Effect of mastication evaluation and intervention on body composition and biochemical indices in female patients with obesity: a randomized controlled trial.

BACKGROUND: A limited number of studies have evaluated the masticatory indices of individuals with obesity who only chew their food a few times and for shorter duration or who were provided with an instructional intervention. This study aimed to examine the effects of a 6-month instructional mastication intervention on the body composition and biochemical indices in female patients with obesity. METHODS: Female patients with obesity were randomly classified into a conventional treatment group (CTG; 12 individuals), which only received normal nutritional and exercise guidance, and a mastication intervention group (MIG; 16 individuals), which received an additional mastication guidance. The MIG received guidance on foods requiring increased number of chews and chewing duration, eating techniques, and the proper method of cutting foods. RESULTS: Changes in the masticatory, body composition, and biochemical indices were compared before and after the 6-month intervention. The values of body composition indices decreased significantly in both groups; however, the rate of change in body mass index significantly decreased in the MIG. In addition, the values of biochemical indices were significantly decreased in the MIG compared with that in the CTG, which is attributed to the addition of mastication instruction to female patients with obesity. CONCLUSION: Increasing the number of chews and duration of chewing times for carbohydrates, which are staple foods, possibly contributed to weight loss and improvement of glucose metabolism. TRIAL REGISTRATION: UMIN, UMIN000025875. Registered on 27 Jan 2017.

Ventricular arrhythmias following coronary artery bypass grafting for ischemic cardiomyopathy: When to insert an implanted cardioverter defibrillator?

Objectives: The study objectives were to determine the incidence, predictors, and clinical impact of ventricular arrhythmias after coronary artery bypass grafting and to evaluate the impact of implantable cardioverter defibrillators on the survival of patients with ventricular arrhythmias. Methods: We enrolled 498 patients with a left ventricular ejection fraction of 40% or less who underwent coronary artery bypass grafting between 1993 and 2015. Clinical follow-up was completed in 94.0% of patients, with a median follow-up of 58.4 months. Results: Overall, 212 patients (43%) died, mainly of heart failure (n = 54, 10.8%) or sudden cardiac death (n = 40, 8.0%). The sudden cardiac death rate was highest during the first 6 months, with a monthly rate of 0.37%. Overall, 99 patients (20%) developed postoperative ventricular arrhythmias, and implantable cardioverter defibrillator was implanted in 55 patients. Previous ventricular arrhythmias (hazard ratio, 3.22; 95% confidence interval, 1.98-5.24; P < .001), left ventricular end-systolic dimension (hazard ratio, 1.07; 95% confidence interval, 1.04-1.10; P < .001), and myocardial infarction in the left anterior descending artery territory (hazard ratio, 1.73; 95% confidence interval, 1.10-2.73; P = .02) were independent predictors of postoperative ventricular arrhythmias. Notably, the 5-year survival of patients with ventricular arrhythmias who received an implantable cardioverter defibrillator was significantly higher than that of patients with ventricular arrhythmias who did not receive it (76.1% vs 22.7%, P < .001) and was comparable to that of patients without ventricular arrhythmias (76.1% vs 73.6%, P = .98). Conclusions: Sudden cardiac death affects a significant proportion of patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting, most frequently within 6 months postoperatively. To prevent sudden cardiac death, earlier implantable cardioverter defibrillator implantation should be indicated for high-risk patients with scars in the left anterior descending artery territory and excessive left ventricular remodeling.

Earable Ω (OMEGA): A Novel Clenching Interface Using Ear Canal Sensing for Human Metacarpophalangeal Joint Control by Functional Electrical Stimulation.

(1) Background: A mouth-free interface is required for functional electrical stimulation (FES) in people with spinal cord injuries. We developed a novel system for clenching the human metacarpophalangeal (MP) joint using an earphone-type ear canal movement sensor. Experiments to control joint angle and joint stiffness were performed using the developed system. (2) Methods: The proposed FES used an equilibrium point control signal and stiffness control signal: electrical agonist-antagonist ratio and electrical agonist-antagonist sum. An angle sensor was used to acquire the joint angle, and system identification was utilized to measure joint stiffness using the external force of a robot arm. Each experiment included six and five subjects, respectively. (3) Results: While the joint angle could be controlled well by clenching with some hysteresis and delay in three subjects, it could not be controlled relatively well after hyperextension in the other subjects, which revealed a calibration problem and a change in the characteristics of the human MP joint caused by hyperextension. The joint stiffness increased with the clenching amplitude in five subjects. In addition, the results indicated that viscosity can be controlled. (4) Conclusions: The developed system can control joint angle and stiffness. In future research, we will develop a method to show that this system can control the equilibrium point and stiffness simultaneously.

Masticatory Behaviors and Gender Differences in People with Obesity as Measured via an Earphone-Style Light-Sensor-Based Mastication Meter.

While people with obesity have been found to chew fewer times and for shorter durations, few studies have quantitatively evaluated mastication among this group. This study examined the relationship between the mastication characteristics of people with obesity and the factors correlated with obesity. To this end, 46 people with obesity and 41 healthy participants placed an earphone-style light sensor in the aperture of their outer ear. We also examined the partial correlation between this, their body composition, and various biochemical markers by gender. A two-way analysis of variance (ANOVA) regarding the masticatory index, gender, and the presence/absence of obesity for all three food items revealed the main effects in the gender difference and the presence/absence of obesity. Additionally, the number of times the salad was chewed showed an interaction between the gender and the presence/absence of obesity. In the BMI-corrected partial correlation analysis of the chewing index and the glucose/lipid metabolism index, the chewing time and the number of chews of all the food items negatively correlated with hemoglobin A1c(HbA1c), fasting plasma glucose (FPG), immunoreactive insulin (IRI), and homeostasis model assessment of insulin resistance (HOMA-R) in the female obese group. These findings might be used in weight-loss interventions for men with obesity and treatments that target the metabolic function among women with obesity.

Validation of Earphone-Type Sensors for Non-Invasive and Objective Swallowing Function Assessment.

Standard methods for swallowing function evaluation are videofluoroscopy (VF) and videoendoscopy, which are invasive and have test limitations. We examined the use of an earphone-type sensor to noninvasively evaluate soft palate movement in comparison with VF. Six healthy adults wore earphone sensors and swallowed barium water while being filmed by VF. A light-emitting diode at the sensor tip irradiated infrared light into the ear canal, and a phototransistor received the reflected light to detect changes in ear canal movement, including that of the eardrum. Considering that the soft palate movement corresponded to the sensor waveform, a Bland-Altman analysis was performed on the difference in time recorded by each measurement method. The average difference between the time taken from the most downward retracted position before swallowing to the most upward position during swallowing of the soft palate in VF was -0.01 ± 0.14 s. The Bland-Altman analysis showed no fixed or proportional error. The minimal detectable change was 0.28 s. This is the first noninvasive swallowing function evaluation through the ear canal. The earphone-type sensor enabled us to measure the time from the most retracted to the most raised soft palate position during swallowing and validated this method for clinical application.

Clinical Outcomes After Durable Mitral Valve Repair for Ischemic Mitral Regurgitation.

BACKGROUND: This study aimed to clarify the incidence and determinants of postoperative adverse events in patients with ischemic cardiomyopathy who achieved long-term durable mitral valve repair. METHODS: Between 1999 and 2015, 166 patients with chronic ischemic mitral regurgitation (MR) and a left ventricular ejection fraction ≤40% underwent restrictive mitral annuloplasty. During follow-up (65 ± 34 months), echocardiographic assessments were performed 809 times (mean, 4.9 ± 2.4 times), and 20 patients who had postoperative recurrent MR (moderate or severe) were excluded. Finally, 146 patients (aged 68 [63-75] years) whose MR was well controlled over time were included. RESULTS: A total of 61 deaths or 27 readmissions for heart failure were observed in 76 patients (52%). Among hospital survivors, age (adjusted hazard ratio, 1.05; P = .001) and estimated glomerular filtration rate (adjusted hazard ratio, 0.61; P = .001) were identified as independent predictors of long-term mortality or readmission for heart failure. The degree of postoperative left ventricular function recovery was comparable between patients with and without adverse events. However, the former group showed greater values for systolic pulmonary artery pressure, tricuspid regurgitation severity, inferior vena cava dimension, and plasma brain natriuretic peptide level throughout the follow-up period (group effect P < .05 for all). CONCLUSIONS: Approximately 50% of patients died or were hospitalized for heart failure even in the absence of recurrent MR during the 5-year follow-up, a finding indicating that durable mitral repair does not always lead to favorable clinical outcomes. The adverse events may have been related to volume overload secondary to impaired renal function and less favorable pulmonary hemodynamics.

Heterogeneous reduction in regional wall stress after aortic valve replacement for aortic regurgitation: a distinct feature from aortic stenosis.

Geometric changes caused by volume reduction early after aortic valve replacement (AVR) for aortic regurgitation (AR) may not be uniform, resulting in varying regional end-systolic wall stress (ESS). This study compared changes in regional ESS between AR and aortic stenosis (AS) patients in the early phase following AVR. Computer-tomographic left ventricular (LV) angiography was performed for 10 patients with AR and 13 with AS before and three months after AVR. Regional ESS at the base, middle, and apex levels, each subdivided into four segments, was calculated based on the Janz equation: ESS = end-systolic LV pressure × local cross-sectional area of LV cavity/that of LV wall. Following AVR, median LV end-diastolic volume index fell from 106 to 69 ml/m2 (P = 0.001) in AR and 60 to 46 ml/m2 (P = 0.01) in AS patients. Global ESS also declined in both (AR, 186 to 124 kdyne/cm2, P = 0.02; AS, 187 to 108 kdyne/cm2, P < 0.001, respectively). Regional ESS was reduced in all segments in AS patients, accompanied by left ventricular ejection fraction (LVEF) improvement (71-80%, P = 0.02). In contrast, regional ESS in AR patients was heterogeneously reduced, as regional ESS fell significantly in the antero-septal wall but was unchanged in the infero-lateral wall, and LVEF remained unchanged (65 to 62%, P = 0.42). In the early postoperative phase after AVR, the loading condition of the regional LV wall in AR patients was characterized by a heterogeneous reduction in regional ESS in contrast to a uniform decline in AS patients.

Detrimental effects of elevated transpulmonary gradient on outcomes following restrictive mitral annuloplasty in patients with pre-existing pulmonary hypertension.

BACKGROUND: This study retrospectively examined the association between elevated trans-pulmonary gradient (TPG), which reflects pre-capillary contribution to pulmonary hypertension (PH), and postoperative pulmonary hemodynamics and outcomes following restrictive mitral annuloplasty (RMA) in patients with pre-existing PH. METHODS: Pre- and postoperative (1 month) cardiac catheterization was performed in 64 patients with severely impaired left ventricular function (i.e., ejection fraction ≤40%) and pre-existing PH (mean pulmonary artery pressure (PAP) ≥25 mmHg) who underwent RMA. Patients were segregated into two groups: low TPG (≤12 mmHg) and elevated TPG (>12 mmHg). The mean follow-up period was 54±27 months. The primary outcome seen was a change in pulmonary hemodynamics after RMA; secondary outcomes were composite adverse events, including all-cause mortality and readmission for heart failure. RESULTS: Compared to the low TPG group, patients in the elevated TPG group were more likely to show a postoperative mean PAP of ≥25 mmHg (84% vs. 38%), TPG of >12 mmHg (79% vs. 11%), and pulmonary vascular resistance of ≥240 dynes/sec/cm-5 (84% vs. 6.7%) (all P<0.001), although both groups showed comparable degrees of mitral regurgitation improvement. Serial echocardiography demonstrated that Doppler-derived systolic PAP, which once decreased in both groups, remained stable in the low group while steadily increasing in the elevated group (group effect P<0.001). Patients with elevated TPG had lower freedom from composite adverse events (5-year, 20% vs. 70%, P=0.003). After adjusting for baseline covariates, the elevated TPG was independently associated with increased risk of adverse events (adjusted hazard ratio 2.9, 95% CI: 1.2-6.9, P=0.017). CONCLUSIONS: Elevated TPG negatively affects postoperative pulmonary hemodynamics and late outcomes in patients with advanced cardiomyopathy and pre-existing PH who have undergone RMA. These findings suggest that the assessment of TPG should be included in post-RMA risk stratification.

Bilateral Internal Thoracic Artery Grafting Improves Survival for Severe Left Ventricular Dysfunction and Diabetes.

BACKGROUND: In patients with severe left ventricular (LV) dysfunction requiring coronary artery bypass grafting (CABG), the association between diabetic status and outcomes after surgery, as well as with survival benefit following bilateral internal thoracic artery (ITA) grafting, remain largely unknown.Methods and Results:Patients (n=188; mean [±SD] age 67±9 years) with LV ejection fraction ≤40% who underwent isolated initial CABG were classified into non-diabetic (n=64), non-insulin-dependent diabetic (NIDM; n=74), and insulin-dependent diabetic (IDM; n=50) groups. During follow-up (mean [±SD] 68±47 months), the 5-year survival rate was 84% and 65% among non-diabetic and diabetic patients, respectively (P=0.034). After adjusting for all covariates, both NIDM and IDM were associated with increased mortality, with hazard ratios (HRs) of 1.9 (95% confidence interval [CI] 1.0-3.7; P=0.049) and 2.4 (95% CI 1.2-4.8; P=0.016), respectively. Among non-diabetic patients, there was no difference in the 5-year survival rate between single and bilateral ITA grafting (86% vs. 80%, respectively; P=0.95), whereas bilateral ITA grafting increased survival among diabetic patients (57% vs. 81%; P=0.004). Multivariate analysis revealed that bilateral ITA was significantly associated with a decreased risk of mortality (HR 0.3; 95% CI 0.1-0.8; P=0.024). CONCLUSIONS: NIDM and IDM were significantly associated with worse long-term clinical outcome after CABG for severe LV dysfunction. Bilateral ITA grafting has the potential to improve survival in diabetic patients with severe LV dysfunction.

Incidence, determinants and clinical impact of left ventricular function recovery after surgical treatments for ischaemic cardiomyopathy.

OBJECTIVES: This retrospective study aimed to clarify the incidence, determinants and clinical impact of left ventricular (LV) function non-recovery after coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. METHODS: A total of 490 patients with ischaemic cardiomyopathy (LV ejection fraction ≤ 40%) undergoing CABG were analysed. Follow-up echocardiography was performed at 1 month, 1 year, and annually thereafter. LV function recovery was defined as ejection fraction (EF) ≥40% at least once during follow-up. LV function non-recovery was defined as EF <40% at any follow-up. The primary and secondary end points were changes in LV function and all-cause mortality, respectively. Clinical follow-up was completed in 461 patients (94.1%; mean follow-up: 64.5 ± 45.5 months). RESULTS: During follow-up, echocardiographic assessments were performed 1863 times (mean, 3.8 ± 2.4), and 193 patients (39.4%) exhibiting LV function non-recovery were identified. Overall survival was significantly higher in the recovery group (53.9%) than in the non-recovery group (31.4%) at 10 years (P < 0.001). Independent predictors of LV function non-recovery were preoperative LV end-systolic diameter [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10; P < 0.001] and bilateral internal thoracic artery grafting (OR 0.61, 95% CI 0.39-0.95; P = 0.028). In a multivariable Cox proportional hazards model, LV function non-recovery was significantly associated with all-cause mortality (hazard ratio 2.14, 95% CI 1.60-2.86; P < 0.001). CONCLUSIONS: Almost 40% of patients with ischaemic cardiomyopathy undergoing CABG did not achieve LV function recovery and were associated with poor prognosis. To achieve LV function recovery, CABG with bilateral internal thoracic artery may be recommended before excessive LV remodelling occurs. CLINICAL TRIAL REGISTRATION NUMBER: Institutional review board of Osaka University Hospital, number 16105.

Surgical Ablation Concomitant With Nonmitral Valve Surgery for Persistent Atrial Fibrillation.

BACKGROUND: Consensus regarding an optimal atrial fibrillation (AF) ablation lesion set concomitant with aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) has not been established. METHODS: We enrolled 125 consecutive patients (89 men; 70 ± 8 years old) with persistent AF who underwent radiofrequency-based pulmonary vein isolation (PVI) (PVI group, n = 53) or a Cox-Maze procedure (Maze group, n = 72) with AVR and/or CABG. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent Cox-Maze with and those who underwent PVI, we established weighted Cox proportional-hazards regression models with inverse probability of treatment weighting. Mean follow-up was 63 ± 34 months (maximum, 154 months). RESULTS: There was 1 in-hospital death in each group. Patients who underwent Cox-Maze showed a higher freedom from AF at all follow-up examinations. After the operation, there were 32 deaths, 13 thromboembolisms, 8 hemorrhagic events, and 22 heart failure readmissions. The Maze group had higher rates for 5-year survival (88% vs 64%, P = .013) and freedom from composite events (74% vs 42%, P < .001). After adjustment with inverse probability of treatment weighting, the Cox-Maze procedure still showed a lower risk of overall mortality (adjusted hazard ratio, 0.38; 95% confidence interval, 0.21-0.66; P = .001) and composite adverse events (adjusted hazard ratio, 0.52; 95% confidence interval, 0.35-0.76; P = .001). CONCLUSIONS: In patients with persistent AF indicated for nonmitral valve surgery, a concomitant Cox-Maze procedure resulted in superior AF- and event-free survival compared with PVI, without increased risk of early mortality. These findings may assist decision making for surgical management of persistent AF concomitant with AVR and/or CABG.

Multiple percutaneous coronary interventions worsen outcomes for subsequent surgical correction of chronic ischemic mitral regurgitation.

Objective: We investigated whether or not a history of multiple percutaneous coronary interventions (PCIs) is associated with clinical outcomes after surgery for ischemic mitral regurgitation. Methods: A total of 309 patients with chronic ischemic mitral regurgitation and left ventricular ejection fraction ≤40% who underwent restrictive mitral annuloplasty were classified as follows: patients with no or 1 previous PCI (nonmultiple PCI group [n = 211]) and patients with 2 or more previous PCIs (multiple PCIs group [n = 98]). Mean follow-up duration was 53 ± 40 months. Results: Before surgery, there were no intergroup differences in patient demographic characteristics except for lower estimated glomerular filtration rate in patients with multiple PCIs. These patients underwent concomitant coronary artery bypass grafting less frequently with a lower number of distal anastomoses (P < .05 for both). The 30-day mortality was 3.3% and 2.0% in the nonmultiple and multiple PCIs group, respectively (P = .72). During follow-up, there were 157 deaths. Patients with multiple PCIs showed lower 5-year survival rate (44% vs 64%; P = .002). After adjustments with inverse-probability-of-treatment weighting, multiple PCIs history was an independent risk factor for mortality (adjusted hazard ratio, 1.4; 95% confidential interval, 1.1-1.7; P = .002). Patients with multiple PCIs showed less improvement in left ventricular ejection fraction (interaction effect P < .001). Conclusions: In patients with ischemic mitral regurgitation, a history of previous multiple PCIs was associated with increased risk of long-term postoperative mortality, with less improvement in left ventricular ejection fraction.

Restrictive mitral annuloplasty with or without coronary artery bypass grafting in ischemic mitral regurgitation.

AIMS: In patients with ischaemic mitral regurgitation (MR), the impact of mitral valve surgery with concomitant coronary artery bypass grafting (CABG) on post-operative survival and left ventricular (LV) reverse remodelling remains unknown. Therefore, we investigated these outcomes following restrictive mitral annuloplasty (RMA) with and without CABG in those patients. METHODS AND RESULTS: This study included 309 patients with chronic MR and ischaemic cardiomyopathy for whom concomitant CABG was indicated (n = 225) or not indicated (n = 84) with RMA. The primary endpoint was all cause mortality during the follow-up, and the secondary endpoint was defined as the composite of mortality and re-admission for heart failure. Linear mixed model was used to analyse serial echocardiographic changes in LV function. To reduce the impact of treatment bias and potential confounding in the direct comparisons between patients who underwent RMA with and those who underwent it without CABG, we established weighted Cox proportional-hazards regression models with inverse-probability-of-treatment weighting. Pre-operatively, there were no intergroup differences in age (RMA with CABG, 67 ± 9 vs. RMA without CABG, 68 ± 11, P = 0.409) and logistic EuroSCORE II (16 ± 14 vs. 15 ± 15%, P = 0.496). The 30-day mortalities were 2.7% and 3.6%, respectively (P = 0.67). During follow-up with a mean duration of 72 ± 37 months (range, 5.6-179), there were 157 deaths and 105 re-admissions for heart failure. Overall 1-year and 5-year survival rates were 83 ± 2% and 58 ± 3%, respectively. Patients who did not receive CABG with RMA had a significantly lower 5-year survival rate (45% vs. 63%, P = 0.049) and freedom from adverse events defined as mortality and/or admission for heart failure (19% vs. 43%, P < 0.001) than those who did. After adjustments for clinical covariates with inverse-probability-of-treatment weighting, concomitant CABG was identified as an independent protective factor for adverse events (hazard ratio: 0.53; 95% confidence interval: 0.44-0.64; P < 0.001). Along with significant MR reduction, LV function parameters changed over time after surgery in both groups, with greater improvements in patients who underwent RMA with CABG (time effect, P < 0.001; and interaction effect, P = 0.002). CONCLUSIONS: RMA can be performed with an acceptable operative mortality, irrespective of indications for CABG. Patients with ischaemic MR for whom CABG is indicated with RMA are more likely to show better long-term and event-free survival and greater improvements in LV systolic function. The optimal revascularization strategy should be discussed with a heart team whenever indicated in patients with ischaemic MR; otherwise, they may miss the opportunity to benefit from concomitant CABG during subsequent RMA.

Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion.

Background/Aims: The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods: From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results: A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions: The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.

Simultaneous Measurement of Ear Canal Movement, Electromyography of the Masseter Muscle and Occlusal Force for Earphone-Type Occlusal Force Estimation Device Development.

We intend to develop earphone-type wearable devices to measure occlusal force by measuring ear canal movement using an ear sensor that we developed. The proposed device can measure occlusal force during eating. In this work, we simultaneously measured the ear canal movement (ear sensor value), the surface electromyography (EMG) of the masseter muscle and the occlusal force six times from five subjects as a basic study toward occlusal force meter development. Using the results, we investigated the correlation coefficient between the ear sensor value and the occlusal force, and the partial correlation coefficient between ear sensor values. Additionally, we investigated the average of the partial correlation coefficient and the absolute value of the average for each subject. The absolute value results indicated strong correlation, with correlation coefficients exceeding 0.9514 for all subjects. The subjects showed a lowest partial correlation coefficient of 0.6161 and a highest value of 0.8286. This was also indicative of correlation. We then estimated the occlusal force via a single regression analysis for each subject. Evaluation of the proposed method via the cross-validation method indicated that the root-mean-square error when comparing actual values with estimates for the five subjects ranged from 0.0338 to 0.0969.

Outcomes After Aortic Valve Replacement for Asymptomatic Severe Aortic Regurgitation and Normal Ejection Fraction.

We investigated long-term outcomes following aortic valve replacement (AVR) in asymptomatic patients with severe aortic regurgitation (AR) and normal left ventricular (LV) function. We reviewed 268 patients who underwent isolated AVR for chronic severe AR from 1991 to 2010 and enrolled 162 asymptomatic patients with normal LV ejection fraction (≥50%) preoperatively. They were divided into 2 groups according to LV dimension at surgery, the early stage C group (indexed LV end-systolic diameter ≤25 mm/m2 and LV end-diastolic diameter ≤65 mm, n = 61), and late stage C group (indexed LV end-systolic diameter >25 mm/m2 and/or LV end-diastolic diameter >65 mm, n = 101). Survival was compared with that of an age- and gender-matched Japanese general population using a one-sample log-rank test. Subgroup analysis was performed for patients who survived >10 years after AVR. The mean age of all patients was 59 ± 14 years and mean follow-up period was 10 ± 5 years. Survival after AVR for the early and late stage C groups was not statistically different (P = 0.57). Furthermore, survival for both groups was not statistically different from that of the general population (early stage C, P = 0.63; late stage C, P = 0.14). However, subgroup analysis showed that survival >10 years after AVR was significantly worse for the late stage C group as compared to that of the general population (P < 0.001). Long-term survival following AVR for asymptomatic AR with normal LV ejection fraction was excellent. However, survival more than 10 years after surgery might be dependent on LV dimension at surgery.

Intermediate-term outcomes of our original multiple-knot technique using ePTFE sutures for anterior mitral leaflet prolapse.

PURPOSE: To define the outcomes of our original simple chordal replacement technique using ePTFE sutures for mitral regurgitation. METHODS: Between January, 2004 and March, 2014, 38 patients underwent mitral valve repair using our chordal replacement technique for anterior leaflet prolapse. The mitral regurgitation was caused by degenerative disease in 34 patients and infective endocarditis in 4 patients. RESULTS: The follow-up period was 66 ± 37 months and the 5-year survival rate was 95 ± 4%. Two patients had recurrent mitral regurgitation, caused by degenerative change not associated with the procedure. The 5-year rate of freedom from recurrent mitral regurgitation was 94 ± 4%. In the late postoperative period, 15 (42%) patients had a mean pressure gradient > 5 mmHg. Stepwise logistic regression analysis showed that the use of a full ring (odds ratio 8.9; 95% confidence interval 1.2-64; p = 0.031) and a 26 mm annuloplasty (odds ratio 7.5; 95% confidence interval 1.1-50; p = 0.037) were significant independent risk factors for a mean pressure gradient > 5 mmHg. CONCLUSION: The intermediate-term outcomes of our original chordal replacement technique were not inferior to those in previous reports, although a 26 mm annuloplasty was found to be associated with a higher mitral valve gradient at rest.

Earable POCER: Development of a Point-of-Care Ear Sensor for Respiratory Rate Measurement.

We have carried out research and development on an earphone-type respiratory rate measuring device, earable POCER. The name earable POCER is a combination of "earable", which is a word coined from "wearable" and "ear", and "POCER", which is an acronym for "point-of-care ear sensor for respiratory rate measurement". The earable POCER calculates respiratory frequency, based on the measurement values over one minute, through the simple attachment of an ear sensor to one ear of the measured subject and displays these on a tablet terminal. The earable POCER irradiates infrared light using a light-emitting diode (LED) loaded on an ear sensor to the epidermis within the ear canal and, by receiving that reflected light with a phototransistor, it measures movement of the ear canal based on respiration. In an evaluation experiment, eight healthy subjects first breathed through the nose 12 times per minute, then 16 times per minute, and finally 20 times per minute, in accordance with the flashing of a timing instruction LED. The results of these evaluation tests showed that the accuracy of the respiratory frequency was 100% for nose breathing 12 times per minute, 93.8% at 16 times, and 93.8% at 20 times.

[Beneficial Effects of Restrictive Annuloplasty on Subvalvular Geometry in Patients with Functional Mitral Regurgitation and Advanced Cardiomyopathy].

OBJECTIVES: The effects of restrictive mitral annuloplasty (RMA) on subvalvular geometry remains unknown. We evaluated changes in left ventricular(LV) function, severity of mitral regurgitation(MR) and leaflet tethering parameters after RMA and clarified their associations. METHODS: In 44 patients with clinically-relevant functional MR who underwent RMA, distances between papillary muscle( PM) tips and anterior mitral annulus( PM-tethering distance), leaflet angles relative to lines connecting annuli, and interpapillary muscle distance( IPMD) were serially quantified. RESULTS: One month after surgery, LV function and MR severity improved with decreased anterior (34±5 to 30±4 mm) and posterior PM-tethering distance (37±4 to 32±4 mm), anterior-leaflet angle (ALA)[32±8 to 22±7 degree], and IPMD (31±6 to 25±5 mm), while these variables remained abnormal and posterior-leaflet angle (PLA) increased (34±8 to 48±14 degree)[p<0.01 for all]. During follow-up (66±37 months), these effects were maintained in 33 patients without MR recurrence, whereas 11 with it showed worsened tethering with less LV function recovery. Multiple linear regression analyses identified that change in MR severity from baseline to 12-month examination independently associated with corresponding change in IPMD (parameter estimate of 0.100 with standard error of 0.039, p=0.019) and that in posterior PM- tethering distance( parameter estimate of 0.104 with standard error of 0.045, p=0.035), while not with change in PLA. The IPMD change was independently associated with change in LV end-systolic dimension (parameter estimate of 0.299 with standard error of 0.110, p=0.013). CONCLUSIONS: RMA procedure partially relieved leaflet tethering, evidenced by decreased tethering distances and IPMD;the latter was the main determinant of MR. These beneficial effects might be mainly attributed to post-RMA reverse LV remodeling, potentially offsetting the negative effect of augmented PLA in selected patients.

Mouthwitch: A Novel Head Mount Type Hands-Free Input Device that Uses the Movement of the Temple to Control a Camera.

We have developed an interface (mouthwitch) for a head-mounted type camera with which pictures can be taken with a head-mounted camera, hands-free, simply by "opening your mouth continuously for approximately one second and then closing it again". This mouthwitch uses a sensor equipped with an LED and photo transistor on the temple to optically measure the changes in the form of the temple that occur when the mouth is opened and closed. Eight test subjects (males and females aged between 21 and 44 years old) performed evaluation tests using this mouthwitch when resting, speaking, chewing, walking, and running. The results showed that all test subjects were able to open and close the mouth, and the measurement results pertaining to the temple shape changes that occurred at this time were highly reproducible. Additionally, the average value for accuracy obtained for the eight test subjects through the verification tests was 100% when resting, chewing, or walking, and 99.8% when speaking or running. Similarly, the average values for precision were 100% for all items, and the average values for recall were 100% when resting or chewing, 98.8% when speaking, 97.5% when walking, and 87.5% when running.