Efficacy of Preemptive Embolization of Sac Branches During Endovascular Aneurysm Repair Using N-butyl-2-cyanoacrylate.

OBJECTIVE: A type 2 endoleak (T2EL) is the most frequently occurring endoleak type after endovascular aneurysm repair (EVAR). Residual T2ELs may cause aneurysm rupture; however, the management of a T2EL remains controversial. This study evaluated sac branch preemptive embolization using N-butyl-2-cyanoacrylate, aiming to prevent T2ELs and sac shrinkage. METHODS: Twelve consecutive patients underwent elective preemptive embolization during EVAR at our hospital between August 2018 to March 2019. Their demographic information, operative details, and sac diameters were examined at 6 months after EVAR. RESULTS: No procedural complications were observed. There were no in-hospital deaths among the 12 patients. Sac shrinkage was observed in this cohort (53.8-52.1 mm, p = 0.01). A total of 33 lumbar arteries were occluded with this procedure, and 2 patients had residual T2ELs at 6 months. CONCLUSIONS: A T2EL in preemptive sac branch embolization during EVAR has advantages in terms of safety and reduction. Although no clear evidence is available for the management of T2ELs, this study proposes a new standard to prevent it and improve the long-term outcomes after EVAR. However, embolization remains imperfect and further research is necessary.

Locally Self-Adjustive Smoothing for Measurement Noise Reduction with Application to Automated Peak Detection.

Smoothing is a widely used approach for measurement noise reduction in spectral analysis. However, it suffers from signal distortion caused by peak suppression. A locally self-adjustive smoothing method is developed that retains sharp peaks and less distorted signals. The proposed method uses only one parameter that determines the global smoothness of data, while balancing the local smoothness using the data itself. Simulation and real experiments in comparison with existing convolution-based smoothing methods indicate both qualitatively and quantitatively improved noise reduction performance in practical scenarios. We also discuss parameter selection and demonstrate an application for the automated smoothing and detection of a given number of peaks from noisy measurement data.

Photoluminescence from FRET pairs coupled with Mie-resonant silicon nanospheres.

Optically resonant nanoparticles decorated with donor-acceptor molecular pairs have been attracting attention for applications as nanoprobes in bioimaging and biosensing. We produced composite nanoparticles composed of donor-acceptor molecular pairs and silicon nanospheres (Si NSs) with diameters of 100-200 nm exhibiting Mie resonances in the visible range and studied the effect of Mie resonances on their photoluminescence properties. We showed that the photoluminescence spectra are strongly modified by Mie resonances and the spectral shape is controlled in a wide range by the Si NS size; by controlling the size, we can achieve the photoluminescence maximum from that of a donor molecule to that of an acceptor molecule almost continuously. From the photoluminescence decay properties in combination with theoretical calculations, we showed that the observed strong modification of the spectral shape is mainly due to the Purcell effect on donor and acceptor molecules, and the effect of Mie resonances on the Förster resonance energy transfer (FRET) rate is relatively small. We also showed that because of the large Purcell effect and the small FRET rate enhancement, Mie resonances decrease the FRET efficiency.

Surgical Management of Giant Unruptured Left Sinus of Valsalva Aneurysm With Severe Aortic Regurgitation.

Left sinus of Valsalva aneurysms are extremely rare. Concomitant aortic valve regurgitation is a comorbidity in this pathology. This case report summarizes successful surgical treatment with aortic root replacement with a modified Bentall procedure in a 49-year-old female patient who had an unruptured huge left sinus of Valsalva aneurysm with severe aortic valve regurgitation. The intraoperative assessment showed severe adhesion between the left main trunk of the coronary artery and the left sinus of Valsalva aneurysm, and meticulous adhesion detachment was required.

Noise Reduction of Low-Count STEM-EDX Data by Low-Rank Regularized Spectral Smoothing.

Statistically weighted principal component analysis (wPCA) is widely used to reduce the noise of scanning transmission electron microscopy-energy-dispersive X-ray (STEM-EDX) spectroscopic data. It is beneficial to retain the spatial resolution of observation in each step of the analysis, but the direct application of wPCA without preprocessing, such as spatial averaging, often fails against low-count STEM-EDX data. To enhance the applicability of wPCA while retaining spatial resolution, a step-by-step noise reduction method is considered in this study. Specifically, a numerical optimization is developed to simultaneously characterize the smoothness of EDX spectra and the low rankness of the data. In the presented approach, low-count data are first spectrally smoothed by solving this optimization problem, and then further denoised by using wPCA to project onto a subspace rigorously spanned by a small number of components. A challenging example is provided, and the improved noise reduction performance is demonstrated and compared to existing spectral smoothing techniques.

AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure.

OBJECTIVE: Post-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). METHODS: From January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. RESULTS: Postoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5-12.2) years and 6.8 (1.8-11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9-12.1) years and 4.8 (0.8-8.8) years respectively (P < 0.001). CONCLUSIONS: Scar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.

Reflection characteristics of a cavity-resonator-integrated guided-mode resonance mirror for a microdiameter Gaussian beam.

A guided-mode resonance mirror was designed for reflecting a vertically incident Gaussian beam of 3.6-µm beam waist to a backpropagating Gaussian beam. A grating coupler (GC) is integrated in a waveguide resonance cavity consisting of a pair of distributed Bragg reflectors (DBRs) on a reflection substrate. An incident free-space wave is coupled by the GC into the waveguide, and the guided wave is resonated in the waveguide cavity and coupled out by the same GC to a free-space wave simultaneously in resonance condition. The reflection phase can vary by 2π rad, according to wavelength in a wavelength band of resonance. The grating fill factors of the GC were apodized to have a Gaussian profile in its coupling strength and resultantly maximize a Gaussian reflectance defined by the power ratio of backpropagating Gaussian beam to the incident Gaussian beam. The fill factors of the DBR were also apodized in the boundary zone to the GC in order to avoid discontinuity in equivalent refractive index distribution and resultant scattering loss. Guided-mode resonance mirrors were fabricated and characterized. The Gaussian reflectance of the mirror with the grating apodization was measured to be 90%, higher by 10% than that of the mirror without apodization. It is also demonstrated that the reflection phase changes more than π rad within wavelength band of 1 nm. The fill factor apodization narrows the resonance band.

Identification of overlapping plastic sheets using short-wavelength infrared hyperspectral imaging.

Plastic identification is a fundamental step in material and chemical recycling. Overlap between plastics is a common limitation of existing identification methods, and it is necessary for plastic waste to be shredded and spread over an area to avoid overlapping between flakes. However, this process decreases sorting efficiency and also increases the risk of misidentification. This study specifically focuses on plastic sheets and aims to develop an efficient identification method for overlapping plastic sheets, by using short-wavelength infrared hyperspectral imaging. The method is based on the Lambert-Beer law and is simple to implement. We consider a practical situation with a reflection-based measurement system and demonstrate the identification performance of the proposed method. The tolerance of the proposed method against error sources of measurement is also discussed.

Successful Medical Treatment for Aortoesophageal Fistula after Thoracic Endovascular Aortic Repair.

Aortoesophageal fistula is a fatal disease that requires surgical treatment. Due to the patient's wishes, we chose medical treatment for aortoesophageal fistula after thoracic endovascular aortic repair for a pseudoaneurysm in the distal anastomotic site after total aortic arch replacement. Satisfactory early and long-term outcomes were obtained with complete fasting and appropriate antibiotics.

Indoxyl sulfate decreases uridine adenosine tetraphosphate-induced contraction in rat renal artery.

The protein-bound uremic toxin indoxyl sulfate has negative effects on a variety of physiological activities including vascular function. Uridine adenosine tetraphosphate (Up4A), a new dinucleotide molecule affects vascular function including induction of vasocontraction, and aberrant responsiveness to Up4A is evident in arteries from disorders such as hypertension and diabetes. The link between indoxyl sulfate and the Up4A-mediated response is, however, unknown. We used Wistar rat's renal arteries to see if indoxyl sulfate will affect Up4A-mediated vascular contraction. In renal arteries of indoxyl sulfate, the contractile response generated by Up4A was dramatically reduced compared to the non-treated control group. Indoxyl sulfate increased endothelin-1-induced contraction but had no effect on phenylephrine, thromboxane analog, or isotonic K+-induced renal arterial contractions. UTP, ATP, UDP, and ADP-produced contractions were reduced by indoxyl sulfate. CH223191, an aryl hydrocarbon receptor (AhR) antagonist, did not reverse Up4A, and UTP contraction decreases caused by indoxyl sulfate. The ectonucleotidase inhibitor ARL67156 prevents indoxyl sulfate from reducing Up4A- and UTP-mediated contractions. In conclusion, we discovered for the first time that indoxyl sulfate inhibits Up4A-mediated contraction in the renal artery, possibly through activating ectonucleotidase but not AhR. Indoxyl sulfate is thought to play a function in the pathophysiology of purinergic signaling.

Posterior mitral leaflet augmentation with autologous pericardial patch for the surgical treatment of severe atrial functional mitral regurgitation.

Atrial functional mitral regurgitation (MR) in patients with chronic atrial fibrillation has not been thoroughly discussed. Although there is insufficient evidence to surgically treat atrial functional MR, it is considered to be reasonable for those patients with severe atrial functional MR who have symptoms of heart failure despite adequate medical therapy. Herein, we report a useful technique for mitral valve repair using posterior mitral leaflet (PML) augmentation with autologous pericardium to obtain good mitral valve coaptation and eliminate atrial functional MR, including tethered PML, in a nonelderly patient.

Nitric Oxide Inhalation and V-V ECMO for Severe Respiratory Failure after Acute Type A Aortic Dissection Surgery.

A 65-year-old man was admitted to our hospital with acute type B aortic dissection that extended into both common iliac arteries with an occluded right common iliac artery and large bullae in bilateral upper lung fields. Femoro-femoral arterial bypass surgery with an artificial blood vessel was performed. Two days postoperatively, acute type B aortic dissection progressed to acute type A aortic dissection. Emergency total arch graft replacement (TAR) was performed through a median sternotomy on the same day. Immediately following TAR, the patient experienced hypoxemia. Acute respiratory distress syndrome (ARDS) was diagnosed following TAR for acute aortic dissection with pneumonia. Nitric oxide inhalation (NOI) therapy was commenced at 20 ppm from the fourth day post-surgery. However, 6 d following TAR, he developed bilateral pneumothorax due to ruptured bullae requiring chest tube management and thoracoscopic left upper lobe bullectomy. Eight days following TAR, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated and NOI therapy was completed. V-V ECMO was withdrawn 18 d after TAR. Postoperatively, after 2 years 3 months, the patient remains ambulatory without assistance, walking to the outpatient clinic.

A Japan nationwide web-based survey of patient preference for renal denervation for hypertension treatment.

Renal denervation is a potential alternative to antihypertensive drug therapy. However, data on patient preference for this treatment option are limited and there are no data specifically from Asian patients. This study evaluated patient preference for renal denervation in patients with hypertension from Japan. Patients were a subset of those who participated in a March 2020 online electronic survey of patients with hypertension who had regularly visited medical institutions for treatment, were receiving antihypertensive drug therapy and had home blood pressure recordings available. The survey included a question about patient preference for treatment with renal denervation. A total of 2,392 patients were included (66% male, mean age 59.8 ± 11.6 years, mean duration of hypertension 11.4 ± 9.5 years). Preference for renal denervation was expressed by 755 patients (31.6%), and was higher in males than in females, in younger compared with older patients, in those with higher versus lower blood pressure, in patients who were less adherent versus more adherent to antihypertensive drug therapy, and in those who did rather than did not have antihypertensive drug-related side effects. Significant predictors of preference for renal denervation on logistic regression analysis were younger patient age, male sex, higher home or office systolic blood pressure, poor antihypertensive drug adherence, the presence of heart failure, and the presence of side effects during treatment with antihypertensive drugs. Overall, a relevant proportion of Japanese patients with hypertension expressed a preference for renal denervation. This should be taken into account when making shared decisions about antihypertensive drug therapy.

A Japan nationwide web-based survey of estimation on patients for renal denervation based on blood pressure level and the number of antihypertensives (J-NEEDs survey).

Catheter-based renal denervation (RDN) is currently being developed as a new complementary treatment option for hypertension. RDN has not yet received approval in Japan and so the number of possible candidates for RDN in Japan also remains unknown. A total of 10 756 hypertensive patients who regularly visit medical institutions and reported their latest home blood pressure (BP) values were identified from registrants at an online research company. They filled out a survey regarding their prescribed antihypertensives and latest BP values in March 2020 in Japan. The mean age of the patients was 61.3 years old (83.5% male). According to JSH 2019, the prevalence of resistant hypertension (RHT) was estimated to be 1.4% (0.52% having an office BP of 140/90 mm Hg or more while taking three antihypertensives, including diuretics; 0.84% taking four or more antihypertensives regardless of BP level). Assuming the indication for RDN was RHT with morning home systolic BP (HSBP) ≥ 135 mm Hg and office systolic BP (OSBP) ≥ 140 mm Hg, the number of candidates for RDN was estimated to be approximately 340 000 and 372 000, respectively. When hypertensive patients prescribed three or more, two, one, and no antihypertensives were included, the estimated number based on uncontrolled HSBP and OSBP cumulatively increased 2.6, 14.2, 40.6, and 58.0-fold; 1.8, 8.6, 25.3, and 36.4-fold, respectively. These findings revealed that a substantial number of hypertensive patients are unable to adequately control their BP level with existing treatments, and new complemental therapies, such as RDN, would alleviate the burden of hypertension in this population.

Echocardiography-guided aortic cannulation by the Seldinger technique for type A dissection with cerebral malperfusion.

OBJECTIVE: The purpose of this study was to assess the efficacy of echocardiography-guided ascending aortic central cannulation using the Seldinger technique during surgery for type A acute aortic dissection complicated by stroke due to cerebral malperfusion. METHODS: Between April 2007 and December 2017, 208 patients with type A acute aortic dissection underwent echocardiography-guided ascending aortic central cannulation using the Seldinger technique. We analyzed 16 of these patients (7.7%; median age, 63 years; 8 men) with stroke due to cerebral malperfusion, including 10 in a comatose state (Glasgow Coma Scale ≤8) and 6 with hemiplegia (manual muscle test ≤1) on hospital arrival. The Modified Rankin Scale was used to evaluate activities of daily living. RESULTS: The median time from onset of symptoms to establishment of cardiopulmonary bypass was 327 (176-561) minutes. The median time from the start of surgery to establishment of cardiopulmonary bypass was 34 (30-44) minutes. The mortality rate was 6.3% (1/16). In patients with preoperative coma, the Glasgow Coma Scale improved significantly after surgery from 4.5 to 15 at 30 days (P < .001). In patients with preoperative hemiplegia, 4 showed improved motor function on the manual muscle test score at 90 days. In all patients, Modified Rankin Scale scores improved significantly from 5.0 preoperatively to 1.0 after follow-up (P < .001). CONCLUSIONS: Echocardiography-guided ascending aortic central cannulation using the Seldinger technique has potential as a rapid and reliable perfusion route during surgery for type A acute aortic dissection complicated by stroke due to cerebral malperfusion.

[Bronchogenic Cyst with Rapid Increase and Emergency Operation;Report of a Case].

A 21-year-old man was admitted with fever and back pain. Chest computed tomography(CT) showed a cystic mass of 7×6 cm in the right middle mediastinum. After 3 days, symptoms worsen, and chest X-ray revealed the enlargement of the cyst, and an emergent operation was performed. Since the tumor was severely adhered to the superior vena cava and the azygous vein, the cystic mass was partially resected. The pathological diagnosis was bronchogenic cyst.

[Osimertinib Was Effective for Liver Metastasis after Surgery for Lung Cancer with Simultaneous Expression of EGFR L858Ra nd T790M Mutations-A Case Report].

A 63-year-old woman underwent right lower lobectomy and mediastinal dissection for lung cancer. At 5 years and 5 months after surgery, chest computed tomography revealed multiple liver metastasis. EGFR gene mutations of L858R and T790M were detected in both the primary lung cancer lesion and the liver metastasis specimen. Gefitinib was initiated as the first-line treatment, but the tumors increased in size. Osimertinib, as second-line treatment, was remarkably effective against the liver metastatic lesions and it maintained a partial response for approximately 1 year. Thus, osimertinib was effective for liver metastasis of lung cancer with EGFR mutations of L858R and T790M.

[Late-onset Chylothorax after Right Upper Lobectomy;Report of a Case].

Chylothorax after pulmonary resection is diagnosed usually within a few days after surgery, hence late-onset chylothorax is relatively rare complication. A 79-year-old woman underwent right upper lobectomy and mediastinal dissection for lung cancer. A chest tube was removed on postoperative day (POD)3, and she was discharged on POD 8. Fifty days after an operation, the patient developed a dyspnea on effort, and chest radiography revealed a right-sided pleural effusion, which we diagnosed as chylothorax. Because the treatments of a fat-free diet and subcutaneous octreotide acetate administration were ineffective, thoracic duct ligation was finally performed. The post-reoperative course was uneventful.

[Micronodular Thymoma with Lymphoid Stroma;Report of a Case].

We report a surgical case of micronodular thymoma with lymphoid stroma (MNT), which is a rare type of thymoma. A 66-year-old man was referred to our hospital for further examination and treatment of a nodule in the mediastinum. Computed tomography(CT) showed a 20-mm nodule in the anterior mediastinum, and positron emission tomography-CT showed slight uptake in the same region. Thymoma was suspected and videoassisted thymectomy was performed. Histopathological findings showed spindleshaped tumor cells forming storiform, with the background of lymphoid stroma, and the tumor was diagnosed as MNT. The long-term outcome after resection of MNT currently remains unclear, and accumulation of further cases is required.

Hyperspectral photometric stereo for a single capture.

We present a single-capture photometric stereo method using a hyperspectral camera. A spectrally and spatially designed illumination enables a point-wise estimation of reflectance spectra and surface normals from a single hyperspectral image. The illumination works as a reflectance probe in wide spectral regions where reflectance spectra are measured, and the full spectra are estimated by interpolation. It also works as the resource for shadings in other spectral regions. The accuracy of estimation is evaluated in a simulation. Also, we prepare an experimental setup and demonstrate a surface reconstruction against a real scene.