Shared and Reciprocal Mechanisms Between Heart Failure and Cancer　- An Emerging Concept of Heart-Cancer Axis.

Epidemiological evidence of increased risks of cancer in heart failure (HF) patients and HF in cancer patients has suggested close relationships between the pathogenesis of both diseases. Indeed, HF and cancer share common risk factors, including aging and unhealthy lifestyles, and underlying mechanisms, including activation of the sympathetic nervous system and renin-angiotensin-aldosterone system, chronic inflammation, and clonal hematopoiesis of indeterminate potential. Mechanistically, HF accelerates cancer development and progression via secreted factors, so-called cardiokines, and epigenetic remodeling of bone marrow cells into an immunosuppressive phenotype. Reciprocally, cancer promotes HF via cachexia-related wasting and metabolic remodeling in the heart, and possibly via cancer-derived extracellular vesicles influencing myocardial structure and function. The novel concept of the "heart-cancer axis" will help in our understanding of the shared and reciprocal relationships between HF and cancer, and provide innovative diagnostic and therapeutic approaches for both diseases.

Large ovarian tumor-caused failure of VA-ECMO in a patient with cardiac arrest related to massive pulmonary embolism.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) plays an important role in patients with massive pulmonary embolism (PE)-related cardiac arrest. A 47-year-old healthy Japanese woman was brought to the emergency department because of shock. The patient suddenly collapsed due to cardiac arrest in an ambulance. The patient was diagnosed with PE on transthoracic echocardiography during cardiopulmonary resuscitation (CPR). Emergency VA-ECMO cannulation was performed percutaneously. Although VA-ECMO support was initiated, the return cannula flow could not be pumped because of the high resistance. Circulation support with VA-ECMO was discontinued. Subsequently, pulmonary angiography under CPR revealed numerous thrombi in the bilateral pulmonary arteries, and aspiration thrombectomy and catheter fragmentation were performed. The patient achieved spontaneous recovery of circulation after successful catheter fragmentation. After the procedure to investigate the cause of VA-ECMO failure, whole-body computed tomography showed a large ovarian tumor and compression of the femoral artery and abdominal aorta. The patient died of multiple organ failure due to hypoxic encephalopathy. Undiagnosed gynecological tumors often cause fulminant PE and may also cause the failure of VA-ECMO due to vascular compression. Alternative cannulation sites and prior thrombolysis should be immediately considered. The complexity of PE management necessitates a well-trained PE response team. Learning objective: Large gynecological tumors may cause pulmonary embolism-related cardiac arrest and consequent failure of venoarterial extracorporeal membrane oxygenation using the femoral artery approach due to vascular compression by the tumor. An adequate strategy should be considered to achieve immediate recovery of spontaneous circulation and circulation support as simultaneous systematic thrombolysis and an alternative central cannulation approach to protect against hypoxic organ damage. The complexity of pulmonary embolism (PE) management necessitates a well-trained PE response team.

Improved upper extremity function following low-frequency hybrid assistive neuromuscular dynamic stimulation therapy in a patient with hemiplegia: A case report.

BACKGROUND: Although hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy may improve upper extremity functionality in patients with paralysis or paresis due to stroke, it is usually only provided in hospitals as a frequent intervention during the phase of early recovery in stroke. Home-based rehabilitation is limited by frequency and duration of visits. PURPOSE: To investigate the effectiveness of low-frequency HANDS therapy using motor function assessment. STUDY DESIGN: Case report. METHODS: We performed HANDS therapy for 1 month on the patient, who was a woman in her 70s with left-sided hemiplegia. It was initiated on day 183 post the onset of stroke. Movement and motor function were evaluated using the Fugl-Meyer Assessment upper-extremity (FMA-UE) motor items and the Motor Activity Log consisting of Amount of Use (MAL-AOU), as well as Quality of Movement (MAL-QOM) scales. This evaluation was performed before starting HANDS therapy and after its conclusion. RESULTS: Following HANDS therapy, there was improvement in the FMA-UE (21 points â†’ 28 points), MAL-AOU (0.17 points â†’ 0.33 points), and MAL-QOM (0.08 points â†’ 0.33 points) scores when compared to the scores before therapy, and the patient was able to use both hands for activities of daily living (ADLs). CONCLUSIONS: Low-frequency HANDS therapy combined with encouragement to include the affected hand in ADLs may improve upper extremity function in cases of paralysis.

Subcutaneous implantable cardioverter defibrillator for spontaneous coronary artery dissection with ventricular fibrillation: A report of two cases.

The efficacy of implantable cardioverter defibrillators (ICDs) for secondary prevention in spontaneous coronary artery dissection (SCAD) with ventricular fibrillation (VF) remains unclear. Herein, we report two cases of SCAD. In both cases, VF and ST-elevation myocardial infarction (STEMI) were noted, which were previously reported to increase the risk of VF recurrence and sudden cardiac death (SCD). Hence, a subcutaneous (S)-ICD was implanted for secondary prevention in each case. Previous studies have suggested that among patients with SCAD, those with a history of VF and left ventricular ejection fraction (LVEF) of <50% are at a higher risk of ventricular tachycardia or VF recurrence, whereas those with a history of smoking, STEMI, onset during pregnancy, recurrent SCAD, LVEF <50%, and left coronary artery main trunk lesion or proximal lesion are at a higher risk of SCD. Moreover, S-ICD is associated with fewer complications than transvenous-ICD, and the rate of inappropriate shock is decreasing. Therefore, risk stratification and consideration of S-ICD implantation in high-risk patients may be an important therapeutic strategy for the secondary prevention of SCAD. Learning objective: Previous studies have not shown the efficacy of implantable cardioverter defibrillators (ICDs) for spontaneous coronary artery dissection (SCAD). Meanwhile, it was also suggested that patients with SCAD, including those with a history of ventricular fibrillation (VF) and ST-elevation myocardial infarction, are at high risk of VF recurrence or sudden cardiac death. For the secondary prevention of SCAD with VF, subcutaneous ICD implantation in high-risk patients may be an important strategy.

Comparison of Echocardiographic Changes Between Surgery and Medication Treatment in Patients With Primary Aldosteronism.

Background Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although most have not adjusted for baseline disease status. In this study, we investigated the difference in cardiovascular outcomes between surgery and medication treatment for primary aldosteronism after adjusting for baseline clinical characteristics, including aldosterone level and pretreatment echocardiographic information. Methods and Results We retrospectively analyzed 220 patients diagnosed with primary aldosteronism who underwent adrenalectomy (n=144) or medication treatment (n=76) between 2009 and 2019. Echocardiographic changes were evaluated pretreatment and 1 year posttreatment. The surgery group had lower potassium, lower plasma renin activity, and higher plasma aldosterone concentration than the medication group, indicating a severe primary aldosteronism phenotype in the former. The decrease in left ventricular mass index after treatment was significantly greater in the surgery group than in the medication group (P=0.047). However, this relationship was not noted after multivariable regression analysis (standard ß=-0.08, P=0.17). Additionally, decreased parameter values related to left ventricular diastolic dysfunction and left atrial enlargement were not different between the groups. Pretreatment echocardiographic values were most associated with changes in all echocardiographic parameters. The findings were consistent in the propensity score-matched analysis. Conclusions This study's findings suggest that there is no difference in cardioprotective efficacy between surgical and medication treatment under similar disease severity; however, it should be considered that several study participants with severe hyperaldosteronism were managed surgically.

A toxin-antitoxin system confers stability to the IncP-7 plasmid pCAR1.

Toxin-antitoxin (TA) systems were initially discovered as plasmid addiction systems. Previously, our studies implied that the high stability of the IncP-7 plasmid pCAR1 in different Pseudomonas spp. hosts was due to the presence of a TA system on the plasmid. Bioinformatics approaches suggested that ORF174 and ORF175 could constitute a type II TA system, a member of the RES-Xre family, and that these two open reading frames (ORFs) constitute a single operon. As expected, the ORF175 product is a toxin, which decreases the viability of the host, P. resinovorans, while the ORF174 product functions as an antitoxin that counteracts the effect of ORF175 on cell growth. Based on these findings, we renamed ORF174 and ORF175 as prcA (antitoxin gene) and prcT (toxin gene), respectively. The prcA and prcT genes were cloned into the unstable plasmid vector pSEVA644. The recombinant vector was stably maintained in P. resinovorans and Escherichia coli cells under nonselective conditions following 6 days of daily subculturing. The empty vector (without the prcA and prcT genes) could not be maintained, which suggested that the PrcA/T system can be used as a tool to improve the stability of otherwise unstable plasmids in P. resinovorans and E. coli strains.

Salvage from hemodialysis via percutaneous transluminal renal artery stenting for a jeopardized solitary functioning kidney: A case report.

Atherosclerotic renal artery stenosis (ARAS) causes resistant hypertension, progressively declining renal function, and cardiac destabilization syndromes, including heart failure. We report a patient who underwent successful percutaneous transluminal renal angioplasty (PTRA) for anuretic acute kidney injury (AKI) due to ARAS. This patient, admitted to our hospital with congestive heart failure, developed anuretic AKI and started hemodialysis 3 days after admission. Computed tomography and magnetic resonance angiograms showed total occlusion of the proximal right renal artery, with atrophy of the right kidney and severe stenosis of the proximal left renal artery. These findings suggested that only the left kidney was functioning. We performed PTRA of the left renal artery in which the culprit lesion causing the AKI appeared to be located. Using intravascular ultrasound, severe calcification in the ostium of the left renal artery and a necrotic core with plaque rupture in the culprit lesion were observed. Kidney function recovered immediately after revascularization, which permitted successful withdrawal of hemodialysis. There is no clear consensus regarding the indication for PTRA in patients with ARAS; however, our experience suggests that PTRA may be beneficial for patients with a jeopardized solitary functioning kidney. .

Pregnancy and delivery in women receiving maintenance hemodialysis in Japan: analysis of potential risk factors for neonatal and maternal complications.

INTRODUCTION: Average dialysis vintage in Japan is among the longest in the world, providing a unique opportunity to characterize pregnancy under conditions of long dialysis vintage. In 2017, we carried out a nationwide survey following up on a similar survey in 1996, in which we investigated the prevalence and outcomes of pregnancy in women undergoing dialysis and assessed risk factors associated with neonatal and maternal complications. METHODS: The target population was women aged 15-44 years undergoing maintenance dialysis between 2012 and 2016. The survey was conducted in 2693 dialysis units. RESULTS: A response was obtained from 951 dialysis units, yielding a target population of 1992 women of childbearing age receiving hemodialysis or peritoneal dialysis. Pregnancy occurred only among women receiving hemodialysis, with 25 pregnancies (1.26% in 5 years) being reported for 20 women. Detailed information about 19 pregnancies (mean age 34.6 ± 5.7 years at conception, mean dialysis vintage 8.4 ± 7.3 years) indicated 4 spontaneous abortions, 1 elective abortion, no neonatal deaths, and 14 surviving infants, including 5 full-term (≥ 37 weeks at birth), 2 late preterm (34-36), and 3 extremely preterm (< 28) cases. Neonatal complications occurred in the offspring of 3 mothers who had end-stage renal disease (ESRD) caused by primary glomerulonephritis and serum albumin levels (sAlb) ≤ 3.2 mg/dL in the first trimester. These mothers had started dialysis at 12, 17, and 30 years of age. ESRD caused by diabetic nephropathy or primary glomerulonephritis, age at conception ≥ 38 years, and sAlb ≤ 3.2 mg/dL were associated with maternal complications, although not significantly. CONCLUSIONS: In this study, the pregnancy rate of Japanese women with ESRD was 0.25% per year. The study generates the hypothesis that ESRD caused by diabetic nephropathy and age at conception ≥ 38 years are potential risk factors for maternal complications but not for neonatal complications in dialysis patients, and that hypoalbuminemia is a potential risk factor for both kinds of complications.

Initial national investigation of the prenatal diagnosis of congenital heart malformations in Japan-Regional Detection Rate and Emergency Transfer from 2013 to 2017.

BACKGROUND: Investigation into the detection rate (DR) of congenital heart diseases (CHDs) in fetuses is important for the assessment of fetal cardiac screening systems. OBJECTIVES: We highlight issues of fetal cardiac screening in Japan. METHODS: We performed an initial national survey of fetal diagnosis of CHDs from the data of the national registry for congenital heart surgery from 2013 to 2017. Subjects were neonates and infants with moderate or severe CHDs. We investigated DR in each prefecture in Japan and emergency transfer (ET) for neonates by analyzing distance and admission day of ET with or without fetal diagnoses. RESULTS: The overall average DR in Japan was 0.41 (0.02 increase every year). No regional significant relationship was found between DR and population in each prefecture. ET was performed in 12% of neonates with prenatal diagnosis and in 63% of neonates without resulting in significant risk for ET in fetuses without a fetal diagnosis [OR 13.3 (11.6-15.3), p<0.001]. The distance of ET was shorter and admission was earlier in the neonates with a prenatal diagnosis than in those without [median 6.6 km (IQR: 4.1-25.7) vs 17.0 km (IQR: 7.4-35.3), median 0.0 day (IQR: 0.0-0.0) vs 0.0 day (IQR: 0.0-1.0), p<0.001, p<0.001, respectively] CONCLUSIONS: Prenatal cardiac diagnosis reduces geographic and chronological risks of ET for moderate to severe CHDs. DR is still developing and periodic official surveillance is required for improving prenatal cardiac diagnosis in Japan.

Irradiation effect of a submillimeter wave from 420†GHz gyrotron on amyloid peptides in vitro.

On using the far-infrared radiation system, whether the irradiation effect is thermal or non-thermal is controversial. We irradiated amyloid peptides that are causal factors for amyloidosis by using a submillimeter wave from 420 GHz gyrotron. Fluorescence reagent assay, optical and electron microscopies, and synchrotron-radiation infrared microscopy showed that the irradiation increased the fibrous conformation of peptides at room temperature for 30 min. The temperature increase on the sample was only below 5 K, and a simple heating up to 318 K hardly induced the fibril formation. Therefore, the amyloid aggregation was driven by the far-infrared radiation with little thermal effect.

Effect of scheduled intravenous acetaminophen on postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery.

PURPOSE: The aim of this study was to assess the effect of scheduled intravenous acetaminophen (SIVA) on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic gynecologic surgery (LGS). METHODS: This retrospective observational study identified consecutive patients who underwent LGS at our institution from January to November of 2017 and were managed with either our hospital's old protocol (Group H) or a new protocol using SIVA (Group S). Primary outcomes included the incidences of PONV and the amount of additional antiemetic required in the postoperative period. The secondary outcomes included the pain score on postoperative day 1, the requirement for additional analgesic medications, and the length of hospitalization (LOH). RESULTS: Patients in Group S had significantly lower incidences of PONV from postoperative days 0 to 1 and required significantly less antiemetics or tramadol than those in Group H (P = 0.0085). Patients at a low risk for PONV in Group S had significantly lower incidences of PONV than those in Group H (P = 0.0129). Further, the amount of additional tramadol required was lower in Group S than in Group H (P = 0.0021). CONCLUSION: Introduction of SIVA into the postoperative pain management protocol of LGS may reduce the incidence of PONV and the amount of adjunctive antiemetic medication required from postoperative days 0 to 1. In patients undergoing LGS, PONV prophylaxis using antiemetics should be prescribed depending on PONV risk profile; however, SIVA prophylaxis can be used in all patients regardless of PONV risk profile.

Retraction Note: Desflurane anesthesia worsens emergence agitation in adult patients undergoing thyroid surgery compared to sevoflurane anesthesia.

The Editor-in-Chief has retracted this article [1]. The ethics committee approval was granted for an observational study and the need for patient consent was waived. However, the study design described is a randomized controlled trial and therefore patient consent should have been obtained. All authors agree with this retraction.

Evaluation of the Safety of Percutaneous Dilational Tracheostomy Compared with Surgical Tracheostomy in the Intensive Care Unit.

BACKGROUND: Tracheostomy is a necessary procedure for patients who require long-term mechanical ventilation support. There are two methods for tracheostomy in current use: surgical tracheostomy (ST) and percutaneous dilational tracheostomy (PDT). In the current study, we retrospectively compared the safety of both procedures performed in our intensive care unit (ICU). METHODS: In this study, we enrolled subjects who underwent tracheostomy in our ICU between January 2012 and March 2016. We excluded subjects who were <20 years old and underwent tracheostomy in the operating room. As a primary outcome, we evaluated the rate of complications between ST and PDT groups. The length of ICU stay, time to tracheostomy from intubation, and the rate of mechanical ventilation and mortality at 28 postoperative days were also examined as secondary outcomes. RESULTS: Compared with the ST group, the rate of all complications was lower in the PDT group (13.4% vs. 38.8%, p=0.007). Although the rate of intraoperative complications did not differ between the two groups (3.8% vs. 8.1%, p=0.62), relative to the ST procedure, the PDT procedure was associated with fewer postoperative complications (34.6% vs. 9.6%, p=0.003). Among postoperative complications, accidental removal of the tracheostomy tube and an air leak from the tracheostomy fistula were less frequent in the PDT group than the ST group. Between the two groups, there were no significant differences in their secondary outcomes. CONCLUSION: This retrospective study indicates that relative to ST, PDT is a safer procedure to be performed in the ICU. Fewer postoperative complications following PDT might be attributed to the small skin incision made during this procedure.

Type 2 diabetes mellitus complicated with idiopathic hypoparathyroidism where poor glycaemic control was associated with low adherence to exercise and medication due to hypocalcaemia.

We report a rare case of type 2 diabetes mellitus (T2DM) complicated with idiopathic hypoparathyroidism. A 36-year-old Japanese man was admitted to our hospital owing to poor glycaemic control and hypocalcaemia. The patient had myalgia resulting from hypocalcaemia, which prevented adequate exercise. He considered the onset of myalgia to be an adverse event of oral hypoglycaemic agents and reduced compliance to medication; however, his serum calcium level was never measured. Treatment for hypocalcaemia immediately improved the myalgia, facilitating regular exercise therapy and ensuring compliance with prescribed medications, as the now-resolved myalgia was no longer perceived to be an adverse effect of glucose-lowering agents; this improved glycaemic control. Although hypoparathyroidism is a rare disease, it is necessary to assess serum calcium levels in patients with T2DM, particularly in cases presenting with unidentified complaints such as myalgia.

Cardiac output and stroke volume variation measured by the pulse wave transit time method: a comparison with an arterial pressure-based cardiac output system.

Hemodynamic monitoring is mandatory for perioperative management of cardiac surgery. Recently, the estimated continuous cardiac output (esCCO) system, which can monitor cardiac output (CO) non-invasively based on pulse wave transit time, has been developed. Patients who underwent cardiovascular surgeries with hemodynamics monitoring using arterial pressure-based CO (APCO) were eligible for this study. Hemodynamic monitoring using esCCO and APCO was initiated immediately after intensive care unit admission. CO values measured using esCCO and APCO were collected every 6 h, and stroke volume variation (SVV) data were obtained every hour while patients were mechanically ventilated. Correlation and Bland-Altman analyses were used to compare APCO and esCCO. Welch's analysis of variance, and four-quadrant plot and polar plot analyses were performed to evaluate the effect of time course, and the trending ability. A p-value < 0.05 was considered statistically significant. Twenty-one patients were included in this study, and 143 and 146 datasets for CO and SVV measurement were analyzed. Regarding CO, the correlation analysis showed that APCO and esCCO were significantly correlated (r = 0.62), and the bias ± precision and percentage error were 0.14 ± 1.94 (L/min) and 69%, respectively. The correlation coefficient, bias ± precision, and percentage error for SVV evaluation were 0.4, - 3.79 ± 5.08, and 99%, respectively. The time course had no effects on the biases between CO and SVV. Concordance rates were 80.3 and 75.7% respectively. While CO measurement with esCCO can be a reliable monitor after cardiovascular surgeries, SVV measurement with esCCO may require further improvement.

Site-selective conversion of azido groups at carbonyl α-positions into oxime groups leading triazide to a triple click conjugation scaffold.

This paper reports the selective conversion of alkyl azido groups at the carbonyl α-position into oximes through ß-elimination of dinitrogen, followed by transoximation. With this method and diazo conversion, a triazido molecule was transformed into a triple click conjugation scaffold allowing one-pot four-component coupling.

Site-Selective Conversion of Azido Groups at Carbonyl α-Positions to Diazo Groups in Diazido and Triazido Compounds.

This paper reports on the selective conversion of alkyl azido groups at the carbonyl α-position to diazo compounds. Through ß-elimination of dinitrogen, followed by hydrazone formation/decomposition, α-azidocarbonyl moieties were transformed into α-diazo carbonyl groups in one step. As these reaction conditions do not involve aryl or general alkyl azides, site-selective conversions of di- and triazides were achieved. Through this method, the successive site-selective conjugation of the triazido molecule with three different components is demonstrated.

[Medium-remote Term Results of the Atrioventricular Valve Replacement with Mechanical Valve for Functional Single Ventricles].

We prospectively investigated the relation of adaptation, timing of atrioventricular valve replacement (AVVR), valve type, size, durability of replacement valve, and preoperative cardiac function with prognosis of AVVR. The subjects included 26 patients[ 15.5 years old( day 2-43 years)] with functional single ventricle who underwent AVVR at our institution between August 1996 and January 2014. Of these patients, 24 had regurgitation, whereas 2 had stenosis. Of 7 patients who died, 3 were infants who died in the postoperative acute phase, and all of them had severe heart failure at the preoperative stage. The 5-year survival rate was 67% as assessed by Kaplan-Meier curve. On univariate analysis of the preoperative data, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, age at operation, body height, and body weight were significant risk factors for death;of these, only PAP remained in the last model for multiple regression analysis. AVVR for regurgitation is supposed to reduce cardiac volume load and help improve prognosis. Atrioventricular valve plasty or replacement should be performed prior to the development of severe heart failure.