K Kawajiri

Study comparing the double kissing (DK) crush with classical crush for the treatment of coronary bifurcation lesions: the DKCRUSH-1 Bifurcation Study with drug-eluting stents

Background  Classical crush has a lower rate of final kissing balloon inflation (FKBI) immediately after percutaneous coronary intervention (PCI). The double kissing (DK) crush technique has the potential to increase the FKBI rate, and no prospective studies on the comparison of classical with DK crush techniques have been reported.

Time-dependent morphologic characteristics in angiographic chronic total coronary occlusions

Intravascular ultrasound analysis of 70 chronic total occlusions (CTOs), conducted either before intervention or following dilation of a 1.5-mm balloon, showed that older CTOs have more complex plaque composition including a larger calcific burden. This may explain the adverse revascularization profile of older CTOs.

A randomized comparison of sirolimus- vs. paclitaxel-eluting stents for treatment of bifurcation lesions by single stent and kissing balloon: Results of the SINGLE KISS trial

BACKGROUND In the treatment of bifurcation lesions, routine stenting of both branches has thus far failed to demonstrate a clear clinical advantage over a provisional one-stent strategy. On the other hand, large scale data evaluating different stent types for clinical outcomes after one-stent treatment with final kissing inflation (FKI) of bifurcation lesions is also limited. This prospective study evaluated the clinical and angiographic outcomes of paclitaxel-eluting stents (PES) vs. sirolimus-eluting stents (SES) in single crossover main branch stenting followed by FKI in patients with bifurcation lesions. METHODS We randomized 800 patients with single bifurcation lesions to PES (n=400) and SES (n=400) groups. RESULTS Crossover rates to the two-stent strategy were low in both groups (PES 1.5%, SES 2.8%; p=0.23). At 1 year, there was no significant difference in the primary endpoint of this study, target lesion revascularization rate (PES 3.8%, SES 3.2%, hazard ratio 0.83; 95% confidence interval 0.39 to 1.76; p=0.62). Stent thrombosis occurred in only 1 case in the SES group after 282 days. At 9 months, a total of 593 patients underwent quantitative coronary measurement. The main branch restenosis rate in the PES group was significantly higher than that of the SES group (PES 12.2%, SES 5.5%; p=0.004), however both groups exhibited similar high side branch restenosis rates (PES 17.2%, SES 19.3%; p=0.6). CONCLUSIONS In patients with bifurcation lesions, a single stent strategy using PES and SES with FKI indicated similar 1 year clinical outcomes and safety profiles.

Photoion spectroscopy on isolated Mn atoms in the 2p???3d excitation region: I. Total photoion-yield spectrum

With a time-of-flight (TOF) ion analyzer combined with synchrotron radiation, total photoionyield spectrum has been measured on isolated Mn atoms in the 2p →3d excitation region (632 eV to 657 eV) with an estimated resolution 0.065 eV. The analysis of the observed spectrum was performed with the help of ab initio calculations of the excited states using the computer code GRASP92 for the MCDF calculation and of oscillator strengths for the excitation using the related REOS program. The calculations were performed for two outer-shell configuration cases: one considering the single reference-configuration 3d m 4s 2 and another with the multiple reference-configuration 3d m 4s 2 +3d m + 1 4s+3d m+2 (m=5 for the ground state and m=6 for the 2p →3d excited states). This two-step calculation showed the CI effect in the case of the excitation of a deep inner-shell.

Predictive performance of dual modality of computed tomography angiography and intravascular ultrasound for no-reflow phenomenon after percutaneous coronary stenting in stable coronary artery disease

Attenuated plaque on intravascular ultrasound (IVUS) and low attenuation plaque on computed tomography angiography (CTA) are associated with no-reflow phenomenon during percutaneous coronary intervention (PCI). However, evaluation by a single modality has been unable to satisfactorily predict this phenomenon. We investigated whether the combination of IVUS and CTA findings can ameliorate the predictive potential for no-reflow phenomenon after stent implantation during PCI in stable coronary artery disease (CAD). A total of 988 lesions of 707 stable CAD patients who underwent coronary CTA before PCI were enrolled. PCI was performed with preprocedural IVUS and stent implantation. As for plaque characters, very low attenuation plaque (CTA v-LAP) whose minimum density was < 0 Hounsfield units on CTA and attenuated plaque (IVUS AP) on IVUS were evaluated. No-reflow phenomenon was observed in 22 lesions (2.2%) of 19 patients (2.7%). Both CTA v-LAP and IVUS AP were much more frequently observed in patients with no-reflow phenomenon. Positive (PPV) and negative predictive values (NPV) and accuracy for prediction of no-reflow were almost equivalent between CTA v-LAP (13.2, 99.6, and 87.0%) and IVUS AP (15.7, 99.8, and 89.0%). The combination of CTA v-LAP and IVUS AP markedly ameliorated PPV (31.7%) without deterioration of NPV (99.7%) and increased the diagnostic accuracy (95.5%). These findings showed that the combination of CTA v-LAP and IVUS AP improved the predictive power for no-reflow phenomenon after coronary stenting in stable CAD patients, suggesting the usefulness of combined estimation by using CTA and IVUS for predicting no-reflow phenomenon during PCI in clinical practice.

Photoion spectroscopy on isolated Mn atoms in the 2p → 3d excitation region. II. Decay processes of the excited states

A series of time-of-flight (TOF) spectra of isolated Mn atoms were measured in the vicinity of 2p → 3d excitation states (635 to 656 eV) at a high-energy resolution. Synchrotron radiation was used as a light source. From this spectral data, charge-separated photoion-yield spectra and charge-state distribution as functions of the photon energy were obtained. The photoions resulting from the 2p → 3d excitation states are distributed from Mn+ to Mn6+, with the largest component being Mn3+ ions. Based on these spectra, the relaxation processes of the 2p → 3d excitation states are semi-quantitatively considered. For this purpose, highly excited states above the next ionization limit were calculated using the GRASP92 atomic code. It is found that single and double Auger shake-off processes play a central role in the formation of Mn5+ and Mn6+ ions. From the behavior of the charge-state distribution, the lowest 2p ionization limit has been determined to be 647.0 ± 0.3 eV.

Photoion-yield study of the 3p–3d giant resonance excitation region of isolated Cr, Mn and Fe atoms

Using the charge-separated photoion-yield method combined with monochromatized synchrotron radiation, single (M+) and double (M2+) photoionization spectra in the 3p excitation region were observed for isolated atoms M = Cr, Mn and Fe. The relaxation processes of excited states to double ionization, as well as to single ionization, were considered with the help of existing photoabsorption and photoelectron data and some calculations of highly-excited states of M+ using the atomic code GRASP92. In the 3p→3d giant resonance region before the 3p→n(s, d) Rydberg series starts, the spectral features in the M2+ channel are similar to those in the M+ channel. The ratios M2+/M+ in this region are rather constant accordingly against the photon energy with values 0.045 ± 0.005 for Cr, 0.17 ± 0.03 for Mn and 0.30 ± 0.08 for Fe at the giant resonance. The increase in the M2+/M+ ratio with increasing the atomic number Z can be explained by the increasing contribution of two-step double ionization via highly-excited M+ states. It is expected that, at the 3p→3d giant resonance, the one-step double ionization process occurs within a few per cent of the entire decay.

Multiplicity of cytochrome P-450 and its gene structure

Cytochrome P-450 is widely distributed in nature from microorganisms to higher animals and plays an important role in the oxidative metabolism of a great variety of endogenous as well as exogenous lipophilic compounds (Sato & Omura, 1978; Lu & West, 1980). Recent studies involving immunological chemistry and protein chemistry have shown that multiple forms of cytochrome P-450 are present in rat liver microsomes and that their synthesis could be induced in different ways by the administration of various kinds of drugs (Sato & Omura, 1978; Lu & West, 1980). However, the molecular multiplicity and drug induction mechanism of cytochrome P-450 could best be understood by investigation at the gene (DNA) level using recombinant DNA technology.