Growth of Floc Structure and Subsequence Compaction into Smaller Granules through Breakup and Rearrangement of Aluminum Flocs in a Constant Laminar Shear Flow.

We have constructed an outer-cylinder-rotating Couette device for high-speed shear flow in laminar flow conditions and visualized the structure formation and subsequent rearrangement of PACl (flocculant made of aluminum hydroxide gel) and kaolinite flocs by visible light imaging. In a previous report, we analyzed the case of relatively low shear rate (G-value = 29 1/s) and confirmed that the flocculation process could be separated into two stages: a floc growth stage and a breakup/rearrangement stage. Once the large bulky flocs that reached the maximum size appeared, they rearranged and densified through structural fracture and rearrangement. In this report, this process was further investigated by conducting experiments under two different high shear rates (58 and 78 1/s) at which breakup and rearrangement became more pronounced, and three different aluminum kaolinite ratios (ALT ratios) that were over and under the optimum dosage (neutralization point by Zeta potential). Visualization results confirmed that, during the growth stage, the flocculation rate could be approximated by a scaling relationship between floc size and elapsed time, which depended on the ALT ratio. After reaching the maximum size, the floc rapidly became compact and dense following adsorption of the gel, incorporating fine fragments from erosion breakup. The over and under dosages created a lot of fragments of erosion breakup, but less so in the optimum dosage. In the optimum ALT ratio, fragments did not remain because they were incorporated into the flocs and densified, and the floc size was thought to be maintained. The floc circularity distribution peaked at around 0.6 and 1, suggesting that the flocs were spherical in shape due to erosion breakup.

Baseline serum sitosterol level as predictor of adverse clinical events in acute coronary syndrome patients with dyslipidaemia: A sub-analysis of HIJ-PROPER.

BACKGROUND AND AIMS: We aimed to examine the effect of serum sitosterol, a cholesterol absorption marker, on clinical outcomes in acute coronary syndrome patients with dyslipidaemia. METHODS: This is a sub-analysis of the HIJ-PROPER trial that assesses the effect of aggressive low-density lipoprotein cholesterol (LDL-C) lowering treatment with pitavastatin + ezetimibe in 1734 acute coronary syndrome (ACS) patients with dyslipidaemia. Patients were divided into two groups based on sitosterol level at enrolment (cut-off value was 2.2 µg/mL; a median of baseline sitosterol level), and clinical outcomes were examined. RESULTS: The mean LDL-C level after 3 years in the low sitosterol group was 84.8 ± 20.1 mg/dL with pitavastatin-monotherapy and 64.6 ± 20.3 mg/dL with pitavastatin + ezetimibe, while corresponding values in the high sitosterol group were 91.0 ± 22.9 mg/dL and 71.1 ± 23.3 mg/dL, respectively. In the high sitosterol group, the Kaplan-Meier event rate for the primary endpoint at 3 years was 26.0% in the pitavastatin + ezetimibe group, as compared with 34.3% in the pitavastatin-monotherapy group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; p = 0.006, p-value for interaction = 0.010). However, in the low sitosterol group, there was no significant reduction of the primary endpoint by pitavastatin + ezetimibe therapy. CONCLUSIONS: Aggressive lipid-lowering treatment with ezetimibe had a positive effect on clinical outcomes in the high sitosterol subset of ACS patients with dyslipidaemia, but not in the low sitosterol subset. This effect was independent of LDL-C reduction and suggests that sitosterol measurement on admission in ACS patients might contribute to a "personalised" lipid-lowering approach.

Low-density lipoprotein cholesterol targeting with pitavastatin + ezetimibe for patients with acute coronary syndrome and dyslipidaemia: the HIJ-PROPER study, a prospective, open-label, randomized trial.

AIMS: To elucidate the effects of intensive LDL-C lowering treatment with a standard dose of statin and ezetimibe in patients with dyslipidaemia and high risk of coronary events, targeting LDL-C less than 70 mg/dL (1.8 mmol/L), compared with standard LDL-C lowering lipid monotherapy targeting less than 100 mg/dL (2.6 mmol/L). METHODS AND RESULTS: The HIJ-PROPER study is a prospective, randomized, open-label trial to assess whether intensive LDL-C lowering with standard-dose pitavastatin plus ezetimibe reduces cardiovascular events more than standard LDL-C lowering with pitavastatin monotherapy in patients with acute coronary syndrome (ACS) and dyslipidaemia. Patients were randomized to intensive lowering (target LDL-C < 70 mg/dL [1.8 mmol/L]; pitavastatin plus ezetimibe) or standard lowering (target LDL-C 90 mg/dL to 100 mg/dL [2.3-2.6 mmol/L]; pitavastatin monotherapy). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina, and ischaemia-driven revascularization. Between January 2010 and April 2013, 1734 patients were enroled at 19 hospitals in Japan. Patients were followed for at least 36 months. Median follow-up was 3.86 years. Mean follow-up LDL-C was 65.1 mg/dL (1.68 mmol/L) for pitavastatin plus ezetimibe and 84.6 mg/dL (2.19 mmol/L) for pitavastatin monotherapy. LDL-C lowering with statin plus ezetimibe did not reduce primary endpoint occurrence in comparison with standard statin monotherapy (283/864, 32.8% vs. 316/857, 36.9%; HR 0.89, 95% CI 0.76-1.04, P = 0.152). In, ACS patients with higher cholesterol absorption, represented by elevated pre-treatment sitosterol, was associated with significantly lower incidence of the primary endpoint in the statin plus ezetimibe group (HR 0.71, 95% CI 0.56-0.91). CONCLUSION: Although intensive lowering with standard pitavastatin plus ezetimibe showed no more cardiovascular benefit than standard pitavastatin monotherapy in ACS patients with dyslipidaemia, statin plus ezetimibe may be more effective than statin monotherapy in patients with higher cholesterol absorption; further confirmation is needed. TRIAL NO: UMIN000002742, registered as an International Standard Randomized Controlled Trial.

Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: A report from the Angina Pectoris-Myocardial Infarction Multicenter Investigators in Japan.

BACKGROUND: We sought to compare the prognosis of patients with spontaneous coronary artery dissection (SCAD) and atherosclerosis as the cause of acute myocardial infarction (AMI), especially in young females. METHODS AND RESULTS: A total of 20,195 patients with AMI at 20 institutions between 2000 and 2013 were retrospectively studied. Major adverse cardiac event (MACE: cardiac death, AMI or urgent revascularization) was the endpoint. The overall prevalence of SCAD was 0.31% (n=63; female, 94%). SCAD developed following emotional stress in 29% of patients. Revascularization was performed in 56% (35 of 63 patients), and SCAD recurrence developed in the originally involved vessel in 6 of 35 patients with revascularization, compared to none among 28 patients after conservative therapy (p=0.002). We compared the clinical characteristics of young female AMI patients aged ≤50years in the SCAD (n=45) and no-SCAD groups (atherosclerotic AMI, n=55). During a median follow-up of 50months, SCAD recurred in 27% of patients, of which 42% was in the first 30days. Kaplan-Meier analysis showed a significantly higher incidence of MACE in the SCAD group compared to the no-SCAD group (hazard ratio, 6.91; 95% confidence interval, 2.5 to 24.3; p<0.001), although the rate of successful percutaneous coronary intervention for SCAD was as high as 92%. CONCLUSIONS: Young female patients with SCAD represent a high-risk subgroup of patients with AMI and require close follow-up.

Reliability and validity of a quantitative color scale to evaluate masticatory performance using color-changeable chewing gum.

In the present study, we developed a novel color scale for visual assessment, conforming to theoretical color changes of a gum, to evaluate masticatoryperformance; moreover, we investigated the reliability and validity of this evaluation method using the color scale. Ten participants (aged 26.30 years) with natural dentition chewed the gum at several chewing strokes. Changes in color were measured using a colorimeter, and then, linearregression expressions that represented changes in gum color were derived. The color scale was developed using these regression expressions. Thirty-two chewed gums were evaluated using colorimeter and were assessed three times using the color scale by six dentists aged 25.27 (mean, 25.8) years, six preclinical dental students aged 21.23 (mean, 22.2) years, and six elderly individuals aged 68.84 (mean, 74.0) years. The intrarater and interrater reliability of evaluations was assessed using intraclass correlation coefficients. Validity of the method compared with a colorimeter was assessed using Spearman's rank correlation coefficient. All intraclass correlation coefficients were > 0.90, and Spearman's rank-correlation coefficients were > 0.95 in all groups. These results indicated that the evaluation method of the color-changeable chewing gum using the newly developed color scale is reliable and valid.

Properties of a color-changeable chewing gum used to evaluate masticatory performance.

PURPOSE: To clarify the basic properties of a color-changeable chewing gum to determine its applicability to evaluations of masticatory performance under different types of dental status. METHODS: Ten participants with natural dentition aged 26-30 years chewed gum that changes color during several chewing strokes over five repetitions. Changes in color were assessed using a colorimeter, and then L*, a*, and b* values in the CIELAB color system were quantified. Relationships between chewing progression and color changes were assessed using regression analysis and the reliability of color changes was assessed using intraclass correlation coefficients. We then measured 42 dentate participants (age, 22-31 years) and 47 complete denture wearers (age, 44-90 years) to determine the detectability of masticatory performance under two types of dental status. RESULTS: Regression between the number of chewing strokes and the difference between two colors was non-linear. The intraclass correlation coefficients were highest between 60 and 160 chewing strokes. Dentate and edentulous groups significantly differed (Wilcoxon rank sum test) and values were widely distributed within each group. CONCLUSIONS: The color of the chewing gum changed over a wide range, which was sufficient to evaluate the masticatory performance of individuals with natural dentition and those with complete dentures. Changes in the color values of the gum reliably reflected masticatory performance. These findings indicate that the color-changeable chewing gum will be useful for evaluating masticatory performance under any dental status.

Surgical repair of complicated coronary arteriovenous fistula and coronary artery aneurysm in an elderly patient after 26 years of conservative therapy.

We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.

Development of soft denture lining materials containing fluorinated monomers.

PURPOSE: To develop a new fluorine-containing soft denture lining material, the influences of fluorinated monomers on physical properties and contamination resistance were examined. METHODS: Five experimental materials of different chemical compositions in fluorinated monomer and two plasticized acrylics (Supersoft, VertexSoft) were used to evaluate water sorption, solubility, staining resistance, Shore A hardness, and contact angle. Five specimens for each test were fabricated. The results were analyzed with one-way analysis of variance (ANOVA) and Tukey's HSD test using statistical software at p=0.05. RESULTS: The amount of water sorption tended to decrease as the number of the fluorine atoms in fluorinated monomers increased. Similar solubility was shown regardless of the type of fluorinated monomer. The use of fluorinated monomers for immersion in coffee allowed suppression of discoloration. In beta -carotene, there were no significant differences in color changes among four experimental materials with fluorinated monomer. Shore A hardness was decreased and the contact angles tended to increase as the number of fluorine atoms in fluorinated monomers increased. When comparing the experimental materials and commercially available materials, the experimental materials containing fluorinated monomers with large numbers of fluorine atoms showed adequate clinical properties except for staining test of beta -carotene. CONCLUSION: Monomers with a large number of fluorine atoms can be used to develop applicable soft denture lining materials in clinical practice.

[Effect of the viscosity of alginate impression materials on the preliminary impression for complete dentures].

The purpose of this study was to clarify the effect of the viscosity of alginate impression materials on the results of the preliminary impressions for complete dentures. Five experimental alginate impression materials with different viscosity were prepared based on a conventional material. Fifteen complete denture wearers were selected and impressions on using the experimental materials were taken. Impressions were evaluated by the success rates at the mylohyoid ridge area (MR), buccal area (BL) and retromolar pad area (RP). The success rates had a tendency to increase as the viscosity rose at MR and RP. The success rates at BL were not significantly different among the materials. Our results indicate that the viscosity of alginate impression materials has a great effect on the results of preliminary impression for complete dentures, especially at MR. Impression materials with high viscosity may be suitable for recording the anatomical form of the alveolar ridge better than those with low viscosity.

Airway hyperresponsiveness in patients with coronary spastic angina: relationship between coronary spasticity and airway responsiveness.

BACKGROUND: Several reports have suggested a possible link between bronchial asthma and coronary spasm, but the possibility of a relationship in coronary spastic angina (CSA) has not been clarified. METHODS AND RESULTS: Airway responsiveness to methacholine and coronary spasticity to acetylcholine were examined in 42 patients with CSA and 36 patients with chest pain syndrome (CP). Furthermore, 18 control subjects were examined and their airway responsiveness compared with that of the CSA and CP patients. The incidence of airway hyperresponsiveness was significantly higher in the CSA group (74%) than in the CP (19%) and control (17%) groups (p<0.0001). The geometric mean of the log minimum dose (Dmin), defined as the cumulative dose at the point at which respiratory conductance began to decrease, was significantly lower in the CSA group (0.75 log units) than in the CP (1.20 log units) and control (1.38 log units) groups (p=0.004). CONCLUSION: These results demonstrate that acetylcholine-induced coronary spasticity is significantly related to methacholine-induced airway responsiveness in patients with CSA. A generalized hyperresponsiveness of the vascular and nonvascular smooth muscles, including that through cholinergic mechanisms, may exist in patients with CSA.

In vitro study of reduction of stress transferred onto tissues around implants using a resilient material in maxillary implant overdentures.

The purpose of this in vitro study was to investigate the effect of hardness on the reduction of stress transferred to tissues around implants using a resilient material applied to the female parts of the ball attachment in maxillary implant overdentures. A cast chrome-cobalt framework was mounted onto a maxillary acrylic edentulous model, which contained two implants and four strain gauges attached to the implant. Ball abutments were screwed into the implant. One abutment was connected to a dedicated metal cap embedded in the housing, while the others were connected to resilient test materials with four different hardnesses. Loads were applied using a universal testing machine with a magnitude of 50 N. The sums of the absolute values recorded from the four strain gauges were used for stress evaluation. The measured strains were analyzed statistically using two-way ANOVA and multiple comparisons. A resilient material with hardness 90 exhibited strains that did not differ significantly from the control. In contrast, the other resilient materials showed significantly reduced strains under all conditions. In this limited study, application of resilient silicone materials with approximate hardness 80 to the female parts of ball attachments significantly reduced the stress on the tissues around the implant.

Evaluations of masticatory performance of complete denture wearers using color-changeable chewing gum and other evaluating methods.

We have been investigating and developing a color-changeable chewing gum, that tends not to adhere to dentures. The aim of this study was to investigate the color change of the chewing gum comparing to other methods while evaluating post-insertion changes of masticatory performance of complete denture wearers. Color-changeable chewing gum, the peanuts sieve test, a patient satisfaction questionnaire and a food questionnaire were applied to 26 edentulous subjects. The subjects were tested on two occasions: with previous dentures, with new dentures when they had no symptoms after finishing denture adjustment. In comparison between the differences of previous and new dentures, significant correlations were found between the color change of the chewing gum and the scores of patient satisfaction questionnaires and food questionnaire. It was suggested that this chewing gum was useful for an objective masticatory evaluation of the denture wearers and could contribute to prosthetic treatments according to patients' satisfaction for dentures, which is clinically important information for both patients and dentists.

Silent pulmonary artery dissection in a patient with Eisenmenger syndrome due to ventricular septal defect: a case report.

A 62-year-old woman was admitted to our hospital because of fever in August 2002. She had been treated under a diagnosis of Eisenmenger syndrome with ventricular septal defect since 1988. On admission, echocardiography and color Doppler echocardiography revealed a markedly enlarged pulmonary artery with a mobile flap, and dissection of the pulmonary artery. The origin of the fever could not be identified, and the fever subsided spontaneously without specific treatment. She had no chest pain, but fever might have been a sign of dissection in this patient. Longstanding pulmonary hypertension may cause dissection, which may lead to sudden death or pulmonary hemorrhage often seen in patients with Eisenmenger syndrome. Our patient was a rare survivor without serious bleeding complication.

[Predictive value of coagulative molecular markers for thromboembolism in patients with nonvalvular atrial fibrillation: prospective five-year follow-up study].

OBJECTIVES: Nonvalvular atrial fibrillation is a known risk factor for thromboembolism. This study investigated the use of coagulation markers to predict thromboembolism in nonvalvular atrial fibrillation patients. METHODS: One hundred thirty nonvalvular atrial fibrillation patients (104 males, 26 females, mean age 63.7 +/- 10.7 years) treated at the Sendai Cardiovascular Center from April 1996 to August 1997 were enrolled in this study. Coagulation markers such as prothrombin fragment 1 + 2, thrombin-antithrombin III complex and D-dimer were measured, and the patients were followed up prospectively to October 2001. RESULTS: One hundred and twenty-six patents (100 males, 26 females, chase rate 96.9%) were included in this investigation based on the medical chart and telephone interview. During five-year follow-up, 16 patients had thromboembolism accidents (3.25%/year) and two were suspected to die of thromboembolism. Three patients died of malignant disease, four of heart disease, and five of other diseases. Eight (25.8%) of the 31 patients with high levels of thrombin-antithrombin III complex and 6 (33.3%) of 18 patients with high levels of D-dimer suffered thromboembolism accidents. High thrombin-antithrombin III complex and D-dimer were statistically positive predictive markers for thromboembolism in patients with nonvalvular atrial fibrillation (p < 0.05). CONCLUSIONS: Coagulation markers such as thrombin-antithrombin III complex and D-dimer can predict thromboembolism accidents in nonvalvular atrial fibrillation patients.

Solitary cardiac metastasis of rectal adenocarcinoma.

Solitary cardiac metastasis is rarely recognized. We report a case of solitary cardiac metastasis from a rectal adenocarcinoma that was manifested as superior vena cava (SVC) syndrome. Invasion of the deep cardiac structures was so severe that only its palliative resection and right atrial reconstruction were performed using a cardiopulmonary bypass to release the SVC obstruction. The postoperative course was uneventful and the patient was discharged home without any complications. Adjuvant chemotherapy could not be performed because of the renal dysfunction. Eleven months later, the patient died from multiple metastasis of adenocarcinoma. Even though the surgery was not curative, it might be effective for release from symptoms and for elongating life expectancy.

[Complex myxoma detected by syncope: a case report].

A 23-year-old man was admitted to our hospital for evaluation of syncope and intracardiac masses. Echocardiography revealed three masses in the right ventricle and one in the left ventricle. The largest mass, 4 by 5 cm, occupied the right ventricular outflow tract and prolapsed through the pulmonary valve orifice. Right ventricular systolic pressure was 65 mmHg. A soft mass, 4 by 5 cm, was found on the left subcostal abdominal wall and multiple pigmented spots on the face and trunk. Histological examination of the resected tumors, including the abdominal soft mass, were consistent with myxoma. The combination of multiple cardiac and abdominal wall myxomas and pigmented skin lesions in this young patient is considered to be a diagnostic feature of Carney complex.

[A study on evaluation methods of masticatory ability for complete denture wearers--correlation between evaluation using a questionnaire and masticatory performance].

The purpose of this study was to investigate the relation between evaluation by a questionnaire on masticatory aspects of 20 foods, and masticatory performance obtained using the sieving method, previously used in many studies. After replacement of upper and lower complete dentures made newly, 28 edentulous patients voluntarily participated in this study. The basal seat area of each patient was scored and divided into two groups, and masticatory ability was evaluated by two methods: using a questionnaire and the sieving method. The following conclusions were drawn from the data: 1. Evaluation of masticatory ability by both methods used in this study were not associated with gender, age, and evaluation of the basal seat area. 2. Evaluation using a questionnaire and masticatory performance showed significant correlation, and Spearman's correlation coefficient was 0.628 (p < 0.001).