Acute Cholecystitis Caused by Campylobacter jejuni Mimicking Acute Coronary Syndrome.

Campylobacter spp. is a widely recognized pathogen accountable for acute enteritis, frequently linked to sepsis, primarily attributed to C. jejuni. Instances of Campylobacter-induced cholecystitis are infrequent, with only a limited number of documented case reports. Acute cholecystitis has been sporadically documented to induce electrocardiographic alterations, occasionally simulating an acute coronary syndrome (ACS). Herein, we present an instance of cholecystitis induced by C. jejuni, posing a challenge in its differentiation from ACS due to electrocardiographic modifications. An 85-year-old Japanese male presented to our hospital with a complaint of chest discomfort lasting one hour. His medical history included hypertension, dyslipidemia, and effort angina pectoris, with a prior percutaneous coronary intervention. The chest discomfort, accompanied by pain and pressure, raised uncertainty about its similarity to a previous angina episode. Vital signs were in the normal range. Physical examination revealed no abnormal heart or lung sounds. Electrocardiography indicated a right bundle branch block and new ST-segment elevation in V2-3. Echocardiography, chest X-rays, and blood tests showed no abnormalities. Emergency coronary angiography revealed no stenosis. Post-angiography, chest discomfort persisted, and the patient developed fever and chills. Contrast-enhanced CT revealed gallbladder lithiasis, prompting suspicion of sepsis. C. jejuni was detected, and antimicrobial therapy resolved symptoms.

Bailout Strategy for Paclitaxel-Coated Nitinol Self-Expanding Stent Deployment Failure: The Cut and Peel Technique.

The patient received endovascular therapy for a superficial femoral artery occlusion. Placement of a SMART stent distal to the lesion was successful, but deployment issues occurred with the Innova stent, requiring forceful retraction and causing elongation. The "cut and peel technique" was developed as a bailout strategy for such cases.

Naphazoline intoxication with transient QT prolongation and acute myocardial injury.

A 27-year-old Japanese woman with a history of depression and an eating disorder presented to our emergency department with a chief complaint of generalized weakness. Electrocardiography showed prominent QT prolongation with multiple ventricular contractions. Chest X-ray plain computed tomography revealed pulmonary edema. Echocardiography showed decreased left ventricular systolic function. Suspecting acute myocarditis, we performed a myocardial biopsy from the right ventricular septum. The biopsy histology revealed extensive myocardial fibrosis and a very mild inflammatory cell infiltrate. In an additional detailed medical interview, the patient admitted that she had consumed three bottles of a first-aid liquid containing naphazoline approximately ~12 h before her presentation, in a suicide attempt. Her QTc and left ventricular ejection fraction improved during hospitalization. Learning objective: Acute drug intoxication can cause QT prolongation and ventricular arrhythmias, cardiomyopathy, and pulmonary edema. When acute QT prolongation, myocardial damage, and pulmonary edema are seen (suggesting acute myocarditis), naphazoline intoxication should be investigated in the differential diagnosis.

Long-term effects of ipragliflozin on blood pressure in patients with type 2 diabetes: insights from the randomized PROTECT trial.

Although previous reports have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors have a blood pressure (BP) lowering effect, relevant long-term data is limited. This study aimed to evaluate the effect of the SGLT2 inhibitor ipragliflozin on BP, and associations between BP reduction and changes in cardiometabolic variables in diabetic patients. This was a sub-analysis of the PROTECT trial, a multicenter, randomized, open-label study to assess if ipragliflozin delays carotid atherosclerosis in patients with type 2 diabetes. Participants were randomized to ipragliflozin and control groups. The primary endpoint of the present sub-analysis was the trajectory of systolic BP over 24 months. Correlations between systolic BP changes and cardiometabolic variables were also evaluated. A total of 232 eligible participants with well-balanced baseline characteristics were included in each study group. Throughout the 24-month study period, mean systolic BP was lower in the ipragliflozin group. At 24 months, a between-group difference (ipragliflozin minus control) in mean systolic BP change from baseline was -3.6 mmHg (95% confidence interval, -6.2 to -1.0 mmHg), and the reduction in systolic BP in the ipragliflozin group was consistent across subgroups examined. Changes in systolic BP significantly correlated with those in body mass index in the ipragliflozin group, while no significant correlations with other cardiometabolic variables tested were observed. In conclusion, ipragliflozin treatment was associated with BP reduction throughout the 24-month follow-up period as compared to control treatment. BP reduction correlated with weight loss, which might be one of the mechanisms for the BP lowering effect of SGLT2 inhibitors.

Sequential Multiple Visceral Artery Dissection within a Short Time, without Aortic Dissection.

A 65-year-old Japanese man without medical history presented with sudden onset lower abdominal pain to our emergency department. Contrast-enhanced computed tomography (CT) revealed dissections of the inferior mesenteric artery and left renal artery with false lumen thrombosis without aortic dissection. He was immediately hospitalized, and conservative treatment was administered. However, on the third-day post-onset, the patient reported severe upper abdominal pain and contrast-enhanced CT showed a new superior mesenteric artery dissection. He continued to receive conservative treatment, and his symptoms improved. He was discharged after ten days of hospitalization.

Tertiary Cardiovascular Syphilis Presenting as Aortic Regurgitation, Aortitis, Thrombus, and Coronary Artery Occlusion, Requiring Percutaneous Coronary Intervention.

BACKGROUND Heart failure is caused by coronary artery disease, valvular disease, and arrhythmias and is highly treatable with recent technology. However, the incidence of syphilis is increasing worldwide. This case report describes tertiary cardiovascular syphilis, accompanied by aortic regurgitation, syphilitic aortitis complicated by thrombus of the ascending aorta, and coronary artery occlusion, requiring percutaneous coronary artery intervention. CASE REPORT A 51-year-old Japanese man with no significant medical history was admitted to the hospital for worsening shortness of breath on exertion. On physical examination, there was no edema in either lower leg. Chest X-rays showed an enlarged heart and pulmonary congestion, and echocardiography showed a left ventricular ejection fraction of 18%, with full circumferential wall motion impairment. Heart failure was diagnosed, and the patient was found to have severe coronary artery disease and aortic regurgitation. He underwent percutaneous coronary intervention (PCI) for his coronary artery occlusion and was treated with medications for heart failure. Two months later, his condition improved, and PCI was performed for the revascularization of the remaining coronary artery. After PCI was completed, the patient was evaluated for vasculitis. The aortic wall lesion was likely a result of non-active syphilitic aortitis, and the results of serological tests of syphilis were positive. Therefore, we concluded that the diagnosis was cardiovascular syphilis. CONCLUSIONS This case report has highlighted the need for clinicians to be aware of the cardiovascular findings in syphilis, including syphilitic aortitis, particularly at this time, when the global incidence of syphilis is increasing.

Glucocorticoid-Induced Cardiomyopathy Caused by Uncontrollable Asthma.

Hypercortisolism is a risk factor for adverse cardiovascular and cerebrovascular outcomes, including hypertension, hyperglycemia, and dyslipidemia. It has been suggested that cardiovascular risk increases with increasing steroid use in patients taking oral steroids as immunosuppressive drugs. Cardiomyopathy is often reported to occur concomitantly in patients with Cushing's syndrome. Reports of cases of long-term high-dose glucocorticoid ingestion and concomitant cardiomyopathy are rare. We report a case of cardiomyopathy in a 63-year-old Japanese man. He had refractory bronchial asthma and had been on prednisolone ≥15 mg/day equivalent for >20 years. Echocardiography showed severe left ventricular dilatation, left ventricular systolic dysfunction, and mitral regurgitation. Since other secondary cardiomyopathies were excluded, a diagnosis of glucocorticoid cardiomyopathy was made, cardioprotective drugs were introduced, and the steroid dose was reduced during hospitalization. Four months after the patient's discharge, echocardiography showed normalization of left ventricular systolic function.

Transcoronary mapping using a guidewire during transcoronary ethanol ablation for ventricular tachycardia with a deep intramural substrate: a case report.

Background: Transcoronary ethanol ablation is effective in treating ventricular tachycardia (VT) in the deep myocardium. The selection of the target coronary artery plays an important role in the success of transcoronary ethanol ablation. Transcoronary mapping, using a guidewire, may be effective for identifying the target coronary artery. Case summary: A 72-year-old man, who had undergone thrombolytic therapy for acute myocardial infarction 40 years ago, was admitted to the emergency department with a chief complaint of syncope. Five years ago, a cardiac resynchronization therapy defibrillator was implanted for a left bundle branch block (QRS duration 153 ms), with New York Heart Association Class Ⅲ and a left ventricular ejection fraction of 30%.Due to VT, he experienced a critical deterioration in his vital parameters, leading to shock. The first VT ablation was performed on the 3rd day of hospitalization. Activation mapping showed that the earliest activation site was located in the mid-anterior septum of the left ventricle. Mapping from the endocardial surface showed no mid-diastolic potential around the VT. Radiofrequency catheter ablation therapy was performed at the targeted site, resulting in transient termination of VT. However, the VT showed recurrence the next day. A transcoronary ethanol ablation was performed on the 10th day of hospitalization. A 0.014 inch guidewire and microcatheter were advanced into the target coronary septal branch, and the myocardial septum was mapped. The guidewire-assisted transcoronary mapping showed a potential 43 ms ahead of QRS onset during VT. The coronary septal artery branch was considered the target artery, and 0.5 mL of ethanol was injected. No further VT was observed for 12 months after the transcoronary ethanol ablation. Discussion: Transcoronary ethanol ablation is considered in cases where a deep intramural substrate is suspected or when early activation at the interventricular septum is identified. Guidewire-assisted transcoronary mapping allows mapping of VT with deep intramural substrates and may be useful in selecting target coronary arteries while performing transcoronary ethanol ablation.

Ethylene polymerization using N-Heterocyclic carbene complexes of silver and aluminum.

Various transition metal catalysts have been utilized for ethylene polymerization. Silver catalysts have attracted less attention as the catalysts, but are potential for production of high molecular weight polyethylene. Herein, we report that silver complexes with various N-heterocyclic carbene (NHC) ligands in combination with modified methylaluminoxane (MMAO) afford polyethylene with high molecular weight (melting point over 140°C). SEM observation showed that the produced polyethylene has ultra-high molecular weight. NMR investigation of the reaction between the silver complexes with organoaluminums indicate that the NHC ligands transfer from the silver complex to aluminum to produce NHC aluminum complexes. Ph3C[B(C6F5)4] abstract methyl group from the NHC aluminum complex to afford cationic aluminum complex. The NHC aluminum complex promoted ethylene polymerization in the presence of Ph3C[B(C6F5)4] and organoaluminums. NHC ligand also promoted ethylene polymerization in combination with MMAO to produce polyethylene with high melting point (140.7°C). Thus, the aluminum complexes are considered to be the actual active species in silver-catalyzed ethylene polymerization.

Acute aortic dissection with left coronary artery obstruction.

If the electrocardiogram shows ST-segment elevation in lead aVR, the complication of aortic dissection must always be assumed.

Congenital Isolated Unilateral Agenesis of Pulmonary Arteries with 3-Year Follow-Up after Initiation of Treatment.

Background and objective: Unilateral agenesis of pulmonary arteries (UAPA) is a rare disease, with approximately 400 cases reported to date. UAPA is often associated with congenital heart disease, and the uncomplicated form is isolated UAPA, which accounts for approximately 30% of all cases of UAPA. The incidence of pulmonary hypertension due to UAPA has been reported to range from 19 to 44%. There is no consensus treatment for pulmonary hypertension associated with UAPA. We present the first reported case in which a three-drug combination, comprising of iloprost inhalation, riociguat, and ambrisentan, was administered to a patient with UAPA, and was followed-up for 3 years post-diagnosis. Case presentation: A 68-year-old Japanese woman presented to our hospital with dyspnea and chest discomfort. She underwent chest radiography, blood tests, and echocardiography; however, the cause of the patient's symptoms could not be identified. During regular follow-up, an echocardiography 21 months after the initial visit revealed elevated right ventricular pressure (peak tricuspid regurgitation velocity: 5.2 m/s and right ventricular systolic pressure: 120 mmHg) and a diagnosis of pulmonary hypertension was made. Contrast-enhanced computed tomography (CT) of the chest and a pulmonary blood flow scintigram were performed to investigate the cause of pulmonary hypertension, and isolated UAPA was diagnosed. The patient was treated with a three-drug combination of iloprost inhalation, riociguat, and ambrisentan and followed up for 3 years with good therapeutic outcomes. Conclusions: We present a case of pulmonary hypertension caused by isolated UAPA. Although rare, this disease can lead to pulmonary hypertension and should be treated cautiously. While there is no consensus regarding the treatment of this disease, a three-drug combination of iloprost inhalation, riociguat, and oral ambrisentan proved effective.

Body fluid regulation via chronic inhibition of sodium-glucose cotransporter-2 in patients with heart failure: a post hoc analysis of the CANDLE trial.

BACKGROUND: In patients with chronic heart failure (CHF) and type 2 diabetes (T2D), sodium-glucose cotransporter-2 (SGLT2) inhibition improves cardiorenal outcomes, but details of the effects on distinct subsets of body fluid volume remain incomplete. METHODS: This was a post hoc analysis of patients with CHF and T2D in the CANDLE trial (UMIN000017669), an investigator-initiated, multi-center, randomized open-label trial that compared the effect of canagliflozin (100 mg, n = 113) with glimepiride (starting dose: 0.5 mg, n = 120) on changes in N-terminal pro-brain natriuretic peptide. The estimated plasma volume (ePV, calculated with the Straus formula) and estimated extracellular volume (eEV, determined by the body surface area) were compared between treatment groups at weeks 4, 12, and 24. RESULTS: Among 233 patients analyzed, 166 (71.2%) had an ejection fraction (EF) > 50%. Reductions in ePV and eEV were observed only in the canagliflozin group until week 12 (change from baseline at week 12, ePV; - 7.63%; 95% confidence interval [CI], - 10.71 to - 4.55%, p < 0.001, eEV; - 123.15 mL; 95% CI, - 190.38 to - 55.92 mL, p < 0.001). While ePV stopped falling after week 12, eEV continued to fall until week 24 ([change from baseline at week 24] - [change from baseline at week 12], ePV; 1.01%; 95%CI, - 2.30-4.32%, p = 0.549, eEV; - 125.15 mL; 95% CI, - 184.35 to - 65.95 mL, p < 0.001). CONCLUSIONS: Maintenance of a modest reduction in ePV and continuous removal of eEV via chronic SGLT2 inhibition suggests that favorable body fluid regulation contributes to the cardiorenal benefits of SGLT2 inhibitors in patients with CHF, irrespective of EF. TRIAL REGISTRATION: UMIN000017669.

Successful Bail Out of Rotablator Driveshaft Fracture Due to Severe Calcified Lesion and Proximal Tortuosity.

A 59-year-old male dialysis patient with a history of coronary artery bypass graft surgery underwent percutaneous coronary intervention of a right coronary artery with a severely calcified lesion. While debulking calcification using a Rotablator, the driveshaft was suddenly fractured. We attempted to move a child-in-mother catheter closer and across a second floppy wire and we dilated a 2.0-mm noncompliant balloon to trap the driveshaft, which we then removed, and restarted the intervention.

Thermoelectric Properties of Conductive Freestanding Films Prepared from PEDOT:PSS Aqueous Dispersion and Ionic Liquids.

In this study, freestanding poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) films modified with an ionic liquid (IL) were synthesized assuming modulization. These films were easily peeled off the glass substrate in water, producing hydrophobic and flexible freestanding films that exhibited extremely high mechanical strengths. The thermoelectric properties of the IL-doped PEDOT:PSS films depended on the amount of IL incorporated. To analyze the mechanism of this dependence in detail, the compositions, higher-order structures, and electronic states of the polymer films were studied by X-ray photoelectron spectroscopy, X-ray diffraction analysis, and electronic absorption spectroscopy. In addition, the carrier density in the polymer film was quantified using electrochemical techniques, and its correlation with the thermoelectric conversion properties was analyzed.

Two cases of 18F-FDG-PET/CT positive Schloffer tumor following curative surgery of colon cancer.

We report two cases of Schloffer tumor that required resection after radical colon cancer surgery because of suspected lymph node recurrence on contrast-enhanced (CE) CT and 18F-FDG-PET/CT. Case1 is a 69-year-old man with sigmoid colon cancer pStage IIA, and case2 is a 61-year-old man with descending colon cancer pStage IIIB.

Comparative evaluation of standard maintenance-dose clopidogrel versus low-dose prasugrel in patients with stable coronary artery disease after percutaneous coronary intervention.

BACKGROUND: Treatment with low-dose prasugrel might be more beneficial even in chronic stable coronary artery disease (CAD) patients treated with clopidogrel. We compared platelet reactivity between standard maintenance-dose and low-dose prasugrel in stable CAD patients. METHODS: This multicenter study enrolled 164 stable CAD patients receiving dual antiplatelet therapy with aspirin and clopidogrel. Patients were randomly assigned to continue treatment with 75-mg clopidogrel daily (n = 80) or switch to 3.75-mg prasugrel daily (n = 84). Platelet reactivity was evaluated by measuring P2Y12 reaction unit (PRU) before randomization and at 5 and 30 days thereafter using the VerifyNow® assay. Patients were classified into three groups according to CYP2C19-clopidogrel metabolic phenotype: extensive (without a *2 or *3 allele), intermediate (one *2 or *3 alleles), or poor (two *2 or *3 alleles) metabolizers. RESULTS: The PRU level was comparable between the two groups at baseline but was significantly lower in the prasugrel group than in the clopidogrel group on days 5 (133.0 vs. 156.8 PRU, P = 0.005) and 30 (124.3 vs. 158.0 PRU, P < 0.001). On day 30, the PRU level was lower in the prasugrel group among patients categorized as poor and intermediate metabolizers but not among extensive metabolizers. CONCLUSIONS: Low-dose prasugrel achieves more consistent antiplatelet effects than clopidogrel irrespective of the metabolic phenotype in Japanese patients with stable CAD. Low-dose prasugrel might be also beneficial in the chronic phase without increasing the bleeding risk among stable CAD patients in other countries.