Clinical outcomes of ST elevation myocardial infarction patients without standard modifiable risk factors.

BACKGROUND: Standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes mellitus, dyslipidemia, and smoking) are widely recognized as risk factors for coronary artery disease. However, the associations between absence of SMuRFs and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients are unclear. METHODS: Consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) between 1999 and 2015 were retrospectively analyzed. The primary endpoint was up to 5-year all-cause mortality. Clinical characteristics and outcomes were compared between patients with at least one of the SMuRFs and those without any SMuRFs. RESULTS: Of 1963 STEMI patients, 126 (6.4 %) did not have any SMuRFs. Patients without SMuRFs were significantly older, had lower body mass index, and were more likely to be female. During a median follow-up period of 4.9 years, the cumulative incidence of death was significantly higher in patients without SMuRFs than in those with SMuRFs (log-rank p < 0.0001). Landmark analysis showed that patients without SMuRFs had higher mortality within 30 days of STEMI onset (log-rank p = 0.0045) and >30 days after STEMI onset (log-rank p = 0.0004). Multivariable Cox hazards analysis showed that absence of SMuRFs was associated with a higher risk of mortality (hazard ratio, 1.59; 95 % confidence interval, 1.14-2.21; p = 0.006). CONCLUSIONS: Of STEMI patients undergoing primary PCI, patients without any SMuRFs had higher mortality than those with at least one of the SMuRFs. Patients without any SMuRFs have a poor prognosis and require more attention.

A Case of Floating Aortic Arch Thrombosis in a Patient without Thrombophilia.

Floating aortic arch thrombi-blood clots forming in an aorta without aneurysms or atherosclerosis-in a normal aorta are exceedingly rare. The etiology is unknown, and there are no guidelines for appropriate treatment strategies. We report a case of floating aortic arch thrombosis in a patient without coagulopathy that was treated surgically. As the mass could not be identified preoperatively as a tumor or thrombus, synthetic graft replacement was performed, allowing resection of the lesion site. Histopathological examination revealed erosion and fissures in the tunica intima of the aorta, which suggested vessel damage to the tunica intima as the cause.

Multiple Systemic Embolization Associated with Chest Compression in a Patient with Cardiac Arrest.

The patient was an 80-year-old woman with chronic atrial fibrillation, chronic heart failure, cerebellar infarction, hyperlipidemia, and hypertension, who suddenly collapsed while playing gateball outdoors. The doctor at a nearby clinic doctor found her in a state of cardiopulmonary arrest and started basic life support. Twelve minutes after discovery, spontaneous circulation returned. On arrival, she was in a deep coma state with atrial fibrillation-related tachycardia. A physical examination revealed pulseless right radial and left popliteal arteries with cyanosis. Whole-body-enhanced computed tomography and head magnetic resonance imaging demonstrated multiple ischemic organs. Taken together, it was considered that a massive-free thrombus from the left atrium, which was caused by atrial fibrillation, had first obstructed the left ventricular outflow tract, resulting in cardiac arrest. Then, the thrombus had been scattered throughout the body by chest compression. Her condition was judged to be irreversible and she died on day 3. This is the first reported case of multiple systemic embolization associated with chest compression in a patient with cardiac arrest. This unique case adds one more cause to the list of the documented etiologies of complications caused by chest compression.

A study of factors associated with the prognosis of cardiac arrest patients in a depopulated area with a high elderly population transported by Shimoda Fire Department.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.

Bladder deformity accompanied by pelvic fracture indirectly indicates clinical severity.

BACKGROUND: That the bladder can be compressed by extraperitoneal hematoma induced by obstetrics and gynecologic diseases, is well known. However, there have been no reports on the clinical significance of compressed bladder induced by pelvic fracture (PF). We therefore retrospectively investigated the clinical features of compressed bladder induced by the PF. METHODS: From January 2018 to December 2021, we performed a retrospective review of the hospital medical charts of all emergency outpatients who were treated by emergency physicians at the department of acute critical care medicine in our hospital, and who were diagnosed with PF based on computed tomography (CT) on arrival. The subjects were divided into two groups: the Deformity group, in which the bladder was compressed by extraperitoneal hematoma, and the Normal group. Variables were compared between the two groups. RESULTS: During the investigation period, 147 patients with PF were enrolled as subjects. There were 44 patients in the Deformity group and 103 in the Normal group. There were no significant differences between the two groups with regard to sex, age, GCS, heart rate or final outcome. However, the average systolic blood pressure in the Deformity group was significantly lower, and the average respiratory rate, injury severity score, rate of unstable circulation, rate of transfusion and duration of hospitalization in the Deformity group were significantly greater in comparison to the Normal group. CONCLUSIONS: The present study showed that bladder deformity induced by PF tended to be a poor physiological sign that was associated with severe anatomical abnormality, unstable circulation requiring transfusion, and long hospitalization. Accordingly, physicians should evaluate shape of bladder when treating PF.

Glyceraldehyde-derived advanced glycation end-products are associated with left ventricular ejection fraction and brain natriuretic peptide in patients with diabetic adverse cardiac remodeling.

Objectives: Glyceraldehyde-derived advanced glycation end-products (Glycer-AGEs) have a strong binding affinity for their cognate receptor and elicit oxidative stress and inflammation. However, it remains unknown whether the levels of Glycer-AGEs correlate with the severity of cardiac function and heart failure in patients with diabetic adverse cardiac remodeling (DbCR). Fourteen heart failure patients with type 2 diabetes mellitus (DM) without other cardiac disorders (DbCR group) were enrolled. Another 14 patients with idiopathic dilated cardiomyopathy (DCM) without DM were served as a control (DCM group). All patients were assessed for serum Glycer-AGEs, nitrotyrosine (NT), and tumor necrosis factor alpha (TNFα) and for plasma brain natriuretic peptide (BNP). The left ventricular ejection fraction (LVEF) was evaluated by echocardiography. Results: The mean serum levels of Glycer-AGEs, NT, and TNFα in the DbCR group were significantly higher than those in the DCM group (for Glycer-AGEs, p = .0073; for NT, p = .005; for TNFα, p < .0001, respectively). In the patients with DbCR, the levels of serum Glycer-AGEs and TNFα were closely associated with LVEF and BNP values. Conclusions: Both Glycer-AGEs and TNFα showed close associations with LVEF and the levels of BNP in patients with DbCR. Glycer-AGEs and TNFα may play a pathological role in the development of DbCR.

Increased plasma glutamate in non-smokers with vasospastic angina pectoris is associated with plasma cystine and antioxidant capacity.

Objectives. Endothelial dysfunction caused by oxidative stress plays an important role in the development of vasospastic angina pectoris (VSAP). Glutamate causes endothelial dysfunction by generating oxidative stress, and it inhibits cystine import into endothelial cells via the cystine/glutamate antiporter (XC-), which leads to depletion of antioxidant glutathione. However, whether glutamate and cystine are implicated in the pathogenesis of VSAP remains unclear. We investigated plasma glutamate and cystine levels, oxidative stress markers and antioxidant capacity in non-smoker patients with VSAP to determine whether glutamate and cystine are associated with the development of VSAP. We assessed 49 non-smokers assigned to groups with (n = 27) and without (n = 22) VSAP, and also measured plasma glutamate, cystine, nitrotyrosine, reactive oxygen metabolites and biological antioxidant potential. Results. Plasma glutamate and cystine values were significantly higher in the group with, than without VSAP (59.8 ± 25.7 vs. 43.5 ± 18.7 µmol/L, p = .016 and 35.3 ± 14.2 vs. 25.2 ± 9.1 µmol/L, p = .0056, respectively). Plasma glutamate and cystine values were significantly and positively associated (r = 0.32, p = .027). Levels of the oxidative stress markers nitrotyrosine and reactive oxygen metabolites, and biological antioxidant potential of as a measure of antioxidant capacity, did not significantly differ between the two groups. However, glutamate and biological antioxidant potential values were significantly and negatively associated (r = -0.3, p = .036). Conclusion. Plasma glutamate levels were increased in patients with VSAP who did not smoke, and they were positively associated with plasma cystine and negatively associated with the biological antioxidant potential levels.

Magnetic, thermal, and neutron diffraction studies of a coordination polymer: bis(glycolato)cobalt(ii).

The two-dimensional quadratic lattice magnet, bis(glycolato)cobalt(ii) ([Co(HOCH2CO2)2]), showed antiferromagnetic ordering at 15.0 K and an abrupt increase in magnetisation at H = 22 600 Oe and 2 K, thereby acting as a metamagnet. Heat capacity measurements revealed that the associated entropy change ΔS around the transition temperature was evaluated to be 6.20 J K-1 mol-1 and that the Co(ii) ion had the total angular momentum of J = 1/2 at low temperatures. Neutron diffraction studies suggested that the magnetic moment vectors of the Co(ii) ions had an amplitude of 3.59µB and were not aligned in a fully antiparallel fashion to those of their neighbours, which caused canting between the magnetic moment vectors in the sheet. The canting angle was determined to be 7.1°. Canting induced net magnetisation in the sheet, but this magnetisation was cancelled between sheets. The magnetisations in the sheets were oriented parallel to the magnetic field at the critical magnetic field.

Crystal structures, and magnetic and thermal properties of basic copper formates with two-dimensional triangular-lattice magnetic networks.

Basic copper formate, [Cu3(OH)4(HCOO)2], was selectively prepared by hydrolysis of formate ions in concentrated aqueous solutions of copper formate. This material exhibits a two-dimensional distorted triangular-lattice magnetic network of Cu(ii) ions where S = 1/2. The dominance of antiferromagnetic interactions with J/k B = 35.7(2) K and a magnetic anomaly at approximately 2.3 K that corresponds to a paramagnetic-to-antiferromagnetic ordering transition were revealed by magnetic measurements. The field dependence of the magnetisation at 2 K corresponds to the 1/3-magnetisation plateau that is commonly observed in a two-dimensional triangular-lattice system. Moreover, heat-capacity measurements found a λ-type anomaly at 2.15 K, which is the magnetic transition temperature. This material may be a good candidate for a geometrical frustration system with novel magnetic phenomena such as spin-liquid states.

Deuterium substitution effects on the structural and magnetic phase transitions of a hydrogen-bonded coordination polymer, bis(glycolato)copper(ii).

Bis(glycolato)copper(ii) [Cu(HOCH2CO2)2] shows a structural phase transition around 220 K under cooling and 270 K under heating, and ferromagnetic ordering at 1.1 K. Deuterium substitution of the hydroxyl groups in it induced a large shift in the structural transition temperature while no shift in the ferromagnetic transition temperature took place.

Prediction of all-cause death using (11)C-hydroxyephedrine positron emission tomography in Japanese patients with left ventricular dysfunction.

OBJECTIVES: The aim of this study was to determine whether (11)C-hydroxyephedrine ((11)C-HED) can predict adverse events including all-cause death in Japanese patients with left ventricular (LV) dysfunction. BACKGROUND: Although (11)C-HED PET has been used to assess cardiac sympathetic innervation in various disease conditions, data on their prognostic value are limited. METHODS: Sixty patients (mean LVEF, 42 ± 14 %) with LV dysfunction (42 ischemic and 18 non-ischemic heart disease) underwent (11)C-HED PET. Myocardial retention was calculated for (11)C-HED PET as a measure of cardiac sympathetic neuronal integrity. Statistical analysis was performed using Cox proportional hazards regression and log-rank test. RESULTS: Thirteen deaths (7 cardiac and 6 non-cardiac deaths) occurred during a mean follow-up period of 33 ± 23 months. The patients with death were associated with significantly lower (11)C-HED retention (7.1 ± 2.1 vs 9.0 ± 2.4, p = 0.015) than those without death. The hazard ratio for global (11)C-HED retention per unit (/min) was 0.762 (p = 0.039), which remained significant in multivariate analysis. When the patients were divided into the high (≥8.5) and low (<8.5) (11)C-HED retention groups, the low (11)C-HED retention group was associated with significantly poorer survival than the high (11)C-HED retention group (p = 0.004). CONCLUSION: The low global (11)C-HED retention is a marker of poor overall survival in patients with LV dysfunction in this study.

Impact of injection dose, post-reconstruction filtering, and collimator choice on image quality of myocardial perfusion SPECT using cadmium-zinc telluride detectors in the rat.

BACKGROUND: The aims of this study were (1) to evaluate the impact of injection dose, post-reconstruction filtering, and collimator choice on image quality of myocardial perfusion single-photon emission computed tomography (SPECT) using cadmium-zinc telluride (CZT) detectors and (2) to determine how these factors affect measured infarct size in the in vivo rat. METHODS: Twenty-four healthy and eight myocardial infarct (MI) rats underwent myocardial perfusion SPECT imaging after injection of various doses (25 to 200 MBq) of (99m)Tc-tetrofosmin using a standard (STD) five-pinhole collimator and high-sensitivity (HS) five-pinhole collimator. Image quality score, contrast-to-noise ratio, sharpness index, coefficient of variation (CV), and measured defect size were assessed as measures of image quality. RESULTS: The image quality score increased and CV decreased as a function of injection dose. The contrast-to-noise ratio increased and sharpness index decreased as a function of Gaussian kernel size. When STD and HS were compared, HS tended to show higher image quality score and lower CV than STD. The use of post-reconstruction filter significantly improved image quality score and lessened CV. The reproducibility of defect size measurements, as assessed by intraclass correlation coefficients (ICC), between the collimators was poor-to-moderate (ICC = -0.31~0.57) with low (25 MBq) injection dose and with no or light (1.5-mm kernel size) filtering, whereas it was good-to-excellent (ICC = 0.75~0.97) with high (200 MBq) dose or low dose with heavy (2.5-mm kernel size) filtering. The filtering-related reproducibility was poor (ICC = -0.18~0.17) for STD with low injection dose, whereas it was good-to-excellent (ICC = 0.79~0.89) for HS. Furthermore, there was a filtering-related underestimation of defect size particularly with the use of heavy smoothing. CONCLUSIONS: Appropriate imaging setting is important to obtain high quality images and thereby reliable measurements using a preclinical myocardial SPECT in the rat. When only a low injection dose (25 MBq) is allowed, we would recommend to use HS with light (1.5-mm kernel size) filtering.

Ferromagnetic ordering in the organic radical cation salt BBDTA·Au(CN)2 at 8.2 K.

An organic radical cation salt, BBDTA·Au(CN)2, with a slipped π-stacking columnar structure and intercolumnar short contacts, shows ferromagnetic ordering at 8.2 K, the highest reported temperature among the BBDTA(+) cation salts.

Donor-acceptor segregated paracyclophanes composed of naphthobipyrrole and stacked fluoroarenes.

The expeditious synthesis of donor-acceptor segregated paracyclophanes has been achieved by a selective SNAr reaction of hexafluorobenzene with o-dipyrrolylbenzenes and subsequent cyclodehydrogenation. An orthogonally arranged D-A segregated structure was confirmed by X-ray crystallography. The combined results of DFT calculations and absorption spectra revealed the charge transfer (CT) nature from the naphthobipyrrole (donor) to the stacked fluoroarene moiety (acceptor).

Pyrrole-fused azacoronene family: the influence of replacement with dialkoxybenzenes on the optical and electronic properties in neutral and oxidized states.

A novel pyrrole-fused azacoronene family was synthesized via oxidative cyclodehydrogenation of the corresponding hexaarylbenzenes as the key step, and the crystal structures of tetraazacoronene 3b and triazacoronene 4a were elucidated. The photophysical properties for neutral compounds 1-4 were investigated using steady-state UV-vis absorption/emission spectroscopy and time-resolved spectroscopy (emission spectra and lifetime measurements) at both room temperature and 77 K. The observation of both fluorescence and phosphorescence allowed us to estimate the small S1-T1 energy gap (ΔES-T) to be 0.35 eV (1a), 0.26 eV (2a), and 0.36 eV (4a). Similar to the case of previously reported hexapyrrolohexaazacoronene 1 (HPHAC), electrochemical oxidation revealed up to four reversible oxidation processes for all of the new compounds. The charge and spin delocalization properties of the series of azacoronene π-systems were examined using UV-vis-NIR absorption, ESR, and NMR spectroscopies for the chemically generated radical cations and dications. Combined with the theoretical calculations, the experimental results clearly demonstrated that the replacement of pyrrole rings with dialkoxybenzene plays a critical role in the electronic communication, where resonance structures significantly contribute to the thermodynamic stability of the cationic charges/spins and determine the spin multiplicities. For HPHAC 1 and pentaazacoronene 2, the overall aromaticity predicted for closed-shell dications 1(2+) and 2(2+) was primarily based on the theoretical calculations, and the open-shell singlet biradical or triplet character was anticipated for tetraazacoronene 3(2+) and triazacoronene 4(2+) with the aid of theoretical calculations. These polycyclic aromatic hydrocarbons (PAHs) represent the first series of nitrogen-containing PAHs that can be multiply oxidized.

Myocardial sympathetic innervation, function, and oxidative metabolism in non-infarcted myocardium in patients with prior myocardial infarction.

OBJECTIVE: The purpose of this study was to investigate the relationship between sympathetic innervation, contractile function, and the oxidative metabolism of the non-infarcted myocardium in patients with prior myocardial infarction. METHODS: In 19 patients (14 men, 5 women, 65 ± 9 years) after prior myocardial infarction, sympathetic innervation was assessed by (11)C-hydroxyephedrine (HED) positron emission tomography (PET). Oxidative metabolism was quantified using (11)C-acetate PET. Left ventricular systolic function was measured by echocardiography with speckle tracking technique. RESULTS: The (11)C-HED retention was positively correlated with left ventricular ejection fraction (LVEF) (r = 0.566, P < 0.05), and negatively with peak longitudinal strain in systole in the non-infarcted myocardium (r = -0.561, P < 0.05). Kmono, as an index of oxidative metabolism, was significantly correlated with rate pressure product (r = 0.649, P < 0.01), but not with (11)C-HED retention (r = 0.188, P = 0.442). Furthermore, there was no significant correlation between Kmono and LVEF (r = 0.106, P = 0.666) or peak longitudinal strain in systole (r = -0.256, P = 0.291) in the non-infarcted myocardium. When the patients were divided into two groups based on the median value of left ventricular end-systolic volume index (LVESVI) (41 mL), there were no significant differences in age, sex, and rate pressure product between the groups. However, the large LVESVI group (>41 mL) was associated with reduced (11)C-HED retention and peak longitudinal strain in systole, whereas Kmono was similar between the groups. CONCLUSIONS: This study indicates that remodeled LV after myocardial infarction is associated with impaired sympathetic innervation and function even in the non-infarcted myocardial tissue. Furthermore, oxidative metabolism in the non-infarcted myocardium seems to be operated by normal regulatory mechanisms rather than pre-synaptic sympathetic neuronal function.

Hydrogen bonded anion ribbons, networks and clusters and sulfur-anion interactions in novel radical cation salts of BEDT-TTF with sulfamate, pentaborate and bromide.

The novel radical cation salt (BEDT-TTF)3(sulfamate)2·2H2O (BEDT-TTF = bis(ethylenedithio)tetrathiafulvalene) is semiconducting with donor stacks comprised of pairs of partially oxidized molecules and a single more highly oxidized molecule which is twisted out of the stack by ca. 30°. Hydrogen bonded pairs of sulfamate ions are linked into parallel ribbons by further hydrogen bonding between sulfamates and bridging water molecules. In contrast, the BEDT-TTF salt with pentaborate contains infinite layers formed of a network of hydrogen bonded pentaborate anions. Two new bromide salts of BEDT-TTF are reported, one is a semiconducting 1 : 1 salt in which the bromide is integrated among the BEDT-TTF donors, while the other contain a square of four bromide ions linked together by hydrogen bonding to a centrally located H5O2(+) cation for every five BEDT-TTF molecules.

Crystal growth, structure, and magnetic properties of a two-dimensional triangular lattice magnet, Cu2(OH)3HCO2.

We prepared single crystals of basic copper formate Cu(2)(OH)(3)HCO(2) (1) by hydrolysis of formate anions in an aqueous solution of copper formate. X-ray structure analysis showed that this material has a two-dimensional triangular lattice network with S = 1/2. The temperature dependence of magnetic susceptibility revealed antiferromagnetic ordering at 5.4 K. A spin-flop transition was observed at about 20 kOe at 2 K, thereby indicating metamagnetic-like behavior. The saturation magnetization was almost one-half of the theoretical value at 2 K under 70 kOe. The magnetic behaviors of 1 were also discussed with regard to its crystal structure. The preparation method presented herein is convenient and available for single crystal growth of metal hydroxide derivatives with various anions.