Differential impacts of self-care behavior on clinical outcomes in patients with and without recent heart failure hospitalization.

BACKGROUND: Although clinical guidelines recommend self-care assessment for patients with chronic heart failure (CHF), its prognostic significance remains controversial. This study aimed to compare the prognostic significance of self-care behavior on mortality between patients with and without a history of recent hospitalization for heart failure (HF). METHODS: We analyzed consecutive 1907 CHF patients from a Japanese multicenter registry (January 2020-June 2023) using the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9) at enrolment. Suboptimal self-care behavior was defined as a score < 70 on the EHFScBS-9. Patients were divided into recent (within 30 days post-discharge, n = 664) and no recent hospitalization for HF groups (n = 1263), respectively. The primary outcome was a composite of all-cause death and rehospitalization for HF. RESULTS: During a median follow-up period of 427 (interquartile range 273-630) days, the primary outcome occurred in 100 patients. Patients with suboptimal self-care behavior exhibited a higher incidence of the primary outcome in the recent hospitalization for HF group (p = 0.020) but not in the no recent hospitalization for HF group (P = 0.16). Multivariable regressions showed suboptimal self-care behavior was independently associated with the primary outcome in the recent hospitalization for HF group with a significant interaction (P = 0.029). CONCLUSION: In patients recently hospitalized for HF, but not in those without a recent hospitalization history for HF, suboptimal self-care behavior was associated with adverse events. This indicates the importance of self-care education for these patients.

Cognitive screening test for rehabilitation using spatiotemporal data extracted from a digital trail making test part-A.

We investigated a newly developed digitized Trail Making Test using an iPad (iTMT) as a brief cognitive function screening test. We found that the iTMT part-A (iTMT-A) can estimate generalized cognitive function in rehabilitation inpatients examined using the Mini-Mental State Examination (MMSE). Forty-two hospitalized participants undergoing rehabilitation (rehab participants), 30 of whom had cerebral infarction/hemorrhage (stroke participants), performed the iTMT five times (first three times: iTMT-A; fourth: paper version of TMT-A; fifth: the inverse version of iTMT-A) and the MMSE once. Each iTMT-A trial's completion time was divided into the move and dwell times. A linear mixed model following post-hoc tests revealed that the completion time of the third and fourth iTMT-A was faster compared to that of the first iTMT-A, suggesting the presence of a learning effect. In the partial least squares (PLS) regression analysis, the coefficient of determination for estimating the MMSE score was increased by using the dwell and move times extracted from the repeated iTMT-A and the availability of TMT-B, even for subjects with low MMSE scores. These findings indicate that the dwell time of iTMT-A may be important for estimating cognitive function. The iTMT-A extracts significant factors temporally and spatially, and by incorporating the learning effect of repeated trials, it may be possible to screen cognitive and physical functions for rehabilitation patients.

Venous Malformation in the Anterior Mediastinum.

Venous malformations (VMs) located in the anterior mediastinum are rare. Thus, diagnosis using imaging is often challenging, and they are typically diagnosed only after total tumor resection. Herein, we report a case of VM located in the anterior mediastinum diagnosed using computed tomography (CT) and magnetic resonance imaging (MRI). A 56-year-old woman presented for further evaluation of an anterior mediastinal mass observed during a chest CT. On CT, the mass was observed to have scattered calcifications and early and persistent enhancement with contrast material pooling dorsally in the delayed phase. On MRI, the mass was isointense on T1-weighted imaging and hyperintense on T2-weighted imaging without flow voids. From these images, we suspected the mass to be a VM, but the possibility of an arterial malformation/fistula could not be ruled out. Initially, a contrast material was injected via the arm, but to improve differentiation, it was also injected via the leg. The 4D-CT of the leg indicated no early enhancement of the mass; however, gradual enhancement was observed. This led to a definite diagnosis of VM. As she had no symptoms, we opted for a CT follow-up, and the mass remained stable for one year post-diagnosis. This case report underscores the usefulness of injecting contrast material through the leg in distinguishing VM from AVM/Fs in the anterior mediastinum.

Pen-point Trajectory Analysis During Trail Making Test Based on a Time Base Generator Model.

The Trail Making test (TMT) is a widely used neuropsychological test to assess the cognitive function of patients. This paper presents the analysis method of pen-point trajectory during the TMT based on a time base generator (TBG). In the proposed method, the movement segments between targets are first extracted from pen-point trajectories, which are measured during performance of the TMT on an iPad. By fitting the extracted trajectories with a TBG-based trajectory generation model, the proposed method can then calculate quantitative indices representing the shape and collapse of the velocity profile. In the experiment, we analyzed TMT data from 25 stroke patients who were classified into three groups according to their scores on the Mini-Mental State Examination (MMSE). The results revealed that most of the measured inter-target trajectories had unimodal bell-shaped velocity profiles, as seen in reaching movements. Furthermore, we found that the degree of collapse in the velocity profile shape increased significantly when the cognitive function decreased.

Five Non-motile Dinotom Dinoflagellates of the Genus Dinothrix.

Dinothrix paradoxa and Gymnodinium quadrilobatum are benthic dinoflagellates possessing diatom-derived tertiary plastids, so-called dinotoms. Due to the lack of available genetic information, their phylogenetic relationship remains unknown. In this study, sequencing of 18S ribosomal DNA (rDNA) and the rbcL gene from temporary cultures isolated from natural samples revealed that they are close relatives of another dinotom, Galeidinium rugatum. The morphologies of these three dinotoms differ significantly from each other; however, they share a distinctive life cycle, in which the non-motile cells without flagella are their dominant phase. Cell division occurs in this non-motile phase, while swimming cells only appear for several hours after being released from each daughter cell. Furthermore, we succeeded in isolating and establishing two novel dinotom strains, HG180 and HG204, which show a similar life cycle and are phylogenetically closely related to the aforementioned three species. The non-motile cells of strain HG180 are characterized by the possession of a hemispheroidal cell covered with numerous nodes, while those of the strain HG204 form aggregations consisting of spherical smooth-surface cells. Based on the similarity in life cycles and phylogenetic closeness, we conclude that all five species should belong to a single genus, Dinothrix, the oldest genus within this clade. We transferred Ga. rugatum and Gy. quadrilobatum to Dinothrix, and described strains HG180 and HG204 as Dinothrix phymatodea sp. nov. and Dinothrix pseudoparadoxa sp. nov.

Area-Based Medicine in the Super-Ageing Society in Japan.

Japan's health insurance system has reached a critical turning point owing to a decreasing birthrate, increasing longevity, and changes in disease trends. The Japanese government is promoting the establishment of a community-based integrated care system aimed at maintaining the dignity of elderly individuals and supporting independent living. This care system will ensure medical and nursing care, preventive measures, and independent living support. This type of care system should be based on the characteristics of individual geographical areas, as there are marked regional variations in patterns of aging, lifestyle, and the adequacy of local medical care. Therefore, it is important that medical services are tailored to fit the kind of medical care needed by residents of each geographical area and to provide medical services accordingly. In this paper, we propose a need for area-based medicine, whereby medical care is provided according to the characteristics of individual geographical areas in super-ageing societies such as that of Japan. J. Med. Invest. 67 : 40-43, February, 2020.

A case of ventricular asystole without escape rhythm 4 days after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy with drug-resistant paroxysmal atrial fibrillation.

A 42-year-old man with a more than 10-year history of hypertrophic obstructive cardiomyopathy, but no history of heart failure or syncope, had left ventricular outflow tract pressure gradient (LVOT-PG) of 50-80 mmHg on Doppler echocardiography. In June 2010, he experienced general malaise on effort, and LVOT-PG increased to 124 mmHg. Two months later, he suffered a transient ischemic attack, complicated with atrial fibrillation (AF). He underwent cardiac defibrillation and was prescribed amiodarone, but the arrhythmia recurred easily. Therefore, percutaneous transluminal septal myocardial ablation (PTSMA) was performed to prevent AF. The procedure entailed transient complete atrioventricular block (CAVB), which was resolved after a few hours. Four days later, CAVB recurred and advanced to fatal ventricular asystole without escape rhythm. The patient was resuscitated instantaneously and recovered without brain damage. Finally, a DDD permanent pacemaker was implanted 10 days after the procedure. Except for conduction problems, his cardiac condition was good after PTSMA, as paroxysmal AF disappeared and LVOT-PG was markedly decreased. CAVB is a well-known complication of PTSMA, but fatal ventricular asystole several days after the procedure is rare. Intensive care is required after PTSMA implementation.

[Underlying examination in the imaging of 89Sr bremsstrahlung radiation].

The radiopharmaceutical strontium chloride ((89)Sr) has been released as a new means of pain relief for painful bone metastasis in cancer patients. Because (89)Sr is a pure beta-emitting nuclide, it was considered difficult to know its distribution in the body from outside. Imaging with a gamma camera using bremsstrahlung radiation has been reported as one method, but there has been little detailed basic examination. We examined the optimal energy window and collimator when imaging with a gamma camera using bremsstrahlung radiation produced from (89)Sr beta rays. The results showed that setting the energy window at 75 keV, which is the peak formed by the characteristic X-ray of lead that is produced by the interaction of bremsstrahlung radiation and lead, is optimal for imaging. Also important are the material of the collimator and the use of an MELP collimator.

Usefulness of a breath-holding acquisition method in PET/CT for pulmonary lesions.

OBJECTIVE: To evaluate the usefulness of a breath-holding (BH) (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography ((18)F-FDG-PET) technique for PET/computed tomography (CT) scanning of pulmonary lesions near the diaphragm, where image quality is influenced by respiratory motion. METHODS: In a basic study, simulated breath-holding PET (sBH-PET) data were acquired by repeating image acquisition eight times with fixation of a phantom at 15 s/bed. Free-breathing PET (FB-PET) was simulated by acquiring data even as moving the phantom at 120 s/bed (sFB-PET). Images with total acquisition times of 15 s, 30 s, 45 s, 60 s, and 120 s were generated for sBHPET. Receiver-operating characteristic (ROC) analyses and determination of the statistical significance of differences between sFB-PET images and sBH-PET images were performed. A total of 22 pulmonary lesions in 21 patients (12 men and 9 women, mean age 61.3 +/- 10.6 years, 10 benign lesions in 9 patients and 12 malignant lesions in 12 patients) were examined by FB-PET and BH-PET). For evaluation of these two acquisition methods, displacement of the lesion between CT and PET was considered to be a translation, and the statistical significance of differences in maximum standardized uptake value (SUV(max)) of the lesion was assessed using the paired t test. RESULTS: In the basic study, sBH-PET images with acquisition times of 45 s, 60 s, and 120 s had significantly higher diagnostic accuracy than 120-s sFB-PET images (P < 0.05). In clinical cases, translation of the BH-PET images was significantly lower than that of the FB-PET images (benign: 5.29 +/- 4.02 mm vs. 11.79 +/- 8.27 mm, P = 0.005; malignant: 4.29 +/- 3.36 mm vs. 18.26 +/- 12.31 mm, P = 0.003). The SUV(max) of the lesions in the BH-PET images was significantly higher than that in the FB-PET images (benign: 2.40 +/- 0.86 vs. 2.20 +/- 0.85, P = 0.005; malignant: 4.84 +/- 2.16 vs. 3.75 +/- 2.11, P = 0.001). CONCLUSIONS: BH-PET provides images with better diagnostic accuracy, avoids image degradation owing to respiratory motion, and yields more accurate attenuation correction. This method is very useful for overcoming the problem of respiratory motion.

Description of a new dinoflagellate with a diatom endosymbiont, Durinskia capensis sp. nov. (Peridiniales, Dinophyceae) from South Africa.

A new dinoflagellate Durinskia capensis Pienaar, Sakai et Horiguchi sp. nov. (Peridiniales, Dinophyceae), from tidal pools along the west coast of the Cape Peninsula, Republic of South Africa, is described. The dinoflagellate produces characteristic dense orange-red colored blooms in tidal pools. The organism is characterized by having a eukaryotic endosymbiotic alga. Ultrastructure study revealed the organism has a cellular construction similar to that of other diatom-harboring dinoflagellates. The cell is thecate and the plate formula is: Po, x, 4', 2a, 6'', 5c, 4s, 5''', 2'''', which is the same as that of Durinskia baltica, the type species of the genus Durinskia. D. capensis can, however, be distinguished from D. baltica by overall cell shape, the relative size of the 1a and 2a plates, the degree of cingular displacement, and the shape of the eyespot. Our molecular analysis based on SSU rDNA revealed that D. capensis is closely allied to D. baltica, thus supporting the assignment of this new species to this genus. This Durinskia clade takes a sister position to another diatom-harboring dinoflagellate clade, which includes Kryptoperidinium foliaceum and Galeidinium rugatum. Molecular analysis based on the rbcL gene sequence and ultrastructure study revealed that the endosymbiont of D. capensis is a diatom. The SSU rDNA gene trees indicated that four species with a diatom endosymbiont formed a clade, suggesting a single endosymbiotic origin.

[Atypical takotsubo cardiomyopathy with preservation of apical contraction: a case report including pathological findings].

A 60-year-old woman presented with sudden chest and back pain. Electrocardiography suggested anterior myocardial infarction but coronary angiography revealed no significant stenosis in the coronary artery. Left ventriculography revealed akinesis of the mid ventricle and preserved contraction of the apical wall. The clinical condition of atypical left ventricular akinesia was suggested to be the same as conventionally reported typical takotsubo cardiomyopathy. Repeated left ventriculography revealed the abnormal wall motion had disappeared. The findings of endomyocardial biopsy were compatible with takotsubo cardiomyopathy. Although the clinical presentation of the left ventricle is atypical, the pathological findings may be the same as typical takatsubo cardiomyopathy.

Usefulness of positron-emission tomographic images after proton therapy.

PURPOSE: To examine the positron emission tomography (PET) image obtained after proton irradiation and investigate the usefulness of the image for confirmation of the irradiated volume in proton radiotherapy (RT). METHODS AND MATERIALS: A homogenous phantom was irradiated separately by carbon-ion and proton beams and the images obtained were compared. The PET images of cancer patients just after proton RT were then taken after informed consent. RESULTS: In the PET image produced by carbon-ion beams, the high pixel counts in the image corresponded to the Bragg peak; however, in that produced by proton beams, they were visible throughout the entire track of the proton beams and were not related to the Bragg peak. The PET image of patients treated with proton RT was similar to that of the phantom experiment. CONCLUSION: The PET image after proton RT was different from that of carbon-ion RT. It was found that the PET image was very useful in proton RT to verify treatment planning.