Impact of the Clinical Frailty Scale on Long-term Outcomes After Transcatheter Aortic Valve Implantation.

BACKGROUND: The semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI. METHODS: We prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9. The patients were divided into the low (CFS level, 1-3; N = 842), intermediate (4; N = 469), and high (5-7; N = 283) groups according to their CFS levels. RESULTS: In the low, intermediate, and high groups, 3-year all-cause mortality rates were 17.4%, 29.4%, and 41.7% (P <0.001) and composite rates of cardiovascular mortality and heart failure hospitalization were 12.1%, 19.1%, and 23.9% (P <0.001), respectively. Multivariable analysis showed that higher frailty was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio [HR], 1.63, 95% confidence interval [CI], 1.24-2.15, P <0.001; high group: adjusted HR, 2.18, 95% CI, 1.59-2.99, P <0.001) and composite of cardiovascular mortality and heart failure hospitalization (intermediate group: adjusted HR, 1.47, 95% CI, 1.04-2.08, P = 0.030; high group: adjusted HR, 1.66, 95% CI, 1.09-2.51, P = 0.018) and this result was consistent, irrespective of stratification based on age, sex, body mass index, left ventricular ejection fraction, Society of Thoracic Surgeons score, and New York Heart Association functional class without significant interaction. CONCLUSIONS: The simple CFS tool predicts the long-term adverse outcomes post-TAVI.

Unusual optical coherence tomography findings resembling sea anemone tentacles after orbital atherectomy for nodular calcification lesions in a haemodialysis patient: a case report.

Background: Optical coherence tomography (OCT) can be used to characterize the details of calcified plaques because it allows high-resolution evaluation of coronary plaques, thrombi, and calcium. Case summary: A 72-year-old man on haemodialysis who had stenosis with a severe calcified lesion at the left anterior descending artery underwent percutaneous coronary intervention. Pre-intervention OCT imaging identified a nodular calcification (NC) that protruded into the lumen of the left anterior descending artery. To treat this lesion, we performed orbital atherectomy using the Diamondback 360 coronary orbital atherectomy system. After ablation of the nodular lesions at low and high speed, OCT showed newly emerged granular and filamentous structures that resembled sea anemone tentacles (these represented calcified nodule-like OCT findings). These structures appeared to extend from the proximal part of the ablated small NC, and shifted distally after balloon dilatation. Stent implantation was performed to entirely cover these structures, with no resulting complications. However, early in-stent restenosis occurred at 4 months follow-up. Discussion: A tentacle-like OCT appearance in calcified lesions has not been previously reported. This represents a very rare and interesting imaging finding that reflects the relationship and origins of NCs and calcified nodules. The maturity of the NC lesions and the lateral sanding style of the orbital atherectomy system may have contributed to this striking OCT finding.

Severe Aortic Regurgitation Due to Aortic Valve Injury During Percutaneous Coronary Intervention.

Iatrogenic acute aortic regurgitation (AR) is an uncommon condition, and its presentation as severe AR following coronary angiography or percutaneous coronary intervention (PCI) is exceedingly rare. We report a case of iatrogenic severe AR resulting from aortic valve injury caused by manipulation of the guiding catheter during PCI.

Who tailors the blanket?

The gap between the Markov blanket and ontological boundaries arises from the former's inability to capture the dynamic process through which biological and cognitive agents actively generate their own boundaries with the environment. Active inference in the free-energy principle (FEP) framework presupposes the existence of a Markov blanket, but it is not a process that actively generates the latter.

Functions of consciousness: conceptual clarification.

There are many theories of the functions of consciousness. How these theories relate to each other, how we should assess them, and whether any integration of them is possible are all issues that remain unclear. To contribute to a solution, this paper offers a conceptual framework to clarify the theories of the functions of consciousness. This framework consists of three dimensions: (i) target, (ii) explanatory order, and (iii) necessity/sufficiency. The first dimension, target, clarifies each theory in terms of the kind of consciousness it targets. The second dimension, explanatory order, clarifies each theory in terms of how it conceives of the explanatory relation between consciousness and function. The third dimension, necessity/sufficiency, clarifies each theory in terms of the necessity/sufficiency relation posited between consciousness and function. We demonstrate the usefulness of this framework by applying it to some existing scientific and philosophical theories of the functions of consciousness.

A new experimental phenomenological method to explore the subjective features of psychological phenomena: its application to binocular rivalry.

The subjective features of psychological phenomena have been studied intensively in experimental science in recent years. Although various methods have been proposed to identify subjective features of psychological phenomena, there are elusive subjective features such as the spatiotemporal structure of experience, which are difficult to capture without some additional methodological tools. We propose a new experimental method to address this challenge, which we call the contrast-based experimental phenomenological method (CEP). CEP proceeds in four steps: (i) front-loading phenomenology, (ii) online second-personal interview, (iii) questionnaire survey, and (iv) hypotheses testing. It differs from other experimental phenomenological methods in that it takes advantage of phenomenal contrasts in collecting phenomenological data. In this paper, we verify the validity and productivity of this method by applying it to binocular rivalry (BR). The study contributes to empirical research on BR in three respects. First, it provides additional evidence for existing propositions about the subjective features of BR: e.g. the proposition that the temporal dynamics of the experience depend upon subject-dependent parameters such as attentional change. Second, it deepens our understanding of the spatiotemporal structures of the transition phase of BR. Third, it elicits new research questions about depth experience and individual differences in BR. The presence of such contributions demonstrates the validity and productivity of CEP.

Development and characterization of a new rice cultivar, 'Chikushi-kona 85', derived from a starch-branching enzyme IIb-deficient mutant line.

A new super-hard rice cultivar, 'Chikushi-kona 85', which was derived from a cross between 'Fukei 2032' and 'EM129', was developed via bulk method breeding. 'Chikushi-kona 85' showed a higher content of resistant starch than the normal non-glutinous rice cultivar, 'Nishihomare', and a higher grain yield than the first super-hard rice cultivar, 'EM10'. The amylopectin chain length of 'Chikushi-kona 85' and its progenitor line 'EM129' was longer than that of 'Nishihomare', and was similar to that of 'EM10'. This suggests that the starch property of 'Chikushi-kona 85' was inherited from 'EM129', which is a mutant line deficient in a starch branching enzyme similar to 'EM10'. Genetic analysis of 'Chikushi-kona 85' crossed with 'Nishihomare' also showed that the starch property of 'Chikushi-kona 85' was regulated by a single recessive gene. Consumption of processed cookies made from 'Chikushi-kona 85' flour showed a distinctive effect in controlling blood sugar levels in comparison to the normal non-glutinous rice cultivar 'Hinohikari'. These results show that 'Chikushi-kona 85' is a novel genetic source to develop new products made of rice, which could reduce calorie intake and contribute to additional health benefits.

Detection and validation of QTLs for milky-white grains caused by high temperature during the ripening period in Japonica rice.

The occurrence of chalky rice (Oryza sativa L.) grains caused by high temperature is a serious problem in rice production. Of the several kinds of chalky grains, milky-white grains are not well analyzed. The milky-white rice grain phenomenon is caused by genetic factors as well as environmental and nutritional conditions. To analyze the genetic control system for rice grain quality, we raised recombinant inbred lines from progeny produced from 'Tsukushiroman' (high temperature sensitive) and 'Chikushi 52' (high temperature tolerant) cultivars. Quantitative trait locus (QTL) analysis revealed that the QTL on chromosome 4, linked to the simple sequence repeat marker RM16424, contributed substantially to the occurrence of milky-white grains, as it was detected over two experimental years. To validate the effect of the QTL, we developed near isogenic lines that have the 'Chikushi 52' segment on the short arm of chromosome 4 in the 'Tsukushiroman' genetic background, and that had a lower milky-white grain ratio than that of 'Tsukushiroman' when exposed to high temperatures during the ripening period. These results suggest that the 'Chikushi 52' allele on chromosome 4 suppresses the occurrence of milky-white grains and improves rice grain quality under heat stress during the grain ripening period.

Detection of QTLs for white-back and basal-white grains caused by high temperature during ripening period in japonica rice.

There is increasing evidence that global warming affects the development of rice. High temperatures during ripening increase the ratio of undesirable chalky grains followed by deteriorating grain appearance quality. In order to detect quantitative trait loci (QTLs) controlling the occurrence of white-back and basal-white chalky grains of brown rice, QTL analysis was performed using recombinant inbred lines derived from a cross between two strains, 'Tsukushiroman' (sensitive to heat stress) and 'Chikushi 52' (tolerant of heat stress). The F7 and F8 lines were exposed to heat stress during the ripening period in two locations, Fukuoka and Kagoshima, in Japan. QTLs for white-back grains and basal-white grains were detected on chromosomes 1, 3, and 8, and those for basal-white grains were detected on chromosomes 2, 3, and 12. QTLs on chromosome 8 for white-back grains were shared in the plants grown in both locations. Near-isogenic lines (NILs), which harbored a segment from 'Chikushi 52' on chromosome 8 with the genetic background of 'Tsukushiroman', showed relatively lower ratios of white-back grains than 'Tsukushiroman'. Therefore, insertion of the 'Chikushi 52' genomic region of the QTL on chromosome 8 can improve the quality of rice when it is grown under heat stress conditions.

Generation and properties of ascorbic acid-overproducing transgenic tobacco cells expressing sense RNA for l-galactono-1,4-lactone dehydrogenase.

L-Galactono-1,4-lactone dehydrogenase (GalLDH; EC 1.3.2.3) is the last enzyme in the putative L-ascorbic acid (AsA) biosynthetic pathway of plants. Here, we show for the first time that the overexpression of GalLDH can increase AsA content in tobacco (Nicotiana tabacum L.) BY-2 cells. To see the effect, we analyzed the properties of these AsA-overproducing transgenic cell lines, especially in relation to AsA content of cells, cell division, senescence and resistance to oxidative stress. The mitotic index in AsA-overproducing cells was higher than in wild-type cells. Moreover, the browning of these cells was markedly restrained, and the proportion of dead cells was reduced, especially in the later period of culture. These AsA-overproducing cells also acquired resistance to paraquat (methyl viologen), which produces active oxygen species. These results contribute to the previous insights about AsA and raise the possibility of the generation of plants that have resistance to environmental stresses by increasing their AsA content.