The distal radial approach (dTRA) is increasingly recognized as a viable alternative to the conventional radial approach in coronary interventions. However, its utility in ST-elevation myocardial infarction (STEMI)—where rapid revascularization is critical—remains underexplored. To evaluate the feasibility and procedural characteristics of dTRA in STEMI patients undergoing primary percutaneous coronary intervention (PCI), using a prespecified subanalysis of the SPEEDY PCI study. Among 370 STEMI patients enrolled, 63 underwent PCI via dTRA and 307 via the conventional radial approach. A propensity score–matched analysis was performed using Killip class, GRACE score, and door-to-sheath time as covariates. After matching, the dTRA group had significantly shorter sheath-to-balloon (12.5 ± 11.5 vs. 19.7 ± 11.7 min, p = 0.002) and door-to-balloon times (50.2 ± 25.9 vs. 62.3 ± 19.9 min, p = 0.007). Procedural success and 30-day mortality rates were comparable between groups. dTRA appears feasible and safe for STEMI patients in high-volume centers. While shorter time metrics were observed, these may reflect institutional practices and operator experience rather than the access site alone.

The ratio of uric acid to albumin is a marker of not only inflammation, but also prognosis of cardiovascular disease. However, whether this ratio is associated with left ventricular (LU) diastolic function remains unknown. This study tested the hypothesis that the uric acid-to-albumin ratio (UAR) is associated with LU diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no significant perfusion abnormalities. Participants in this retrospective study comprised 216 patients with no significant perfusion abnormalities and preserved ejection fraction. The peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained as LU diastolic parameters using gated SPECT. Serum levels of uric acid and albumin were also examined. Significant associations were observed between the UAR and both the PFR (r = -0.22, P = 0.001) and 1/3 MFR (r = -0.23, P = 0.001). Multivariate linear regression analysis was performed to determine factors associated with LU diastolic parameters. Age (l = -0.14, P = 0.045), LU end-diastolic volume (l = -0.26, P = 0.001), and the UAR (l = -0.16, P = 0.024) were significantly associated with the PFR. Moreover, age (l = -0.19, P = 0.004), LU mass index (l = -0.21, P = 0.001), and the UAR (l = -0.14, P = 0.047) were significantly associated with the 1/3 MFR. These results demonstrate that the UAR is associated with LU diastolic function, as derived from gated SPECT in patients with no significant perfusion abnormalities.

The ratio of uric acid to albumin is a marker of not only inflammation, but also prognosis of cardiovascular disease. However, whether this ratio is associated with left ventricular (LV) diastolic function remains unknown. This study tested the hypothesis that the uric acid-to-albumin ratio (UAR) is associated with LV diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no significant perfusion abnormalities.Participants in this retrospective study comprised 216 patients with no significant perfusion abnormalities and preserved ejection fraction. The peak filling rate (PFR) and one-third mean filling rate (1/3 MFR) were obtained as LV diastolic parameters using gated SPECT. Serum levels of uric acid and albumin were also examined.Significant associations were observed between the UAR and both the PFR (r = -0.22, P = 0.001) and 1/3 MFR (r = -0.23, P = 0.001). Multivariate linear regression analysis was performed to determine factors associated with LV diastolic parameters. Age (β = -0.14, P = 0.045), LV end-diastolic volume (β = -0.26, P = 0.001), and the UAR (β = -0.16, P = 0.024) were significantly associated with the PFR. Moreover, age (β = -0.19, P = 0.004), LV mass index (β = -0.21, P = 0.001), and the UAR (β = -0.14, P = 0.047) were significantly associated with the 1/3 MFR.These results demonstrate that the UAR is associated with LV diastolic function, as derived from gated SPECT in patients with no significant perfusion abnormalities.

Prolonged corrected QT interval (QTc) is known to be associated with adverse cardiovascular events in patients with heart failure. The delayed heart-to-mediastinum (H/M) ratio obtained from 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a marker of cardiac sympathetic nervous (CSN) activity and has been proposed as a prognostic marker of severe aortic stenosis (AS). However, the association between prolonged QTc and CSN overactivity in patients with AS remains unclear. This study retrospectively analyzed 83 patients with severe AS who underwent electrocardiography, echocardiography, and 123I-MIBG scintigraphy. Prolonged QTc was defined as QTc > 450 and > 470 ms in men and women, respectively. CSN overactivity was defined as delayed H/M ratio < 2.2 and washout rate (WR) > 34%. Prolonged QTc was detected in 14 patients, and these patients had higher left ventricular (LV) mass index and lower LV ejection fraction as compared to those with normal QTc. A significantly higher proportion of patients with prolonged QTc demonstrated CSN overactivity (p = 0.02). In addition, the prolonged QTc group had a lower delayed H/M ratio and higher WR. QTc was inversely correlated with the delayed H/M ratio in men (r = - 0.53, p = 0.02) and women (r = - 0.29, p = 0.02). QTc was positively correlated with WR in men (r = 0.55, p = 0.01) and women (r = 0.42, p = 0.001). Multivariate analysis identified age and prolonged QTc as significantly associated with CSN overactivity. Thus, prolonged QTc is associated with CSN overactivity, as assessed using 123I-MIBG scintigraphy in patients with severe AS.

Reducing total ischemic time in ST-elevation myocardial infarction (STEMI) is crucial for improving outcomes. While procedural time during primary percutaneous coronary intervention (PCI) is critical, strategies to shorten it need to be explored. To examine whether the single-catheter PCI (SC-PCI) method using a universal guiding catheter, Ikari-Left curve, without catheter exchange reduces PCI time compared to conventional PCI (C-PCI). The Speedy PCI study is a prospective, multicenter, randomized trial comparing SC-PCI versus C-PCI. The primary endpoint was the time from sheath insertion to first device activation (S2B) time. Secondary endpoints included door-to-balloon time, total ischemia time, fluoroscopy time, contrast volume, hospital expenses, and 30-day mortality. A total of 380 patients (SC-PCI: 194; C-PCI: 186) were analyzed. Both groups had high primary PCI success rates (92.3 vs. 91.9

Bacteria can adhere to cardiac endothelium damaged by regurgitation or shunt jet; however, healthy cardiac endothelium is supposedly resistant to bacterial adhesion. Bacterial vegetations are most common on cardiac valves, but are rarely observed at other sites. We report a case of a vegetation on the surface of left ventricular muscle/subvalvular tissue without regurgitation or shunt jet. Transthoracic echocardiography did not detect the vegetation because of its unique location; however, transesophageal echocardiography (TEE) did detect. In conclusion, vegetations can form without exposure to regurgitation or shunt jet, and TEE is highly sensitive for detecting the vegetation in unusual locations.

Although there is reportedly a usefulness of left ventricular global longitudinal strain (LV GLS) on 2D speckle-tracking echocardiography in excluding significant coronary artery disease (CAD) in suspected intermediate- or low-risk non-ST-segment elevation–acute coronary syndrome (NSTE–ACS), the efficacy of post-systolic index (PSI) in this context is yet unknown. Therefore, we explored the usefulness of PSI in facilitating stratification of risk in patients with intermediate- or low-risk NSTE–ACS. We assessed 50 consecutive patients suspected of intermediate- or low-risk NSTE–ACS, and finally analyzed 43 patients whose echocardiographic images were suitable for strain analysis. All patients underwent CAG. Among the 43 analyzed patients, 26 had CAD, and 21 underwent percutaneous coronary intervention (PCI). Patients with CAD had higher PSI (25

Crop damage caused by mammals is not uniformly distributed and is more localized near the forest; this damage distribution differs from that of insect pests. Species that cause damage are often forest inhabitants and hence the damage sites are also biased toward the forest edge. However, these species do not necessarily use forests as their home ranges for cover or shelter, but may be entirely urban (e.g., urban bears). Forest vegetation cannot be considered essential for these species, as this contradicts the behavior of animals that use urbanized areas only. Our review illustrates why crop damage is uneven, localized at forest edges, and less likely to occur on farmlands away from forests in terms of population density, food availability, personality, habituation, and human behavior. This review reveals the role and risk perception of human disturbances. If risk of farmland is perceived to be greater than the true risk, mammals prefer farmlands near forests with low degrees of human disturbances (perceptual trap). The current damage distribution is a result of this perceptual trap because hunting pressures are not always higher in farmlands than in forests.

BACKGROUND:Nocturnal hypertension assessed by a home blood pressure monitoring (HBPM) device is associated with an increased risk of cardiovascular events. However, it is still difficult to assess nighttime blood pressure (BP) frequently. The purpose of this cross-sectional study was to identify significant correlates of nocturnal hypertension assessed by an HBPM device in patients with hypertension who are treated with antihypertensive drugs. METHODS:We measured nighttime BP, morning BP, and evening BP by an HBPM device for 7 consecutive days in 365 medicated patients with hypertension. RESULTS:Of the 365 subjects, 138 (37.8%) had nocturnal hypertension defined as a mean nighttime systolic BP of ≥ 120 mm Hg. Receiver operating characteristic curve analyses showed that the diagnostic accuracy of morning systolic BP for subjects with nocturnal hypertension was significantly superior to that of evening systolic BP (P = 0.04) and that of office systolic BP (P < 0.001). Multivariate analysis revealed that morning systolic BP of 125-<135 mm Hg (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.13-4.58; P = 0.02), morning systolic BP of ≥ 135 mm Hg (OR, 16.4; 95% CI, 8.20-32.7; P < 0.001), and a history of cerebrovascular disease (OR, 3.99; 95% CI, 1.75-9.13; P = 0.001) were significantly associated with a higher risk of nocturnal hypertension and that bedtime dosing of antihypertensive drugs was significantly associated with a lower risk of nocturnal hypertension (OR, 0.56; 95% CI, 0.32-0.97; P = 0.04). CONCLUSIONS:Morning systolic BP of ≥ 125 mm Hg, a history of cerebrovascular disease, and bedtime dosing were significant correlates of nocturnal hypertension in medicated patients with hypertension, and may help detect this risky BP condition. CLINICAL TRIALS REGISTRATION:University Hospital Medical Information Network Clinical Trials Registry (UMIN000019173).

Objective: We aimed to evaluate the visual measurements of coronary artery calcium (CAC) on nonelectrocardiogram (ECG)-gated chest computed tomography (CT) using a simple scoring method that involves counting the number of CT slices containing CAC. Materials and Methods: We analyzed 163 participants who underwent both coronary and chest CT examinations at six centers within 3 months. Agatston scores were calculated on standard ECG-gated scans and classified as none (0), mild (1-99), moderate (100-400), or severe (>400). Next, chest CT images were reconstructed to standard 5.0 mm axial slices. Then, CAC on chest CT scans was measured using two methods: the Weston score (sum of the assigned score of each vessel, range: 0-12) and number of slices showing CAC (Ca-slice#). Results: When the Weston score and Ca-slice# were divided into four levels according to the optimal divisional levels corresponding to the Agatston score classes, good agreements with the 4-grade Agatston score were observed (kappa value=0.610 and 0.794, respectively). The sensitivity and specificity of Ca-slice# ≥9 to identify severe Agatston scores of >400 were 86% and 96%, respectively. Conclusion: The Ca-slice#, a simple scoring method using chest CT scans, was in good agreement with the ECG-gated Agatston score.

We previously reported that four hyperglycemia loci are located on three chromosomes in the Nagoya-Shibata-Yasuda (NSY) mouse model, commonly used to study type 2 diabetes. However, we did not search for hyperglycemia loci across all chromosomes. In this study, we performed quantitative trait loci (QTLs) mapping of longitudinal phenotypes from crosses between NSY (hyperglycemic) and C3H (normoglycemic) mice. We identified four new QTLs for hyperglycemia, namely Nidd5nsy , Nidd6nsy , Nidd1c3h , and Nidd2c3h , on Chromosome 1, 4, 10, and 13, respectively. These QTLs were associated with hyperglycemia in young mice and had attenuated effects in older mice. Nidd5nsy and Nidd6nsy were hyperglycemic with NSY alleles, and Nidd1c3h and Nidd2c3h were hyperglycemic with C3H alleles. We further bred Nidd5nsy congenic mice and demonstrated that Nidd5nsy has a strong effect on hyperglycemia when young, accompanied by insulin resistance and visceral fat accumulation. These results showed that the effects of individual QTLs strengthened or weakened with age, and that the sum of the effects of QTLs captured the age-related deterioration of glucose tolerance in individuals. Our results support the importance of longitudinal phenotypes in the genetic analysis of polygenic traits and have implications for the genetic basis and pathogenesis of type 2 diabetes in humans.

Bacteria can adhere to cardiac endothelium damaged by regurgitation or a shunt jet; however, healthy cardiac endothelium is supposedly resistant to bacterial adhesion. A 22-year-old man presented to our emergency department with fever. Physical examination revealed no obvious cardiac murmur, but there was evidence of splinter hemorrhages and Janeway lesions. Transthoracic echocardiography did not reveal vegetative lesions, but a 15 × 7-mm vegetation was identified on the surface of the left ventricular muscle just below the anterolateral commissure of the mitral valve without regurgitation or a shunt jet by means of transesophageal echocardiography. Surgery was performed on the seventh day, but the patient's postoperative course was unstable. Some complications occurred because the vegetation existed in a unique location. Although the patient continued to have an uncontrollable infection over the subsequent course, he was discharged on the 94th hospital day. We present a case of a vegetation in a unique location without exposure to regurgitation or a shunt jet. This case indicates that vegetative lesions may develop even in the absence of regurgitation and shunt jets. In case of infective endocarditis where a vegetation exists in a unique location, comprehensive testing or strategy are required to treat this condition. .

The Japanese marten (Mantes melampus) invades houses through holes and causes excrement problems. These holes should be covered to prevent the marten's intrusion into houses. However, there is no information about what size of hole they can squeeze through. Therefore, we investigated the sizes of the holes that they could pass through using three reared individuals in summer and winter. We put a bait in an experimental box with a replaceable front panel, which had a square or round hole. The minimum passable sizes were recorded in summer. For a square hole the minimum size was 5.0 cm for each side, and for a round hole the minimum sized hole had a diameter of 5.5 cm. It is necessary to cover holes of these sizes or more to prevent their house invasion. The body weight and the hole shape had no significant effect on the minimum passable area. On the other hand, the season had a significant effect on the minimum passable areas. The shoulder seems to be the limiting factor for whether the martens can pass through the holes. Therefore, the seasonal change in the body size around the shoulder may affect the minimum passable area of holes.

Purpose: We sought to evaluate the visual measurements of coronary artery calcium (CAC) in chest CT without ECG gating, and to compare their predictive abilities for obstructive coronary artery disease (CAD). Methods: We analyzed 163 subjects who underwent both coronary and chest CT examinations at 6 centers within 3 months. Agatston scores were calculated on standard ECG-gated scans and then classified into none (0), mild (1–99), moderate (100–400), and severe (>400) grades. Chest CT images were reconstructed with standard 5.0 mm axial slices. CAC in chest CT scans was measured using two methods: Weston score (sum of the assigned score of each vessel, range: 0–12) and number of slices showing CAC (Ca-slice#). Results: We found excellent inter-observer agreement in the estimates of the Weston score and Ca-slice# (R² = 0.913 and 0.955, respectively). When each of the two scores was divided into four levels, good agreement with the 4-grade Agatston score was observed (kappa value = 0.604 and 0.794, respectively). Of the 155 patients remaining after excluding non-diagnostic studies, obstructed CAD, defined as the presence of ≥70% stenosis on CT angiography, was found in 43 (27%). Receiver-operator characteristic curves of 4-grade hierarchies of Agatston score, Weston score, and Ca-slice# provided similar diagnostic powers to detect obstructed CAD (0.722, 0.706, and 0.718, respectively).Conclusion: The visual assessments of CAC detected by ECG non-gated chest CT scans were in good agreement with the ECG-gated Agatston score and also provided equivalent power to detect obstructive CAD. This study was registered at UMIN-CTR (identifier: UMIN000039178; registered date; Jan 16, 2020)

Abstract Background Both genetic and environmental factors contribute to type 2 diabetes development. We used consomic mice established from an animal type 2 diabetes model to identify susceptibility genes that contribute to type 2 diabetes development under specific environments. We previously established consomic strains (C3H-Chr 11NSY and C3H-Chr 14NSY) that possess diabetogenic Chr 11 or 14 of the Nagoya-Shibata-Yasuda (NSY) mouse, an animal model of spontaneous type 2 diabetes, in the genetic background of C3H mice. To search genes contribute to type 2 diabetes under specific environment, we first investigated whether sucrose administration deteriorates type 2 diabetes-related traits in the consomic strains. We dissected loci on Chr 11 by establishing congenic strains possessing different segments of NSY-derived Chr 11 under sucrose administration. Results In C3H-Chr 11NSY mice, sucrose administration for 10 weeks deteriorated hyperglycemia, insulin resistance, and impaired insulin secretion, which is comparable to NSY mice with sucrose. In C3H-Chr 14NSY mice, sucrose administration induced glucose intolerance, but not insulin resistance and impaired insulin secretion. To dissect the gene(s) existing on Chr 11 for sucrose-induced type 2 diabetes, we constructed four novel congenic strains (R1, R2, R3, and R4) with different segments of NSY-derived Chr 11 in C3H mice. R2 mice showed marked glucose intolerance and impaired insulin secretion comparable to C3H-Chr 11NSY mice. R3 and R4 mice also showed impaired insulin secretion. R4 mice showed significant decreases in white adipose tissue, which is in the opposite direction from parental C3H-Chr 11NSY and NSY mice. None of the four congenic strains showed insulin resistance. Conclusions Genes on mouse Chr 11 could explain glucose intolerance, impaired insulin secretion, insulin resistance in NSY mice under sucrose administration. Congenic mapping with high sucrose environment localized susceptibility genes for type 2 diabetes associated with impaired insulin secretion in the middle segment (26.0–63.4 Mb) of Chr 11. Gene(s) that decrease white adipose tissue were mapped to the distal segment of Chr 11. The identification of diabetogenic gene on Chr 11 in the future study will facilitate precision medicine in type 2 diabetes by controlling specific environments in targeted subjects with susceptible genotypes.

Additional file 2. The chromosomal construction of consomic strain (C3H-Chr 11NSY) and the four congenic strains.

A recent study revealed that recurrence of myocarditis occurs in a significant proportion of patients, but multiple recurrences of myocarditis have rarely been reported. The pathophysiology and best treatments for multiple recurrences of myocarditis remain unclear. A 60-year-old man presented to our emergency department with fever and chest pain. Physical examination, imaging, and laboratory findings were consistent with fulminant myocarditis. Paired titers confirmed adenovirus infection. The patient was treated with intra-aortic balloon pump and percutaneous cardiopulmonary support for 7 days and was discharged with near-normal electrocardiographic and echocardiographic findings on day 26. Over the subsequent 3 years, the patient experienced six episodes of recurrence of myocarditis with a progressive decrease in his ability to perform activities of daily living. At the time of his sixth recurrence, he died of ventricular fibrillation. Autopsy revealed mild enlargement of the left ventricle, extensive inflammatory cell infiltration, and mild interstitial fibrosis, suggesting left ventricle remodeling because of repetitive myocarditis. We have presented a case of multiple recurrences of myocarditis. This is the largest number of recurrences in a single patient reported to date. Further studies are needed to elucidate the underlying pathogenesis and best treatment of this condition. .

Mechanisms of acute myocardial infarction caused by traumatic coronary artery injury have been reported. However, late-onset coronary artery stenosis associated with trauma is less well known. We experienced a case in which acute myocardial infarction of the right coronary artery occurred at the time of blunt chest trauma (BCT) caused by a traffic accident and an increase in coronary artery stenosis in the left anterior descending artery (LAD) branch about 1 year later. A comparison of a volume-rendering image created from enhanced-contrast computed tomography at the time of trauma and coronary angiography revealed that the trauma site and the stenotic lesion in the LAD were in very close proximity, suggesting to us that traumatic coronary artery injury without flow limitation may have developed into high-grade stenosis in the LAD 1 year later. In this case we were able to demonstrate a causal relationship between BCT and delayed coronary artery stenosis. After BCT, it is necessary to be aware of the possibility of delayed coronary artery stenosis even if coronary injury is absent in the acute phase. .