Impact of antiplatelet therapy on tissue prolapse at super acute phase after stenting: serial OCT study in acute coronary syndrome patients.

Although drug-eluting stents have improved clinical outcomes, percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains a challenging procedure in terms of thrombus management. A new-generation P2Y12 receptor inhibitor, prasugrel, provides more rapid and potent antiplatelet action compared with clopidogrel. Prasugrel achieved significant reduction of ischemic events compared with clopidogrel in ACS. The aim of this optical coherence tomography (OCT) study was to evaluate temporal changes in tissue prolapse after stenting under different antiplatelet regimens (aspirin plus prasugrel or clopidogrel) in ACS patients. A total of 119 ACS patients were randomized to either prasugrel or clopidogrel at the time of PCI. OCT analysis was available in 119 patients at baseline (just after stenting), 77 patients at 2 weeks, and 62 patients at 4 months after stenting. Cross-sectional analysis for every 1 mm was performed at in-stent and adjacent reference segment. Tissue prolapse area was calculated by lumen area minus stent area within the stented segment. Baseline patient and procedural characteristics were not different between the prasugrel and clopidogrel groups. Tissue prolapse area was significantly lower in the prasugrel compared with the clopidogrel group after stenting (0.24 ± 0.23 vs. 0.36 ± 0.23 mm2, p = 0.003) and at 2 weeks (0.11 ± 0.13 vs. 0.19 ± 0.16 mm2, p = 0.005). However, there was no significant difference at 4 months. In conclusion, our study suggests prasugrel was effective in reducing tissue prolapse in the super acute phase in ACS patients compared with clopidogrel. However, the effect of tissue prolapse reduction was not different up to 4 months follow-up.

Temporal changes of incomplete stent apposition during early phase after everolimus-eluting stent implantation: serial optical coherence tomography analyses at 2-week and 4-month.

The healing process of acute incomplete stent apposition (ISA) in the early phase after stent implantation has not been well understood. We evaluated the temporal changes of ISA during the early phase after everolimus-eluting stent (EES) implantation using serial optical coherence tomography (OCT) analyses. Serial OCT examinations were performed immediately post-stenting and 2-week and 4-month after EES implantation for patients with ST-segment elevation myocardial infarction. At the most proximal cross-section of the implanted stent, the prevalence of ISA and maximum ISA distance were serially evaluated. In 45 patients with ST-segment elevation myocardial infarction, serial OCT analyses at 2-week and 4-month were performed. The prevalence of ISA gradually decreased over time, being 53.3% at baseline, 37.8% at 2-week follow-up, and 11.1% at 4-month follow-up (P < 0.001). The maximum ISA distance also decreased over time (P < 0.001). A receiver-operating curve analysis found that the optimal cut-off values of the baseline ISA distance for predicting persistent ISA at 2-week follow-up and 4-month follow-up were > 140 µm and > 215 µm, respectively. The baseline ISA distance was closely associated with the healing of ISA in the early phase after EES implantation. Maintaining the minimum ISA distance at post-stenting facilitates early phase healing of acute ISA.

Clinical feasibility of resting full-cycle ratio as a unique non-hyperemic index of invasive functional lesion assessment.

The resting full-cycle ratio (RFR) is a new physiologic index to assess myocardial ischemia. RFR and fractional flow reserve (FFR), the conventionally used index, have not been directly compared in evaluating the entire cardiac cycle. Accordingly, we aimed to compare the diagnostic performance of RFR directly with FFR and clarify the clinical feasibility of RFR as a unique non-hyperemic index in evaluating the cardiac cycle. The diagnostic performance of RFR was compared with FFR using an automated online calculation software. A total of 156 consecutive patients with 220 intermediate lesions were enrolled. RFR showed significant correlation with FFR (r = 0.774, p < 0.001). RFR systole and RFR diastole did also with FFR (r = 0.918, p < 0.001, and r = 0.733, p < 0.001, respectively). With FFR < 0.80 as a reference standard, RFR showed good diagnostic accuracy (DA: 80.5%), similar DA between RFR systole and RFR diastole (79.6% and 87.5%, p = 0.58, respectively), and good DA in any lesion locations, especially in non-left anterior descending coronary artery (LAD) lesions (73.7% and 87.6% for LAD vs. non-LAD, p < 0.05, respectively). RFR is a feasible and reliable non-hyperemic index regardless of the difference in cardiac cycle in evaluating physiological lesion severity in daily practice.

Epidemiological Features and Clinical Presentations of Acute Coronary Syndrome in Young Patients.

Objective Although acute coronary syndrome (ACS) is an uncommon entity in young patients, it constitutes an important problem due to the devastating effects of the disease on the more active lifestyle of young patients. At present, there are no guidelines regarding the prevention of ACS in young patients. Methods We performed a retrospective study of ACS patients between 2014 and 2017. Epidemiological data, clinical findings, and short-term outcomes were evaluated between young ACS patients (≤50 years old) and elderly ACS patients (>50 years old). Results Of a total of 361 consecutive ACS patients, 37 were young ACS patients (10.2%). Compared with elderly ACS patients, young ACS patients showed a higher prevalence of males (94.6% vs. 73.8%, p<0.001), current smoking (70.3% vs. 29.9%; p<0.001), and overweight persons (67.6% vs. 27.8%, p<0.001). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio was significantly lower in young ACS patients than in elderly ACS patients [0.17 (0.12-0.25) vs. 0.25 (0.18-0.37), p=0.002]. The prevalence of cardio-pulmonary arrest and percutaneous cardiopulmonary support use was higher in young ACS patients than in elderly ACS patients (24.3% vs. 8.6%, p=0.003, 16.2% vs. 3.1%, p<0.001). Conclusion The features were markedly different between young ACS patients and elderly ACS patients. In young ACS patients, smoking, being overweight, and a low EPA/AA ratio were distinctive risk factors, and more serious clinical presentations were observed at the onset of ACS than in older patients.

Diagnostic Performance of High-Resolution Intravascular Ultrasound for the Detection of Plaque Rupture in Patients With Acute Coronary Syndrome.

BACKGROUND: The new 60-MHz high-resolution intravascular ultrasound (HR-IVUS) is the next-generation IVUS technology, providing higher image resolution than conventional IVUS. It gives clear images of plaque morphology and can discriminate the underlying mechanism of acute coronary syndrome (ACS). Our study aimed to evaluate the diagnostic performance of 60-MHz HR-IVUS in the detection of plaque rupture in patients with ACS.Methods and Results:Patients with ACS who underwent percutaneous coronary intervention for de novo native coronary artery lesions were enrolled. Both HR-IVUS and optical coherence tomography (OCT) were performed for the culprit lesions prior to interventions other than aspiration thrombectomy. Keeping plaque rupture detected by OCT as the gold standard, the diagnostic performance of HR-IVUS was evaluated. Overall, 70 patients underwent both HR-IVUS and OCT examinations. Of these, imaging assessments by HR-IVUS were available for all 70 patients (100%), and those by OCT were available for 54 patients (77.1%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of HR-IVUS for identifying a plaque rupture were 84.8%, 57.1%, 75.7%, 70.6%, and 74.1%, respectively. CONCLUSIONS: HR-IVUS had high sensitivity, but modest specificity for identifying OCT-derived plaque rupture. Compared with results from previous conventional IVUS studies, HR-IVUS might have increased ability to detect OCT-derived plaque rupture, but there is still substantial scope for improvement, especially in the specificity.

Development and validation of an improved diced electrophoresis gel assay cutter-plate system for enzymomics studies.

Diced electrophoresis gel (DEG) assay is a methodology to identify enzymes with a specified activity in complex cell or tissue lysates by means of two-dimensional separation using isoelectric focusing and native PAGE, followed by dicing of the gel into small pieces that are assayed separately, and digestion and peptide fingerprinting to identify the protein(s) of interest in positive wells. The existing hand-made system has some disadvantages, and here we describe the development and validation of an improved cutter-plate system that enables simple, reliable and reproducible DEG assay in a 384-well plate-based format with signal readout using fluorometric or LC-MS-based reaction monitoring. To illustrate the usefulness of this system, we describe its application to profile esterase activities in ovarian adenocarcinoma SKOV3 cell lysate and mouse liver lysate that activate a fluorogenic substrate, fluorescein dibutyrate (FDBu), as well as esterase activities in mouse liver lysate that activate S-bromobenzylglutathione dicyclopentyl ester (BBGDC), a prodrug of anti-tumor agent S-bromobenzylglutathione. The activity spot patterns detected for FDBu and BBGDC were completely different, indicating that different metabolic systems are involved in hydrolysis of these substrates. The major detected spot in each case was identified. The developed system provides a highly reproducible general assay platform that should be useful for characterizing novel protein functions in complex bio-samples, as well as enzymomics studies.

Early-Phase Vascular Healing of Bioabsorbable vs. Durable Polymer-Coated Everolimus-Eluting Stents in Patients With ST-Elevation Myocardial Infarction　- 2-Week and 4-Month Analyses With Optical Coherence Tomography.

BACKGROUND: Despite the revolution of coronary stents, there remain concerns about the risk of stent thrombosis, especially in patients with ST-elevation myocardial infarction (STEMI). The present study compared early vascular healing as a contributing factor to reducing stent thrombosis between Xience everolimus-eluting stents (X-EES) and Synergy everolimus-eluting stents (S-EES) in patients with STEMI. Methods and Results: The present study included 47 patients with STEMI requiring primary percutaneous coronary intervention with X-EES (n=25) or S-EES (n=22). Optical coherence tomography (OCT) assessments of the stented lesions were performed 2 weeks and 4 months after stent implantation. Neointimal strut coverage, malapposition and the frequency of thrombus formation were evaluated. In the 2-week OCT analysis, the proportion of covered struts in S-EES (42.4±15.4%) was significantly higher than in X-EES (26.3±10.1%, P<0.001). In the 4-month OCT analysis, the proportion of covered struts in S-EES (72.2±17.9%) was still significantly higher than in X-EES (62.0±14.9%, P=0.04). CONCLUSIONS: Compared with X-EES, S-EES showed a higher proportion of covered struts in the early phase after stent implantation for STEMI patients.

SEX DIFFERENCES IN THE EFFECTS OF DIVERSE SOUNDS ON HEART RATE VARIABILITY.

With the goal of facilitating the creation of relaxing sound environments in stressful places, such as offices, we examined differences in the heart rate fluctuations of men and women induced by different sounds. Twenty-three healthy students (13 males and 10 females) aged between 18 and 23 listened to seven different sounds while we collected electrocardiogram data. We extracted the high frequency component (HF) and low frequency component (LF) of the signals using the wavelet method, and calculated LF/HF. We found no statistically significant differences between males and females in the frequency distribution of a no change group, increased group, and decreased group for any sound. However, certain sounds had somewhat similar patterns for men and women for all three groups. Additionally, the pairs of experimental sounds with highly similar effects on individuals were different for men and women.

DETECTING THE GAZING ATTENTION POINTS OF YOUNG AND ELDERLY CYCLISTS.

This study analyzed the perceived attention represented by "gazing" points of cyclists to expose a latent accidental factor hidden in cyclist behaviour. Eleven elderly people and 23 young people equipped with an eye camera participated in the study. From the camera images, the objects viewed by the cyclists were analyzed. A main road and a community road were used in the experiment. The objects viewed by the cyclists were categorized into nine items that would be indirectly related to the cause of bicycle traffic accidents: gates and porches, parking lots, signals, alleys, other bicycles on the road, pedestrians, signs and painted symbols on the road, schoolyards and houses, and other items. The results of the study indicated that many elderly cyclists always confirmed their safety at alley intersections along both main and community roads, whereas many young people were not so dutiful. The results for unsafe gazing behavior such as looking at a schoolyard or house while cycling were the same for the two groups in that most individuals did not look away from the road while cycling along the main and community roads. Dissimilar results, especially those for alley intersections, resulted from young people not paying due attention to objects, suggesting that such gazing behaviour could be strongly related to traffic accidents involving a bicycle.

Influences of raised ambient temperature on cardiorespiratory performance in a 3-minute step test.

We investigated the effects of raised ambient temperature on cardiorespiratory performance in a 3- min step test. Subjects repeatedly performed the step exercise under three ambient thermal conditions. A cardiorespiratory fitness index was computed from heart rate (HR) measurements during a recovery period after the exercise. Raised ambient temperature was associated with significantly increased HR not only during the rest period before exercise but also during the recovery period. The cardiorespiratory fitness index for the high temperature condition was significantly poorer than those for the moderate conditions. The variability of the pre-exercise HR among the three thermal condi- tions was highly correlated with the variability of the cardiorespiratory index. These results indicate that the 3-min step test should be performed under identical ambient thermal conditions and, if necessary, cardiorespiratory fitness evaluation based on HR recovery after the 3-min step exercise should be corrected for individual acclimation states or heat stress properties.

How does the edge height of curb ramps obstruct bicycles?

The aim of this study is to recommend revisions, based on empirical data, to the current curb ramp standards for keeping bicyclists safe. Four types of curb ramps were tested: (1) concrete with a 50 mm edge height, (2) concrete reinforced by a metal plate with a 50 mm edge height, (3) plastic with a 20 mm edge height, and (4) recycled rubber with a 10 mm edge height. Twenty subjects aged 20-60 years ascended the curbs on a bicycle under various conditions. The angles of approach were 15 degrees, 30 degrees, 45 degrees, 60 degrees, 75 degrees and 90 degrees. Experiments were executed under both wet and dry conditions. We found that when approaching from an angle of 45 degrees or more, all subjects could ascend all ramps under both conditions. From a 15 degrees approach under wet conditions, no subjects ascended the concrete ramps. Some could not ascend at a 15 degrees approach on the concrete ramps in dry conditions, and some could not ascend from a 30 degrees approach on the reinforced concrete ramp in wet conditions. Bicyclists riding on roadways cannot easily ascend a curb ramp with a 50 mm edge, even in dry conditions. We thus recommend that curb ramp edge heights be lower than 50 mm. Keywords: friction coefficient; approach angle

How does a cyclist avoid obstacles?

The purpose of this research is to examine the ways bicycles swerve off sidewalks onto roads under various conditions. Seven students, five males and two females participated in an experiment on a road with a 100-cm wide sidewalk. Footage of each participant on a bicycle evading obstacles such as a utility pole and pedestrian were taken with a video camera, while a front-wheel view of the path taken by the bicycle was recorded simultaneously with a digital camera. Twelve experimental conditions were used for each participant, consisting of all the combinations of (1) three obstacle types, (2) the side (left or right) to which the bicycle went to avoid the obstacle, and (3) two weather conditions. Based on the two recorded scenes, the path was then analyzed from the viewpoint of how the bicycle swerved to avoid hitting the obstacle. We found that the conditions of riding a bicycle with an umbrella caused a larger swerve to avoid the obstacle than those conditions when the rider did not have an umbrella. In particular, the condition in which the obstacle was a pedestrian who also had an umbrella caused the largest swerve. Furthermore, the distance required to become aligned with the sidewalk when the obstacle was a pedestrian walking toward the cyclist was longer than that for other obstacles. The swerve width data showed interesting results, including a tendency for swerve width to be wider when the obstacle was a utility pole compared with other obstacles.

Effect of passenger position on fear of danger experienced during sudden bus stops.

The purpose of this study was to identify the effect of bus passengers' positions on their fear of danger when a bus stopped suddenly. A temporary bus running course with one bus stop was set up on the campus of the Tokyo University of Agriculture and Technology (TUAT). The bus ran the course 14 times with the bus stopping twice during the course, once at the bus stop and again just after re-starting from the bus stop. The driver was asked to brake more strongly than usual when stopping. Sixteen students (15 males and 1 female) between the ages of 18 and 21 years participated. In turn, all participants were asked to take 14 different postures in the bus. Participants were also asked to report their level of fear on a rating scale each time the bus stopped. The study showed that (1) passengers' fear of danger at the first sudden stop was typically higher than that at the second stop, (2) standing passengers who held hand straps experienced more fear than those who held fixed safety devices, (3) bus passengers sitting on the centre of the rear seat had a great risk of injury if the bus stopped suddenly, and (4) when passengers faced the window and stood transversely with respect to from the moving direction of the bus and the bus stopped suddenly, passengers' fear of danger was affected by the side of the bus on which they stood as well as which hand they used to grasp a safety device.

Experimental study on the grip and hold strength for stanchions and handrails in buses.

The purpose of this study was to investigate the effective use of stanchions and handrails in buses. We constructed experimental equipment resembling bus stanchions and handrails and examined the grip and hold strength exerted when used. The total number of subjects was 80: 30 elderly and 19 young males, and 22 elderly and 9 young females. The experimental equipment comprised four parts: a handle part to imitate safety devices in buses such as stanchions, handrails, and straps, which was pulled by a winch at a constant speed; and a load cell wired with an analyzing processor, which output the strength exerted. The handle part was designed to measure grip and hold strengths against pulling forces in three directions, that is, forward, in the direction of the back of the hand, and in the direction of the palm. The subjects were asked to grasp the handle part against a pulling force. The maximum grip and hold strengths were recorded and analyzed. The strengths when pulled forward were the largest independent of the sex and age of the subjects. The results indicate that standing bus passengers should grip the fixtures, such as a stanchion, with their right hand when they are standing on the right side in a bus facing the windows.