chemically Modified with Methacryolyl Groups.

Nanofibrillated bacterial cellulose (NFBC), a type of cellulose nanofiber biosynthesized by Gluconacetobacter sp., has extremely long (i.e., high-aspect-ratio) fibers that are expected to be useful as nanofillers for fiber-reinforced composite resins. In this study, we investigated a composite of NFBC and poly(methyl methacrylate) (PMMA), a highly transparent resin, with the aim of improving the mechanical properties of the latter. The abundant hydroxyl groups on the NFBC surface were silylated using 3-(methacryloyloxy)propyltrimethoxysilane (MPTMS), a silane coupling agent bearing a methacryloyl group as the organic functional group. The surface-modified NFBC was homogeneously dispersed in chloroform, mixed with neat PMMA, and converted into PMMA composites using a simple solvent-casting method. The tensile strength and Young's modulus of the composite increased by factors of 1.6 and 1.8, respectively, when only 0.10 wt% of the surface-modified NFBC was added, without sacrificing the maximum elongation rate. In addition, the composite maintained the high transparency of PMMA, highlighting that the addition of MPTMS-modified NFBC easily reinforce PMMA. Furthermore, interactions involving the organic functional groups of MPTMS were found to be very important for reinforcing PMMA.

Facile Post-Carboxymethylation of Cellulose Nanofiber Surfaces for Enhanced Water Dispersibility.

To improve the water dispersibility of cellulose nanofibers without deteriorating the physical properties, it is necessary to develop methods that can selectively modify fiber surfaces. Herein, the reaction conditions for carboxymethylation of the surface of nanofibrillated bacterial cellulose were optimized using chloroacetic acid as an etherification agent. Carboxymethylation in a high-concentration alkaline solution (>5 wt %) in the presence of isopropanol caused the mercerization and carboxymethylation of not only the nanofiber surface but also the cellulose crystals within the nanofiber, resulting in nanofiber swelling and an increase in fiber width. In contrast, with a dilute alkaline aqueous solution (3 wt %), the nanofiber surface was successfully carboxymethylated without changing the inner structure. Furthermore, the morphology was not affected by the carboxymethylation reaction, and no fiber swelling occurred under these reaction conditions. When the substitution reaction proceeded only on the nanofiber surface, the maximum degree of substitution (i.e., the average number of carboxymethyl groups substituted per anhydroglucose residue in cellulose) was 0.091. After surface modification, the nanofibers became more negatively charged, which improved the dispersibility in water through electrostatic repulsion, resulting in a drastic increase in the transparency of the nanofiber dispersion. This method provides a general approach for the surface modification of cellulose nanofibers to increase water dispersibility.

Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures　- Large-Scale Multicenter Analysis.

BACKGROUND: Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS: CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

[Familial Mediterranean Fever-Associated Lenticulostriate Artery Aneurysm Presenting with Intracranial Hemorrhage and Disappearing Spontaneously: A Case Report].

Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.

Nanofibrillated Bacterial Cellulose Modified with (3-Aminopropyl)trimethoxysilane under Aqueous Conditions: Applications to Poly(methyl methacrylate) Fiber-Reinforced Nanocomposites.

The development of eco-friendly fiber-reinforced composite resins is an important objective from an environmental perspective, and nanofibrillated bacterial cellulose (NFBC), with extremely long high-aspect-ratio fibers, is a filler material with high potential for use in such composite resins. In this study, we investigated chemical modification of the surfaces of NFBC fibers by coupling with (3-aminopropyl)trimethoxysilane and fabricated nanocomposite materials using the prepared surface-modified NFBC. The product prepared by the one-pot reaction of (3-aminopropyl)trimethoxysilane with NFBC microfibrils dispersed in aqueous acid retained the same nanofibril structure as the intact NFBC. The degree of molar substitution and the silicon states on the surface of the product depended on the NFBC/(3-aminopropyl)trimethoxysilane ratio. The thermal analysis revealed that the thermal degradation temperature of the products increases with an increase of degree of molar substitution. Highly transparent (78-89% at 600 nm) poly(methyl methacrylate)-based nanocomposites were prepared by solvent casting; the nanocomposite containing 1.0 wt % (3-aminopropyl)trimethoxysilylated NFBC was only 8% less transparent than neat poly(methyl methacrylate) at 600 nm. In addition, the tensile strength of the nanocomposite was more than twice that of neat poly(methyl methacrylate) when 1 wt % of the surface-modified NFBC was added. The surface-modified NFBC is expected to be a reinforcing nanofiber material that imparts excellent physical properties to fiber-reinforced resins.

Substituent distribution of propyl cellulose studied by nuclear magnetic resonance.

A series of propyl cellulose (PC) samples with different degrees of substitution (DS) ranging from 0.34 to 2.02 were prepared by a slurry method using propyl bromide as the etherification reagent. Two-dimensional nuclear magnetic resonance (NMR) studies were performed to identify the 1H and 13C chemical shifts of eight anhydroglucose units (AGUs) in PC chains including un-, 2-mono-, 3-mono-, 6-mono-, 2,3-di-, 2,6-di-, 3,6-di-, and 2,3,6-tri-substituted ones. In addition, the mole fractions (χ) of these AGUs in the studied PC samples and their changes with DS were determined from the quantitative 13C NMR spectra. The obtained χ-DS profiles were different from those of methyl and ethyl celluloses prepared by a similar slurry method, indicating that the molecular sizes of the substituent reagents utilized for cellulose ethers strongly affected their substituent distributions.

Solid-state relaxation NMR dataset for a water-soluble ß-(1→3, 1→6)-glucan from Aureobasidium pullulans and schizophyllan from Schizophyllum commune.

We report the solid-state nuclear magnetic resonance (NMR) relaxation dataset for a triple helix and a random structure of water-soluble Aureobasidium pullulans ß-(1→3, 1→6)-d-glucan (APG) and those of schizophyllan from Schizophyllum commune (SPG), obtained by the Bruker BioSpin 500 MHz NMR spectrometer. These data include solid-state proton spin-lattice relaxation in the rotating frame (T 1ρH) and 13C spin-lattice relaxation (T 1C) of these two ß-(1→3, 1→6)-glucans, which are related to the subject of article in International Journal of Biological Macromolecules, entitled "Characterization of the secondary structure and order-disorder transition of a ß-(1→3, 1→6)-glucan from Aureobasidium pullulans" [1]. Data can help to investigate the structural characterization of the structural polysaccharides.

Detailed Structural Analyses of Nanofibrillated Bacterial Cellulose and Its Application as Binder Material for a Display Device.

Nanofibrillated bacterial cellulose (NFBC) is produced by culturing a cellulose-producing bacterium under agitated aerobic conditions in a carboxymethylcellulose (CMC)-supplemented medium. Detailed structural analyses revealed that NFBC fiber widths varied with the degree of substitution of the CMC used, and zeta potential values decreased with the increment of CMC concentration in the medium. Transmission electron microscopy observation after immunostaining demonstrated that CMC molecules were present on the NFBC microfibril surfaces. We tested NFBC for utility as a binder for a display device that uses electrochromic (EC) material. Introduction of a quaternary ammonium group into the EC molecules enhanced their interactions with the negatively charged NFBC microfibrils. A casting process homogeneously adsorbed the EC molecules onto the surface of a transparent electrode with NFBC. A homogeneous color change was successfully observed upon applying an electric field, suggesting that NFBC could be used as a binder material for uniform surface adsorption.