Significance of switching of the nucleos(t)ide analog used to treat Japanese patients with chronic hepatitis B virus infection from entecavir to tenofovir alafenamide fumarate

The significance of switching of the nucleos(t)ide analog used to treat patients with hepatitis B virus (HBV) from entecavir (ETV) to tenofovir alafenamide fumarate (TAF) is uncertain. The subjects of this study were 159 patients with HBV who received treatment with ETV followed by TAF. Among these patients, serial changes in the HBV marker levels were monitored in 92 patients in whom the serum HBsAg levels were ≥100 IU/mL during the 48-week period immediately before and after the switching. A questionnaire survey for medication compliance was performed in 127 patients. The serum HBsAg levels (log IU/mL) decreased by 0.041 during the ETV treatment period and by 0.068 during the TAF administration period. The degree of reduction was higher during the TAF administration period than during the ETV administration period in patients without cirrhosis (P = .030), patients with genotype B HBV (P = .014), and patients with undetectable serum HBcrAg (P = .038). Multivariate analysis revealed the HBV genotype (B vs C; odds ratio, 3.400; P = .025) and serum aspartate aminotransferase level (every 1+; 1.111; P = .015) at the time of switching as factors influencing the treatment efficacy. Thirty-six patients (28%) responded that the number of days that they forgot to take the drug decreased after the drug switching, and 77 patients (61%) reported feeling satisfied with the drug switching. Switching of the nucleos(t)ide analog used from ETV to TAF may be useful in the treatment of patients with HBV infection, as it is associated with both a decrease in the serum HBsAg level and improvement of the medication compliance.     

Influence of resting before sonographic examination on Doppler measurements of renal blood flow

Renal artery stenosis (RAS) is the most common cause of secondary hypertension, via increases in plasma renin–angiotensin–aldosterone levels. Renal artery stenosis is diagnosed from blood examinations such as renin activity and from imaging examinations such as sonography. Patients are required to lie on the bed for 30 min before and during phlebotomy, since plasma renin activity is easily altered by posture. However, no such pre‐examination rest is required for sonography. The present study therefore investigated the possible influence of resting before examination on Doppler parameters used for the diagnosis of RAS. Subjects comprised 55 healthy young adults (24 males, 31 females; mean age, 22 ± 1 years). Sonographic measurements were made shortly after subjects entered the examination room and again after 30 min of rest lying on a bed. Median peak systolic velocity in the renal artery was significantly decreased after rest (106 cm/s, interquartile range (IQR) 96–121 cm/s) compared with before rest (120 cm/s, IQR 107–135 cm/s; p < .001). Median acceleration time in the intra‐renal segmental artery was also significantly shorter after rest (49 ms, IQR 38–54 ms) compared to before rest (50 ms, IQR 38–59 ms; p = .039). The present results suggest that serious consideration should be given regarding whether pre‐examination resting is needed to accurately interpret Doppler measurements of renal blood flow when diagnosing RAS from sonography.     

Blood flow energy loss: a predictor for the recovery of left ventricular function after bioprosthetic aortic valve replacement

 Open in a separate windowOBJECTIVESIt is difficult to estimate the improvement in left ventricular (LV) function after aortic valve replacement (AVR). The present study aimed to evaluate whether energy loss (EL) can predict the postoperative LV function after AVR.METHODSNine patients who underwent AVR with a bioprosthetic valve were enrolled in the present study. Porcine prostheses were used in 5 patients and bovine pericardial prostheses were used in 4 patients. The aortic flow pattern was visualized and EL and cardiac output (CO) were measured using 4-dimensional flow magnetic resonance imaging from the LV to the descending aorta; the EL/CO ratio in the extracted area was calculated as total EL/CO ratio.RESULTSWith a porcine valve, a severe helical flow was observed in the ascending aorta during the holosystolic phase. In contrast, with a bovine pericardial valve, straight transvalvular aortic flow was observed in the early systolic phase and 2 large vortical flows occurred on both sides of the greater and lesser curvature of the ascending aorta after the mid-systolic period. The total EL/CO ratio was strongly correlated with LV ejection fraction improvement after AVR (r = 0.74, P = 0.02).CONCLUSIONSThe aortic flow pattern is different between the porcine valve and bovine pericardial valve. The total EL/CO ratio is a valuable tool for evaluating the postoperative LV ejection fraction improvement after AVR. Optimization of total EL/CO ratio would have potential to improve haemodynamic performances after AVR.     

Leadless cardiac pacemaker implantations after infected pacemaker system removals in octogenarians

BackgroundManagement of pacemaker (PM) infections among advanced aged patients possesses particular clinical challenges due to higher rates of concurrent cardiovascular disease and medical comorbidities. Novel leadless cardiac pacemakers (LCPs) may provide new opportunities for better management options in this population, however, there is limited data especially in Asian populations to guide the decision making.MethodsWe reviewed 11 octogenarians (median age: 86 [minimum 82–maximum 90] years; male: 73%; median body mass index (BMI): 20.1 kg/m²) who received Micra Transcatheter Pacing System (Medtronic Inc, Minneapolis, MN) implantations following transvenous lead extractions (TLEs) for PM infections. ResultsAll patients had more than two medical comorbidities (average 3.7 comorbidities). The indications for LCP implantations were atrioventricular block in four patients, atrial fibrillation bradycardia in five, and sinus node dysfunction in two. Eight patients (73%) were bridged with temporary pacing using active fixation leads (median interval of 14.0 days), while one with severe dementia underwent a concomitant LCP implantation and TLE during the same procedure. Successful TLEs and LCP implantations were successfully accomplished in all without any complications. The median time from the TLE procedure to discharge was 22 days (minimum 7–maximum 136). All patients remained free of infections during a mean follow-up period of 17.2 ± 6.5 months.ConclusionsLCP implantations were safe and effective after removing the entire infectious PM system in all octogenarians. The novel LCP technology may offer an alternative option for considering a re-implantation strategy after transvenous PM infections in elderly patients, particularly those with severe frailty and PM dependency.

The incidence of cardiac pacemaker (PM) infections among patients with an advanced age has been increasing owing to the continually widening indications and growing number of generator replacements.^[1–3] In current clinical practice, there is a class l indication for removing all hardware in the case of a proven or suspected device infection, and after a recovery window, a new conventional PM is implanted in PM dependent patients.^[1,4,5] However, this management for the elderly population is one of the most sensitive issues, since they possess particular clinical challenges due to higher rates of concurrent cardiovascular disease and medical comorbidities.^[6–10]Recently, the implantation of a Micra Transcatheter Pacing System (Medtronic Inc, Minneapolis, MN) has emerged as a new option for PM re-implantations after the removal of infectious PMs.^[11–17] Without the use of leads and a device pocket, this leadless cardiac pacemaker (LCP) potentially reduces the risk of pocket infections and lead associated endocarditis.^[16,17] However, there have not been enough data supporting the feasibility of leadless PM implantations following the removal of infectious PMs in people with an older age, particularly in octogenarians. Furthermore, there has been no data regarding those therapeutic strategies in Asian populations who have a low body mass index (BMI) and are at a higher risk of a transvenous lead extraction (TLE) procedure. Therefore, in this case series, we sought to characterize the procedure for LCP implantations following TLEs of infected PMs in octogenarians at 2 Japanese high-volume centers.     

Effect of Continuous Ingestion of 2 g of Medium-Chain Triglycerides on Substrate Metabolism during Low-Intensity Physical Activity

Increasing fat burning during physical activity is thought to be an effective strategy for maintaining health and preventing lifestyle-related diseases, such as obesity and diabetes. In recent years, medium-chain triglycerides (MCTs) have gained attention as a dietary component for increasing fat-burning. However, this fat-burning effect has been unclear in people with high body mass index (BMI). Therefore, we aimed to clarify the effects of 2 g of daily ingestion of MCTs over 2 weeks on substrate oxidation during low-intensity physical activity in sedentary (i.e., with no exercise habit) subjects with a BMI from 25 (kg/m²) to less than 30, which is classified as obese in Japan. A placebo-controlled, randomized, double-blind, crossover study with a 2-week washout period was conducted. The rate of fat oxidation as well as the respiratory exchange ratio (RER) during exercise (with a cycle ergometer at a 20-watt load) were measured with a human calorimeter. MCTs ingestion significantly increased fat oxidation during physical activity and decreased RER compared to long-chain triglycerides ingestion. In conclusion, we suggest that daily ingestion of 2 g of MCTs for 2 weeks increases fat burning during daily physical activities in sedentary persons with a BMI ranging from 25 to less than 30.     

An anaplastic pleomorphic xanthoastrocytoma with periventricular extension: An autopsy case report and review of the literature

Pleomorphic xanthoastrocytomas (PXAs) are rare low-grade astrocytic tumors that typically present as superficial nodular cystic tumors of the cerebrum attached to the leptomeninx. Histologically, they are pleomorphic, hypercellular glial neoplasms. Despite the presence of microscopic pleomorphism, patients’ postoperative prognosis is generally good. Anaplastic PXAs (APXAs) have a high mitotic index and patients with APXAs have a worse prognosis than patients with PXAs. Here, we report an autopsy case of APXA initially diagnosed as PXA. After gross total resection, the tumor recurred and was diagnosed as an APXA; thereafter, the patient died. An autopsy revealed that the tumor had relapsed at the primary site and had spread to the leptomeningeal space while concurrently invading the cerebrum including the periventricular area forming multifocal lesions. The histological findings of the autopsy were similar to those for epithelioid glioblastoma (EGBM) and small cell glioblastoma (SCGBM). In particular, the periventricular area with multifocal lesions was composed of SCGBM-like cells. It has been shown that multifocal lesions are frequently identified in patients with SCGBM. This is the first histopathologically confirmed case of APXA-related tumor presenting with periventricular extension and multifocal lesion formation. The periventricular extension might be a feature of PXAs and APXAs. However, suspected periventricular spread on imaging in past cases of PXAs and APXAs might instead represent the malignant transformation of these tumors to glioblastoma-like high-grade tumors, which often show SCGBM-like histological patterns.     

Design and synthesis of proton-dopable organic semiconductors

This paper shows how protonated 3,4-ethylene dioxythiophene moieties can be used as an end group to make organic conductors. An organic semiconductor 2,5-bis(5-(2,3-dihydrothieno[3,4-b][1,4]dioxin-5-yl)-3-dodecylthiophen-2-yl)thieno[3,2-b]thiophene is designed and synthesized. This molecule could be doped by protonic acid in both solution and solid-state, resulting in a broad absorption in the near-infrared range corresponding to polaron and bipolaron absorption. Electrical conductivity of ca. 0.1 S cm⁻¹ was obtained at 100 °C (to avoid the water uptake by the acid). The adducts with protons bound at the end-thiophene α-position were confirmed by ¹H Nuclear Magnetic Resonance spectra.

The use of protonated 3,4-ethylenedioxythiophene moieties as an end group could be a promising approach to prepare organic conductors.     

Clinical characteristics after surgery of non-small cell lung cancer which measures 20 mm or less in diameter

Today's advances in diagnostic image-technologies often enable us to find small lung cancers. However, we have few definite strategies including how to diagnosis and treat them. In this study, we performed a retrospective analysis of 122 consecutive patients who underwent surgery for non-small cell lung cancer 20 mm or less in diameter to clarify the clinical features of small lung cancer. Of 122 patients, there were 114 patients of pN0, and 8 patients with lymph node metastasis. Seventy three patients underwent lobectomy, 45 underwent segmentectomy, and 4 underwent wedge resection based on the findings of preoperative CT and anatomical and oncological view during operation. Overall survival rate( OS) and progression free survival( PFS) at 3-year was, 94% and 84%, respectively. There were no differences in OS or PFS between lobectomy group and limited resection group, which might suggest that we adapted appropriate surgical procedures. Multivariate analysis revealed that pathological pleural invasion, lymphatic vessel invasion, and vascular vessel invasion were likely to be unfavorable prognostic-factors. We believe that further investigations should be required to clarify the characteristics of small lung cancer.