Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry.

Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (-) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan-Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.

Lymphangioleiomyoma of the Uterus and Pelvic Lymph Nodes: A Report of 3 Cases, Including the Potentially Earliest Manifestation of Extrapulmonary Lymphangioleiomyomatosis.

We present 3 cases of extrapulmonary lymphangioleiomyomatosis (LAM) identified incidentally in the uterine corpus and pelvic nodes resected for other reasons. One patient, a 47-yr-old female with corpus cancer, underwent a total hysterectomy and nodal dissection; the other 2 patients, aged 44 and 49 yr, underwent simple hysterectomy for corpus leiomyomas. None of the patients had evidence of tuberous sclerosis complex or any significant lesions in other organs. An area of spindle cell proliferation, intimately associated with dilated and tortuous lymphatic vessels, was found in the myometrium of all 3 patients, and nodal involvement with spindle cell proliferation was observed in the patient with corpus cancer. The spindle cells had faintly eosinophilic cytoplasm and a bland appearance. They were immunoreactive for α-SMA, gp100 (HMB45), and Melan-A. Tumor cell clusters lined with a single layer of lymphatic endothelium were floating in the lymphatic vessel lumen. These lesions were diagnosed as lymphangioleiomyoma in the uterine corpus and associated lymph nodes. Two of the cases seemed to be the earliest manifestations of extrapulmonary LAM, and the other case represents early-phase metastasis of LAM from the uterus. The present cases support the speculation that the uterus is the primary source of LAM cells.

Impact of changes in body mass index after percutaneous coronary intervention on long-term outcomes in patients with coronary artery disease.

Little is known about the impact of changes in body mass index (BMI) after the percutaneous coronary intervention (PCI) on long-term outcomes in patients with coronary artery disease (CAD). Therefore, this study aimed to clarify this issue. We investigated data on CAD obtained from the SHINANO Registry, a prospective, observational, multicenter cohort study, from 2012 to 2013 in Nagano, Japan. One year after PCI, the enrolled patients were divided into the following three groups based on changes in BMI by tertiles: reduced, maintained, and elevated BMI. The associations among the groups and the 4-year outcomes [major adverse cardiac events (MACEs), all-cause death, Q-wave myocardial infarction, and stroke] were examined. Five hundred seventy-two patients were divided into the reduced, maintained, and elevated BMI groups. Over the 4-year follow-up period, the cumulative incidence of MACEs was 10.5% (60 cases). In the Kaplan-Meier analysis, the incidence rates of MACE were significantly higher in the reduced BMI group than in the maintained and elevated BMI groups [17.7% versus (vs.) 7.3% vs. 9.0%, p = 0.004]. Multivariable cox regression analysis showed that the reduced group showed increased risks of MACEs (hazard ratio 2.15; 95% confidence interval 1.29-3.57; p = 0.003). The long-term clinical outcomes of patients with CAD who underwent PCI were affected by the reduction in BMI after PCI. Furthermore, the elevation of BMI after PCI was not a poor prognostic factor.

Evaluation of flow dynamics in distal stent graft-induced new entry using 4D flow MRI.

Distal stent graft-induced new entry may occur after stent grafting for aortic dissection. Four-dimensional magnetic resonance imaging is useful for predicting outcomes, showing accelerated flow and increased wall shear stress, indicating further false lumen expansion.

CELER: A 365-Participant Corpus of Eye Movements in L1 and L2 English Reading.

We present CELER (Corpus of Eye Movements in L1 and L2 English Reading), a broad coverage eye-tracking corpus for English. CELER comprises over 320,000 words, and eye-tracking data from 365 participants. Sixty-nine participants are L1 (first language) speakers, and 296 are L2 (second language) speakers from a wide range of English proficiency levels and five different native language backgrounds. As such, CELER has an order of magnitude more L2 participants than any currently available eye movements dataset with L2 readers. Each participant in CELER reads 156 newswire sentences from the Wall Street Journal (WSJ), in a new experimental design where half of the sentences are shared across participants and half are unique to each participant. We provide analyses that compare L1 and L2 participants with respect to standard reading time measures, as well as the effects of frequency, surprisal, and word length on reading times. These analyses validate the corpus and demonstrate some of its strengths. We envision CELER to enable new types of research on language processing and acquisition, and to facilitate interactions between psycholinguistics and natural language processing (NLP).

The Impact of Hyperuricemia on Patients With Low Body Mass Index After Endovascular Treatments: Data From the I-PAD Registry.

We investigated the prognostic effects of hyperuricemia and high or low body mass index (BMI) in peripheral artery disease (PAD) after endovascular therapy (EVT). Between July 2015-2016, 357 consecutive patients with PAD who underwent EVT were enrolled. Patients were divided into 2 groups: BMI < 25 kg/m2 (low BMI) and ≥ 25 kg/m2 (high BMI); they were also divided into 2 more groups based on the presence/absence of hyperuricemia. The primary and secondary endpoints were major adverse cardiovascular and limb events (MACLE), and all-cause death at 3 years post-EVT. Patients with hyperuricemia had significantly lower freedom from MACLE than patients without hyperuricemia at 3 years (57.0 vs 71.9%, p = .0068). The overall survival of patients with hyperuricemia was significantly lower than that of patients without hyperuricemia (63.9 vs 81.7%, p = .0012). Patients with hyperuricemia who had low BMI experienced significantly lower freedom from MACLE than those without hyperuricemia who had low BMI (48.2 vs 69.9%, p = .002). The overall survival of patients with hyperuricemia who had low BMI was significantly lower than that of patients without hyperuricemia who had low BMI (55.2 vs 77.1%, p = .003). Patients with hyperuricemia had significantly more MACLE and a lower survival at 3 years than patients without hyperuricemia, even if they had a low BMI.

L2 Learners Do Not Ignore Verb's Subcategorization Information in Real-Time Syntactic Processing.

This study addressed the question of whether L2 learners are able to utilize verb's argument structure information in online structural analysis. Previous L2 research has shown that L2 learners have difficulty in using verb's intransitive information to guide online syntactic processing. This is true even though L2 learners have grammatical knowledge that is correct and similar to that of native speakers. In the present study, we contrasted three hypotheses, the initial inaccessibility account, the intransitivity overriding account, and the fuzzy subcategorization frame account, to investigate whether L2 learner's knowledge of intransitive verbs is in fact ignored in L2 online structural analysis. The initial inaccessibility account and the fuzzy subcategorization frame account predicted that L2 learners cannot access intransitivity information in building syntactic structures in any situation. The intransitivity overriding account predicted that intransitivity information is accessed in L2 parsing, but this process is overridden by the strong transitivity preference when a verb is followed by a noun phrase. Importantly, the intransitivity overriding account specifically predicted that L2 learners would be able to use intransitive information in online syntactic processing when a noun phrase does not appear immediately following a verb. We tested the three accounts in an eye-tracking reading experiment using filler-gap dependency structures. We manipulated verb's transitivity information and lexically based plausibility information and tested English native speakers as a control L1 group (N = 29) and Japanese-English L2 participants (N = 32). The results showed that L2 learners as well as native speakers processed sentences differently depending on the subcategorization information of the verb, and adopted transitive analysis only when the verb was optionally transitive, providing support for the intransitivity overriding. The results further demonstrated that L2 learners had strong expectations for the transitive structure, which is consistent with the view proposed by the hyper-active gap-filling hypothesis. In addition, the results showed that the semantic mismatch in the incorrect transitive analysis facilitated native speaker's processing but caused difficulty for L2 learners. Together, the current study provides evidence that L2 learners use intransitive information of the verbs to guide their structural analysis when there are no overriding constraints.

Predictive Value of Abdominal Fat Distribution on Coronary Artery Disease Severity Stratified by Computed Tomography-Derived SYNTAX Score.

This study aimed to evaluate the association between abdominal fat distribution (AFD) and coronary artery disease (CAD) complexities using the computed tomography (CT)-derived SYNTAX score (CT-SXscore). Coronary computed tomographic angiography (CCTA) was performed in patients with suspected CAD. Plain abdominal CT was performed to measure visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas. To assess AFD, VAT/SAT (V/S) ratios were calculated. The CT-SXscore was calculated in patients with significant stenoses assessed by CCTA. Of 942 enrolled patients, 310 (32.9%) had 1 or more significant stenoses. The CT-SXscore showed a positive correlation with the V/S ratio (r = 0.33, p < 0.001). In the multivariate regression analysis, the V/S ratio was the only independent predictor for CAD severity based on the CT-SXscore (ß = 0.25; t = 4.14; p < 0.001), even though the absolute SAT and VAT areas showed no relationship to the CT-SXscore. Regarding the 4 CAD-patient groups divided according to their median VAT and SAT areas, the CT-SXscore was significantly higher for the high VAT/low SAT group than for any other group (19.6 ± 11.5 vs 13.3 ± 9.6 in the low VAT/low SAT, 10.1 ± 8.5 in the low VAT/high SAT, and 12.2 ± 8.7 in the high VAT/high SAT groups; p < 0.001 for all). In conclusion, it was found that the V/S ratio is a useful index for predicting CAD severity and that AFD may be a more important risk factor for CAD than the absolute amount of each abdominal fat.

Cytochrome P450 monooxygenases involved in anthracene metabolism by the white-rot basidiomycete Phanerochaete chrysosporium.

Cytochrome P450 monooxygenases (P450s) involved in anthracene metabolism by the white-rot basidiomycete Phanerochaete chrysosporium were identified by comprehensive screening of both catalytic potentials and transcriptomic profiling. Functional screening of P. chrysosporium P450s (PcCYPs) revealed that 14 PcCYP species catalyze stepwise conversion of anthracene to anthraquinone via intermediate formation of anthrone. Moreover, transcriptomic profiling explored using a complementary DNA microarray system demonstrated that 12 PcCYPs are up-regulated in response to exogenous addition of anthracene. Among the up-regulated PcCYPs, five species showed catalytic activity against anthracene. Based upon both catalytic and transcriptional properties, these five species are most likely to play major roles in anthracene metabolic processes in vivo. Thus, the combination of functional screening and a microarray system may provide a novel strategy for obtaining a thorough understanding of the catalytic functions and biological impacts of PcCYPs.

Synergistic effect of HLA class II loci and cytokine gene polymorphisms on the risk of gastric cancer in Japanese patients with Helicobacter pylori infection.

It has been reported that polymorphisms of human leukocyte antigen (HLA) genes and several cytokine genes are associated with an increased risk of developing gastric cancer (GC). However, the results of studies from different geographic regions, ethnic groups and study groups are inconsistent. The aim of this study was to evaluate the influence of H. pylori infection and host genetic factors on GC susceptibility in Japanese patients with GC. We analyzed genotypes for HLA class I and II, tumor necrosis factor alpha, interleukin (IL)-1beta, IL-1 receptor, IL-4, IL-4Ralpha and IL-10 in 330 H. pylori-infected noncardia patients with GC and 190 H. pylori-infected nonulcer dyspeptic controls. Haplotype analyses indicated that the frequencies of the HLA DRB1*0405 and DQB1*0401 alleles were increased in the patients with intestinal-type GC when compared with controls (both DRB1*0405 and DQB1*0401: p = 0.015, OR = 1.57, 95% CI = 1.09-2.26), but the changes were not statistically significant after correction for multiple comparisons. None of the cytokine gene polymorphisms were associated with GC susceptibility, whether patients with GC were analyzed as a group according to the histological subtype. Of interest was the comparison of controls and patients with intestinal-type GC. The frequency of an IL-10-592AA homozygote showing concomitant carriage of the HLA DRB1*0405-DQB1*0401 haplotype was significantly higher in patients with intestinal-type GC (chi(2) = 6.369, p = 0.0116, p(c) = 0.0464, OR = 2.43, 95% CI = 1.21-4.48). Our results suggest that the HLA class II and IL-10-592A/C polymorphisms synergistically affect the susceptibility to GC development of H. pylori-infected individuals in the Japanese population.

An Extra Cue Is Beneficial for Native Speakers but Can Be Disruptive for Second Language Learners: Integration of Prosody and Visual Context in Syntactic Ambiguity Resolution.

It has long been debated whether non-native speakers can process sentences in the same way as native speakers do or they suffer from certain qualitative deficit in their ability of language comprehension. The current study examined the influence of prosodic and visual information in processing sentences with a temporarily ambiguous prepositional phrase ("Put the cake on the plate in the basket") with native English speakers and Japanese learners of English. Specifically, we investigated (1) whether native speakers assign different pragmatic functions to the same prosodic cues used in different contexts and (2) whether L2 learners can reach the correct analysis by integrating prosodic cues with syntax with reference to the visually presented contextual information. The results from native speakers showed that contrastive accents helped to resolve the referential ambiguity when a contrastive pair was present in visual scenes. However, without a contrastive pair in the visual scene, native speakers were slower to reach the correct analysis with the contrastive accent, which supports the view that the pragmatic function of intonation categories are highly context dependent. The results from L2 learners showed that visually presented context alone helped L2 learners to reach the correct analysis. However, L2 learners were unable to assign contrastive meaning to the prosodic cues when there were two potential referents in the visual scene. The results suggest that L2 learners are not capable of integrating multiple sources of information in an interactive manner during real-time language comprehension.

T-wave alternans in a case with systemic lupus erythematosus-related myocarditis.

A 42-year-old woman presented with fever, dyspnea, lower-leg edema, significant pulmonary congestion, pleural effusion, and severely reduced left ventricular contractions. She was resistant to treatment for heart failure, including catecholamines, furosemide, phosphodiesterase III inhibitors, and human atrial natriuretic peptide, and antibiotics failed to reduce her inflammation. She had renal dysfunction and hypocomplementemia and was positive for anti-nuclear and anti-ds-DNA antibodies. The patient was diagnosed with myocarditis and pleurisy associated with systemic lupus erythematosus (SLE). Prednisolone administration improved her general condition, reducing inflammation and improving left ventricular function. On day 1, an electrocardiography (ECG) revealed a T-wave inversion similar to a T-U complex configuration in leads II, aVF, and V3-6. By day 8, however, ECG showed prolonged corrected QT (QTc) and T-wave alternans (alternating beat-to-beat T-wave patterns) in lead V3-6. Careful ECG monitoring should be used to identify potentially fatal ventricular arrhythmias during the recovery phase of SLE-related myocarditis. .

It's Harder to Break a Relationship When you Commit Long.

Past research has produced evidence that parsing commitments strengthen over the processing of additional linguistic elements that are consistent with the commitments and undoing strong commitments takes more time than undoing weak commitments. It remains unclear, however, whether this so-called digging-in effect is exclusively due to the length of an ambiguous region or at least partly to the extra cost of processing these additional phrases. The current study addressed this issue by testing Japanese relative clause structure, where lexical content and sentence meaning were controlled for. The results showed evidence for a digging-in effect reflecting the strengthened commitment to an incorrect analysis caused by the processing of additional adjuncts. Our study provides strong support for the dynamical, self-organizing models of sentence processing but poses a problem for other models including serial two-stage models as well as frequency-based probabilistic models such as the surprisal theory.

Persistence of Initial Misanalysis With No Referential Ambiguity.

Previous research reported that in processing structurally ambiguous sentences comprehenders often preserve an initial incorrect analysis even after adopting a correct analysis following structural disambiguation. One criticism is that the sentences tested in previous studies involved referential ambiguity and allowed comprehenders to make inferences about the initial interpretation using pragmatic information, suggesting the possibility that the initial analysis persisted due to comprehenders' pragmatic inference but not to their failure to perform complete reanalysis of the initial misanalysis. Our study investigated this by testing locally ambiguous relative clause sentences in Japanese, in which the initial misinterpretation contradicts the correct interpretation. Our study using a self-paced reading technique demonstrated evidence for the persistence of the initial analysis with this structure. The results from an eye-tracking study further suggested that the phenomenon directly reflected the amount of support given to the initial incorrect analysis prior to disambiguating information: The more supported the incorrect main clause analysis was, the more likely comprehenders were to preserve the analysis even after the analysis was falsified. Our results thus demonstrated that the preservation of the initial analysis occurs not due to referential ambiguities but to comprehenders' difficulty to fully revise the highly supported initial interpretation.

Predicting the unbeaten path through syntactic priming.

A number of previous studies showed that comprehenders make use of lexically based constraints such as subcategorization frequency in processing structurally ambiguous sentences. One piece of such evidence is lexically specific syntactic priming in comprehension; following the costly processing of a temporarily ambiguous sentence, comprehenders experience less processing difficulty with the same structure with the same verb in subsequent processing. In previous studies using a reading paradigm, however, the effect was observed at or following disambiguating information and it is not known whether a priming effect affects only the process of resolving structural ambiguity following disambiguating input or it also affects the process before ambiguity is resolved. Using a visual world paradigm, the current study addressed this issue with Japanese relative clause sentences. Our results demonstrated that after experiencing the relative clause structure, comprehenders were more likely to predict the usually dispreferred structure immediately upon hearing the same verb. No compatible effect, in contrast, was observed on hearing a different verb. Our results are consistent with the constraint-based lexicalist view, which assumes the parallel activation of possible structural analyses at the verb. Our study demonstrated that an experience of a dispreferred structure activates the structural information in a lexically specific manner, leading comprehenders to predict another instance of the same structure on encountering the same verb.

Immediate use of prosody and context in predicting a syntactic structure.

Numerous studies have reported an effect of prosodic information on parsing but whether prosody can impact even the initial parsing decision is still not evident. In a visual world eye-tracking experiment, we investigated the influence of contrastive intonation and visual context on processing temporarily ambiguous relative clause sentences in Japanese. Our results showed that listeners used the prosodic cue to make a structural prediction before hearing disambiguating information. Importantly, the effect was limited to cases where the visual scene provided an appropriate context for the prosodic cue, thus eliminating the explanation that listeners have simply associated marked prosodic information with a less frequent structure. Furthermore, the influence of the prosodic information was also evident following disambiguating information, in a way that reflected the initial analysis. The current study demonstrates that prosody, when provided with an appropriate context, influences the initial syntactic analysis and also the subsequent cost at disambiguating information. The results also provide first evidence for pre-head structural prediction driven by prosodic and contextual information with a head-final construction.

Ictal electroencephalographic correlates of posttreatment neuropsychological changes in electroconvulsive therapy: a hypothesis-generation study.

OBJECTIVES: Electroconvulsive therapy (ECT) has been associated with memory and neuropsychological changes, but which features of ECT are associated with those changes have not been well investigated. The aim of this hypothesis-generation study was to examine correlations between ictal electroencephalographic (EEG) characteristics and cognitive side effects after ECT. METHODS: Eight patients with major depressive disorder were examined with the Wechsler Memory Scale-Revised (WMS-R), the Stroop test, the Trail Making Test, and verbal fluency before and after ECT treatment. Seven ictal EEG measurements (eg, slow-wave phase amplitude, postictal suppression) were manually rated by 3 independent psychiatrists. The correlations between ictal EEG measurements, changes in WMS-R subset scores, and non-memory-related neuropsychological assessments were examined with Spearman rank correlation. RESULTS: Verbal memory, general memory, attention/concentration, delayed memory of WMS-R subset scores, and the Stroop test scores improved significantly after ECT treatment. Postictal suppression and slow-wave amplitude correlated positively with delayed memory and visual/verbal discrepancy score. Slow-wave amplitude correlated negatively with letter fluency. The longer the polyspike wave duration, the higher the attention/concentration test results. CONCLUSIONS: Certain ictal EEG measurements were associated with changes in several neuropsychological test results that had improved 2 weeks after the final ECT treatment. A hypothesis-testing study with a larger sample is needed to verify the relationships between EEG measurements and neuropsychological test performance.

Memory, attention, and executive functions before and after sine and pulse wave electroconvulsive therapies for treatment-resistant major depression.

OBJECTIVE: Studies of the cognitive effects of electroconvulsive therapy (ECT) have resulted in controversial findings up to now, partly because researchers and reviewers have not always made a clear distinction among various aspects of cognition and because there are many parameters involved in the administration of ECT that have a potential impact on cognition. The present study focused on the impact of sine and pulse waveforms on anterograde memory and nonmemory cognitive functions. METHODS: We assigned 18 patients with unipolar major depression or bipolar I or II disorder, most recent episode depressed, to receive sine wave or pulse wave ECT and assessed their cognitive function before and after ECT, using a neuropsychologic test battery that measured anterograde memory, attention, and executive functions. Outcomes were measured, on average, 8.2 days after the last ECT session. RESULTS: Both waveforms were equally effective in alleviating depression. Those who received sine wave ECT showed statistically significant deterioration in attention and executive tasks, such as the Stroop test, which measures selective attention (P = 0.02), and the dual task, which taps divided attention (P = 0.01). On the other hand, those who received pulse wave ECT improved to a significant degree in certain memory tasks, such as visual memory (P = 0.01) and general memory (P = 0.01) of the Wechsler Memory Scale-Revised (WMS-R), as well as in the dual task (P = 0.01). The between-group comparison revealed robust superiority of the pulse wave over the sine wave in terms of the dual task (P = 0.004). CONCLUSIONS: Anterograde memory improved to a statistically significant or nonsignificant degree at 1 week post-ECT in comparison with pre-ECT regardless of waveforms. Attention/executive functions tended to deteriorate with sine wave ECT but improved with pulse wave ECT.

Citrulline and DRIP-1 protein (ArgE homologue) in drought tolerance of wild watermelon.

Drought-affected plants experience more than just desiccation of their organs due to water deficit. Plants transpire 1000 times more molecules of water than of CO2 fixed by photosynthesis in full sunlight. One effect of transpiration is to cool the leaves. Accordingly, drought brings about such multi-stresses as high temperatures, excess photoradiation and other factors that affect plant viability. Wild watermelon serves as a suitable model system to study drought responses of C3 plants, since this plant survives drought by maintaining its water content without any wilting of leaves or desiccation even under severe drought conditions. Under drought conditions in the presence of strong light, wild watermelon accumulates high concentrations of citrulline, glutamate and arginine in its leaves. The accumulation of citrulline and arginine may be related to the induction of DRIP-1, a homologue of ArgE in Escherichia coli, where it functions to incorporate the carbon skeleton of glutamate into the urea cycle. Immunogold electron microscopy reveals the enzyme to be confined exclusively to the cytosol. DRIP-1 is also induced by treating wild watermelon with 150 mM NaCl, but is not induced following treatment with 100 microM abscisic acid. The salt treatment causes the accumulation of gamma-aminobutyrate, glutamine and alanine, in addition to a smaller amount of citrulline. Citrulline may function as a potent hydroxyl radical scavenger.