Low Consultation Rate of General Population with Atrial Fibrillation.

In order to prevent ischemic stroke, it is important to identify and treat patients with atrial fibrillation (AF) who do not consult a doctor in a medical institution. The aim of this study was to determine the consultation rate at medical institutions for patients with AF in group medical examinations conducted in a city in western Japan. Of 6101 examinees of group medical examinations (40 years of age or older) conducted in Ibara City, Okayama Prefecture, Japan, from 2012 to 2014, 4338 participants (71.1%) who were evaluated by electrocardiogram (ECG) gave written informed consent and responded to surveys in the form of questionnaires through a personal interview conducted by nurses were included in the Ibara-AF study. A cumulative total of 82 subjects were diagnosed as having AF by ECG (prevalence of AF = 1.89%), and 51 individuals had AF during the three-year period.15 (29.4%) of the 51 patients with AF did not regularly visit medical institutions. Among them, 46.7% (n = 7) and 53.3% (n = 8) of the patients were symptomatic and asymptomatic, respectively, and 73.3% of the patients had a CHADS2 score of more than one point. There were no significant differences in patients' characteristics between regular and non-regular visit groups. In conclusion, about one-third of the patients with AF did not regularly see a doctor in a medical institution and most of them had a CHADS2 score of more than one point in a Japanese rural area. Educating the public about the risks of AF is required.

Dual antiplatelet therapy can be discontinued at three months after implantation of zotarolimus-eluting stent in patients with coronary artery disease.

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention increases the risk of bleeding. We studied the safety and clinical outcomes of switching from DAPT to aspirin monotherapy at 3 months after ZES implantation. We retrospectively evaluated 168 consecutive patients with coronary artery disease who had been implanted with a ZES from June 2009 through March 2010. After excluding 40 patients according to exclusion criteria such as myocardial infarction, 128 patients were divided into a 3-month DAPT group (67 patients, 88 lesions) and a 12-month conventional DAPT group (61 patients, 81 lesions). Coronary angiographic followup and clinical followup were conducted at more than 8 months and at 12 months after ZES implantation, respectively. Minor and major bleeding events, stent thrombosis (ST), and major adverse cardiac events (MACE) (death, myocardial infarction, cerebrovascular accident, target lesion revascularization, and target vessel revascularization) were evaluated. There were no statistically significant differences in the incidences of ST and MACE between the two groups. The incidence of bleeding events was significantly lower in the 3-month group than in the 12-month group (1.5% versus 11.5%, P < 0.05). DAPT can be safely discontinued at 3 months after ZES implantation, which reduces bleeding risk.

Quantum yields and quantitative spectra of firefly bioluminescence with various bivalent metal ions.

We measured quantitative spectra of firefly (Photinus pyralis) bioluminescence in the presence of Zn(2+) and other bivalent metal ions to investigate the effects of these metal ions on luciferin-luciferase reaction. We studied the dependence of the quantum yield and spectrum on quantity and kind of bivalent metal ions. Adding various amounts of Mg(2+), Mn(2+) and Ca(2+) produced virtually no change in the quantum yields or the spectra of bioluminescence. In contrast, increasing amounts of ions such as Zn(2+) and Cd(2+) decreased quantum yields and changed the bioluminescence color from yellow-green to red. Quantitative analysis showed that the sensitivities of the quantum yield and color to various metal ions were in the order of Hg(2+) >Zn(2+), Cd(2+) >Ni(2+), Co(2+), Fe(2+) ≫Mg(2+), Mn(2+), Ca(2+). We propose that the changes in quantum yield and spectrum caused by the metal ions are due to their effect on luciferase that surrounds oxyluciferin during its radioactive decay. We also found that having more metal ions accelerated bioluminescence reactions. The sensitivity of the reaction rate had no correlation with those of the quantum yield and spectrum.

Development of a quantitative bio/chemiluminescence spectrometer determining quantum yields: re-examination of the aqueous luminol chemiluminescence standard.

We have developed a bio/chemiluminescence spectrometer with a cooled charge-coupled-device (CCD) detector to obtain a quantitative luminescence spectrum as the absolute number of all emitted photons at each wavelength. The integrated area of the spectrum divided by the number of reacted substrate molecules gives the quantum yield. Calibration of the absolute sensitivity of the CCD-spectrometer system was performed by using lasers and a tungsten lamp with calibrated powers as primary light standards, and calibration of the light-collection efficiency of the spectrometer with several kinds of cells for liquid samples was achieved by introducing a simple reference double-plate cell. The reference cell is not convenient for final bio/chemiluminescence measurements but is useful for the calibration because it has well-defined angular dependence of light emission, allowing accurate calculation of the light-collection efficiency. Using this CCD-spectrometer system, we re-examined the quantum yield of aqueous luminol chemiluminescence with H2O2 catalyzed by horseradish peroxidase. The quantum yield was constant for a wide range of luminol concentrations, whereas it changed and had an optimum against H2O2 concentrations. The optimum quantum yield was 1.23(+/-0.20)%, which is in good agreement with previously reported values.

A method for correcting an inverted nipple with an artificial dermis.

Various methods have been reported to correct an inverted nipple. Although a satisfactory outcome has been reported with most techniques, each method carries a drawback inherent in the technique itself, including complicated operative technique, sensory disturbance of the nipple, marked scarring of the nipple areola and other donor regions, destruction of breast function, and incomplete correction. This report describes a simple method for correcting an inverted nipple. It incorporates a new concept of using artificial dermis for tissue augmentation and is performed without sacrificing any donor site and complex design. It was applied to four nipples in two nulliparous cases. For all four corrected inverted nipples, good results were obtained, and there have been no complications. There were no deformities of the nipples or the areolas after this procedure, and the surgical scars were inconspicuous.

End-to-side nerve graft for facial nerve reconstruction.

Reconstruction of multiple branches of the facial nerve by sural nerve graft using end-to-side nerve suture was performed successfully on a patient with advanced parotid tumor. In this technique, one end of the grafted nerve is sutured with the stump of the facial nerve trunk in an end-to-end manner. Epineural windows are made on the nerve graft, and the distal stumps of the facial nerve branches (temporal, zygomatic, and buccal branches) are sutured with the graft in an end-to-side manner. Functional recovery of all branches and satisfactory facial expression were obtained within 2 years postoperatively. Axonal regeneration through the graft was confirmed by electrodiagnosis. Regeneration through the anastomosis at the stump of the facial nerve trunk using this technique is more efficient than conventional cable grafting, and the length of the nerve required is minimal. This technique may be a useful option for facial nerve reconstruction managing multiple branches.

Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm.

In the process of establishing a less invasive assessment strategy for coronary artery disease (CAD) in patients with infrarenal abdominal aortic aneurysm (AAA), the incidence of CAD and the surgical and mid-term outcomes were reviewed. From January 1994 through September 2001, 94 elective surgical repairs of AAA were carried out. Preoperative coronary angiography showed 43 patients (45.7%) had CAD: 29 (67.4%) were asymptomatic, 23 had single-vessel disease (1VD), 12 had 2VD and 8 had 3VD. Of the 43 patients with CAD, 19 (44.2%) underwent coronary interventional therapy before aortic surgery (11 percutaneous transluminal coronary angioplasty (PTCA), 8 coronary artery bypass grafting). Eight asymptomatic patients underwent coronary interventional therapy. None of the patients died of cardiac causes or experienced a postoperative cardiac event. During the follow-up period, 10 late deaths occurred: 7 patients with CAD, and 3 cerebrovascular or cardiac deaths. There was no statistical difference in the survival rate between the groups with and without CAD. Two patients with CAD underwent PTCA during the follow-up period. The findings confirm the need for a less invasive assessment strategy of CAD that does not overlook asymptomatic myocardial ischemia, because the incidence of CAD in patients with AAA is high.

[Simultaneous determination of dichlorvos and trichlorfon in agricultural products by GC-FPD].

We studied a gas chromatographic method for the determination of dichlorvos (DDVP) and trichlorfon (DEP) in agricultural products. DDVP and DEP were extracted from agricultural products with acetone and re-extracted with ethyl acetate instead of dichloromethane. DDVP and DEP were eluted in one fraction on a silica gel column using n-hexane-acetone (1:1). DEP is a thermally labile compound, so it was derived to a more thermally stable compound by acylation with N-methylbis(trifluoroacetamide) and pyridine in acetone at 60 degrees C for 2 hours. DDVP and the DEP-TFA derivative were determined simultaneously by GC-FPD. The recoveries of DDVP and DEP from agricultural products spiked at levels of 0.1 microgram/g were 72.6-117.7% and 86.2-106.6%, respectively. The detection limits were 0.03 microgram/g in powdered tea and < or = 0.01 microgram/g in other samples. An interlaboratory study by 6 laboratories was conducted to validate this proposed method for 6 crops. Repeatability ranged from 3.1 to 7.8% for DDVP and from 3.4 to 8.3% for DEP, and reproducibility, from 6.9 to 15.5% for DDVP, and from 7.9 to 21.8% for DEP. Precision values were well within statistically predicted levels.