Fukui CardioVascular Center

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Introduction: Raynaud’s phenomenon (RP) can be classified as either primary or secondary and is traditionally characterized by triphasic color changes, including white/ischemia (blanching), blue/cyanosis, and red/hyperemia. Secondary RP, resulting from the use of handheld vibrating tools, is also referred to as vibration white finger. Blanching typically occurs in the fingertips; however, there are no documented cases of severe bilateral cyanosis associated with hand-arm vibration syndrome (HAVS). Case Presentation: A 69-year-old male with a 40-year history of using vibrating tools such as chainsaws, picks, and vibrators presented with symptoms of coldness, burning, and numbness. Photographs of the RP were taken during the winter after the patient had been outdoors without adequate warm clothing or gloves. The images depict blanching and cyanosis in all five fingers of both the hands. In this case, nailfold capillaroscopy did not reveal any structural changes such as reduced capillary density, capillary enlargement, or neovascularization but showed minor bleeding. At the 2-year follow-up, finger skin temperature, assessed using cold-water immersion testing, showed no improvement. Conclusion: This was a rare case of extensive blanching followed by cyanosis. Clinicians should consider a history of vibrating tool use when evaluating patients with blue fingers. This case enhances our understanding of RP and HAVS and offers insights into occupational health practices for individuals using hand-arm vibratory tools.

Cambodia is experiencing rapid urbanization, posing significant risks to its natural capital (NC) and long-term sustainability. The absence of robust estimates quantifying the environmental costs of urban expansion has perpetuated this challenge. Here, we present an integrated approach to evaluate the sustainability of urban growth in Cambodia by (1) delineating the boundaries of major cities, (2) assessing urban expansion dynamics, and (3) quantifying the associated depletion of NC from 2010 to 2020. Using Landsat imagery at 30m resolution and machine learning techniques, we identified clusters of built-up areas to map urban growth. By employing the UN Inclusive Wealth Index framework, we estimate the economic cost of NC depletion, providing insights into the sustainability of urban development. Results reveal that, while urban expansion has maintained positive inclusive wealth growth, NC density has declined by an average of 3% between 2010 and 2020. Projections using a cellular automata model suggest that, if current trends continue, urban expansion could place over USD 56million worth of ecosystems at risk of depletion by 2030. These findings underscore the need for targeted investments and protective measures to safeguard NC and ensure sustainable urban growth.

The EMPA-REG OUTCOME trial confirmed empagliflozin reduced mortality and heart failure hospitalization risk. These findings raised the possibility that empagliflozin may modulate cardiac autonomic function in patients with type 2 diabetes (T2D). The EMPYREAN study was a prospective randomized open-label assessor-blinded multicenter investigation of patients with T2D without prior antidiabetic therapy with sodium-glucose cotransporter 2 or dipeptidyl peptidase 4 inhibitors. Electrocardiographic monitoring was performed at study onset and after 12 and 24 weeks of treatment. Heart rate variability was analyzed using the MemCalc method. The primary endpoint was the change in the low frequency (LF; 0.04-0.15 Hz)/high frequency (HF; 0.15-0.4 Hz) ratio from baseline to 24 weeks. In all, 113 patients were randomized. The median age in the empagliflozin and sitagliptin groups was 60 and 63 years, respectively. There were no significant differences in serial changes in the LF/HF ratio (0.52, 95% confidence interval [CI] -0.15 to 1.19, P=0.126) or HF (16.13, 95% CI -11.58 to 43.84, P=0.251) between the 2 groups. In time domain analysis, serial changes in root mean square successive difference (1.90, 95% CI -0.56 to 4.38, P=0.12) and percent of difference between adjacent normal RR intervals >50 ms (1.04, 95% CI -0.32 to 2.41, P=0.13) were not significantly different. The effects of empagliflozin and sitagliptin on autonomic nerve activity did not differ significantly in patients with T2D.

Posterior cruciate ligament (PCL) buckling and anterior tibial subluxation are observed in patients with insufficient anterior cruciate ligament (ACL). Here, we report the case of a patient after ACL reconstruction in whom these symptoms were improved by anterior scar resection of buckled PCL. The patient was a 46-year-old man. Six years ago, he underwent ACL reconstruction; however, his condition was not satisfactory. Magnetic resonance imaging (MRI) showed intercondylar impingement of the graft, anterior tibial subluxation, and PCL buckling. Intercondylar notchplasty and resection of the anterior scar of PCL were performed arthroscopically. Postoperative MRI showed improvement in PCL buckling and anterior tibial subluxation. His symptoms improved, and he was able to jog one year after surgery. Anterior scar resection of PCL may improve PCL buckling and anterior tibial subluxation after ACL reconstruction.

Abstract The fatigue life of Type 316 stainless steel in the pressurized water reactor (PWR) water environment and its dependency on that in air were investigated. Specimens from two heats of the material were prepared for fatigue tests, and additionally, previous test findings obtained using another heat were applied. The fatigue test results obtained for various strain ranges and strain rates revealed that the fatigue life in the water environment Nf(env) did not depend on that in air Nf(air) when the strain rate was 0.4%/s. The variation in the ratio of Nf(env) to Nf(air) was larger when Nf(air) obtained for each heat of the material was used than that when a general Nf(air) was used. The changes in the penalty factor Fen with applied strain range and strain rate could be predicted by assuming Nf(env) depended not on strain rate but on rise time.

Abstract BackgroundParents of children with medical complexity (CMC) have extra child‐raising responsibilities because of the time commitments necessary for care, and their social participation is often compromised. Experiencing leisure excursions with such children may be a solution to some of these problems but the first‐hand experience of excursions in regard to their psychological impact on the caregivers of CMC remains to be appraised.MethodsSemi‐structured interviews were conducted, via video conference, with eight informal and eight formal caregivers of CMC who attended an excursion to Tokyo Disney Land (TDL). We investigated the psychological changes that they had experienced through the excursion, performing inductive thematic analysis.ResultsThree themes were identified among parents and five were identified among medical professionals. Themes reported by the parents were: Increased trust in the public and society (Theme 1); confidence for other challenges (Theme 2), and connection with other parents in the non‐medical settings (Theme 3). Themes reported by medical professionals were: Expanding the initiative to other CMC (Theme 1); feeling bonded with other caregivers within the working group (Theme 2); information exchange across different working groups (Theme 3), positive responses from CMC (Theme 4); families' confidence to go out (Theme 5).ConclusionsThis study showed that the excursion to TDL led to positive psychological changes in both medical professionals and parents of CMC, enhancing trust, connection, and confidence. The promising results of this study suggest a need for further research about the impact of an excursion on caregivers of CMC.

ObjectivesThis study aimed to compare the short-term outcomes of transcatheter and surgical aortic valve replacements (TAVR and SAVR) in high-, intermediate-, and low-preoperative risk patients.MethodsA total of 454 patients who underwent TAVR or SAVR were included. Patients were categorized into high-, intermediate-, and low-risk according to the Society of Thoracic Surgery-Predicted Risk of Mortality score and clinical outcomes were compared between TAVR and SAVR groups.ResultsTAVR was less invasive, with less bleeding and transfusion (p < 0.001), less frequent new-onset atrial fibrillation (p < 0.001), and shorter intensive care unit stay (p < 0.001). Furthermore, transcatheter valves performed better than surgical valves, with lower peak velocity (p = 0.003) and pressure gradient (p < 0.001) and higher effective orifice area index (p < 0.001). The clinical outcomes of TAVR were comparable to or even superior to those of SAVR in high- and intermediate-risk patients. In low-risk patients, the 1- and 2-year mortality rates were 6.3% and 12.1%, respectively, in the TAVR group and 0% and 0.9%, respectively, in the SAVR group (p < 0.001). Mild or greater paravalvular leakage was a risk factor for mortality (hazard ratio 35.78; p < 0.001).ConclusionsTAVR was superior to SAVR in the sense of less invasiveness and valvular function. However, the indication of TAVR in low-risk patients should be carefully discussed, because paravalvular leakage was a risk factor for short-term mortality.

Late open conversion (LOC) after endovascular aneurysm repair (EVAR) is associated with high morbidity and mortality. Standard surgical technique of LOC has not been established. This report presents a rapid aneurysmal formation in the unreplaced infrarenal aorta after LOC with complete endograft explantation without suprarenal fixations. A 76-year-old man presented with a left common iliac artery aneurysm (CIAA), for which he underwent EVAR to embolize the left internal iliac artery. Although his aneurysmal sac size initially showed a reduction, computed tomography at the 3-year interval post-EVAR demonstrated an increased sac size. Thus, he underwent open aortic repair of the CIAA. Though the postoperative course was uneventful, the size of the unreplaced infrarenal aorta showed a significant increase one year after open conversion. Reoperation was performed, but vascular prosthesis infection occurred as a complication and the patient died on the 196th postoperative day.