Coexistence Case of Papillary Fibroelastoma and Lambl's Excrescence of the Left Heart, Which Is Occasionally Associated with Significant Stroke.

Papillary fibroelastoma (PFE) is a benign tumor that arises mostly from left-sided valves. PFE can cause stroke, and surgical resection may be needed. Lambl's excrescence (LE) is a filiform valvular lesion and is considered a possible cause of stroke. A 79-year-old man with light-headedness and left-sided hemiparesis was diagnosed with stroke. Transesophageal echocardiography (TEE) revealed a round-shaped mobile mass in the left ventricular outflow tract (LVOT), which was considered the cause of the stroke. Surgical resection was performed transaortically, and during surgery, a mass was incidentally detected on the noncoronary cusp (NCC), which was also resected followed by aortic valve replacement. Pathology confirmed that the mass in the LVOT was a PFE and that the filiform mass on the NCC was LE. We herein report a rare case of PFE in the LVOT and coexisting LE on the NCC. A careful examination via TEE helps to identify other possible causes of stroke hidden behind the obvious cause.

Detection of PPB-Level H2S Concentrations in Exhaled Breath Using Au Nanosheet Sensors with Small Variability, High Selectivity, and Long-Term Stability.

The continuous monitoring of hydrogen sulfide (H2S) in exhaled breath enables the detection of health issues such as halitosis and gastrointestinal problems. However, H2S sensors with high selectivity and parts per billion-level detection capability, which are essential for breath analysis, and facile fabrication processes for their integration with other devices are lacking. In this study, we demonstrated Au nanosheet H2S sensors with high selectivity, ppb-level detection capability, and high uniformity by optimizing their fabrication processes: (1) insertion of titanium nitride (TiN) as an adhesion layer to prevent Au agglomeration on the oxide substrate and (2) N2 annealing to improve nanosheet crystallinity. The fabricated Au nanosheets successfully detected H2S at concentrations as low as 5.6 ppb, and the estimated limit of detection was 0.5 ppb, which is superior to that of the human nose (8-13 ppb). In addition, the sensors detected H2S in the exhaled breath of simulated patients at concentrations as low as 175 ppb while showing high selectivity against interfering molecules, such as H2, alcohols, and humidity. Since Au nanosheets with uniform sensor characteristics enable easy device integration, the proposed sensor will be useful for facile health checkups based on breath analysis upon its integration into mobile devices.

Impedance-guided modified CLOSE protocol ablation can reduce ablation index necessary for pulmonary vein isolation in patients with atrial fibrillation.

BACKGROUND: Real-time monitoring of generator impedance drop is not considered in CLOSE protocol pulmonary vein (PV) isolation (PVI) in patients with atrial fibrillation (AF). We verified whether additional information of impedance drop could minimize ablation index required for PVI using modified CLOSE protocol (target ablation index ≥ 500 on anterior wall and ≥400 on posterior wall along with inter-lesion distance of 3-6 mm and maximum power of 35 W) without any adverse effect of procedural data and efficacy. METHODS: Sixty consecutive Japanese AF patients [paroxysmal AF: 43 (72 %) patients] underwent first-time PVI with modified CLOSE protocol with real-time monitoring of impedance drop (impedance-guided modified CLOSE protocol). Ablation tags were colored according to impedance drop and ablation was immediately terminated before reaching target ablation index if impedance drop of ≥10â€¯Ω was confirmed. Ablation index needed for PVI, first-pass PVI rate, other procedural data, and atrial tachyarrhythmia recurrence were evaluated. RESULTS: Mean ablation index and impedance drop on anterior and posterior walls were 437.6 ±â€¯43.5â€¯Ω and 10.2 ±â€¯2.6â€¯Ω and 393.3 ±â€¯27.4â€¯Ω and 9.3 ±â€¯2.2 Ω, respectively. First-pass PVI per PV pair was accomplished in 90/120 (75 %). No complications occurred. PV gaps after first-pass ablation were locationally most often found on right posterior wall than on the other parts (p < 0.001). There were no differences in mean contact force, impedance drop, and ablation index between walls with and without PV gaps after first-pass PV ablation. During a mean follow-up of 24 ±â€¯9 months, survival from atrial tachyarrhythmia recurrence was 51/60 (85 %) patients. CONCLUSIONS: Using additional generator impedance drop information may be useful to minimize radiofrequency current application to accomplish PVI with modified CLOSE protocol while maintaining efficacy and safety in Japanese AF population.

Origin of the High Selectivity of the Pt-Rh Thin-Film H2 Gas Sensor Studied by Operando Ambient-Pressure X-ray Photoelectron Spectroscopy at Working Conditions.

The Pt-Rh thin-film sensors exhibit excellent sensitivity and selectivity for H2 gas detection. Here, we studied the mechanism of highly selective detection of H2 by the Pt-Rh thin-film sensors with ambient-pressure X-ray photoelectron spectroscopy (AP-XPS) measurements at working conditions, which were paralleled with electric resistivity measurements. The elemental composition and chemical state of surface Pt and Rh drastically change depending on the background gas environments, which directly link to the sensor response. It is revealed that surface segregated Pt atoms accelerate dissociative adsorption of H2, resulting in a reduction of the sensor surface and then a decrease of electric resistivity of the film, whereas a thin oxidized Rh layer blocks dissociation of the other reducing agent, that is, NH3. This is supported from the adsorption energetics obtained by the density functional theory (DFT) calculations.

Simultaneous Detection of Mixed-Gas Components by Ionic-Gel Sensors with Multiple Electrodes.

The sensing of gas components in a mixed gas is required for breath-based health monitoring and diagnosis. In this work, we report the simultaneous detection of mixed-gas components using a sensor consisting of [EMIM][BF4]-based ionic gel with four electrodes made of Au, Pt, Rh, and Cr. The voltage between any given pair of electrodes depends on the gas molecules absorbed in the ionic gel and the elements the electrodes are made of. When the voltage signals between all pairs of electrodes were used, H2, NH3, and C2H5OH concentrations were simultaneously estimated by a neural-network-based inference. From molecular dynamics simulations, the origin of the voltage signal was attributed to the catalytically generated adsorbates on the electrodes.

In situ AP-XPS analysis of a Pt thin-film sensor for highly sensitive H2 detection.

In situ ambient-pressure X-ray photoelectron spectroscopy (AP-XPS) combined with resistivity measurement was performed for a Pt thin-film H2 gas sensor. We experimentally demonstrate that the chemical state of the Pt surface changes under working conditions, and it directly links to the sensing performance. Moreover, the operating principle is discussed at the atomic scale.

Relationship between a Urine Protein-to-creatinine Ratio of 150 mg/gram Creatinine and Dipstick Grade in the Health Checkup: Substantial Number of False-negative Results for Chronic Kidney Disease.

OBJECTIVE: Proteinuria is a marker for cardiovascular diseases and all-cause mortality. In the Specific Health Checkups in Japan, when subjects show trace proteinuria (grade±) on dipstick assay, further examination is recommended to them. Although 150 mg/gCr is a threshold for diagnosing chronic kidney disease (CKD), little data on the relationship between dipstick grade± and the protein-creatinine ratio have been reported. METHODS: A cross-sectional study using urine specimens obtained in a single institute, JCHO Saitama Northern Medical Center, was performed from October 2014 to March 2016. The level of proteinuria was measured in fresh morning urine samples from 819 volunteer participants of the Specific Health Checkups by two methods: Eiken Uropaper III to detect and qualitatively grade proteinuria, and total protein concentration by the pyrogallol red method. RESULTS: Sensitivity, specificity, and the positive likelihood ratio to detect proteinuria of 30 mg/dL by 1+ were 90.3%, 97.8%, and 41.9, whereas 150 mg/gCr by ± were 45.3%, 81.4%, and 2.4, respectively. Therefore, screening for 150 mg/gCr by dipstick grade± had a false-negative rate of 54.7% and false-negative rate was significantly higher in women (8.0%) than in men (1.7%) (p < 0.0001). CONCLUSIONS: Although the dipstick assay is useful to detect clinically significant proteinuria, substantial numbers of false-negative results occur in checkups for identifying subjects with a risk of CKD.

A novel application of the culotte stent technique to bail out a jailed common iliac artery.

Implanting a self-expandable stent at the ostium of the common iliac artery (CIA) may lead to coverage of the orifice of the contralateral CIA. Here, we describe a novel application of the culotte stent technique using a balloon-expandable stent to bail out an ostial stenotic legion of a jailed CIA due to prior self-expandable stent placement. The bilateral CIAs were revascularized by culotte stenting, and patency of the stents was confirmed 3 years after the procedure. The culotte stent technique was successfully applied to an ostial stenotic lesion of a jailed CIA.

Deionization of Dopants in Silicon Nanofilms Even with Donor Concentration of Greater than 10(19) cm(-3).

Understanding the dopant properties in heavily doped nanoscale semiconductors is essential to design nanoscale devices. We report the deionization or finite ionization energy of dopants in silicon (Si) nanofilms with dopant concentration (ND) of greater than 10(19) cm(-3), which is in contrast to the zero ionization energy (ED) in bulk Si at the same ND. From the comparison of experimentally observed and theoretically calculated ED, we attribute the deionization to the suppression of metal-insulator transition in highly doped nanoscale semiconductors in addition to the quantum confinement and the dielectric mismatch, which greatly increase ED in low-doped nanoscale semiconductors. Thus, for nanoscale transistors, ND should be higher than that estimated from bulk Si dopant properties in order to reduce their resistivity by the metal-insulator transition.

Effects of walking on medical cost: A quantitative evaluation by simulation focusing on diabetes.

AIMS/INTRODUCTION: Recently, the prevalence of lifestyle-related disease has increased, and its associated medical costs have become considerable. Although walking is thought to prevent lifestyle-related disease, few studies have evaluated its effect on medical costs in Japanese subjects. We aimed at evaluating the effect of walking on medical costs by simulation mainly focusing on diabetes in the Japanese population. MATERIALS AND METHODS: A Markov model focusing on diabetes was constructed. As complications of diabetes, 'dialysis', 'ischemic heart disease' and 'stroke' were included. The model has four states: 'non-diabetes', 'diabetes', 'dialysis' and 'dead', and 'ischemic heart disease' and 'stroke' were included as events that occurred in each state. The effect of walking was included as changing the rate of transition and incident rates of events. RESULTS: After 10 years, the numbers of subjects with diabetes were 4.3 and 7.3% lower for daily increase of 3,000 and 5,000 steps, respectively. The numbers of cases of ischemic heart disease and stroke also decreased. Lower medical costs were also seen according to the daily increase in steps. In 10 years, the total medical costs were 5.2 and 8.4% lower for 3,000 and 5,000 steps increase, respectively. The cost reduction associated with a daily increase of 3,000 steps walked was calculated as ¥0.00146 for each step. CONCLUSIONS: Walking is one of the most common and accessible forms of exercises. The present results suggested that walking reduced the medical costs associated with lifestyle-related disease, which will have a large impact on health policy.

A morbid obese Japanese woman with a body mass index of 83.2 kg/m2: before and after sleeve gastrectomy.

A 34-year-old Japanese woman presented at our institution weighing 182.7 kg, 148.2 cm tall, and with a body mass index of 83.2 kg/m(2). She had been overweight since childhood, but no abnormality was found to explain her obesity. Treatments, including mazindol, bofu-tsusho-san, dietary restriction, and BioEnterics Intragastric Balloon, did not result in improvement of her obesity. Finally, we performed sleeve gastrectomy, and she has maintained her weight within 130-140 kg without rebounding for 2 and a half years. We followed the clinical changes before and after the operation. This case provides potentially interesting information regarding operative treatment for morbid obesity in Japanese.

Income, wealth and risk of diabetes among older adults: cohort study using the English longitudinal study of ageing.

BACKGROUND: Socio-economic status has been associated with diabetes in cross-sectional studies. This study aimed to evaluate associations of household income and wealth with both prevalent and incident diabetes among older adults in the UK. It also evaluated the association between obesity and socio-economic status. METHODS: A cohort of people aged ≥50 years was selected from the English Longitudinal Study of Ageing. The relation of prevalent and incident self-reported physician diagnosed diabetes to household income and wealth was evaluated in logistic regression models adjusting for education, social class, housing tenure, age, ethnicity, marital status, body mass index (BMI), smoking, alcohol use and physical activity stratified by sex. The relation of prevalent obesity to household income and wealth was also evaluated using logistic regression models. RESULTS: There were 9053 participants (4021 men and 5032 women) including 721 (8.0%) with diabetes at baseline. Among 8332 participants initially free from diabetes, 246 (3.0%) were diagnosed with diabetes during ∼4 years follow-up. The adjusted odds ratio for prevalent diabetes in the lowest quintile of wealth compared with the highest was 1.56 for men and 2.08 for women. Incident diabetes was associated with lower wealth (P for trend 0.05 for men and 0.004 for women) after adjusting for socio-economic and demographic factors, but attenuated after further adjustment for lifestyle and BMI. Prevalent obesity was significantly associated with lower wealth in women but not in men. CONCLUSION: Lower wealth, but not income, may be associated with prevalent and incident diabetes among older adults in UK.

Congener-specific polychlorinated biphenyls and the prevalence of diabetes in the Saku Control Obesity Program (SCOP).

The prevalence of diabetes is increasing globally. In addition to established risk factors for diabetes, such as diet, inactivity, overweight and obesity, the involvement of persistent organic pollutants, including dioxins and polychlorinated biphenyls (PCBs), has also been suggested to be a possible, but controversial, cause of this epidemic. The present study investigated the association between blood PCB congener levels and the prevalence of diabetes among middle-aged, overweight and obese Japanese participants in the Saku Control Obesity Program. One hundred seventeen participants had their congener-specific PCB levels measured in addition to undergoing routine blood analyses at the time of a medical checkup. Prevalent diabetes was defined according to two methods: definite diabetes was defined as people with an HbA1c level ≥ 6.9% or who were taking medication for diabetes, and all diabetes was defined as people with an HbA1c level ≥ 6.5%, a fasting plasma glucose level ≥ 126 mg/dL, or a history of doctor-diagnosed diabetes. A multiple logistic regression analysis was performed to analyze the association between the PCB levels and the prevalence of diabetes, with adjustments for sex, age, body mass index and total lipids. As a result, PCB 146 and 180 were positively associated and PCB 163/164 and 170 were negatively associated with the prevalence of definite diabetes. The significance of the association of PCB 180 and 163/164 with the prevalence of diabetes persisted regardless of the definition of diabetes or adjustments for total lipids, suggesting the possibility that these parameters may modify the risk of diabetes.

Hemoglobin variant HbE found in two South Asian diabetic patients.

Glycohemoglobin, also known as hemoglobin (Hb) A(1c), is a marker of long-term glycemic control in patients with diabetes. We present two South-Asian diabetic patients whose HbA(1c) peaks were not measurable using high performance liquid chromatography (HPLC). Further investigations showed that these patients were homozygous for a hemoglobin variant, HbE (beta26 Glu-->Lys). Because of the increasing numbers of immigrants in Japan, area-specific hemoglobinopathies are now encountered more frequently than before. Thus, if discrepant results are found on an HbA(1c) assay or if the HbA(1c) value cannot be measured, such patients should be screened for hemoglobinopathies and alternative measurements for monitoring diabetes should be considered.

Use of insulin glargine in Japanese patients with type 1 diabetes.

OBJECTIVE: To evaluate the results of treatment with an insulin glargine-based regimen as compared with those of an NPH insulin-based regimen. METHODS: We reviewed the charts of 83 Japanese patients with Type 1 diabetes treated with insulin glargine for 12 months. PATIENTS: Median age, 56.9 years (range, 24.6-74.8 years), mean (+/-S.D.) body mass index, 21.2 (+/-2.2) kg/m2. RESULTS: The average HbA1c level of the cohort was 7.8 +/- 1.2% at baseline and 7.7 +/- 1.0% at the end of the 12-month treatment (P=0.34). The average insulin requirement per day in the cohort remained unchanged after the 12-month treatment (35.0 +/- 11.6 units/day versus 35.2 +/- 11.2 units/day (P=0.58). Of the 36 patients who were receiving twice or three times daily injections of NPH insulin, 30 could be switched to a single-daily injection of insulin glargine. The frequency of severe hypoglycemia with unconsciousness became lower after switching to the insulin glargine-based regimen than during treatment with the NPH-based regimen. The average ratio of the daily usage of insulin glargine to that of total insulin after 12 months was smaller than that reported from other countries (0.34 +/- 0.09). CONCLUSION: These results obtained from a larger number of patients as compared to previous Japanese studies confirm earlier reports that insulin glargine provides equivalent glycemic control to human NPH insulin, with a lower incidence of severe hypoglycemia. Thus, treatment with insulin glargine provides some benefits to Japanese patients with Type 1 diabetes.