One Year Outcomes of Zilver PTX Versus Eluvia for Femoropopliteal Disease in Real-World Practice: REALDES Study.

PURPOSE: This multicenter, prospective, observational study aimed to compare Zilver PTX and Eluvia stents in real-world settings for treating femoropopliteal lesions as the differences in the 1-year outcomes of these stents have not been elucidated. MATERIALS AND METHODS: Overall, 200 limbs with native femoropopliteal artery disease were treated with Zilver PTX (96 limbs) or Eluvia (104 limbs) at 8 Japanese hospitals between February 2019 and September 2020. The primary outcome measure of this study was primary patency at 12 months, defined as a peak systolic velocity ratio of ≤2.4, without clinically-driven target lesion revascularization (TLR) or stenosis ≤50% based on angiographic findings. RESULTS: The baseline clinical and lesion characteristics of Zilver PTX and Eluvia groups were roughly comparable (of all limbs analyzed, approximately 30% presented with critical limb-threatening ischemia, approximately 60% presented with Trans-Atlantic Inter-Society Consensus II C-D, and approximately half had total occlusion), except for the longer lesion lengths in the Zilver PTX group (185.7±92.0 mm vs 160.0±98.5 mm, p=0.030). The Kaplan-Meier estimates of primary patency at 12 months were 84.9% and 88.1% for Zilver PTX and Eluvia, respectively (log-rank p=0.417). Freedom from clinically-driven TLR rates were 88.8% and 90.9% for Zilver PTX and Eluvia, respectively (log-rank p=0.812). CONCLUSIONS: The results of the Zilver PTX and Eluvia stents were not different regarding primary patency and freedom from clinically-driven TLR at 12 months after treating patients with femoropopliteal peripheral artery disease in real-world settings. CLINICAL IMPACT: This is the first study to reveal that the Zilver PTX and Eluvia have similar results in real-world practice when the proper vessel preparation is performed. However, the type of restenosis in the Eluvia stent may differ from that in the Zilver PTX stent. Therefore, the results of this study may influence the selection of DES for femoropopliteal lesions in routine clinical practice.

Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report.

A left atrial appendage aneurysm (LAAA) is a rare congenital or acquired anomaly that often causes fatal complications. Although many reports recommend surgical resection for treatment, there is no clear definition of LAAA. Therefore, the diagnosis and treatment are ambiguous. A 73-year-old woman with cardiogenic stroke was admitted to our hospital because of a suspected LAAA as the source of the embolus. She was incidentally diagnosed with LAAA seven years ago, which was managed with continuous anticoagulation therapy, although atrial fibrillation was not observed. The patient underwent aneurysm resection, and the postoperative course was uneventful.As LAAA symptoms are nonspecific, careful observation is required when LAAA is suspected. The risks associated with surgery are generally low and the surgical outcome is good; however, even with appropriate medical therapy, fatal complications can occur. Therefore, surgical resection of the LAAA should be considered even in asymptomatic patients, considering the low surgical risk.

Recombinant Activated Factor VII in Aortic Surgery for Patients Under Hypothermic Circulatory Arrest.

Purpose: We aimed to identify the risk factors of critical bleeding and investigate the safety of recombinant activated factor VII (rFVIIa) in aortic surgery under hypothermic circulatory arrest (HCA). Patients and Methods: The present single-center retrospective study compared the baseline characteristics of 144 patients who underwent aortic surgery under HCA at our institute. Among the total cohort of 144 patients, 42 received rFVIIa (rFVIIa group), while the remaining 102 patients did not (non-rFVIIa group). Perioperative bleeding and transfusions, postoperative 30-day mortality, and adverse events (AEs) were analyzed in 29 propensity score-matched pairs. Results: Before surgery, the rFVIIa group demonstrated a greater number of shocks (p=0.019), higher JapanSCORE II mortality rate (p=0.033), low platelet count (p=0.015) and fibrinogen (p<0.001) level, prolonged activated partial thromboplastin time (aPTT) (p=0.005) and prothrombin time international normalized ratio (PT-INR) (p=0.006), and longer aortic cross clamp time (p=0.049). Postoperative bleeding, transfusion, 30-day mortality, and AEs were comparable between the groups both in the entire-unmatched cohort and propensity score matching cohort. Conclusion: Preoperative shock, higher JapanSCORE II mortality rates, low platelet and fibrinogen levels, prolonged aPTT and PT-INR, and longer aortic clamping time might be risk factors for excessive bleeding and indicate the need for rFVIIa treatment. The present study suggests that rFVIIa can be safely used to address critical and continuous bleeding in spite of adequate transfusion and supplementation of other coagulation factors in aortic surgery under HCA, without an increase in 30-day mortality and AEs.

Bond strength between a veneering composite resin and zirconia frameworks with attached mechanical retentive devices.

The effects of mechanical retentive devices and various surface treatments on the shear bond strength between a veneering composite resin and zirconia was investigated. Zirconia disks were classified into three surface-treatment groups: airborne-particle abrasion, overglazing, and overglazing with white alumina particles of three different grain sizes (50, 70, and 105 µm) attached onto zirconia disks (ZR-50, ZR-70, and ZR-105, respectively). They were further divided into four groups (n=44): unprimed, Clearfil Porcelain Bond Activator (CA), Clearfil Photo Bond (CB), and CA+CB. An indirect composite resin was bonded to zirconia specimens. Shear bond strengths were measured. For the ZR-70 and ZR-105 groups, the CB and CA+CB specimens exhibited higher bond strengths than the other two specimens after thermocycling. The ZR-70 and ZR-105 groups achieved micromechanical interlocking, and priming with a phosphate monomer (MDP) yielded stable bond strengths between the composite resin and zirconia with alumina particles attached as retentive devices.

Endovascular Reintervention for Stent-Graft Dislocation after Open Surgical Conversion for Thoracoabdominal Aortic Aneurysm Treated by Thoracic Endovascular Aortic Repair.

Complex anatomical restrictions can lead to further interventions after the emergence of a postoperative aneurysm enlargement in thoracic endovascular aortic repair (TEVAR) for a thoracoabdominal aortic aneurysm (TAAA). A 75-year-old male underwent a TEVAR for a Crawford extent I TAAA. The main device and the distal extension were placed using a fenestrated technique, outside of the instructions for use. The aneurysm expanded because of an endoleak and stent graft migration; and was surgically repaired by fully salvaging the previous endografts 38 months after the first TEVAR. However, the distal extension, which was the proximal anastomosis site with a prosthetic graft, became completely dislocated from the main device eight months after the open surgical conversion, resulting again in the enlargement of the aneurysm. An additional TEVAR was successfully performed to correct the dislocated stent graft. An appropriate treatment strategy is crucial to prevent multiple reinterventions for TAAA with complex anatomical restrictions.

Simultaneous aortic and pulmonary valve replacement in a young patient after intracardiac repair for tetralogy of Fallot: mechanical or biological valve? A case report.

Pulmonary valve stenosis and regurgitation can occur in the distant stages after intracardiac repair of tetralogy of Fallot (TOF). Aortic regurgitation (AR) can also occur, although it is rare in postoperative patients. However, there are few reports of simultaneous replacement of the pulmonary and aortic valves in young patients after intracardiac repair of TOF, and there are no clear guidelines for selecting a valve prosthesis in such patients. We report a case of severe pulmonary valve stenosis and regurgitation with severe AR 38 years after the TOF operation, in which urgent double valve replacement and right ventricular outflow tract patching were performed with a mechanical valve in the aortic valve position and a bioprosthetic valve in the pulmonary valve position, with a successful outcome.

Influence of roughening procedures and priming agents on shear bond strength of CAD/CAM materials to zirconia frameworks.

This study investigated the influence of roughening procedures and application of primers on shear bond strengths of CAD/CAM composite resin material or ceramic material to zirconia frameworks. A CAD/CAM composite resin block (Katana Avencia Block; AVE) and lithium disilicate glass-ceramic block (IPS e.max CAD; IEC) were used as veneer materials. The veneers were divided into three surface treatment groups; HF, hydrofluoric acid etching; AB, airborne-particle abrasion; and CON, no surface treatment. Each veneer was primed with four agents: Clearfil Porcelain Bond Activator (ACT), Clearfil Photo Bond (CPB), Clearfil Photo Bond with Porcelain Bond Activator (CPB+ACT), and no priming (UP). The zirconia frameworks and AVE or IEC veneers were resin-bonded. In the AVE specimen, AB treatment showed significantly higher shear bond strength than the other treatments at 0 and 20,000 thermocycles, except for UP and CPB+ACT groups at 20,000 thermocycles. Airborne-particle abrasion is necessary for resin bonding to Avencia blocks.

Shear bond strength between gingival composite resin and glazed gingival porcelain for implant-supported prostheses.

This study determined the shear bond strength (SBS) between an indirect gingival composite resin and glazed gingival porcelain after various surface treatments. A total of 176 porcelain disks with natural glazing were used and assigned to one of four groups: no surface treatment, airborne-particle abrasion, hydrofluoric acid etching, or a combination of airborne-particle abrasion followed by hydrofluoric acid etching. Each group was divided into two subgroups: one subgroup was unprimed, and the other was silanized. An indirect composite resin was then bonded to the porcelain disks. Half of the specimens in each group (n = 11) were exposed to 5000 thermocycles. SBSs were measured, and data were analyzed with the Kruskal-Wallis and Steel-Dwass tests. Among silanized specimens, those treated with the combination of airborne-particle abrasion and hydrofluoric acid etching exhibited the highest bond strengths both before and after thermocycling. However, the SBS values of the silanized and unprimed hydrofluoric acid etched specimens did not differ significantly. Airborne-particle abrasion followed by hydrofluoric acid etching with silane application yielded stronger, more durable bonds between the indirect gingival composite resin and glazed gingival porcelain.

Serum Neuron-Specific Enolase Level as Predictor of Neurologic Outcome after Aortic Surgery.

BACKGROUND: This study aimed to evaluate the significance of serum neuron-specific enolase (NSE) level as a predictor of neurologic injury in thoracic aortic surgery. METHODS: We neurologically assessed 60 consecutive patients who underwent thoracic aortic surgery for thoracic aortic aneurysm (n = 26) and aortic dissection (n = 34). Using moderate hypothermic circulatory arrest with antegrade cerebral perfusion, total arch replacement and hemiarch replacement were performed in 37 and 23 patients, respectively. Serum NSE levels in venous blood samples drawn before surgery and at 1 day after surgery were measured. Severity of neurologic injury was categorized as either uncomplicated (n = 48), temporary neurologic dysfunction (TND, n = 5), or permanent neurologic dysfunction (PND, n = 7). The extent of stroke was estimated on computed tomography or magnetic resonance imaging. RESULTS: The NSE level significantly differed among the three groups (PND > TND > uncomplicated) on the first postoperative day. Receiver-operating characteristic curve analysis showed that the cutoff value of NSE level was 34.14 ng/mL for neurologic injury (sensitivity, 0.769; specificity, 0.851) and 43.56 ng/mL for PND (sensitivity, 1.000; specificity, 0.963). The NSE level significantly correlated with the extent of stroke (r = 0.61, p < 0.001). CONCLUSION: Serum NSE level is a significant predictor of adverse neurologic outcomes and extent of stroke after thoracic aortic surgery.

Successful endovascular repair of a ruptured isolated iliac artery aneurysm: A case report.

While isolated iliac artery aneurysm is rare, its rupture can lead to complete circulatory collapse and possibly death. Herein, we report a case of rupture of a large isolated aneurysm of the right common iliac artery that led to circulatory collapse and rapid endovascular repair saved the patient's life.

Bond strength of CAD/CAM-manufactured composite resin and ceramic veneers to a zirconia framework.

This study investigated bond strength of CAD/CAM-manufactured composite resin and ceramic veneers to a zirconia framework and analyzed the effect of treatments of veneer surfaces. A CAD/CAM resin-based (AVE) composite or lithium disilicate ceramic (IEC) block was used as the veneer material. AVE and IEC specimens were assigned to receive one of three surface treatments (n = 22): no surface treatment, acid-etching with 9.5% hydrofluoric acid gel, and airborne-particle abrasion with alumina particles. Zirconia disks and AVE or IEC specimens in each group were bonded with a resin-based luting agent, and shear bond strength of the specimens was measured at 0 and 20,000 thermocycles. Significant differences were assessed by the Steel-Dwass test for multiple comparisons and Mann-Whitney U-test (α = 0.05). As compared with other surface treatments, bond strengths were significantly higher at 0 and 20,000 thermocycles in the airborne-particle abraded AVE and acid-etched IEC specimens. Airborne-particle abrasion of the surface of AVE specimens increased bond strength between AVE veneers and zirconia frameworks, while hydrofluoric acid treatment enhanced bond strength between IEC veneers and zirconia frameworks.

Bond strengths between gingiva-colored layering resin composite and zirconia frameworks coated with feldspathic porcelain.

This study evaluated shear bond strengths of two gingiva-colored layering resin composites to zirconia frameworks coated with feldspathic porcelain. Airborne-particle abraded porcelain-coated zirconia disks were treated with one of the following primers: Clearfil Photo Bond, Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB+Activator), Estenia Opaque Primer, Porcelain Liner M Liquid B (PLB), or no primer. A light-polymerizing (CER) or a photo/heat-polymerizing gingiva-colored indirect resin composite (EST) was bonded to the porcelain-coated zirconia disks in each group (n=11). Shear bond strength was measured. For both CER and EST specimens, bond strengths in CPB+Act group were significantly higher than those in the other groups. In all priming groups, bond strength was significantly higher for EST specimens than for CER specimens. Combined application of a phosphate monomer and silane enhanced initial bond strength of light-polymerized and photo/heat-polymerized gingiva-colored layering resin composites to porcelain-coated zirconia ceramics.

Cerebral Circulation During Retrograde Cerebral Perfusion: Evaluation Using Laser Speckle Flowgraphy.

BACKGROUND: The cerebroprotective effect of retrograde cerebral perfusion (RCP) and selective antegrade cerebral perfusion (SCP) still remains controversial. Laser speckle flowgraphy has shown much promise for novel perioperative neuromonitoring by assessing blood flow of the optic nerve head. This study aimed to evaluate the cerebral microcirculation in humans using laser speckle flowgraphy during simple circulatory arrest, RCP, and SCP under moderate hypothermia and to investigate whether RCP under moderate hypothermia is a reliable method of cerebral protection. METHODS: A total of 23 consecutive patients who underwent a scheduled aortic arch or hemiarch surgical procedure on thoracic aorta aneurysm were enrolled. The laser speckle flowgraphy measurement that calculates mean blur ratio, a parameter of cerebral circulation, was obtained 6 times: after induction of anesthesia, baseline (T1), after initiation of cardiopulmonary bypass with cardiac arrest (T2), simple circulatory arrest (T3), RCP (T4), SCP (T5), and after the termination of cardiopulmonary bypass (T6). RESULTS: Both mean blur ratios of simple circulatory arrest and RCP were significantly decreased compared with baseline. In contrast, no significant differences were observed between simple circulatory arrest and RCP. The mean blur ratio of SCP was significantly increased compared with both simple circulatory arrest and RCP. CONCLUSIONS: In conclusion, no significant difference was observed in the cerebral circulation between RCP and simple circulatory arrest without adjunctive strategy under moderate hypothermia. In contrast, the cerebral circulation during SCP was significantly higher than simple circulatory arrest and RCP. These results suggest that cerebral microcirculation may not be adequate during RCP compared with SCP under moderate hypothermia.

[Pericardial Hematoma Mimicking Pericardial Tumor;Report of a Case].

A case was diagnosed as pericardial tumor preoperatively, which was found to be pericardial hematoma and localized constrictive pericarditis intraoperatively. A pericardial hematoma resection and a pericardiectomy were performed.

Effect of a silane and phosphate functional monomer on shear bond strength of a resin-based luting agent to lithium disilicate ceramic and quartz materials.

This study examined the effect of silane and phosphate functional monomer on bond strengths between a resin-based luting agent joined to a lithium disilicate ceramic (IPS e.max) and silica (quartz) materials. The e.max and quartz specimens were assigned to 6 groups with different priming/bonding agents, namely, Clearfil Porcelain Bond Activator, Clearfil Photo Bond, Clearfil Photo Bond Universal with Clearfil Porcelain Bond Activator, Clearfil Photo Bond Catalyst with Clearfil Porcelain Bond Activator, Clearfil Photo Bond with Clearfil Porcelain Bond Activator, and unprimed. The corresponding specimens were bonded by using a resin-based luting agent (Panavia V5). Shear bond strengths were determined before and after 5,000 thermocycles. For both the e.max and quartz specimens, the Clearfil Photo Bond Universal with Clearfil Porcelain Bond Activator group had the highest pre- and post-thermocycling bond strength values. Combined use of silane in the acidic environment of a phosphate functional monomer and initiators enhances bond strength of a resin-based luting agent to e.max ceramic and quartz materials.

Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report.

We report a case of total arch replacement in a patient who suffered repeated cerebral infarctions due to unstable plaque simultaneously in the innominate and left subclavian arteries.

Effect of priming agents on shear bond strengths of resin-based luting agents to a translucent zirconia material.

PURPOSE: The purpose of the present study was to evaluate the effect of priming agents and artificial aging with thermocycling on shear bond strengths of two resin-based luting agents to a translucent zirconia material. METHODS: A total of 308 pairs of translucent zirconia disk specimens were divided into seven treatment groups: Alloy Primer (ALP), Clearfil Ceramic Primer Plus (CCP), Meta Fast Bonding Liner (MFB), MR. bond (MRB), Super-Bond PZ Primer Liquid B (PZB), V-Primer (VPR), and an unprimed group (UP). The specimens in each group were bonded with Panavia V5 Universal (UNI) and Opaque shade (OPA). Shear bond strengths (n=11 each) were tested before and after 5000 thermocycles. The data were analyzed with the Kruskal-Wallis test and the Steel-Dwass test. RESULTS: For both 0 and 5000 thermocycles, the ALP (47.8 and 41.5MPa, respectively) and CCP (45.8 and 42.3MPa, respectively) groups showed significantly higher bond strengths than other groups in the UNI luting agent. For the OPA luting agent, CCP group (45.8MPa) exhibited the highest pre-thermocycling bond strength in all groups. The ALP (32.4MPa) and CCP (36.5MPa) groups had significantly higher post-thermocycling shear bond strengths than other groups. In several groups, the shear bond strengths of the UNI luting agent were significantly higher than those of the OPA luting agent before and after thermocycling. CONCLUSIONS: Application of priming agents containing hydrophobic phosphate monomer (MDP) yielded the durable bond strengths of resin-based luting agents to a translucent zirconia material.

Iron depletion is a novel therapeutic strategy to target cancer stem cells.

Adequate iron levels are essential for human health. However, iron overload can act as catalyst for the formation of free radicals, which may cause cancer. Cancer stem cells (CSCs), which maintain the hallmark stem cell characteristics of self-renewal and differentiation capacity, have been proposed as a driving force of tumorigenesis and metastases. In the present study, we investigated the role of iron in the proliferation and stemness of CSCs, using the miPS-LLCcm cell model. Although the anti-cancer agents fluorouracil and cisplatin suppressed the proliferation of miPS-LLCcm cells, these drugs did not alter the expression of stemness markers, including Nanog, SOX2, c-Myc, Oct3/4 and Klf4. In contrast, iron depletion by the iron chelators deferasirox and deferoxamine suppressed the proliferation of miPS-LLCcm cells and the expression of stemness markers. In an allograft model, deferasirox inhibited the growth of miPS-LLCcm implants, which was associated with decreased expression of Nanog and Sox2. Altogether, iron appears to be crucial for the proliferation and maintenance of stemness of CSCs, and iron depletion may be a novel therapeutic strategy to target CSCs.

[Trial of the Profit Optimization of the Department of Cardiac Surgery in the Local National University Hospital].

In recent years economic sense is required in hospital management, the national university hospital is also no exception. We performed duty improvement efforts as well as the current state analysis in the department of cardiac surgery for the purpose of revenue optimization in our hospital. At result, we succeeded in the improvement of the medical index as well as medical profit and found the key of solution to the serious problem that national university hospital has.