A wafer-like apparatus for two-dimensional measurement of plasma parameters and temperature distribution in low-temperature plasmas.

A wafer-type monitoring apparatus that can simultaneously measure the two-dimensional (2D) distributions of substrate temperature and plasma parameters is developed. To measure the temperature of the substrate, a platinum resistance temperature detector is used. The plasma density and electron temperature are obtained using the floating harmonics method, and incoming heat fluxes from the plasma to the substrate are obtained from the plasma density and electron temperature. In this paper, 2D distributions of the substrate temperature, plasma density, and electron temperature are obtained simultaneously for the first time in inductively coupled plasma. The shapes of the 2D distributions of the substrate temperature and incoming heat flux are similar to each other, but some differences are found. To understand that, an energy balance equation for the substrate is established, which shows good agreement with the experimental results. This apparatus will promote the understanding of surface reactions, which are very sensitive to the temperatures and plasma densities in plasma processing.

Subclinical cardiac perforation by cardiac implantable electronic device leads detected by cardiac computed tomography.

BACKGROUND: The relationship between the characteristics of cardiac implantable electronic device (CIED) leads and subclinical cardiac perforations remains unclear. This study aimed to evaluate the incidence of subclinical cardiac perforation among various CIED leads using cardiac computed tomography (CT). METHODS: A total of 271 consecutive patients with 463 CIED leads, who underwent cardiac CT after CIED implantation, were included in this retrospective observational study. Cardiac CT images were reviewed by one radiologist and two cardiologists. Subclinical perforation was defined as traversal of the lead tip past the outer myocardial layer without symptoms and signs related to cardiac perforation. We compared the subclinical cardiac perforation rates of the available lead types. RESULTS: A total of 219, 49, and 3 patients had pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy, respectively. The total subclinical cardiac perforation rate was 5.6%. Subclinical cardiac perforation by screw-in ventricular leads was significantly more frequent than that caused by tined ventricular leads (13.3% vs 3.3%, respectively, p = 0.002). There were no significant differences in the incidence of cardiac perforation between atrial and ventricular leads, screw-in and tined atrial leads, pacing and defibrillator ventricular leads, nor between magnetic resonance (MR)-conditional and MR-unsafe screw-in ventricular leads. Screw-in ventricular leads were significantly associated with subclinical cardiac perforation [odds ratio, 4.554; 95% confidence interval, 1.587-13.065, p = 0.005]. There was no case subclinical cardiac perforation by septal ventricular leads. CONCLUSIONS: Subclinical cardiac perforation by screw-in ventricular leads is not rare. Septal pacing may be helpful in avoiding cardiac perforation.

Body Mass Index Variability and Long-term Risk of New-Onset Atrial Fibrillation in the General Population: A Korean Nationwide Cohort Study.

OBJECTIVE: To assess the effects of body mass index (BMI) variability on the incidence of new-onset atrial fibrillation (AF), stroke, cardiovascular (CV) risk factors, and CV outcomes in a general Asian population. PATIENTS AND METHODS: Data from the National Health Insurance Service-Health Screening cohort in Korea were used: 171,324 patients without AF were included, and BMI measurements occurred biennially from January 1, 2002, through December 31, 2009. Patient outcomes were followed through 2013. The BMI intraindividual variability between visits was measured. RESULTS: During mean ± SD follow-up of 47.4±3.9 months, 1959 patients (1.1%) developed new-onset AF. Overweight or obesity (BMI ≥25) had a greater risk of new-onset AF compared with BMI of 20 to 22.5, with a hazard ratio (HR) of 1.24 (95% CI, 1.10-1.41; P<.001). In underweight or normal-weight participants (initial BMI <25), a 1-kg/m2 increase of BMI variability increased the risk of new-onset AF, with an adjusted HR (aHR) of 1.13 (95% CI, 1.01-1.25; P=.02). Weight gain increased the risk of new-onset AF (aHR, 1.32; 95% CI, 1.01-1.71; P=.04) and myocardial infarction (aHR, 1.52; 95% CI, 1.06-2.18; P=.02) but not stroke. In this group, blood pressure, glucose level, and total cholesterol level were higher in individuals with the greatest BMI variability compared with those with stable BMI. CONCLUSION: In the underweight and normal-weight Asian population, BMI variability, especially weight gain, was related to increased risk of new-onset AF and myocardial infarction. Avoiding weight gain is important to improve CV outcomes.

Serial measurements of neutrophil gelatinase-associated lipocalin: prognostic value in patients with ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention.

BACKGROUND: There are no previous data on serial changes in neutrophil gelatinase-associated lipocalin (NGAL) levels in ST-segment elevation myocardial infarction (STEMI) patients before and after a primary percutaneous coronary intervention (pPCI). The aim of the present study was to evaluate the prognostic value of serial NGAL measurements in patients with STEMI treated by pPCI. MATERIALS AND METHODS: We identified 169 STEMI patients who underwent pPCI within 12 h of symptom onset and had plasma NGAL measurements before (pre-NGAL) and 6 h after (post-NGAL) pPCI. The primary endpoint was 30-day all-cause mortality, including cardiac death, whereas the secondary endpoint was the change in NGAL levels from before to after pPCI. RESULTS: The mean pre-NGAL and post-NGAL levels were 109.2±76.1 and 93.3±83.8 ng/ml, respectively. Thirty-day mortality occurred in 12 (7.1%) patients. In terms of changes in serial NGAL levels, post-NGAL levels were decreased in 132 (79%) patients. Patients with elevated post-NGAL levels showed increased mortality compared with patients with decreased post-NGAL levels (P=0.005). Multivariate analyses indicated that old age and high post-NGAL levels were independent risk factors for 30-day mortality. CONCLUSION: In a large percentage of STEMI patients, plasma post-pPCI NGAL levels were decreased compared with pre-pPCI NGAL levels, even with the administration of potentially nephrotoxic contrast medium. Post-NGAL levels seemed to be superior to pre-NGAL levels for the prediction of 30-day mortality outcome.

Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea.

AIMS: For healthy populations without comorbidities, whether prehypertension and impaired fasting glucose (IFG) are associated with new onset atrial fibrillation (AF) is not well known. METHODS AND RESULTS: We included 366 507 subjects (age ≥20 years) not diagnosed with non-valvular AF from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2003 to 2008. In total, 139 306 subjects diagnosed with AF-related comorbidities were excluded, and a 227 102 healthy population was followed up until 2013. The body mass index (BMI), blood pressure (BP), and fasting blood glucose (BG) level were acquired during National health check-ups. Subjects with IFG [hazard ratio (HR) 1.16, P = 0.017] had a higher AF risk and the diastolic BP (HR 1.11, P = 0.045) was a stronger indicator for an AF incidence than the systolic BP. After dividing the subjects into two mutually exclusive groups, AF incidence was increased dramatically by the combination effect of both prehypertension and an IFG in BMI <25 kg/m2 group, but, in BMI ≧25 kg/m2 group, did not show this tendency. An IFG related to AF risk was more prominent in the BMI <25 kg/m2 population (HR 1.18, P = 0.025) than those with a BMI ≥25 kg/m2, and subjects with both an IFG and prehypertension had a greater AF risk (HR 1.27, P = 0.016) than those without. CONCLUSION: Even in a healthy Asian populations without comorbidities, prehypertension and IFG were important risk factors of AF. Specifically, when prehypertension, including systolic and diastolic BPs, was finally combined with the IFG, the risk of new onset AF was increased especially in the BMI <25 kg/m2 group.

Delayed left atrial appendage contrast filling in computed tomograms after percutaneous left atrial appendage occlusion.

BACKGROUND: The gold standard for the follow-up of left atrial appendage occlusion (LAAO) is performing transesophageal echocardiogram (TEE) at 45 days after LAAO; however, the duration for complete LAA seal-off after percutaneous LAAO is unknown in humans. We retrospectively evaluated the LAA contrast-filling (CF) rate in follow-up cardiac computed tomography (CT) scans after LAAO. METHODS: We included 35 patients (age 67.5±10.9 years, CHA2DS2VASc 4.2±1.6, HAS-BLED 3.7±1.5) who underwent LAAO [16 WATCHMAN, 19 Amplatzer cardiac plug (ACP)] and follow-up cardiac CT within 6 months after LAAO, and evaluated the LAA-CF rates. Eighteen patients (51.4%) underwent multiple episodes of CT follow-up. RESULTS: 1. The proportions of patients with LAA-CF were 54.2% (19/35) at 6 months, 55.5% (5/9) at 6-18 months, and 33.3% (3/9) at >18 months after LAAO. 2. Among 23 patients with no peridevice leak at the 2 months TEE, LAA-CFs were found in 12 patients at 2.8±1.5 months (66.6% in WATCHMAN and 36.3% in ACP; p=0.158). 3. Among eight patients with consecutive follow-up CT (≥3 times), LAA-CFs were partially reduced in three; however, there was no complete LAA seal-off at 19.0±11.3 months. 4. A larger LAA landing zone diameter was independently associated with LAA-CF in follow-up CT [OR 1.45 (1.08-1.96), p=0.013, adjusted for age, sex, and device type]. CONCLUSIONS: Delayed LAA-CF is common after LAAO, with considerable discrepancies between cardiac CT and TEE findings. Although the clinical significance of LAA-CF is unclear, 45 days seem to be insufficient for complete LAA seal-off after LAAO.

Prognostic value of preoperative N-terminal pro-brain natriuretic peptide in non-cardiac surgery of elderly patients with normal left ventricular systolic function.

AIM: We investigated the prognostic value of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) in non-cardiac surgery in elderly patients who showed normal left ventricular function on preoperative echocardiography. METHODS: We analyzed 1459 patients aged older than 70 years who had consulted a cardiologist for the evaluation of cardiovascular risk for non-cardiac surgery. Of the 721 patients who simultaneously underwent echocardiography and NT-proBNP assessments, 506 who showed normal left ventricular systolic function were included. The predictive power of NT-proBNP for the risk of major adverse cardiac and cerebrovascular events (MACCE) was evaluated. RESULTS: MACCE occurred in 40 (7.9%) of the 506 patients, and the median value of NT-proBNP was higher in patients with complications than in those without (MACCE group: 1700.5 pg/mL vs non MACCE group: 206.35 pg/mL; P < 0.001). The area under the receiver operating characteristic curve was 0.804 (P < 0.001), with an optimal cut-off of 425.3 pg/mL. Multivariate analysis showed that increased NT-proBNP (>425.3 pg/mL; odds ratio 6.381; P < 0.001) was the only independent risk factor for the prediction of MACCE. CONCLUSIONS: In elderly patients who showed normal left ventricular systolic function on echocardiography, measurement of preoperative NT-proBNP concentration might be a useful test for predicting the occurrence of MACCE after non-cardiac surgery. Geriatr Gerontol Int 2016; 16: 1109-1116.

Characterization of anti-factor VIII antibody in a patient with acquired hemophilia A.

Acquired hemophilia A (AHA) is a bleeding disorder caused by the development of an auto-antibody against endogenous factor VIII (FVIII). In this study, the epitope of the autoantibody was identified in a 67-year-old female patient with AHA. A prolonged activated partial thromboplastin time (77.4 s) that failed to correct in an incubation mixing test (68.2 s), a decreased FVIII activity, and a high FVIII inhibitor (14.6 Bethesda units/mL) were observed. Enzyme-linked immunosorbent assay demonstrated that the antibody belonged to the immunoglobulin G4 subclass. An immunoblotting assay revealed the light chain (A3/C1/C2 domain) of FVIII as the binding region of the antibody. The bleeding experienced by our patient resulted from the interference of FVIII binding to both FIX by anti-A3 antibodies and phospholipids and von Willebrand factor by anti-C2 antibodies. To the best of our knowledge, this is the first study in Korea characterizing an autoantibody in the context of AHA.