Publications by authors named "Masato Murakami"

113 Publications

Comparison between cryoballoon ablation and radiofrequency catheter ablation for atrial fibrillation in patients on hemodialysis.

Indian Pacing Electrophysiol J 2021 Mar-Apr;21(2):67-72. Epub 2021 Feb 6.

Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.

Background: Difficulties are often encountered while controlling atrial fibrillation (AF), especially in hemodialysis (HD) patients. Previous data revealed that cryoballoon ablation (CBA) for treating paroxysmal atrial fibrillation (PAF) was not inferior to radiofrequency ablation (RFA); however, HD patients were excluded in this prior trial. Thus, the efficacy of CBA for HD patients is still unknown.

Methods: This retrospective study analyzed HD patients who underwent catheter ablation (CA) for AF from August 2011 to June 2019. Patients who received CBA (CBA group) and those who received RFA (RFA group) were compared. The primary endpoint was defined as freedom from a composite outcome (a documented recurrence of any atrial tachyarrhythmia or a prescription of antiarrhythmic drugs) at one year after CA.

Results: The RFA and CBA groups were composed of 21 and 23 patients, respectively. Freedom from a composite outcome was 58.4% in the RFA group and 68.2% in the CBA group (Log-rank: p = 0.571).

Conclusion: Our results suggest that patients on HD with AF who were treated with CBA tended to have better outcomes than patients treated with RFA. Therefore, CBA could be a suitable ablation method for HD patients.
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http://dx.doi.org/10.1016/j.ipej.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952891PMC
February 2021

Serum Globulin Is Associated with Endoscopic Findings and Mucosal Healing in Japanese Patients with Ulcerative Colitis.

Dig Dis Sci 2021 Feb 4. Epub 2021 Feb 4.

Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.

Background: Serum globulin is an inflammation marker. To date, no evidence regarding the association between serum globulin and disease activity in patients with ulcerative colitis has been reported.

Aims: We evaluated the association between serum globulin and endoscopic activity in patients with ulcerative colitis.

Methods: Serum globulin was divided into tertiles based on the distribution of study subjects (low globulin, ≤ 2.7 g/dl (reference); moderate globulin, 2.7-3.1 g/dl; and high globulin, > 3.1 g/dl). A single endoscopic specialist evaluated the endoscopic findings, and mucosal healing was based on Mayo endoscopic subscore.

Results: A total of 277 patients with ulcerative colitis were included in the study. Serum globulin was independently positively associated with diminished or absent vascular markings [moderate: adjusted odds ratio (OR) 3.70 (95% confidence interval, CI: 1.82-7.88) and high: adjusted OR 2.40 (95%CI: 1.20-4.94), p for trend = 0.005]. A similar positive association between globulin and erosion was found [high: adjusted OR 2.00 (95%CI: 1.05-3.86)]. Serum globulin was independently inversely associated with mucosal healing [moderate: adjusted OR 0.37 (95%CI: 0.18-0.73) and high: adjusted OR 0.31 (95%CI: 0.14-0.64), p for trend = 0.001] and adjusted partial mucosal healing [moderate: OR 0.51 (95%CI: 0.26-0.98), p for trend = 0.048]. The inverse association between globulin and mucosal healing was significant in the low but not the high C-reactive protein group.

Conclusions: In patients with ulcerative colitis, serum globulin was significantly positively associated with endoscopic activity, and was significantly inversely associated with mucosal healing, especially in the low C-reactive protein group.
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http://dx.doi.org/10.1007/s10620-021-06834-5DOI Listing
February 2021

Clinical outcomes of ablation versus non-ablation therapy for atrial fibrillation in Japan: analysis of pooled data from the AF Frontier Ablation Registry and SAKURA AF Registry.

Heart Vessels 2021 Apr 24;36(4):549-560. Epub 2020 Nov 24.

Tokyo Women's Medical University Hospital, Tokyo, Japan.

Whether ablation for atrial fibrillation (AF) is, in terms of clinical outcomes, beneficial for Japanese patients has not been clarified. Drawing data from 2 Japanese AF registries (AF Frontier Ablation Registry and SAKURA AF Registry), we compared the incidence of clinically relevant events (CREs), including stroke/transient ischemic attack (TIA), major bleeding, cardiovascular events, and death, between patients who underwent ablation (n = 3451) and those who did not (n = 2930). We also compared propensity-score matched patients (n = 1414 in each group). In propensity-scored patients who underwent ablation and those who did not, mean follow-up times were 27.2 and 35.8 months, respectively. Annualized rates for stroke/TIA (1.04 vs. 1.06%), major bleeding (1.44 vs. 1.20%), cardiovascular events (2.15 vs. 2.49%) were similar (P = 0.96, 0.39, and 0.35, respectively), but annualized death rates were lower in the ablation group than in the non-ablation group (0.75 vs.1.28%, P = 0.028). After multivariate adjustment, the risk of CREs was statistically equivalent between the ablation and non-ablation groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.71-1.11), but it was significantly low among patients who underwent ablation for paroxysmal AF (HR 0.68 [vs. persistent AF], 95% CI 0.49-0.94) and had a CHADS-VASc score  < 3 (HR 0.66 [vs. CHADS-VASc score ≥ 3], 95% CI 0.43-0.98]). The 2-year risk reduction achieved by ablation may be small among Japanese patients, but AF ablation may benefit those with paroxysmal AF and a CHADS-VASc score < 3.
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http://dx.doi.org/10.1007/s00380-020-01721-xDOI Listing
April 2021

Association between platelet count and mucosal healing in Japanese patients with ulcerative colitis: a cross-sectional study.

BMC Gastroenterol 2020 Nov 16;20(1):384. Epub 2020 Nov 16.

Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0205, Japan.

Background: Mucosal healing (MH) has been indicated as the therapeutic goal for ulcerative colitis (UC). Platelet count is known as an inflammation evaluation. However, the association between platelet count and MH among patients with UC is still scarce. We therefore assessed this issue among Japanese patients with UC.

Methods: The study subjects consisted of 345 Japanese patients with UC. Platelet count was divided into quartiles on the basis of the distribution of all study subjects (low, moderate, high, and very high). Several endoscope specialists were responsible for evaluating MH and partial MH, which was defined as a Mayo endoscopic subscore of 0 and 0-1, respectively. Estimations of crude odds ratios (ORs) and their 95% confidence intervals (CIs) for partial MH and MH in relation to platelet count were performed using logistic regression analysis. Age, sex, CRP, steroid use, and anti-Tumor necrosis factor α (TNFα) preparation were selected a priori as potential confounding factors.

Results: The percentage of partial MH and MH were 63.2 and 26.1%, respectively. Moderate and very high was independently inversely associated with partial MH (moderate: OR 0.40 [95%CI 0.19-0.810], very high: OR 0.37 [95%CI 0.17-0.77], p for trend = 0.034). Similarly, moderate, high, and very high were independently inversely associated with MH (moderate: OR 0.37 [95% CI 0.18-0.73], high: OR 0.41 [95% CI 0.19-0.83], and very high: OR 0.45 [95% CI 0.21-0.94], p for trend = 0.033) after adjustment for confounding factors.

Conclusions: Among patients with UC, platelet count was independently inversely associated with MH.
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http://dx.doi.org/10.1186/s12876-020-01538-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670794PMC
November 2020

Clinical Outcomes of Off-Label Underdosing of Direct Oral Anticoagulants After Ablation for Atrial Fibrillation.

Int Heart J 2020 Nov 13;61(6):1165-1173. Epub 2020 Nov 13.

Tokyo Women's Medical University Hospital.

Direct oral anticoagulants (DOACs) are sometimes prescribed at off-label under-doses for patients who have undergone ablation for atrial fibrillation (AF). This practice may be an attempt to balance the risk of bleeding against that of stroke or AF recurrence.We examined outcomes of 1163 patients who continued use of a DOAC after ablation. The patients were enrolled in a large (3530 patients) multicenter registry in Japan. The study patients were classified as 749 (64.4%) appropriate standard-dose DOAC users, 216 (18.6%) off-label under-dose DOAC users, and 198 (17.0%) appropriate low-dose DOAC users.Age and CHADS-VASc scores differed significantly between DOAC dosing regimens, with patients given an appropriate standard-dose being significantly younger (63.3 ± 9.4 versus 64.8 ± 9.5 versus 73.2 ± 6.8 years, P < 0.0001) and lower (2.1 ± 1.5 versus 2.4 ± 1.6 versus 3.4 ± 1.4, P < 0.0001) than those given an off-label under-dose or an appropriate low-dose. During the median 19.0-month follow-up period, the AF recurrence rate was similar between the appropriate standard-dose and off-label under-dose groups but relatively low in the appropriate low-dose group (42.5% versus 41.2% versus 35.4%, P = 0.08). Annualized rates of thromboembolic events, major bleeding, and death from any cause were 0.47%, 0.70%, and 0.23% in the off-label under-dose group, while those rates were 0.74%, 0.73%, and 0.65% in the appropriate standard-dose, and 1.58%, 2.12%, and 1.57% in the appropriate low-dose groups.In conclusion, the clinical adverse event rates for patients on an off-label under-dose DOAC regimen after ablation, predicated on careful patient evaluations, was not high as seen with that of patients on a standard DOAC dosing regimen.
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http://dx.doi.org/10.1536/ihj.20-335DOI Listing
November 2020

Excess Conductivity Analysis of Polycrystalline FeSe Samples with the Addition of Ag.

Materials (Basel) 2020 Nov 6;13(21). Epub 2020 Nov 6.

SIT Research Laboratories, Shibaura Institute of Technology, Tokyo 135-8548, Japan.

Bulk FeSe superconductors of the iron-based (IBS) "11" family containing various additions of silver were thoroughly investigated concerning the microstructure using optical microscopy and electron microscopy (TEM and SEM). The measurements of electrical resistivity were performed through the four-point technique in the temperature interval T= 2-150 K. The Aslamazov-Larkin model was employed to analyze the fluctuation-induced conductivity (FIC) in all acquired measurements. In all studied products, we found that the FIC curves consist of five different regimes of fluctuation, viz. critical region (CR), three-dimensional (3D), two-dimensional (2D), one-dimensional (1D), and shortwave fluctuation (SWF) regimes. The critical current density (Jc), the lower and upper critical magnetic fields (Bc1 and Bc2), the coherence length along the -axis at zero-temperature (ξc(0)), and further parameters were assessed with regards to the silver amount within the products. The analyses discloses a diminution in the resistivity and a great reduction in ξc(0) with Ag addition. The optimal silver doping amount is achieved for 7 wt.%, which yields the best superconducting transition and the greatest Jc value.
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http://dx.doi.org/10.3390/ma13215018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664390PMC
November 2020

Impact of age on mid-term clinical outcomes and left ventricular reverse remodeling after cardiac resynchronization therapy.

J Cardiol 2021 Mar 7;77(3):254-262. Epub 2020 Oct 7.

Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.

Introduction: The number of heart failure (HF) patients has been rapidly increasing in Japan, and considering the most explosive aging occurring in Asia, the management of elderly HF patients and longer life expectancy are critical issues. The aim of the present study was to evaluate whether the mid-term prognosis after cardiac resynchronization therapy (CRT) implantation was influenced by age and to investigate, in detail, the difference in the change ratio of echocardiographic parameters according to the age group of interest.

Methods And Results: This retrospective analysis included 173 patients who underwent CRT implantation in our hospital from February 2008 to March 2019. Eighty patients (46%) were classified into the elderly group (≥75 years) and the rest in the non-elderly group. The study population was also classified with propensity score matching. The mid-term prognosis including all-cause death and hospitalization for HF, and the ratio of CRT responders were compared between the 2 groups. CRT response was defined as left ventricular (LV) end-systolic volume reduction ≥15% at follow-up echocardiography within a year. During a median follow-up of 1057 [interquartile range: 412, 2107] days, adverse events were not significantly different between the 2 groups before and after matching (before matching; all-cause death: log-rank p = 0.323, hospitalization for HF: log-rank p = 0.376, after matching; all-cause death: log-rank p = 0.325, hospitalization for HF: log-rank p = 0.516). Moreover, the rate of CRT responders was not significantly different between the 2 groups before and after matching (before matching, p = 0.718; after matching, p = 0.666).

Conclusions: In elderly HF patients, CRT provided the same clinical benefits as in non-elderly HF patients, furthermore, there was a similar trend in LV reverse remodeling between the 2 groups. The present study demonstrated that the indication of CRT implantation should not be determined by age.
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http://dx.doi.org/10.1016/j.jjcc.2020.09.004DOI Listing
March 2021

Femtosecond Pulse Ablation Assisted Mg-ZnO Nanoparticles for UV-Only Emission.

Nanomaterials (Basel) 2020 Jul 6;10(7). Epub 2020 Jul 6.

Department of Physics, Indian Institute of Technology Madras, Chennai 600036, India.

The need for improved UV emitting luminescent materials underscored by applications in optical communications, sterilization and medical technologies is often addressed by wide bandgap semiconducting oxides. Among these, the Mg-doped ZnO system is of particular interest as it offers the opportunity to tune the UV emission by engineering its bandgap via doping control. However, both the doped system and its pristine congener, ZnO, suffer from being highly prone to parasitic defect level emissions, compromising their efficiency as light emitters in the ultraviolet region. Here, employing the process of femtosecond pulsed laser ablation in a liquid (fs-PLAL), we demonstrate the systematic control of enhanced UV-only emission in Mg-doped ZnO nanoparticles using both photoluminescence and cathodoluminescence spectroscopies. The ratio of luminescence intensities corresponding to near band edge emission to defect level emission was found to be six-times higher in Mg-doped ZnO nanoparticles as compared to pristine ZnO. Insights from UV-visible absorption and Raman analysis also reaffirm this defect suppression. This work provides a simple and effective single-step methodology to achieve UV-emission and mitigation of defect emissions in the Mg-doped ZnO system. This is a significant step forward in its deployment for UV emitting optoelectronic devices.
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http://dx.doi.org/10.3390/nano10071326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407115PMC
July 2020

Impact of bleeding events after percutaneous coronary intervention in patients on hemodialysis.

Heart Vessels 2020 Oct 16;35(10):1323-1330. Epub 2020 Apr 16.

Department of Cardiology, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura, 247-8533, Japan.

Coronary artery disease is common in patients on dialysis; there is a high rate of bleeding events after percutaneous coronary intervention (PCI) in such patients. We investigated the impact of bleeding events after PCI on mortality in patients on hemodialysis. We included 386 consecutive hemodialysis patients who underwent PCI using a drug-eluting stent (DES) between September 2004 and December 2017 in our hospital, and investigated the impact of bleeding events on all-cause mortality after PCI. Bleeding events were assessed by the Thrombolysis in Myocardial Infarction (TIMI) bleeding definition within 24 months after PCI. A total of 42 patients experienced bleeding events. Of these, 30 patients (71.4%) had TIMI major bleeding events and 12 patients (28.6%) had TIMI minor bleeding events. Patients with bleeding events had significantly higher mortality than patients without bleeding events (survival rate, 55.1% vs 81.5%, log-rank: p < 0.001). These results suggest that bleeding events after PCI with a DES are notably associated with all-cause mortality among patients on hemodialysis. This is the first report about relationship between bleeding events and mortality to focus on patients on hemodialysis.
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http://dx.doi.org/10.1007/s00380-020-01605-0DOI Listing
October 2020

Production of Sharp-Edged and Surface-Damaged YBaCuO by Ultrasound: Significant Improvement of Superconducting Performance of Infiltration Growth-Processed YBaCuO Bulk Superconductors.

ACS Omega 2020 Mar 17;5(12):6250-6259. Epub 2020 Mar 17.

Superconducting Materials Laboratory, Graduate School of Science and Engineering, Shibaura Institute of Technology, 3-7-5, Toyosu, Koto-ku, Tokyo 135-8548, Japan.

Growth and physical properties of bulk REBaCuO (REBCO) superconductors fabricated by the infiltration growth (IG) method strongly depend on the initial size and morphology of the REBaCuO (211) particles. The present work details the novel method we developed for producing sharp-edged and surface-damaged 211 particles to be added to the REBCO bulks. We employed high-energy ultrasonic irradiation for pretreating the 211 particles and fabricated high-performance bulk single-grain YBaCuO (YBCO) superconductors via the top-seeded IG process. Increasing the ultrasound irradiation power and time duration mechanically damaged the surface of the 211 particles, producing more fine and sharp edges. Systematic investigations of the microstructural properties of the final YBCO bulks indicated that the size and content of the 211 particles gradually decreased without any additional chemical doping. The effective grain refinement and improved interfacial defect densities enhanced the critical current density by a factor of two at 77 K and self-field as compared to a YBCO sample fabricated without any pretreatment. A maximum trapped field of 0.48 T at 77 K was obtained for a sample (20 mm diameter) with 211 particles treated for 60 min and 300 W ultrasound radiation. The effectiveness of the novel method is demonstrated by the superior performance of the YBCO bulk samples prepared as compared to bulk samples fabricated with the addition of Pt and CeO. This method is novel, cost effective, and very convenient, maintaining high sample homogeneity, and is free of chemical contaminants as compared to other methods which significantly affect the properties of all REBCO bulk products grown by sintering, melt growth, and IG methods.
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http://dx.doi.org/10.1021/acsomega.9b02816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114162PMC
March 2020

The efficacy of modified jailed balloon technique for true bifurcation lesions.

Catheter Cardiovasc Interv 2020 07 25;96(1):20-28. Epub 2020 Feb 25.

Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.

Objective: To evaluate the short-, long-term clinical and angiographic outcomes after treatment of true bifurcation lesions using a modified jailed balloon technique (MJBT).

Background: Percutaneous coronary intervention (PCI) for true bifurcation lesions has high risk for adverse events. Side branch (SB) occlusion is one of the most serious complications. Therefore, novel strategies to avoid SB occlusion during main branch stenting and to keep its patency are important.

Methods And Results: Between February 2015 and February 2018, 328 patients with 349 true bifurcation lesions underwent PCI using MJBT. True bifurcation lesions were defined as Medina classifications (1.1.1), (1.0.1) or (0.1.1) lesions. We investigated the procedural and long-term clinical outcomes. Furthermore, angiographic outcomes were assessed at follow-up diagnostic angiography. The mean age of patients was 71.6 ± 9.9 years. Procedural success was achieved in all patients; postoperative SB occlusion was noted in only one patient (0.3%). The cumulative incidence of all-cause death was 23 patients (7.0%) in the follow-up period (median 717 days). Target lesion revascularization was performed in 19 patients (5.8%) with 23 lesions (6.6%), and 0.6% of myocardial infarction and 0% of definite stent thrombosis were observed. Angiographic follow-up was performed in 243 patients (74.1%); the percent diameter stenosis in SB was not significantly different between after the index procedure and follow-up angiography.

Conclusions: This MJBT is safe and effective in preserving SB patency for true bifurcation lesions. Furthermore, long-term clinical and angiographic outcomes after MJBT are feasible.
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http://dx.doi.org/10.1002/ccd.28812DOI Listing
July 2020

Nitrogen Incorporated Photoactive Brownmillerite CaFeO for Energy and Environmental Applications.

Sci Rep 2020 Feb 17;10(1):2713. Epub 2020 Feb 17.

Crystal Growth Centre, Anna University, Chennai, 600025, India.

CaFeO (CFO) is a potentially viable material for alternate energy applications. Incorporation of nitrogen in CaFeO (CFO-N) lattice modifies the optical and electronic properties to its advantage. Here, the electronic band structures of CFO and CFO-N were probed using Ultraviolet photoelectron spectroscopy (UPS) and UV-Visible spectroscopy. The optical bandgap of CFO reduces from 2.21 eV to 2.07 eV on post N incorporation along with a clear shift in the valence band of CFO indicating the occupation of N 2p levels over O 2p in the valence band. Similar effect is also observed in the bandgap of CFO, which is tailored upto 1.43 eV by N ion implantation. The theoretical bandgaps of CFO and CFO-N were also determined by using the Density functional theory (DFT) calculations. The photoactivity of these CFO and CFO-N was explored by organic effluent degradation under sunlight. The feasibility of utilizing CFO and CFO-N samples for energy storage applications were also investigated through specific capacitance measurements. The specific capacitance of CFO is found to increase to 224.67 Fg upon N incorporation. CFO-N is thus found to exhibit superior optical, catalytic as well as supercapacitor properties over CFO expanding the scope of brownmillerites in energy and environmental applications.
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http://dx.doi.org/10.1038/s41598-020-59454-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026084PMC
February 2020

Isolated Posterior Spinal Artery Aneurysm Presenting with Spontaneous Thrombosis After Subarachnoid Hemorrhage.

World Neurosurg 2020 Feb 28;134:544-547. Epub 2019 Nov 28.

Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

Background: The cause of subarachnoid hemorrhage is more likely to be intracranial than spinal. Bleeding, although common with spinal arteriovenous malformations and spinal cord tumors, rarely occurs with ruptured isolated spinal artery aneurysms. Here, we report a case of isolated thoracic posterior spinal artery aneurysm presenting with thrombosis after subarachnoid hemorrhage.

Case Description: A 67-year-old woman presented with sudden-onset nausea and low back and right thigh pain that worsened with movement. Computed tomography (CT) and magnetic resonance imaging (MRI) scans of the head suggested a small subarachnoid hemorrhage in the high-convexity sulcus, and lumbar puncture showed bloody cerebrospinal fluid. There was no apparent intracranial aneurysm on CT angiography; however, spinal MRI showed a lesion on the right side of the spinal cord at Th10. Contrast-enhanced CT showed an enhancing lesion at this site on day 7 that was not present on day 15. Selective right Th10 intercostal artery angiography on day 22 showed no evidence of aneurysm. The lesion was suspected to be a thrombotic spinal artery aneurysm. Given the unclear natural history of this entity, surgery was performed on day 36. After right Th10 hemilaminectomy and opening the dura, the arachnoid and adhesions were found to be thickened. A fusiform-shaped thrombosed aneurysm continuous with the radiculopial artery was removed. The patient was discharged without neurologic deterioration.

Conclusions: Isolated spinal artery aneurysm is a rare cause of subarachnoid hemorrhage. It is expected that additional cases will clarify the natural history and indications for treatment.
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http://dx.doi.org/10.1016/j.wneu.2019.11.118DOI Listing
February 2020

Impact of Late Ventricular Arrhythmias on Cardiac Mortality in Patients with Acute Myocardial Infarction.

J Interv Cardiol 2019 8;2019:5345178. Epub 2019 Jul 8.

Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Okamoto 1370-1, Kamakura City 247-8533, Japan.

Objectives: This study investigated the relationship between the timing of ventricular tachycardia or ventricular fibrillation (VT or VF) and prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).

Background: It is unknown whether the timing of VT/VF occurrence affects the prognosis of patients with AMI.

Methods: From January 2004 to December 2014, 1004 patients with AMI underwent primary PCI. Of these patients, 888 did not have VT/VF (non-VT/VF group) and 116 had sustained VT/VF during prehospitalization or hospitalization. Patients with VT/VF were divided into two groups: early VT/VF (VT/VF occurrence before and within 2 days of admission, 92 patients) and late VT/VF (VT/VF occurrence >2 days after admission; 24 patients) groups.

Results: The frequency of VT/VF occurrence was high between the day of admission and the 2nd day and between days 6 and 10 of hospitalization. The late VT/VF group had a significantly longer onset-to-balloon time, lower ejection fraction, poorer renal function, and higher creatine phosphokinase (CK)-MB level on admission (p< 0.001). They also had a lower 30-day cardiac survival rate than the early VT/VF and non-VT/VF groups (42% vs. 76% vs. 96%, p < 0.001). Moreover, independent predictors of in-hospital cardiac mortality among patients with AMI who had sustained VT/VF were higher peak CK-MB [Odds ratio (OR: 1.001, 95%confidence interval (CI): 1.000-1.002, p= 0.03)], higher Killip class (OR: 1.484, 95%CI 1.017-2.165, p= 0.04), and late VT/VF (OR: 3.436, 95%CI 1.115-10.59, p= 0.03).

Conclusions: The timing of VT/VF occurrences had a bimodal peak. Although late VT/VF occurrence after primary PCI was less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis.
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http://dx.doi.org/10.1155/2019/5345178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739782PMC
February 2020

Current Status and Clinical Outcomes of Oral Anticoagulant Discontinuation After Ablation for Atrial Fibrillation in Japan - Findings From the AF Frontier Ablation Registry.

Circ J 2019 11 16;83(12):2418-2427. Epub 2019 Oct 16.

Tokyo Women's Medical University Hospital.

Background: The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHADS-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHADS-VASc scores but not with OAC status.

Conclusions: Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.
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http://dx.doi.org/10.1253/circj.CJ-19-0602DOI Listing
November 2019

A conditional inducible JAK2V617F transgenic mouse model reveals myeloproliferative disease that is reversible upon switching off transgene expression.

PLoS One 2019 10;14(10):e0221635. Epub 2019 Oct 10.

Disease Area Oncology, Novartis Institutes for BioMedical Research, Basel, Switzerland.

Aberrant activation of the JAK/STAT pathway is thought to be the critical event in the pathogenesis of the chronic myeloproliferative neoplasms, polycythemia vera, essential thrombocythemia and primary myelofibrosis. The most frequent genetic alteration in these pathologies is the activating JAK2V617F mutation, and expression of the mutant gene in mouse models was shown to cause a phenotype resembling the human diseases. Given the body of genetic evidence, it has come as a sobering finding that JAK inhibitor therapy only modestly suppresses the JAK2V617F allele burden, despite showing clear benefits in terms of reducing splenomegaly and constitutional symptoms in patients. To gain a better understanding if JAK2V617F is required for maintenance of myeloproliferative disease once it has evolved, we generated a conditional inducible transgenic JAK2V617F mouse model using the SCL-tTA-2S tet-off system. Our model corroborates that expression of JAK2V617F in hematopoietic stem and progenitor cells recapitulates key hallmarks of human myeloproliferative neoplasms, and exhibits gender differences in disease manifestation. The disease was found to be transplantable, and importantly, reversible when transgenic JAK2V617F expression was switched off. Our results indicate that mutant JAK2V617F-specific inhibitors should result in profound disease modification by disabling the myeloproliferative clone bearing mutant JAK2.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221635PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786561PMC
March 2020

Efficacy and safety of quizartinib in Japanese patients with FLT3-ITD positive relapsed or refractory acute myeloid leukemia in an open-label, phase 2 study.

Int J Hematol 2019 Dec 31;110(6):665-674. Epub 2019 Aug 31.

Juntendo University, Urayasu Hospital, Urayasu, Japan.

FMS-like tyrosine kinase 3 (FLT3) internal tandem duplication (ITD) mutations in patients with acute myeloid leukemia (AML) are associated with early relapse and poor survival. This multicenter, single-arm, two-stage phase 2 study (NCT02984995) was conducted to evaluate the efficacy and safety of quizartinib hydrochloride (initial dose 20/30 mg/day), an oral, highly potent, selective FLT3 inhibitor in Japanese patients (median age 65 years) with FLT3-ITD positive relapsed/refractory (R/R) AML. The composite complete remission (CRc) rate (primary endpoint) was 53.8% (90% confidence interval 36.2-70.8%) for evaluable patients in the efficacy analysis set. The median duration of CRc and overall survival was 16.1 weeks and 34.1 weeks, respectively. The most frequent treatment-emergent adverse events (TEAEs) were febrile neutropenia (43.2%), platelet count decreased (37.8%), and QT prolonged (35.1%). Two (5.4%) patients experienced TEAEs associated with treatment discontinuation. All serious TEAEs (45.9%), except febrile neutropenia (16.2%), were reported in ≤ 2 patients. The incidence of QTcF 451-480 ms and 481-500 ms was 37.8% and 2.7%, respectively. No QTcF > 500 ms, events of torsade de pointes or arrhythmia with clinical symptoms were reported. Quizartinib monotherapy was well tolerated and resulted in clinically meaningful reductions in blast count in Japanese patients with FLT3-ITD R/R AML.
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http://dx.doi.org/10.1007/s12185-019-02727-6DOI Listing
December 2019

A Novel HER3-Targeting Antibody-Drug Conjugate, U3-1402, Exhibits Potent Therapeutic Efficacy through the Delivery of Cytotoxic Payload by Efficient Internalization.

Clin Cancer Res 2019 12 30;25(23):7151-7161. Epub 2019 Aug 30.

Daiichi Sankyo Co., Ltd., Tokyo, Japan.

Purpose: HER3 is a compelling target for cancer treatment; however, no HER3-targeted therapy is currently clinically available. Here, we produced U3-1402, an anti-HER3 antibody-drug conjugate with a topoisomerase I inhibitor exatecan derivative (DXd), and systematically investigated its targeted drug delivery potential and antitumor activity in preclinical models.

Experimental Design: pharmacologic activities and the mechanisms of action of U3-1402 were assessed in several human cancer cell lines. Antitumor activity of U3-1402 was evaluated in xenograft mouse models, including patient-derived xenograft (PDX) models. Safety assessments were also conducted in rats and monkeys.

Results: U3-1402 showed HER3-specific binding followed by highly efficient cancer cell internalization. Subsequently, U3-1402 was translocated to the lysosome and released its payload DXd. While U3-1402 was able to inhibit HER3-activated signaling similar to its naked antibody patritumab, the cytotoxic activity of U3-1402 in HER3-expressing cells was predominantly mediated by released DXd through DNA damage and apoptosis induction. In xenograft mouse models, U3-1402 exhibited dose-dependent and HER3-dependent antitumor activity. Furthermore, U3-1402 exerted potent antitumor activity against PDX tumors with HER3 expression. Acceptable toxicity was noted in both rats and monkeys.

Conclusions: U3-1402 demonstrated promising antitumor activity against HER3-expressing tumors with tolerable safety profiles. The activity of U3-1402 was driven by HER3-mediated payload delivery via high internalization into tumor cells.
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http://dx.doi.org/10.1158/1078-0432.CCR-19-1745DOI Listing
December 2019

FGF401, A First-In-Class Highly Selective and Potent FGFR4 Inhibitor for the Treatment of FGF19-Driven Hepatocellular Cancer.

Mol Cancer Ther 2019 12 13;18(12):2194-2206. Epub 2019 Aug 13.

Novartis Institutes for Biomedical Research, Oncology Disease Area, Basel, Switzerland.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and it is the third leading cause of cancer-related deaths worldwide. Recently, aberrant signaling through the FGF19/FGFR4 axis has been implicated in HCC. Here, we describe the development of FGF401, a highly potent and selective, first in class, reversible-covalent small-molecule inhibitor of the kinase activity of FGFR4. FGF401 is exquisitely selective for FGFR4 versus the other FGFR paralogues FGFR1, FGFR2, FGFR3, and all other kinases in the kinome. FGF401 has excellent drug-like properties showing a robust pharmacokinetic/pharmacodynamics/efficacy relationship, driven by a fraction of time above the phospho-FGFR4 IC value. FGF401 has remarkable antitumor activity in mice bearing HCC tumor xenografts and patient-derived xenograft models that are positive for FGF19, FGFR4, and KLB. FGF401 is the first FGFR4 inhibitor to enter clinical trials, and a phase I/II study is currently ongoing in HCC and other solid malignancies.
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http://dx.doi.org/10.1158/1535-7163.MCT-18-1291DOI Listing
December 2019

Microstructure and Flux Pinning of Reacted-and-Pressed, Polycrystalline BaKFeAs Powders.

Materials (Basel) 2019 Jul 6;12(13). Epub 2019 Jul 6.

Superconducting Materials Laboratory, Department of Materials Science and Engineering, Shibaura Institute of Technology, Tokyo 135-8548, Japan.

The flux pinning properties of reacted-and-pressed BaKFeAs powder were measured using magnetic hysteresis loops in the temperature range 20 K ≤ ≤ 35 K. The scaling analysis of the flux pinning forces ( F p = j c × B , with j c denoting the critical current density) following the Dew-Hughes model reveals a dominant flux pinning provided by normal-conducting point defects ( δ l -pinning) with only small irreversibility fields, H irr , ranging between 0.5 T (35 K) and 16 T (20 K). Kramer plots demonstrate a linear behavior above an applied field of 0.6 T. The samples were further characterized by electron backscatter diffraction (EBSD) analysis to elucidate the origin of the flux pinning. We compare our data with results of Weiss et al. (bulks) and Yao et al. (tapes), revealing that the dominant flux pinning in the samples for applications is provided mainly by grain boundary pinning, created by the densification procedures and the mechanical deformation applied.
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http://dx.doi.org/10.3390/ma12132173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651224PMC
July 2019

Anomalous origin of the coronary artery coursing between the great vessels presenting with a cardiovascular event (J-CONOMALY Registry).

Eur Heart J Cardiovasc Imaging 2020 02;21(2):222-230

Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikariga-oka, Fukushima City 960-1295, Japan.

Aims: Anomalous origin of the coronary artery (AOCA) with an inter-arterial course (IAC) between the great vessels poses a risk for a life-threatening cardiovascular event. We assessed, in a registry-based study, the clinical features, treatment strategies, and prognoses of life-threatening cardiovascular events ensuant to AOCA.

Methods And Results: Included were 65 AOCA patients (48 men/17 women, aged 41 ± 23 years) from 40 clinical centres who had experienced sudden cardiac arrest (SCA) (n = 30), acute myocardial infarction (AMI) (n = 5), angina (n = 23), or syncope (n = 7). The anomalous vessel was the right coronary artery in 72% of patients and left coronary artery in 28%; the ostium was slit-like in 42%. Coronary luminal narrowing ≥75% was absent in patients with SCA or syncope (86% and 57%, respectively), but occlusion or narrowing was seen in those with AMI (100%) or angina (52%). Age ≤40 years, male sex, sporting activity, absence of prodromal symptoms, acutely angled (≤30°) take-off from the aorta, and absence of luminal narrowing of the IAC segment were associated with SCA in this patient group. Coronary vasospasm was inducible in 12 of 17 patients without coronary narrowing. Management included surgical revascularization (n = 26) percutaneous coronary intervention (n = 9), and medical treatment (n = 26). Four SCA patients died while hospitalized; no others died during the median 5.0 (range, 1.8-7.0)-year follow-up period.

Conclusions: In patients with AOCA, age ≤40 years, male sex, sporting activity, and an acute take-off angle appear to be risk factors for SCA. Appropriate management can be beneficial. Confirmation in a large-scale study is warranted.
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http://dx.doi.org/10.1093/ehjci/jez076DOI Listing
February 2020

Clinical experience of idarucizumab use in cases of cardiac tamponade under uninterrupted anticoagulation of dabigatran during catheter ablation of atrial fibrillation.

J Thromb Thrombolysis 2019 May;47(4):487-494

University of Tsukuba School of Medicine, Ibaraki, Japan.

Anticoagulants are prescribed for prevention of thromboembolic events (TE) of atrial fibrillation (AF), however, their effects have a negative impact on disastrous bleeding outcomes. Idarucizumab was developed to reverse the anticoagulation effects of dabigatran. This study aimed to retrospectively investigate the clinical efficacy and safety of idarucizumab in the setting of progressive emergent bleeding events associated with catheter ablation (CA). Dabigatran is given uninterruptedly as an anticoagulant in patients undergoing CA of AF. The capacity of idarucizumab to reverse the anticoagulant effects of dabigatran in patients with cardiac tamponade associated with CA was examined by measuring the activated partial thromboplastin time (aPTT), active clotting time (ACT), and prothrombin international normalizing ratio (PT-INR). The primary endpoint was effective hemostasis. This analysis included 21 patients receiving idarucizumab, given for restoration of hemostasis. In all 21 patients, hemostasis was restored at a median of 205.6 ± 14.8 min. Normal intraoperative cessation of bleeding was reported in 16 patients, and completion of hemostasis was also ascertained in the remaining four within 5 h. No TEs occurred within 72 h after the idarucizumab administration. Despite a significant reduction in the aPTT and ACT, no significant change was observed in PT-INR after administering idarucizumab. In emergency situations, idarucizumab was able to reverse dabigatran within a relatively short period without any serious adverse events.
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http://dx.doi.org/10.1007/s11239-019-01835-8DOI Listing
May 2019

Superconducting YBCO Foams as Trapped Field Magnets.

Materials (Basel) 2019 Mar 13;12(6). Epub 2019 Mar 13.

ACCESS, Intzestrasse 5, 52072 Aachen, Germany.

Superconducting foams of YBa₂Cu₃O (YBCO) are proposed as trapped field magnets or supermagnets. The foams with an open-porous structure are light-weight, mechanically strong and can be prepared in large sample sizes. The trapped field distributions were measured using a scanning Hall probe on various sides of an YBCO foam sample after field-cooling in a magnetic field of 0.5 T produced by a square Nd-Fe-B permanent magnet. The maximum trapped field (TF) measured is about 400 G (77 K) at the bottom of the sample. Several details of the TF distribution, the current flow and possible applicatons of such superconducting foam samples in space applications, e.g., as active elements in flux-pinning docking interfaces (FPDI) or as portable strong magnets to collect debris in space, are outlined.
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http://dx.doi.org/10.3390/ma12060853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471299PMC
March 2019

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Coronary Artery Stenosis in Patients With Severe Aortic Valve Stenosis: Comparison With Myocardial Perfusion Scintigraphy.

JACC Cardiovasc Interv 2018 10 25;11(20):2032-2040. Epub 2018 Aug 25.

Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan; Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.

Objectives: This study investigated the diagnostic performance of instantaneous wave-free ratio (iFR) in patients with aortic valve stenosis (AS).

Background: The iFR was introduced as a new, nonpharmacologic stress index of coronary stenosis severity. However, the diagnostic performance of iFR has not been sufficiently explored in patients with severe AS.

Methods: We analyzed 95 consecutive patients with AS (57 women) demonstrating intermediate coronary artery stenosis (116 vessels), and compared the iFR values with fractional flow reserve (FFR) values and with adenosine-stress myocardial perfusion imaging as indicators of myocardial ischemia.

Results: The median value and interquartile range (first quartile [Q1], third quartile [Q3]) of the iFR was 0.86 (Q1 to Q3 range, 0.76 to 0.93), and that of the FFR was 0.84 (Q1 to Q3 range, 0.76 to 0.91). The iFR values correlated well with the FFR values (R = 0.854; p < 0.0001). A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.82 for the iFR to indicate an FFR ≤0.75, with an area under the curve of 0.92. The optimal iFR cutoff value indicating myocardial ischemia on perfusion scintigraphy was 0.82 (area under the curve: 0.84).

Conclusions: In patients with severe AS, a good correlation exists between iFR and FFR. Both the iFR and FFR values exhibit good correlation with perfusion scintigraphy-identified myocardial ischemia. The iFR could be a safe diagnostic tool for patients with severe AS. (The Impact of FFR and iFR in Patients with Severe Aortic Stenosis; UMIN000024479).
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http://dx.doi.org/10.1016/j.jcin.2018.07.027DOI Listing
October 2018

Dose and Schedule Determine Distinct Molecular Mechanisms Underlying the Efficacy of the p53-MDM2 Inhibitor HDM201.

Cancer Res 2018 11 22;78(21):6257-6267. Epub 2018 Aug 22.

Disease Area Oncology, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.

Activation of p53 by inhibitors of the p53-MDM2 interaction is being pursued as a therapeutic strategy in p53 wild-type cancers. Here, we report distinct mechanisms by which the novel, potent, and selective inhibitor of the p53-MDM2 interaction HDM201 elicits therapeutic efficacy when applied at various doses and schedules. Continuous exposure of HDM201 led to induction of p21 and delayed accumulation of apoptotic cells. By comparison, high-dose pulses of HDM201 were associated with marked induction of PUMA and a rapid onset of apoptosis. shRNA screens identified PUMA as a mediator of the p53 response specifically in the pulsed regimen. Consistent with this, the single high-dose HDM201 regimen resulted in rapid and marked induction of PUMA expression and apoptosis together with downregulation of Bcl-xL Knockdown of Bcl-xL was identified as the top sensitizer to HDM201 , and Bcl-xL was enriched in relapsing tumors from mice treated with intermittent high doses of HDM201. These findings define a regimen-dependent mechanism by which disruption of MDM2-p53 elicits therapeutic efficacy when given with infrequent dosing. In an ongoing HDM201 trial, the observed exposure-response relationship indicates that the molecular mechanism elicited by pulse dosing is likely reproducible in patients. These data support the clinical comparison of daily and intermittent regimens of p53-MDM2 inhibitors. Pulsed high doses versus sustained low doses of the p53-MDM2 inhibitor HDM201 elicit a proapoptotic response from wild-type p53 cancer cells, offering guidance to current clinical trials with this and other drugs that exploit the activity of p53. .
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http://dx.doi.org/10.1158/0008-5472.CAN-18-0338DOI Listing
November 2018

Neoatherosclerosis 5 Years After Bioresorbable Vascular Scaffold Implantation.

J Am Coll Cardiol 2018 05;71(17):1882-1893

Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura, Japan.

Background: Data regarding neoatherosclerosis after everolimus-eluting bioresorbable vascular scaffold (BVS) (ABSORB BVS Rev. 1.1, Abbott Vascular, Santa Clara, California) implantation are limited.

Objectives: This study investigated the findings of neoatherosclerosis at 5 years after BVS 1.1 implantation by using multi-imaging modalities, including optical coherence tomography (OCT).

Methods: Patients included in the ABSORB EXTEND (ABSORB EXTEND Clinical Investigation) trial at Shonan Kamakura General Hospital underwent OCT at baseline after the index procedure and at 1 and 5 years. Intimal plaque distributions in the in-scaffold and out-scaffold segments were analyzed.

Results: Twenty patients (22 lesions) with stable angina pectoris were enrolled. The median follow-up duration was 67 months (interquartile range: 65 to 69 months), and the mean age was 69 ± 8 years. Patients with diabetes mellitus (25%) were included. Based on the baseline angiogram, 10 (46%) lesions were type B2/C lesions. At 1 and 5 years of follow-up, significant differences in the prevalence of in-scaffold lipid-laden neointima (17% vs. 61%; p = 0.04), calcification (28% vs. 94%; p < 0.01), neovascularization (6% vs. 78%; p < 0.01), and thin-cap fibroatheroma (0% vs. 22%; p = 0.02) were found. In the out-scaffold segments, no significant difference in the plaque prevalence between 1 and 5 years was noted.

Conclusions: The occurrence and progression of in-scaffold neoatherosclerosis with luminal narrowing was observed at 5 years after BVS 1.1 implantation. The small size of the current study warrants confirmation in larger study. (ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789).
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http://dx.doi.org/10.1016/j.jacc.2018.02.051DOI Listing
May 2018

Comparison of uninterrupted anticoagulation with dabigatran etexilate or warfarin in the periprocedural period for atrial fibrillation catheter ablation: Results of the Japanese subgroup of the RE-CIRCUIT trial.

J Arrhythm 2018 04 13;34(2):148-157. Epub 2018 Jan 13.

Division of Cardiology Saiseikai Kumamoto Hospital Kumamoto Japan.

Background: There are limited data on uninterrupted anticoagulation with direct oral anticoagulants during catheter ablation for atrial fibrillation (AF), particularly in Japan. We planned a subgroup analysis of the RE-CIRCUIT study, comparing the use of uninterrupted dabigatran therapy with warfarin therapy during catheter ablation among the Japanese subgroup and with that in the total population.

Methods: The RE-CIRCUIT study utilized a prospective, randomized, open-label, blinded endpoint design, and the primary endpoint was the incidence of major bleeding events (MBEs). Patients were randomized to uninterrupted dabigatran 150 mg twice daily or warfarin. In this study, we analyzed the results in Japanese patients.

Results: Of 704 enrolled patients in the study, 112 Japanese patients were randomized to dabigatran (n = 65) or warfarin (n = 47). MBEs were experienced by two patients: one in the dabigatran group (1.6%, cardiac tamponade) and one in the warfarin group (2.2%, groin hematoma) (risk difference vs warfarin -0.6%; 95% CI -5.8, 4.7). Within the Japanese subgroup, there were no thromboembolic events in both groups.

Conclusion: While not designed to show statistical difference between two treatment groups, our results from the Japanese subgroup supported those from the overall population. Furthermore, this study provided clinical information regarding MBE, especially cardiac tamponade, in Japanese patients.
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http://dx.doi.org/10.1002/joa3.12024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891433PMC
April 2018

Modified jailed balloon technique for bifurcation lesions.

Catheter Cardiovasc Interv 2018 09 4;92(3):E218-E226. Epub 2017 Dec 4.

Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Kamakura City, Japan.

Objectives: We propose a new systematic approach in bifurcation lesions, modified jailed balloon technique (M-JBT), and report the first clinical experience.

Background: Side branch occlusion brings with a serious complication and occurs in more than 7.0% of cases during bifurcation stenting.

Methods: A jailed balloon (JB) is introduced into the side branch (SB), while a stent is placed in the main branch (MB) as crossing SB. The size of the JB is half of the MB stent size. While the proximal end of JB attaching to MB stent, both stent and JB are simultaneously inflated with same pressure. JB is removed and then guidewires are recrossed. Kissing balloon dilatation (KBD) and/or T and protrusion (TAP) stenting are applied as needed.

Results: Between February 2015 and February 2016, 233 patients (254 bifurcation lesions including 54 left main trunk disease) underwent percutaneous coronary intervention (PCI) using this technique. Procedure success was achieved in all cases. KBD was performed for 183 lesions and TAP stenting was employed for 31 lesions. Occlusion of SV was not observed in any of the patients. Bench test confirmed less deformity of MB stent in M-JBT compared with conventional-JBT.

Conclusions: This is the first report for clinical experiences by using modified jailed balloon technique. This novel M-JBT is safe and effective in the preservation of SB patency during bifurcation stenting.
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http://dx.doi.org/10.1002/ccd.27334DOI Listing
September 2018