Comparison of clinical outcomes between percutaneous coronary intervention for the de novo lesion versus in-stent restenosis lesion

Background and objective

Percutaneous coronary intervention (PCI) with metallic coronary stent (bare-metal stents [BMS] and drug-eluting stents [DES]) implantation is most frequently performed therapeutic procedures for coronary artery disease. In-stent restenosis (ISR) is a critical drawback of metallic coronary stents. Incidence of ISR has been reported in up to 30% after BMS implantation. The use of DES has greatly reduced the proportion of restenosis compared with the BMS. However, ISR still remains the primary concern after PCI even in the contemporary DES era, and thought to be associated with worse clinical outcomes. However, comparative data on ISR and de novo lesions are rare.

Purpose

The aim of the present study was to compare the clinical outcomes after PCI for the de novo lesion and the ISR lesion.

Methods

We performed a retrospective analysis of patients who underwent PCI between 2013 and 2020. The incidences of major adverse cardiac and cerebrovascular events (MACCE) and all-cause death were evaluated. MACCE was defined as composite of cardiovascular death, non-fatal myocardial infarction, and stroke.

Results

In this study, 1538 patients were enrolled and divided into two groups: PCI for de novo lesion group (n=1258, 81.8%), and PCI for ISR lesion group (n=280, 18.2%). Patients in the ISR lesion group were significantly older and had higher prevalence of hypertension, diabetes mellitus, dyslipidemia and chronic kidney disease than patients in the de novo lesion group. During a median follow-up period of 1.9 years, Kaplan-Meier curves showed no significant differences in the incidences of MACCE (log-rank, p=0.86) and all-cause death (p=0.84) between two groups. After adjustment for other covariates, PCI for ISR lesion were not significantly associated with MACCE (hazard ratio [HR], 1.10; 95% confidential interval [CI], 0.61–1.97; p=0.76) and all-cause death (HR, 0.93; 95% CI, 0.56–1.56; p=0.79)

Conclusion

PCI for the ISR lesion was not associated with worse clinical outcomes compared with PCI for the de novo lesion.

Funding Acknowledgement

Type of funding sources: None.

The relationship among extent of lipid-rich plaque, factors associated with a reduction of lipid-rich plaque and late lumen loss: a near-infrared spectroscopy and intravascular ultrasound study

Background

Near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS) are useful imaging modalities to identify lipid-rich plaque (LRP) which is associated with an increased risk of future cardiovascular events in individuals undergoing PCI. Pathological studies have raised concerns that treating LRP with stents may impair vascular healing. However, the impact of stent implantation to LRP lesions was less known. Moreover, little information is available about changes in the extent of LRP at before and after PCI.

Purpose

The aim of this study was to investigate changes in LRP by NIRS between pre- and post-stent implantation, and to evaluate an association among impact of LRP by NIRS at pre- and post-stenting and late lumen loss (LLL) by angiography.

Methods

We studied 175 lesions in 149 patients who underwent PCI under NIRS-IVUS guidance and follow-up angiography at 8-month later from 2017 to 2020. Plaque characteristics on IVUS, the extent of LRP [defined as a long segment with a 4-mm maximum lipid core burden index (maxLCBI4mm)] on NIRS, and quantitative coronary angiography measurements were analyzed. We evaluated a change of the extent of LRP between pre- and post-stenting at index PCI procedure, and association between the extent of LRP and a 8-month LLL at follow-up coronary angiography. A large LRP was defined as maxLCBI4mm>400 at pre-stenting.

Results

Mean age was 64.5 years old, and 123 (82%) patients were male. The prevalence of large LRP was 51% and median plaque burden at minimum lumen area was 81%. The extent of LRP at culprit lesion significantly decreased from pre- to post-stenting (median maxLCBI4mm [interquartile range (IQR)]: 407 [199, 580] to 133 [13, 319], p<0.001) (Figure 1). In multivariable liner regression analysis, independent predictors for the reduction of LRP were a pre-stenting LRP (β coefficient = −57.0, 95% confidence interval (CI) [−65.1 to −48.8], p<0.001) and plaque burden (β coefficient = −30.0, 95% CI [−56.6 to −3.4], p<0.001), respectively. On the other hands, patient comorbidities, lipid profile and inflammatory markers were not associated with the reduction of LRP (all p>0.05). Median LLL at follow-up angiogram was 0.17 [0.07–0.35] mm. Both the extent of pre- and post-stenting LRP were not associated with LLL (r=0.018, p=0.80 and r=0.022, p=0.76, respectively) (Figure 2). In addition, there was no significant difference in LLL between the post-stenting large and non-large LRP (median [IQR] 0.18 [0.08–0.35] vs. 0.17 [0.07–0.35]; P=0.95).

Conclusions

This study showed coronary stent implantation significantly reduced the NIRS-derived LRP in patients undergoing PCI. Although the extent of pre-stenting LRP and IVUS plaque burden predicted the reduction of LRP, the extent of pre- and post-stenting LRP were not associated with LLL. These findings suggest that stent implantation for LRP, even in a large LRP, is safe and does not affect LLL.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Scatter plotsFigure 2. CENTRAL Figure

Coronary lipid-rich plaque characteristics with acute coronary syndrome and chronic coronary syndrome: a near infrared spectroscopy and intravascular ultrasound study

Background

Asians have a much lower incidence of adverse coronary events than Caucasians, and the characteristics of vulnerable plaque might be different among the ethnics.

Purpose

The aim of this study was to investigate the clinical characteristics of lipid-rich plaque (LRP) in the Asian population and we also aimed to distinguish the characteristics of an acute coronary syndrome (ACS) culprit lesion and a chronic coronary syndrome (CCS) culprit lesion. Furthermore, we evaluated the association between lipid core burden index (LCBI) and cardiovascular risk factors, lipid profiles, and inflammatory biomarkers, as determined in vivo by near infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging in patients undergoing percutaneous coronary intervention (PCI).

Methods

We evaluated 207 patients (ACS, n=75; CCS, n=132) who underwent PCI under NIRS-IVUS. Plaque characteristics and the extent of LRP [defined as a long segment with a 4-mm maximum LCBI (maxLCBI4mm)] on NIRS in de-novo culprit and non-culprit segments were analyzed.

Results

The mean age was 65 years old and 82% of patients were male. The ACS culprit lesions had a significantly higher maxLCBI4mm (median [interquartile range (IQR)]: 533 [385–745] vs. 361 [174–527], p<0.001) than the CCS culprit lesions. Whereas, no significant difference was seen in maxLCBI4mm between ACS and CCS non-culprit lesion segments (246 [53, 342] vs. 185 [37, 350], p=0.47) (Figure 1). Receiver-operating characteristic analysis showed that the NIRS maxLCBI4mm could distinguish the ACS culprit segment from the CCS culprit segment, with a sensitivity of 73% and a specificity of 69% (c-statistic = 0.69; p<0.001, cut-off value of max LCBI4mm = 408) (Figure 2). On multivariate logistic analysis, a large LRP (defined as maxLCBI4mm ≥400) was the strongest independent predictor of the ACS culprit segment (odds ratio, 3.87; 95% confidence interval, 1.95–8.02). In non-culprit segments, 19.8% of patients had at least one large LRP without a small lumen. No significant correlation was found between the extent of LRP and circulating lipid profiles and inflammatory makers biomarkers (hs-CRP, IL-6, TNF-α) in both the culprit and non-culprit lesion segments, whereas the extent of LRP was positively correlated with IVUS plaque burden (r=0.24, p<0.001).

Conclusions

We confirmed that NIRS-IVUS plaque assessment could be useful to differentiate ACS from CCS culprit lesions, and that a threshold maxLCBI4mm ≥400 was clinically suitable in Japanese patients. No systemic surrogate markers were found to be associated with the extent of LRP by NIRS in culprit and non-culprit segments. Consequently, we believe that direct intravascular evaluation of coronary plaque characteristics remains important for identification of high-risk LRP.

Funding Acknowledgement

Type of funding sources: None. Figure 1. The difference of maxLCBI4mmFigure 2. ROC curve

Superconducting gap structure of spin-triplet superconductor Sr2RuO4 studied by thermal conductivity

To clarify the superconducting gap structure of the spin-triplet superconductor Sr2RuO4, the in-plane thermal conductivity has been measured as a function of relative orientations of the thermal flow, the crystal axes, and a magnetic field rotating within the 2D RuO2 planes. The in-plane variation of the thermal conductivity is incompatible with any model with line nodes vertical to the 2D planes and indicates the existence of horizontal nodes. These results place strong constraints on models that attempt to explain the mechanism of the triplet superconductivity.

Antiproliferative effects of small fruit juices on several cancer cell lines

Juices prepared from small fruits, mainly growing in the northern part of Japan, were studied in an attempt to explore the feasibility of an assay that screens cytotoxic properties. Screening of 43 small fruit juices indicated that Actinidia polygama Maxim., Rosa rugosa Thunb., Vaccinium smallii A. Gray and Sorbus sambucifolia Roem, strongly inhibited the proliferation of all cancer cell lines examined and yet these juices were substantially less cytotoxic toward normal human cell lines.

Differentiation-inducing effects of small fruit juices on HL-60 leukemic cells

Epidemiological studies indicate that high intakes of fruits and vegetables are associated with a reduced risk of cancer, and several plant-derived drugs have been developed in medical oncology. Since only a small part of the flora has been tested for any kind of bioactivity, we chose small fruits as sources of differentiation-inducing activity against HL-60 leukemic cells. We have prepared juices from various small fruits that grow mainly in the northern part of Japan. Screening of 43 samples indicated that juices of Actinidia polygama Maxim., Rosa rugosa Thunb., Vaccinium smallii A. Gray, and Sorbus sambucifolia Roem. strongly induced differentiation of HL-60 cells to monocyte/macrophage characteristics in a concentration-dependent manner as indicated by histochemical and biochemical examinations.

Double stapling method of anastomosis after esophagectomy with endoscopic stapler to prevent postoperative stricture

To prevent stricture of an anastomotic site after operation of esophageal cancer, a new surgical technique, the "double-stapling method," was designed and applied clinically to 29 patients. According to the surgical technique, an automatic suture device for endoscopy was inserted from the side of the lesser curvature of the stomach to the esophageal side after performing end-side anastomosis between the esophagus and the stomach tube using a conventional circular anastomotic device to perform anastomosis between the anterior wall of the esophagus and the posterior wall of the stomach tube. As a result, a conventional anastomotic site, which was a plane (two dimensional), was transformed into a three-dimensional configuration. In the postoperative measurement of the anastomotic site using a measurement forceps, the inner diameter of the site was 8.6+/-3.1 mm in the circular group, while it was 17.2+/-4.5 mm in the DS group, showing a significant difference (p < 0.0001). Minor leakage was observed in three patients as a postoperative complication, but no postoperative hemorrhage occurred.

[Participation of sialic acid residue in the fibrinogen-fibrin conversion by thrombin]

In order to estimate the effects of sialic acid residues in fibrinogen on the fibrinogen-fibrin conversion by bovine thrombin the Michaelis constant (Km) and maximum velocity (Vmax) were determined. The Km value obtained by the use of intact-fibrinogen was smaller than that of asialo-fibrinogen. This fact suggests that the sialic acid residues affected the formation of the enzyme-substrate complex. It was also found that in comparison with the asialo-fibrinogen, the intact-fibrinogen was significantly influenced in the gel formation time by the ionic strength in the reaction solution.

Percutaneous transgastric intestinal decompression: the management of malignant bowel obstruction without nasal intubation

We inserted a long intestinal tube via the percutaneous transgastric route in three patients with an inoperable malignant bowel obstruction. The percutaneous endoscopic gastrostomy technique facilitated this method. The main purpose of our procedure is to achieve direct intestinal decompression without nasal intubation, which is not always possible by venting gastrostomy alone. Palliative intestinal decompression proved to be effective in all patients. This alternative therapeutic strategy for managing bowel obstruction in terminal cancer patients is herein presented.

Role of the gene encoding lipase activator from Pseudomonas sp. strain KWI-56 in in vitro activation of lipase

The function of the gene, act, which encodes lipase activator and that is downstream from the gene that encodes lipase, lip, in Pseudomonas sp. strain KWI-56, was studied with Escherichia coli as the host organism. E. coli carrying both the lip and act genes in either cis or trans produced an active lipase, but E. coli carrying only the lip gene produced an equal amount of inactive lipase protein. The active and inactive lipases had the same molecular weight and the same N-terminal amino acid sequence, so their primary structures were the same. The inactive lipase was not activated spontaneously, but it was activated in vitro by the addition of a crude cell extract of E. coli carrying an expression plasmid of the act gene. Lipase from Pseudomonas sp. strain KWI-56 was completely without enzymatic activity when denatured, but regained activity in vitro upon addition of the crude cell extract. These results indicate that the act gene affects the activation involved in the conformational change of the lipase protein to its active form.

Purification and characterization of a carboxylesterase from Pseudomonas sp. KWI-56

An intracellular carboxylesterase from Pseudomonas sp. was overproduced in E. coli, and purified to homogeneity by a combination of hydrogen bond chromatography, gel filtration, and hydrophobic interaction chromatography. Gel filtration and SDS-PAGE suggested that the purified enzyme consisted of two subunits of molecular mass of 28 kDa. Its isoelectric point was 5.9. The enzyme was thermolabile, and showed its maximum activity at 22 degrees C (pH 7.5). Methyl propionate was hydrolyzed at the highest rate among the fatty acid methyl esters tested. PMSF, DFP, PCMB, and HgCl2 inhibited the enzyme markedly, suggesting that serine and/or cysteine is in or near the active site.

Cloning and sequence analysis of an esterase gene from Pseudomonas sp. KWI-56

The gene encoding an esterase from Pseudomonas sp. KWI-56 was cloned and sequenced. The nucleotide sequence contained an open reading frame encoding a polypeptide comprising 262 amino acids, whose molecular weight agreed well with the value obtained by SDS-PAGE. Comparison of the amino acid sequence with those of the other homologous enzymes suggested that Ser-92 and His-24l might be included in the catalytic triad.

Anthelmintic efficacy of milbemycin D against Toxocara cati and Ancylostoma tubaeforme in domestic cats

Anthelmintic efficacy of milbemycin D was evaluated against Toxocara cati and Ancylostoma tubaeforme in domestic cats. Twelve cats naturally infected with each nematode species were allocated among 2 groups of 6 animals each, and milbemycin D was orally administered to the 2 groups of cats in doses of 0.05 mg/kg and 0.1 mg/kg body weight, respectively. In all the cats infected with T. cati, fecal egg counts decreased followed by their disappearance from the feces and 2-35 worms were excreted into the feces after the medication in both doses of 0.05 mg/kg and 0.1 mg/kg. At postmortem of these medicated groups, no worms were detected from 4 cats of each group, but 1 and 2 immature worms were recovered from the other 2 cats respectively. In the cats infected with A. tubaeforme, fecal egg counts decreased followed by the disappearance from the feces and 2-62 worms were excreted into the feces in all the cats of the 2 groups, no nematodes remaining at postmortem. These results indicate that milbemycin D is fully effective against T. cati and A. tubaeforme in cats in a dose of 0.05-0.1 mg/kg.

[Modified operation for an early stage gastric cancer]

The standard operation for gastric cancer is carried out for advanced gastric cancer with serosal invasion accompanying patent disseminative metastasis to the peritoneum of the omental bursa and lymph node metastases. It consists of subtotal or total gastrectomy, omentobursectomy and extended lymph node dissection. An early stage cancer, which in Japan accounts for almost a half of the resectable cases of gastric cancer, shows no serosal invasion, and lymph node metastases are rare if the cancer remains intramucosal. Such cases represent about a half the cases of the early stage cancer. The diagnosis of the early stage cancer, especially if it remains intramucosal, is made by means of preoperative radiological and endoscopic examinations and intraoperative examination. Since 1977 we have been performing a modified operation as well for cases of the early stage cancer. The surgical procedure is as follows: reduction in the size of gastric resection by 2/3, pylorus-preserving gastrectomy and proximal gastric resection; preservation of the distal portion of the greater omentum and transverse incision of the upper abdomen instead of upper midline incision to prevent ileus due to intestinal adhesion to abdominal wound around umbilicus; sparing bursectomy; narrowing the area of lymph node dissection; sparing thoracotomy for cancer in the esophagogastric junction; sparing splenopancreatectomy; preservation of the hepatic branch of the vagal nerve and postoperative temporary oral administration of cholagogue to prevent postgastrectomy cholelithiasis. In addition, the primary lesion is isolated from the blood circulation by means of ligation of the drainage veins to diminish metastasis through the blood vessels (hepatic metastasis, etc.), which is the main cause recurrence after surgery for the early stage cancer. The results of this new surgery are satisfactory; the five-year postoperative survival rate is 100.0% and it reduced the time needed for surgery, anesthesia and blood transfusion.

Urinary kallikrein and non-kallikrein arginine esterase activities in beagle dogs

The activity of urinary kallikrein and non-kallikrein arginine esterase was measured in the 16hrs urine of 16 beagle dogs. Enzyme activity was assayed using D-valyl-L-leucyl-L-arginine-p-nitroanilide as a substrate at 30 degrees C, pH 8.0, and the unit of measurement was defined as the activity which catalyzes the hydrolysis of 1 mumol of the substrate per minute. Kallikrein activity ranged from 3.87 to 48.92 (28.48 average) mU/ml of urine, or from 1.05 to 12.51 (4.56 average) U/16 hrs; whereas that of non-kallikrein arginine esterase ranged from 0.06 to 24.28 (7.11 average) mU/ml, or from 0.01 to 9.78 (1.43 average) U/16 hrs. The ratio between the activity of these two enzymes was 1: 0.002-1: 2.98 (1: 0.42 average). Male dogs had a tendency to show a higher enzyme activity than females for urinary kallikrein and non-kallikrein arginine esterase.

Scanning electron microscopy of celluloid replicas of the penile spines of the domestic cat

Using scanning electron microscopy of celluloid impressions the feline penile spines in the adult and after castration were studied. A solution of celluloid in a mixture of amyl acetate was placed on the glans. The replica thus obtained was coated with gold in an ion-spatter coater, and observed under a scanning electron microscope (JSM-1). The structure of the penile spines and fine arrangement of superficial cells of the epidermis could be observed three-dimensionally. Since the penile spines are the only known external indicators of the level of male hormone in cats, and since their fine structure can be observed without excising the penile skin, this simple method can be applied for diagnosis of fertility of the male cat.