A newly designed 0.018-in.-compatible inner dilator as a novel option for endovascular therapy with the crossover approach.

This study aimed to investigate the efficacy of guiding sheath delivery with the crossover approach using a newly customized inner dilator for a 0.018-in. guidewire of the Destination® guiding sheath (Terumo Corporation, Tokyo, Japan) (18-system), compared with that of the conventional-type 0.035-in. guidewires with inner dilators (35-system), and to predict failure of guiding sheath delivery. We conducted a prospective multicenter case series study of the contralateral crossover approach using Destination®, to determine whether the 18-system could be a rescue system in cases in which the conventional 35-system failed. To evaluate the efficacy of the 18-system, we created an in vitro aortoiliac bifurcation model by using a silicone vessel. We enrolled 172 cases consecutively. The initial crossover approach with the 35-system failed in 37 cases (21.5%), and a second attempt with the 18-system was successful in all failed cases. The bifurcation angles in the 35-system failure cases were significantly steeper than those in the 35-system success cases. A receiver operating characteristic curve analysis demonstrated that an aortoiliac bifurcation angle of 68° was the optimal cut-off value for predicting failure of the crossover procedure. Data from the analysis using the silicone vessel model suggested that the 18-system provided superior results, especially in aortoiliac bifurcation angles steeper than 60°, consistent with the in vivo findings. The results of the initial use of the 18-system with the crossover approach suggest that it may be superior to the conventional 35-system, especially in cases of steeper aortoiliac bifurcation angles.

Clinical Characteristics and Social Frailty of Super-Elderly Patients With Heart Failure　- The Kitakawachi Clinical Background and Outcome of Heart Failure Registry.

BACKGROUND: Social background is important in preventing admission/readmission of heart failure (HF) patients. However, few clinical studies have been conducted to assess the social background of these patients, especially elderly patients.Methods and Results:The Kitakawachi Clinical Background and Outcome of Heart Failure (KICKOFF) Registry is a prospective multicenter community-based cohort of HF patients, established in April 2015. We compared the clinical characteristics and social background of the super-elderly group (≥85 years old) and the non-super-elderly group (<85 years old). This study included 647 patients; 11.8% of the super-elderly patients were living alone, 15.6% were living with only a partner, and of these, only 66.7% had the support of other family members. The super-elderly group had less control over their diet and drug therapies than the non-super-elderly group. Most patients in the super-elderly group were registered for long-term care insurance (77.4%); 73.5% of the super-elderly patients could walk independently before admission, but only 55.5% could walk independently at discharge, whereas 94% of the non-super-elderly patients could walk independently before admission and 89.4% could walk independently at discharge. CONCLUSIONS: The KICKOFF Registry provides unique detailed social background information of Japanese patients with HF. Super-elderly patients are at serious risk of social frailty; they need the support of other people and their ability to perform activities of daily living decline when hospitalized.

Characterization of bacterial biofilm communities in tertiary treatment processes for wastewater reclamation and reuse.

The concern with wastewater reuse as a sustainable water resource in urban areas has been growing. For the reclamation and distribution of wastewater, biofilm development deserves careful attention from the point of view of its promotion (e.g. biofiltration) and inhibition (e.g. clogging and hygiene problems). As the first step to control biofilm development, bacterial biofilm communities in tertiary treatment processes were characterized by using molecular biological methods. The result of clone library analysis showed that Nitrospirae-related (nitrite-oxydizing bacteria) and Acidobacteria-related (probably oligotrophic bacteria) groups were dominant. The ratio of the Nitrospirae-related group to the Acidobacteria-related group was associated with ammonia load, whereas other operational conditions (process, media, temperature, salt) did not clearly affect the phylum-level community or the dominant sequence of nitrifying bacteria. The result of real-time PCR also indicated that high ammonia load promotes the proliferation of nitrite- and ammonia-oxidizing bacteria. Regarding water supply systems, some researchers also have suggested the dominance of Nitrospirae- and Acidobacteria-related groups in biofilm formed on water distribution pipes. In tertiary wastewater treatment, therefore, it is concluded that oligotrophic and autotrophic bacteria are the dominant groups in biofilm samples because assimilable organic carbon is too poor to proliferate various heterotrophic bacteria.