Bushy sphere dendrites with husk-shaped branches axially spreading out from the core for photo-catalytic oxidation/remediation of toxins.

This work describes densely interlinked bushy "tree-like chains" characterized by neatly branched sphere dendrites (bushy sphere dendrites, BSD) with long fan-like, husk-shaped branching paths that extend longitudinally from the core axis of the {110}-exposed plane. We confirmed that the hierarchical dendrite surfaces created bowls of swirled caves along the tree-tube in the mat-like branches. These surfaces had high-index catalytic site facets associated with the formation of ridges/defects on the dominant {110}-top-cover surface. These swirled caves along the branches were completely filled with 50-100 nm poly-CN nano-sphere-fossils with orb-like appearance. Such structural features are key issues of the inherent surface reactivity of a powerful catalyst/trapper, enabling photocatalytic oxidation and trapping of extremely toxic arsenite (AsO33-) species and photo-induced recovery of arsenate (AsO43-) products from catalyst surfaces. The light-induced release of produced AsO43- from BSD indicates (i) highly controlled waste collection/management (i.e., recovery), (ii) low cost and ecofriendly photo-adsorbent, (iii) selective trapping of real sample water to produce water-free arsenite species; (iv) multiple reuse cycles of catalysts (i.e., reduced waste volume). Matrixed dendrites, covered with 3D microscopic sphere cores that capture solar-light, trap toxins, and are triggered by light, were designed. These dendrites can withstand indoor and outdoor recovery of toxins from water sources.

Effective, Low-Cost Recovery of Toxic Arsenate Anions from Water by Using Hollow-Sphere Geode Traps.

Because of the devastating impact of arsenic on terrestrial and aquatic organisms, the recovery, removal, disposal, and management of arsenic-contaminated water is a considerable challenge and has become an urgent necessity in the field of water treatment. This study reports the controlled fabrication of a low-cost adsorbent based on microscopic C-,N-doped NiO hollow spheres with geode shells composed of poly-CN nanospherical nodules (100 nm) that were intrinsically stacked and wrapped around the hollow spheres to form a shell with a thickness of 500-700 nm. This C-,N-doped NiO hollow-sphere adsorbent (termed CNN) with multiple diffusion routes through open pores and caves with connected open macro/meso windows over the entire surface and well-dispersed hollow-sphere particles that create vesicle traps for the capture, extraction, and separation of arsenate (AsO43- ) species from aqueous solution. The CNN structures are considered to be a potentially attractive adsorbent for AsO43- species due to 1) superior removal and trapping capacity from water samples and 2) selective trapping of AsO43- from real water samples that mainly contained chloride and nitrate anions and Fe2+ , and Mn2+ , Ca2+ , and Mg2+ cations. The structural stability of the hierarchal geodes was evident after 20 cycles without any significant decrease in the recovery efficiency of AsO43- species. To achieve low-cost adsorbents and toxic-waste management, this superior CNN AsO43- dead-end trapping and recovery system evidently enabled the continuous control of AsO43- disposal in water-scarce environments, presents a low-cost and eco-friendly adsorbent for AsO43- species, and selectively produced water-free arsenate species. These CNN geode traps show potential as excellent adsorbent candidates in environment remediation tools and human healthcare.

New clinical decision rule to exclude subarachnoid haemorrhage for acute headache: a prospective multicentre observational study.

OBJECTIVE: To ensure good outcomes in the management of subarachnoid haemorrhage (SAH), accurate prediction is crucial for initial assessment of patients presenting with acute headache. We conducted this study to develop a new clinical decision rule using only objectively measurable predictors to exclude SAH, offering higher specificity than the previous Ottawa SAH Rule while maintaining comparable sensitivity. DESIGN: Multicentre prospective cohort study. SETTING: Tertiary-care emergency departments of five general hospitals in Japan from April 2011 to March 2014. PARTICIPANTS: Eligible patients comprised 1781 patients aged >15 years with acute headache, excluding trauma or toxic causes and patients who presented in an unconscious state. MAIN OUTCOME MEASURES: Definitive diagnosis of SAH was based on confirmation of SAH on head CT or lumbar puncture findings of non-traumatic red blood cells or xanthochromia. RESULTS: A total of 1561 patients were enrolled in this study, of whom 277 showed SAH. Using these enrolled patients, we reached a rule with mainly categorical predictors used in previous reports, called the 'Ottawa-like rule', offering 100% sensitivity when using any of age ≥40 years, neck pain or stiffness, altered level of consciousness or onset during exertion. Using the 1317 patients from whom blood samples were obtained, a new rule using any of systolic blood pressure >150 mm Hg, diastolic blood pressure >90 mm Hg, blood sugar >115 mg/dL or serum potassium <3.9 mEq/L offered 100% sensitivity (95% CI 98.6% to 100%) and 14.5% specificity (12.5% to 16.9%), while the Ottawa-like rule showed the same sensitivity with a lower specificity of 8.8% (7.2% to 10.7%). CONCLUSIONS: While maintaining equal sensitivity, our new rule seemed to offer higher specificity than the previous rules proposed by the Ottawa group. Despite the need for blood sampling, this method can reduce unnecessary head CT in patients with acute headache. TRIAL REGISTRATION NUMBER: UMIN 00004871.

Nanomembrane Canister Architectures for the Visualization and Filtration of Oxyanion Toxins with One-Step Processing.

Nanomembrane canister-like architectures were fabricated by using hexagonal mesocylinder-shaped aluminosilica nanotubes (MNTs)-porous anodic alumina (PAA) hybrid nanochannels. The engineering pattern of the MNTs inside a 60 µm-long membrane channel enabled the creation of unique canister-like channel necks and cavities. The open-tubular canister architecture design provides controllable, reproducible, and one-step processing patterns of visual detection and rejection/permeation of oxyanion toxins such as selenite (SeO3(2-)) in aquatic environments (i.e., in ground and river water sources) in the Ibaraki Prefecture of Japan. The decoration of organic ligand moieties such as omega chrome black blue (OCG) into inorganic Al2O3@tubular SiO2/Al2O3 canister membrane channel cavities led to the fabrication of an optical nanomembrane sensor (ONS). The OCG ligand was not leached from the canister as observed in washing, sensing, and recovery assays of selenite anions in solution, which enabled its multiple reuse. The ONS makes a variety of alternate processing analyses of selective quantification, visual detection, rejection/permeation, and recovery of toxic selenite quick and simple without using complex instrumentation. Under optimal conditions, the ONS canister exhibited a high selectivity toward selenite anions relative to other ions and a low-level detection limit of 0.0093 µM. Real analytical data showed that approximately 96% of SeO3(2-) anions can be recovered from aquatic and wastewater samples. The ONS canister holds potential for field recovery applications of toxic selenite anions from water.

Evaluation of environmental contamination and estimated exposure doses after residents return home in Kawauchi Village, Fukushima Prefecture.

The external and internal exposure doses due to artificial radionuclides after the return of residents to their homes in Kawauchi Village, Fukushima Prefecture, including the restricted area within a 20-km radius from the Fukushima Dai-ichi Nuclear Power Plant (FNPP), were evaluated by gamma spectrometry of the soils and local agricultural products. The prevalent dose-forming artificial radionuclides from all samples were determined to be (134)Cs and (137)Cs (radiocesium). The estimated external effective doses from soils sampled on December 24 and 25, 2012 were 0.0017-9.2 mSv/y in the areas within a 20- to 30-km radius from the FNPP and 0.39-1.3 mSv/y in the areas within a 20-km radius from the FNPP. These levels appeared to be decreasing, despite the distance from the FNPP (median: 0.21 (0.012-0.56) mSv/y), compared to the levels just before the return of the residents to their homes on December 19 and 20, 2011 (median: 0.85 (0.40-1.4) mSv/y). The committed effective doses from the local agricultural samples in Kawauchi Village from May 1, 2012 to March 31, 2013 were sufficiently low, in the range of 18-44 µSv/y for males and 20-48 µSv/y for females (the range was 18-48 µSv/y for children and 25-43 µSv/y for adults), compared to the public dose limit (1 mSv/y, ICRP, 1991), although the potential for radiation exposure still exists. Residents who have not yet returned may be able to return to their homes with a long-term follow-up of environmental monitoring and countermeasures to reduce unnecessary radiation exposure.

Vertical distribution and estimated doses from artificial radionuclides in soil samples around the Chernobyl nuclear power plant and the Semipalatinsk nuclear testing site.

For the current on-site evaluation of the environmental contamination and contributory external exposure after the accident at the Chernobyl Nuclear Power Plant (CNPP) and the nuclear tests at the Semipalatinsk Nuclear Testing Site (SNTS), the concentrations of artificial radionuclides in soil samples from each area were analyzed by gamma spectrometry. Four artificial radionuclides ((241)Am, (134)Cs, (137)Cs, and (60)Co) were detected in surface soil around CNPP, whereas seven artificial radionuclides ((241)Am, (57)Co, (137)Cs, (95)Zr, (95)Nb, (58)Co, and (60)Co) were detected in surface soil around SNTS. Effective doses around CNPP were over the public dose limit of 1 mSv/y (International Commission on Radiological Protection, 1991). These levels in a contaminated area 12 km from Unit 4 were high, whereas levels in a decontaminated area 12 km from Unit 4 and another contaminated area 15 km from Unit 4 were comparatively low. On the other hand, the effective doses around SNTS were below the public dose limit. These findings suggest that the environmental contamination and effective doses on the ground definitely decrease with decontamination such as removing surface soil, although the effective doses of the sampling points around CNPP in the present study were all over the public dose limit. Thus, the remediation of soil as a countermeasure could be an extremely effective method not only for areas around CNPP and SNTS but also for areas around the Fukushima Dai-ichi Nuclear Power Plant (FNPP), and external exposure levels will be certainly reduced. Long-term follow-up of environmental monitoring around CNPP, SNTS, and FNPP, as well as evaluation of the health effects in the population residing around these areas, could contribute to radiation safety and reduce unnecessary exposure to the public.

Evaluation of environmental contamination and estimated radiation doses for the return to residents' homes in Kawauchi Village, Fukushima prefecture.

To evaluate the environmental contamination and radiation exposure dose rates due to artificial radionuclides in Kawauchi Village, Fukushima Prefecture, the restricted area within a 30-km radius from the Fukushima Dai-ichi Nuclear Power Plant (FNPP), the concentrations of artificial radionuclides in soil samples, tree needles, and mushrooms were analyzed by gamma spectrometry. Nine months have passed since samples were collected on December 19 and 20, 2011, 9 months after the FNPP accident, and the prevalent dose-forming artificial radionuclides from all samples were (134)Cs and (137)Cs. The estimated external effective doses from soil samples were 0.42-7.2 µSv/h (3.7-63.0 mSv/y) within the 20-km radius from FNPP and 0.0011-0.38 µSv/h (0.010-3.3 mSv/y) within the 20-30 km radius from FNPP. The present study revealed that current levels are sufficiently decreasing in Kawauchi Village, especially in areas within the 20- to 30-km radius from FNPP. Thus, residents may return their homes with long-term follow-up of the environmental monitoring and countermeasures such as decontamination and restrictions of the intake of foods for reducing unnecessary exposure. The case of Kawauchi Village will be the first model for the return to residents' homes after the FNPP accident.

Simultaneous stent obstruction of triple vessels with very late stent thrombosis after implantation of sirolimus-eluting stents.

A 70-year-old man presented to the emergency department at our hospital with chest pain, 24 months after sirolimus-eluting stents (SESs) were implanted in the proximal left anterior descending coronary artery (LAD), middle right coronary artery (RCA), and middle left circumflex artery (LCX), respectively. Electrocardiogram showed complete right bundle branch block and ST-segment elevation in leads II, III, and aVF. He suddenly went to ventricular tachycardia, followed by ventricular fibrillation. Administration of electrical shock led to cardiac arrest. Immediately, we inserted a percutaneous cardiopulmonary system and intra-aortic balloon pumping. Subsequent emergent coronary angiography showed 100% thrombotic total stent obstruction of triple vessels with thrombolysis in myocardial infarction 0 flow. Thrombectomy and balloon angioplasty were performed at the in-stent thrombotic sites. Despite our intensive care, he died due to heart failure on the third day after hospitalization.

Chronic effect of right ventricular pacing on left ventricular rotational synchrony in patients with complete atrioventricular block.

BACKGROUND: Chronic effect of right ventricular (RV) pacing on left ventricular (LV) rotational synchrony is unknown. The aim of this study is to assess chronic effect of RV pacing on LV rotational synchrony using two-dimensional ultrasound speckle tracking imaging. METHODS AND RESULTS: Thirty-one patients who underwent dual-chamber pacemaker implantation for complete atrioventricular block, and age- and sex-matched 10 healthy controls were assessed. We divided our patients into RV apical (RVA, n = 16) and RV outflow tract (RVOT, n = 15) pacing groups. We compared echocardiographic parameters such as LV rotational synchrony between pacing groups and healthy control. We defined Q to peak rotation interval as the interval from the beginning of the Q-wave to the peak apical counter-clockwise or peak basal clockwise rotation. We calculated apical-basal rotation delay by subtracting basal Q to peak rotation interval from apical one as the representative of rotational synchronization. Apical-basal rotation delay of RVA pacing was significantly longer than that of healthy control (100 ± 110 vs. -6 ± 15 ms, P = 0.002), while there was no statistically significant difference between RVOT pacing and healthy control (-3 ± 99 vs. -6 ± 15 ms, P = 0.919). CONCLUSIONS: LV rotation during RVOT pacing is synchronous at 15 months after pacemaker implantation, while RVA pacing provokes LV rotational dyssynchrony by inducing delayed apical rotation at 7 years after pacemaker implantation in patients with complete atrioventricular block.

Vulnerable disease may induce neointimal coverage after sirolimus-eluting stent implantation.

BACKGROUND: Neointimal formation can protect against thrombosis after sirolimus-eluting stent (SES) implantation; however, promoters of neointimal formation are unknown. METHODS: Six-month follow-up angioscopy was performed in 141 consecutive patients with SES implantation. All patients received aspirin (100 mg) and ticlopidine (200 mg) daily until angioscopy. We defined 2 grades of neointimal coverage as follows: insufficient coverage including no or partial neointimal coverage of stent struts, and sufficient coverage. The possible promoters of neointimal formation that were evaluated in this study were the condition of coronary artery disease (stable angina or acute coronary syndrome); angioscopic markers, including visible thrombus and plaque color (white or yellow); serum markers, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, hemoglobin A(1c), high-sensitive C-reactive protein, and fibrinogen; blood pressure and smoking; intervention markers, including stent size and length and intravascular ultrasound measurements; and medication, including statins, anticoagulants, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, calcium antagonists, and ß-blockers. RESULTS: Univariate analysis revealed that high-sensitive C-reactive protein, plaque color, and the condition of coronary artery disease were significantly correlated with the grade of neointimal coverage. Multivariate analysis using these 3 parameters revealed that only acute coronary syndrome (vulnerable disease) significantly promoted neointimal coverage. CONCLUSION: Vulnerable disease may promote neointimal coverage after SES implantation.

Renin-angiotensin system blockade is associated with the long-term protection against cardiac remodeling after cardioversion in hypertensive patients with atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia, and renin-angiotensin system blockade (RAS-B) may be favorable for AF because of its effect on cardiac remodeling. However, effects of RAS-B on AF in hypertensive patients are controversial. Thus, in this study, we investigated the long-term effects of RAS-B on cardiac remodeling and rhythm control after electrical cardioversion for hypertensive patients with persistent AF. We studied 27 consecutive hypertensive patients with persistent AF (duration > one week) who received electrical cardioversion and once recovered to sinus rhythm. Blood pressure of the patients was controlled by medication including RAS-B. The patients were divided into those who were pre-treated with RAS-B (n = 10) for at least two months before electrical cardioversion and those without RAS-B (n = 17). We performed echocardiography before electrical cardioversion and 3 years after electrical cardioversion in all patients and compared the differences in echocardiographic cardiac remodeling parameters, including left atrial dimension, left ventricular end-diastolic dimension and left ventricular ejection fraction. The AF recurrence-free ratio during the follow-up period was significantly higher in the RAS-B group than in the non-RAS-B group, judged by Kaplan-Meier analysis (60 vs. 24%, P = 0.01). All cardiac remodeling parameters in the RAS-B group showed better values than those in non-RAS-B group (each parameter, P < 0.05), supporting the beneficial effects of RAS-B on AF in hypertensive patients. In hypertensive patients with AF, pre-treatment with RAS-B before electrical cardioversion can prevent cardiac remodeling for 3 years and maintain sinus rhythm.

High incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: angioscopic comparison with sirolimus-eluting stent.

BACKGROUND: Difference of neointimal formational pattern and incidence of thrombus formation between sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) at 18 months after stent implantation has not previously been reported. METHODS: We retrospectively enrolled 35 event-free patients who received SES (15 patients, 18 stents) or PES (20 patients, 23 stents) implantation with 18-month follow-up coronary angioscopy. We divided our patients into SES or PES groups and compared neointimal coverage pattern and incidence of red mural thrombus formation between the 2 groups. Neointimal coverage grades were classified into 4 categories. Minimum neointimal coverage grade, maximum grade, and heterogeneity score were assessed in each stent. Heterogeneity score was calculated by subtracting minimum from maximum grade within one stent. RESULTS: Minimum neointimal coverage grade of PES was significantly lower than that of SES (0.70 +/- 0.64 vs 1.33 +/- 0.69, P = .005), whereas maximum grade was not significantly different (2.48 +/- 0.73 vs 2.22 +/- 0.73, P = .218). Heterogeneity score and incidence of red mural thrombus of PES were higher than those of SES (1.78 +/- 0.80 vs 0.89 +/- 0.76, P = .002 and 70% vs 11%, P < .001). CONCLUSIONS: The present study revealed that PES shows more heterogeneous neointimal coverage and higher incidence of thrombus formation as compared with SES at 18 months after stent implantation.

Difference of neointimal formational pattern and incidence of thrombus formation among 3 kinds of stents: an angioscopic study.

OBJECTIVES: The purpose of this study is to compare the neointimal formational pattern and incidence of thrombus formation among sirolimus-eluting (SES), paclitaxel-eluting (PES), and bare-metal stents (BMS) with coronary angioscopy. BACKGROUND: Neointimal formation and incidence of mural thrombus are different with the type of stent. METHODS: One hundred successive patients who received 43 SES, 40 PES, or 32 BMS implantation underwent 6-month follow-up coronary angioscopy. We evaluated angioscopic parameters, including minimum and maximum neointimal grade; presence and number of red mural thrombus; neointimal grade around thrombus; and heterogeneity score, which is defined by subtracting minimum from maximum grade within 1 stent by classifying angioscopic neointimal coverage grades into 4 categories. We compared these parameters among 3 kinds of stent groups. RESULTS: Heterogeneity scores of SES, PES, and BMS were 0.79 +/- 0.60, 1.27 +/- 0.75, and 1.03 +/- 0.82, respectively (p = 0.011). The PES showed the highest incidence of angioscopic red mural thrombus (50% in PES, 12% in SES, and 3% in BMS, p < 0.001), and the number of thrombus observed within 1 stent in the PES group tended to be larger than those in the SES and BMS groups. CONCLUSIONS: At 6 months after stent implantation, PES showed the most heterogeneous neointimal formation and the highest incidence of thrombus formation compared with SES and BMS.

Two cases of quadricuspid aortic valve.

Quadricuspid aortic valve (QAV) is a rare congenital aortic valve anomaly. We present two cases of QAV diagnosed by using echocardiography including transesophageal echocardiography (TEE) and cardiac computed tomography (CT). The first case, QAV with four equal-sized cusps, was identified in a 58-year-old man. The second case, QAV with a small accessory cusp between the right coronary and non-coronary cusp, was identified in a 42-year-old man. TEE and cardiac CT could lead to accurate diagnosis of QAV. QAV in these two patients could be diagnosed before indication for surgery but it is necessary to continue careful follow-up.

Right ventricular apical pacing impairs left ventricular twist as well as synchrony: acute effects of right ventricular apical pacing.

BACKGROUND: This study was designed to compare the rotation of the left ventricular (LV) apex and base, LV synchrony between LV apical and basal rotation, and LV twist, changing from intrinsic atrioventricular conduction to right ventricular apical (RVA) pacing. METHODS: Thirty consecutive patients with sick sinus syndrome who had undergone DDD pacemaker implantation were studied. Changing from intrinsic atrioventricular conduction to RVA pacing, the acute effect on echocardiographic parameters, including LV rotation and twist and LV apical-basal rotation delay, was assessed. RESULTS: During RVA pacing, values of peak rotation in the LV apex and base and LV twist were significantly lower than during intrinsic atrioventricular conduction (P=.007, P=.003, and P<.0001, respectively). Apical-basal rotation delay during RVA pacing was significantly longer than during intrinsic atrioventricular conduction (P=.02). CONCLUSIONS: RVA pacing decreases apical and basal LV rotation and induces LV apical-basal rotation delay, resulting in impairment of LV twist.

Variant autonomic regulation during active standing in Swedish and Japanese junior high school children.

The present investigation is about cardiovascular responses and relevant autonomic function in Swedish and Japanese pubertal children on active standing using non-invasive continuous beat-to-beat finger arterial pressure (FAP) monitoring and power spectral analysis. Examined were 54 Swedish and 57 Japanese children (13-15 years). FAP and heart rate (HR) was continuously recorded in the supine position and during standing. Supine FAP was significantly higher in Swedish compared with Japanese children (121/62 versus 103/53 mmHg, P < 0.001). Swedish children showed a higher increase in arterial pressure and HR upon uprising, resulting in a higher vasoconstrictor index (5.04 +/- 0.22 versus 2.31 +/- 0.11 mmHg s(-1), P < 0.001, respectively). There were also higher increases in arterial pressure and HR in the following steady state period (1-7 min) between the two groups. These differences were also found after adjustment of body weight and height. Frequency domain analysis of HR and arterial pressure variability indicated significantly higher low/high frequency power of HR and low frequency power of arterial pressure. These results suggest that Swedish pubertal children have higher basal blood pressure and enhanced cardiovascular sympathetic responses. These differences in the two cohorts might be caused by genetic factors.

Preprocedural statin administration can reduce thrombotic reaction after stent implantation.

BACKGROUND: It has been reported that stent deployment results in acute inflammation and platelet deposition as an acute phase reaction and smooth muscle cell (SMC) proliferation as a chronic phase reaction. Other studies have shown that statin therapy can reduce thrombosis as a pleiotropic effect. The present study was undertaken to examine whether preprocedural statin therapy can reduce the thrombotic reaction after stent implantation by using in-stent restenosis (ISR) tissue. METHODS AND RESULTS: The study group consisted of 45 consecutive patients (stable angina) with ISR who underwent directional coronary atherectomy (DCA). According to the histological findings, the patients were divided into 2 groups: those whose ISR tissue included thrombus and SMC (T group), and those whose ISR tissue included only SMC (S group). Just before DCA, serum markers were evaluated, including high-sensitivity C-reactive protein (hs-CRP), lipoprotein (a), plasminogen activator inhibitor-1 (PAI-1), fibrinogen, total cholesterol, triglyceride, high-density lipoprotein cholesterol, fasting blood glucose, and hemoglobin A(1c). Preprocedural medications, including statins, were also evaluated. The values for hs-CRP and PAI-1 in the T group were significantly higher than those in the S group, and the rate of statin use in the T group was significantly lower than that in the S group. There were no significant differences in any of the other factors. Multivariate analysis revealed that preprocedural statin use and the PAI-1 level were significant independent variables affecting the histological findings. CONCLUSION: Preprocedural statins, associated with the involvement of PAI-1, can reduce the thrombotic reaction after stent implantation.

Adsorption behaviors of high-valence metal ions on desferrioxamine B immobilization nylon 6,6 chelate fiber under highly acidic conditions.

Adsorption behaviors of the high-valence metal ions Zr(IV), Hf(IV), Ti(IV), V(V), Nb(V), Ta(V), and Mo(IV) on desferrioxamine B (DFB) immobilization nylon 6,6 chelate fiber was investigated under highly acidic conditions. Though the complexes of DFB and the high-valence metal ions were extracted without selectivity by solvent extraction, the only zirconium ions showed higher adsorption percentages than that of other high-valence metal ions on the DFB immobilization nylon 6,6 chelate fiber. Adsorption properties were caused that limited the freedom of DFB by chemical immobilization. Especially, hafnium ions and zirconium ions, which have similar chemical properties, showed different adsorption behavior in highly acidic aqueous solutions. Zirconium ions were quantitatively adsorbed up to 13.5 micromol/g.

Coronary flow reserve by contrast enhanced transesophageal coronary sinus Doppler measurements can evaluate diabetic microvascular dysfunction.

BACKGROUND: This study was undertaken to investigate whether coronary flow reserve (CFR) using coronary sinus flow (CSF), which can be measured by transesophageal Doppler echocardiography (TEDE), especially when contrast enhanced, is useful in evaluating microvascular dysfunction in patients with diabetes mellitus (DM). METHODS AND RESULTS: CSF recordings using contrast enhanced TEDE were performed before and after adenosine triphosphate infusion (0.15 mg x kg(-1) x min(-1)) in 16 patients with type 2 DM and diabetic retinopathy and in 13 non-DM patients (control). Coronary angiography revealed normal epicardial coronary arteries. CFR was defined as the ratio of the antegrade flow velocity time integral in hyperemic conditions and basal levels. Clear envelopes of CSF were obtained in all DM patients using contrast-enhanced TEDE. CFR using CSF in the DM group was significantly decreased compared with the control group (1.4+/-0.4 vs 2.1+/-0.5, p<0.01), but there were no significant differences of age, ejection fraction, rate of hypertension and hypercholesterolemia between the 2 groups. Using 1.7 of CFR as the cut-off value, diabetic microvascular dysfunction could be detected with 82% sensitivity and 83% specificity. CONCLUSIONS: CFR calculated by CSF using contrast-enhanced TEDE may be useful for evaluating diabetic microvascular dysfunction.

Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy.

OBJECTIVES: We tested a hypothesis that elevation of the plasma level of brain natriuretic peptide (BNP) is one of the characteristics of patients with diastolic heart failure (DHF) independent of left ventricular (LV) hypertrophy. BACKGROUND: The clinical characteristics of DHF are not well acknowledged, although DHF has become a great social burden. Such a lack of clinical information leads to inaccuracy in the diagnosis of DHF. We have demonstrated enhancement of ventricular production of BNP with progression of maladaptive ventricular hypertrophy, but not with development of compensatory hypertrophy in an animal DHF model. METHODS: Of 372 patients who presented to the emergency department because of acute pulmonary congestion without acute coronary syndrome between January 1996 and May 2002, those with an ejection fraction > or =45% upon admission, who were stably controlled at least for a year in our outpatient clinics, comprised the DHF group (n = 19). A control group consisted of 22 hypertensive patients with a LV mass index greater than or equal to its minimum value of the DHF group and an ejection fraction > or =45%, in whom cardiac symptoms had not occurred. RESULTS: Despite a similar distribution of LV mass index, the BNP level was higher in the DHF group than in the control group (149 +/- 38 vs. 31 +/- 5 pg/ml, p < 0.01). There was no difference in LV cavity size or parameters derived from pulsed Doppler transmitral flow velocity curves. CONCLUSIONS: An elevation of BNP may be a hallmark of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy.