Coil Embolization for Coronary Artery Perforation: A Retrospective Analysis of 110 Patients.

OBJECTIVE: Coil embolization (CE) for coronary artery perforation (CAP) has not been thoroughly evaluated. This study aimed to evaluate the extent of myocardial damage and impact on cardiac function after CE for CAP. METHODS: A total of 110 consecutive patients treated with CE for CAP were retrospectively identified. The degree of myocardial damage and impact on cardiac function were evaluated. RESULTS: Forty-nine (44.5%) cases involved chronic total occlusions. A guidewire was the cause of perforation in 97 (88.2%) patients. The success rate of CE was 98.2%. Almost all patients were prescribed either antiplatelet drugs or anticoagulant medication or both. Patients with perforation types III and IV were found to be prone to creatinine kinase (CK) elevation and epicardial main vessel perforation, thereby causing myocardial damage. No changes were noted in the ejection fraction (EF) in patients with type V distal perforation and collateral channel perforation, while patients with perforation of the epicardial main vessel may show impaired cardiac function afterward. CONCLUSIONS: CE is safe and effective for treating CAP, especially when collateral channels and distal vessels are involved. Meanwhile, efforts should be taken to prevent CAP in epicardial main vessels since it may be difficult to treat with CS and cause myocardial damage when bailed out with CE leading to vessel sacrifice. We found that it was not necessary to change the anticoagulant regimen after CE owing to its ability to achieve robust hemostasis.

The "Fracking" technique: a novel approach to crack deep calcified plaque in the common femoral artery with hydraulic pressure.

BACKGROUND: The patency achieved by conventional peripheral interventions for atherosclerotic lesions in the common femoral artery (CFA), called the "no stenting zone", is not superior to that achieved by surgical endarterectomy due to calcified plaque occupying the area. Plaque modification strategies to obtain acute gain in CFA patency provide the better clinical outcomes than standard balloon angioplasty. Atherectomy devices, which focus on the modification of superficial calcifications, contribute to the improvement of clinical outcomes. However, deep calcifications resist vessel expansion such that luminal gain is not easily achieved. MAIN TEXT: We propose a novel calcified plaque modification technique, named the "fracking technique" (FT). The term fracking refers to how a rock is fractured by the high hydraulic pressure. In this technique, deep calcifications are cracked with hydraulic pressure via a balloon indeflator through an 18-gauge needle, which punctures calcifications to achieve greater acute luminal gain. Case 1 involved an 81-year-old male with eccentric calcified plaque in the right CFA. Conventional balloon angioplasty for the lesion yielded a suboptimal minimal lumen area (MLA), which increased from 6.2 to 10.7-mm2 on intravascular ultrasound (IVUS). The FT was implemented to obtain a larger MLA. After the FT was repeated at three locations at up to 8-atm, a greater MLA of 27.1-mm2 was achieved without complications. Case 2 involved a 72-year-old male undergoing hemodialysis due to diabetes mellitus who presented with ischemic pain in his right limbs at rest due to severe stenosis with eccentric calcification in the distal CFA. The MLA on IVUS before and after balloon angioplasty was 10.0-mm2 and 13.1-mm2, respectively, and this result was still suboptimal. The FT was attempted and successfully yielded a greater MLA of 28.9-mm2 without complications. Restenosis has not been detected for 2 years follow-up period. CONCLUSIONS: The FT is an effective option for treating calcified CFA lesions to achieve a larger lumen area. Long-term follow-up studies are necessary.

The "Needle bypass" technique: Percutaneous anatomical bypass with needle rendezvous for patients with peripheral arterial disease that have no other surgical options.

BACKGROUND: The ideal method for recanalization of complex peripheral lesions has not been determined, despite the use of the latest endovascular devices. We describe a novel method for a fully percutaneous anatomical bypass, named the "needle bypass" technique, for treatment of complex vascular lesions with failed previous surgical therapy. MAIN TEXT: A 68-year-old male patient with chronic limb-threatening ischemia presented to our department. He previously had received surgical treatment 10 years prior that included the removal of the right distal common femoral artery and two surgical bypasses, an axillary-femoral bypass and an iliofemoral bypass, because he had repeated infections. He was referred to our center in order to have peripheral interventions. Since the previous conventional bridging/revascularization of the removed common femoral bifurcation had failed, the "needle bypass" technique was then used. With this novel technique, the tips of two percutaneous and bidirectional inserted needles were aligned ("needle rendezvous") for the externalization of a guidewire in a through-and-through manner. Once this was achieved, an endovascular stent graft and an interwoven stent were deployed to cover and connect the lesion. This new technique is a minimally invasive anatomical bypass that directly connects artery to artery without any disturbance of the venous flow, and this technique, as the only option available, was performed successfully in our no-option patient. CONCLUSIONS: The "needle bypass" technique is an effective percutaneous treatment method in patients with no other surgical options.

Status of fracture risk assessment and osteoporosis treatment in Japanese patients with rheumatoid arthritis.

OBJECTIVES: This study aimed to investigate the prevalence of patients with rheumatoid arthritis (RA) at a high risk of major osteoporosis (OP)-related fractures and the status of OP-related medical treatment for these patients. METHODS: We enrolled 120 patients aged ≥40 years (average, 69.1 years) with RA. The Fracture Risk Assessment Tool (FRAX®) was used to evaluate the fracture risk. Of the 120 patients, the femoral neck bone mineral density (BMD) was evaluated in 102 patients, and their FRAX® scores were calculated alongside the BMD values. Patients observed to be at a high risk of a major OP-related fracture (10-year probability >20% or hip fracture risk >3%), according to FRAX®, were identified as those requiring OP treatment; medication ratio for OP (percentage of patients actually receiving medication among patients requiring OP treatment) was assessed. RESULTS: OP treatment was indicated in 75 (63%) patients; the medication ratio for OP was 49%. The use of biological disease-modifying anti-rheumatic drugs and corticosteroids showed a positive effect; however, the use of methotrexate showed a negative effect on the medication ratio. CONCLUSION: The number of potential patients requiring OP treatment is underestimated. All patients with RA should be assessed to determine their eligibility for OP treatment.

Insufficient recovery of fractional flow reserve even after optimal implantation of drug-eluting stents: 3-year outcomes from the FUJI study.

BACKGROUND: Adequate improvement in fractional flow reserve (FFR) is not necessarily achieved in some cases of drug-eluting stent (DES) implantation, even when imaging confirms successful placement. We hypothesized that post-stent FFR may be associated with advanced diffuse atherosclerotic condition. We explored the relationships between FFR values after DES implantation (post-stent FFR). METHODS: A total of 218 patients were included in this prospective, multicenter study and were divided into two groups: adequate FFR group (post-stent FFR >0.80, n=176) and inadequate FFR group (post-stent FFR ≤0.80, n=42). The primary endpoint was a major adverse cardiovascular event (MACE) including cardiac death, non-fatal myocardial infarction (MI), unplanned coronary revascularization, and hospitalization for heart failure. The secondary endpoints were event rate of all-cause death, non-fatal MI, unplanned coronary revascularization, non-fatal stroke, and hospitalization for heart failure. RESULTS: During follow-up of 31.4±8.7 months, 34 patients (16%) had cardiovascular events. Inadequate FFR group was significantly associated with higher risk of MACE (hazard ratio: 3.86; 95% confidence interval: 1.17-12.76, p=0.026; log-rank p=0.027). In particular, the incidence of unplanned coronary revascularization on non-target lesions was significantly higher in the inadequate FFR group (log-rank p=0.031). CONCLUSIONS: Post-stent FFR ≤0.80 was associated with a high incidence of non-target lesion revascularization and could be a surrogate marker for advanced atherosclerotic condition in the vessels of the entire coronary artery.

Comparison of Genetic Structure between Endangered and Common Butterflies, Ypthima multistriata and Y. argus (Lepidoptera; Nymphalidae), Inhabiting Japan.

Genetic structures of two closely related butterflies, Ypthima multistriata and Y. argus, inhabiting Japan were compared based on the mitochondrial cytochrome c oxidase subunit I (COI) sequences. The former species is classified as a vulnerable species and exhibits a characteristic pattern of voltinism: univoltine and bivoltine populations are distributed in a scattered manner. The latter species is common and has a normal geographical pattern of voltinism: the number of annual generations is correlated with latitude. Our genetic analyses of these two species yielded contrasting results: a spatial analysis of molecular variance (SAMOVA) and FST between each pair of populations revealed a locally fragmented genetic structure for Y. multistriata, compared to three distinct geographic groups of Y. argus within which range-wide gene flow occurs. Although Y. argus is a common species, only the southernmost populations in Japan had higher genetic diversity, while the other populations had the same or lower levels of genetic diversity, compared to Y. multistriata. These results indicate that: 1) the degree of fragmentation of Y. multistriata populations was higher; however, markedly lower genetic diversity was not found, and 2) although Y. argus is a common species, its populations may not be genetically robust. In addition, AMOVA revealed a relationship between voltinism and genetic variation in Y. multistriata. This result suggests a phylogenetic constraint of voltinism in this butterfly.

Uncertainty about flying conspecifics causes territorial contests of the Old World swallowtail, Papilio machaon.

BACKGROUND: Male-male aerial contests of territorial butterflies are difficult to explain by major contest models based on game theory because of butterflies' apparent inability to inflict substantial costs on their opponent. As an alternative, the "erroneous courtship hypothesis" was presented. This hypothesis is based on the assumption that territorial butterflies cannot discriminate the sex of flying conspecifics. The hypothesis regards the aerial contest of male butterflies as an inevitable same-sex entanglement in the butterflies' behavioral sequence. To test the robustness of the hypothesis, we investigated the sex recognition abilities of the Old World swallowtail, Papilio machaon. RESULTS: We presented four types of flapping butterfly specimens (fresh male and female, chemicals-removed male and female) to territorial males. The males touched fresh female specimens and showed typical courtship flight. For the other types of specimens, they rarely showed courtship flight although they approached or touched them. In addition, territorial males reacted longer to fresh males than to fresh females. CONCLUSIONS: The results indicated that although territorial males recognize flying females as sexual partners by sensing their semiochemicals, they cannot identify flying conspecific males, and continue to gather information on them. P. machaon is one of the species whose behavior is most incompatible with the erroneous courtship hypothesis, as its males perform a typical courtship flight to flying females, suggesting the ability of sexing flying conspecifics. Nevertheless, the erroneous courtship hypothesis was not disproved by our results.

Agonistic display or courtship behavior? A review of contests over mating opportunity in butterflies.

Male butterflies compete over mating opportunities. Two types of contest behavior are reported. Males of various butterfly species compete over a mating territory via aerial interactions until one of the two contestants retreats. Males of other butterfly species fly around larval food plants to find receptive females. Males of some species among the latter type can find a conspecific pupa, and they gather around it without expelling their rivals. Scramble competition over mating occurs when a female emerges from the pupa. Many studies have been performed on territorial species, and their contest resolution has often been understood from the point of view of contest models based on game theory. However, these models cannot explain why these butterflies perform contest displays despite the fact that they do not have the ability to attack their opponent. A recent study based on Lloyd Morgan's Canon showed that territorial contests of male butterflies are better understood as erroneous courtship between sexually active males. In this paper, I review research on contests over mating opportunity in butterflies, and show that the erroneous courtship framework can explain not only territorial contests of butterflies but also why males do not determine the owner of a conspecific pupa.

Mate-locating behavior of the butterfly Lethe diana (Lepidoptera: Satyridae): do males diurnally or seasonally change their mating strategy?

The mate-locating behavior of male butterflies has been classified into two major types, territorial and patrolling. Territorial males defend a specific site, whereas patrolling males fly around a wider area without having to defend a site. In this study, I investigated the use of these tactics by males of the satyrine butterfly, Lethe diana. A previous study suggested that the males of L. diana change their mate-locating behavior during the day (they patrol in the morning and defend territories in the afternoon) and that patrolling is the primary mating strategy, whereas defending territories is a supplementary one. In the present study, I found that the daily activity pattern of the males of L. diana was similar to that described in the previous study: males often flew around in the morning and competed for territories in the afternoon. However, contrary to the previous study, all courtships and copulations were performed within male territories during their territorial activity. Closer observations revealed that copulations found in male territories were achieved by the owner of the territory. Males tended to feed in the morning, suggesting that the males flying in the morning searched for food rather than females. I conclude that territory holding is the primary male matelocating tactic in L. diana. I further found that, in summer, males exhibited territorial behavior later than in spring or autumn, which may be a strategy for preventing heat stress.

Territorial behavior of a green hairstreak Chrysozephyrus smaragdinus (Lepidoptera: Lycaenidae): site tenacity and wars of attrition.

Males of Chrysozephyrus smaragdinus were active from late morning to late afternoon, during which they showed territorial behavior, perhaps for mating. The territorial male stayed in a particular area and occasionally flew around it, referred to hereafter as the inspection area. When other male intruded into this area, the territorial male rushed to him. Then, they engaged in a circling flight regarded as a "war of attrition". During this flight, the two males sometimes strayed far away from the territory. After the circling flight, the resident returned to his territory in almost all cases (98%). Despite such intrusions, many residents defended their territory for several successive days. This suggests strongly the "effect of prior residence". We recorded the circling flights with a high-speed video camera, and confirmed that the male that ceased the circling flight first was the loser. This finding gave some validity to consider circling flight as wars of attrition. In a few cases, the territorial male mated with a female that came to the territory. These once mated males held the territory no longer, suggesting that mating experience should restrict the next mating opportunity in this species.

A quantitative analysis of geographic color variation in two Geotrupes dung beetles.

We conducted a quantitative analysis of geographic color variation in two species of dung beetles: Geotrupes auratus and G. laevistriatus. The reflectance of the dorsal surfaces was measured from 300 to 700 nm using a spectrophotometer. The reflectance curves for both beetles were bimodal; there were two distinct peaks, namely, the a peak, between 400 and 700 nm, and the beta peak at around 300 nm. A stepwise discriminant analysis indicated that geographic color variation in Geotrupes beetles was primarily characterized by a shift of the a peak. Using beetles from three locations, we compared the wavelength (nm) of the a peak (lambdamax(alpha)) and its reflectance intensity (R(a)) to investigate sex and population differences. Intraspecific geographic variation in coloration was effectively detected by discriminant analysis of spectral reflectance curves. Our results showed that G. auratus and G. laevistriatus had similar coloration within each sampling location. Our study also revealed hidden sex differences in R(a); R(a) of males were significantly higher than those of females in both species. Since the dorsal surface of the beetles shows remarkable color variation, and coloration can be assessed objectively using reflectance spectra, Geotrupes beetles may be good model organisms to investigate geographic color variation.

Wing colors of Chrysozephyrus butterflies (Lepidoptera; Lycaenidae): ultraviolet reflection by males.

Wing colors of the four species of Chrysozephyrus butterflies were analyzed by a spectrophotometer. As the dorsal wing surface of males showed a strong reflectance when the specimen was tilted, measurements were made by the tilting method. The dorsal wing surface of males which appears green to the human eye reflected UV (315-350 nm) as well as green light (530-550 nm). The reflectance rate of UV to visible green light varied among species with a higher rate for C. hisamatsusanus and C. ataxus, and a lower rate for C. smaragdinus and C. brillantinus. The peak wavelength and the peak height did not shift when the specimen was exposed to direct sunlight at least for 16 hr. Artificial removal of scales by scratching the wing surface decreased reflectance. Blue marks on the forewings of C. brillantinus, C. hisamatsusanus and C. ataxus females reflected UV to visible light of short wavelength, and orange marks on the dorsal surface of the forewing and the ventral surface of the hindwing of C. samaragdinus females showed a higher reflectance at longer wavelengths.