OCT で検出された冠動脈のlipid-richプラークに対する至適薬物療法施行後の臨床経過

Background: The aim of this study was to evaluate optical coherence tomography (OCT)-detected lipid-rich coronary plaques (LRCPs) with coronary computed tomography angiography (CCTA) 10 months after optimal medical therapy (OMT). Methods and Results: Baseline OCT detected 28 LRCPs in non-culprit lesions. High-risk plaque features (HRPFs), such as positive remodeling, very low attenuation plaques, napkin-ring sign, and spotty calcification, were observed in 67.9%, 67.9%, 21.4%, and 64.3% of LRCPs, respectively, at the 10-month follow-up CCTA. Lesions with ≥3 HRPFs were defined as high-risk LRCPs (n=12); the remaining were defined as low-risk LRCPs (n=16). The maximum lipid arc on baseline OCT was larger in high- than low-risk LRCPs (221±62° vs. 179±44°, respectively; P=0.04). Receiver operating characteristic curve analysis indicated that a maximum lipid arc >154° on baseline OCT was the optimal cut-off value to predict high-risk LRCPs 10 months after OMT. Patients with high-risk LRCPs had worse clinical outcomes, defined as a composite of cardiac death, target lesion-related myocardial infarction, and target lesion-related revascularization, during follow-up than those with low-risk LRCPs (33.3% vs. 0%; P=0.01). Conclusions: A high-risk LRCP at follow-up CCTA was correlated with a larger maximum lipid arc on baseline OCT. Further aggressive treatment for patients with large LRCPs may reduce vulnerable plaque features and prevent future cardiac events.博士（医学）・甲第869号・令和5年3月15

経皮的冠動脈インターベンションにおけるステント血栓症発症に特徴的なステント留置後の光干渉断層法の冠動脈内の所見

Background:The association between unfavorable post-stent optical coherence tomography (OCT) findings and subsequent stent thrombosis (ST) remains unclear. This study investigated the ST-related characteristics of post-stent OCT findings at index percutaneous coronary intervention (PCI). Methods and Results:Fifteen patients with ST onset after OCT-guided PCI (ST group) were retrospectively enrolled. Post-stent OCT findings in the ST group were compared with those in 70 consecutive patients (reference group) without acute coronary syndrome onset for at least 5 years after OCT-guided PCI. The incidence of acute myocardial infarction (AMI) was higher in the ST than reference group (60.0% vs. 17.1%, respectively; P=0.0005). The incidence of incomplete stent apposition (93.3% vs. 55.7%; P=0.0064), irregular protrusion (IP; 93.3% vs. 62.8%; P=0.0214), and thrombus (93.3% vs. 51.4%; P=0.0028) was significantly higher in the ST than reference group. The maximum median (interquartile range) IP arc was significantly larger in the ST than reference group (265° [217°–360°] vs. 128° [81.4°–212°], respectively; P180° was significantly higher in the ST than reference group (100% vs. 58.3%, respectively; P=0.0265). Conclusions:IP with a large arc was a significant feature on post-stent OCT in patients with ST.博士（医学）・甲第868号・令和5年3月15

ケンキュウ ノート リヨウシャ ノ コエ ダイヤモンド カガク ケンマ ノタメノ コウオン シンクウ ケンマ ソウチ

「なぜ新しいダイヤモンド研磨技術が必要か」 ダイヤモンドはマントル深部から地上にもたらされた鉱物で、地球深部についての情報をもたらしてくれる重要な物質的情報源である。ダイヤモンドから情報を引き出すためには次のようなことが行われる。①ダイヤモンドには複雑な内部構造があり、 ..

Japan’s Post-Triple-Disaster Growth Strategy

The Great East Japan Earthquake on 11 March 2011 was the biggest earthquake recorded in Japanese seismic history, and the fourth largest recorded in the world. The scope of the disaster far exceeded that of the Hanshin Earthquake of 1995. The repercussions of this disaster spread far beyond the geographical areas directly affected. For example, Electric power supply capacity in the Kanto area, which accounts for about 40% of Japanese gross domestic product (GDP), fell at one stage by about 40% from the normal peak - a severe constraint on economic activity, and the supply of nuclear-generated electric power has largely been cut off since then. Production supply chains were significantly disrupted, not only in Japan, but all over Asia. The disaster also highlighted Japan's many other structural challenges besides reconstruction needs, including persistently low growth, population aging and low fertility, burgeoning government debt, declining international competitiveness, and uncertain energy supplies. Moreover, the global financial crisis and the ongoing euro area financial crisis suggest that Japan needs to create its own growth momentum without relying excessively on markets in the United States (US) and Europe. This paper discusses the scope of these challenges and sets out a long-term strategy for overcoming them and putting the Japanese economy on a stable growth path. Domestically, key areas that need to be focused on are supply-side reforms, including support for R&D in high-technology, knowledge-intensive, green growth areas; deregulation to promote growth in service sectors and agriculture; corporate tax reduction; and increased energy security; as well as fiscal and social security reforms to put the public debt to GDP ratio on a sustainable basis. Externally, Japan needs to link its economy firmly with the strong growth track of emerging Asia and its rapidly growing middle class. It needs to promote greater economic links with the rest of Asia, including moves toward an East Asian FTA and support for the TPP that could eventually develop into a trans-Pacific FTAAP

ガクナイ ニ オケル コウサク ギジュツ キョウイク ノ ゲンジョウ ソウリツ 20シュウネン キネン トクシュウ

当大学のカリキュラムの中で、如何に表記の内容が盛り込まれているか、改めて現状を調査してみました。表1は設計製図に関連した授業をピックアップしたのですが、予想外に少なく、将来学生たちの多くが社会に出て生産活動に従事することを考えると、関係者の一人として、心配になってきます。製造業の空洞化がいわれて久しい ..

Mortality and life expectancy of Yokkaichi Asthma patients, Japan: Late effects of air pollution in 1960–70s

<p>Abstract</p> <p>Background</p> <p>The incidence of chronic obstructive pulmonary disease (COPD) and bronchial asthma began increasing in early 1960s in the population of Yokkaichi-city (Mie Prefecture, Japan). The cause of the disease was sulfur oxide air pollution, and it is known as Yokkaichi Asthma. The pollution markedly decreased by the end of 1970s; no new cases have been reported since 1988. This study aimed at examining the late effects of air pollution on the health of Yokkaichi Asthma patients.</p> <p>Methods</p> <p>Mortality rate and life expectancy of patients, registered between 1965 and 1988, were investigated from 1975 through 2000.</p> <p>Results</p> <p>Mortality rates for COPD and asthma in patients from Yokkaichi-city were significantly higher than in the whole population of Mie Prefecture. For all ages (except for males between 80 and 84 years in 1985), the life expectancy of both males and females were significantly reduced in patients from Yokkaichi-city as compared with the whole population of Mie Prefecture. The potential gains in life expectancy excluding the mortality for respiratory diseases including COPD and asthma were larger for all ages in patients from Yokkaichi-city.</p> <p>Conclusion</p> <p>Mortality and life expectancy were adversely affected in patients from Yokkaichi-city, despite the fact that the air pollution problem has been already solved.</p

Fisheries in Iwaki after the Fukushima Dai'ichi Nuclear Accident: Lessons for Coastal Management under Conditions of High Uncertainty?

This article evaluates factors driving perception of risk and uncertainty in fisheries in Iwaki City, Fukushima Prefecture, Japan, following the Fukushima Dai'ichi nuclear accident. Particular attention is paid to lessons that may be learned for managing uncertainties and risks in coastal management more generally. The 2011 accident has had profound effects on Fukushima fisheries. Commercial coastal fisheries have been stopped since, and efforts to understand and monitor the effects of marine radioactive contamination on produce from the sea continue. Small-scale trial fisheries have, however, re-commenced with a view to gradually re-starting Fukushima fisheries over time. Drawing on in-depth interviews, discussion groups, and field observations from Iwaki and Fukushima Prefecture more widely, three factors are discussed: the role of trusted local-level points of contact; the value of transparent monitoring and screening that acknowledges remaining limitations and uncertainties; and the importance of taking seriously the cultural dimensions of rapid and potentially irreversible environmental change

China's quest for oil security: oil (wars) in the pipeline?

China's rapidly expanding demand for crude oil in the 1990s has brought about debates about the potential impact of the energy challenges facing China. Within the country, energy as a security issue has seized the attention of its leaders. Outside China, international strategic thinkers have been arguing among themselves over how China's thirst for oil would impact on regional peace and stability. This paper sets out to examine the following questions: How and why has the basic need for crude oil been perceived as a security question in China? How does China enhance its oil security? Is the option to engage Russia and Central Asia viable and why? What are the possible impacts of China's oil diplomacy on regional security and stability? It concludes that the oil diplomacy with Kazakhstan and Russia is far from promising. In the short run, China has to rely on the oil in the Middle East and to exploit the resource in its offshore areas in the medium to long term. This may lead to festering relations with Russia, the US, Japan, India and the Southeast Asian nations. The growing presence of China in the Persian Gulf and East and South China Sea gives cause for concern to the US, Japan, India and the Southeast Asian states