Language：English   Publisher：(一社)日本循環器学会  

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DOI： 10.1253/circj.CJ-22-0544

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Background: The correlation between the Japanese version of high bleeding risk (J-HBR) criteria and the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score is unknown, as is the relationship of both risk scores with ischemic events. Methods and Results: This study enrolled 842 patients who underwent percutaneous coronary intervention (PCI) between January 2016 and December 2020. The 2 bleeding risk scores at the time of PCI and the subsequent risk of bleeding and ischemic events over a 1-year follow-up were examined. The J-HBR score was significantly correlated with the PRECISE-DAPT score (r=0.731, P<0.001). However, 1 year after PCI, the J-HBR was not significantly associated with the incidence of major bleeding and ischemic events (log-rank, P=0.058 and P=0.351, respectively), whereas the PRECISE-DAPT score predicted both the incidence of major bleeding and ischemic events (log-rank, P=0.006 and P=0.019, respectively). According to receiver operating characteristic curve analysis, a J-HBR score ≥1.5 was significantly associated with a higher cumulative incidence of major bleeding, but not ischemic events (log-rank, P=0.004 and P=0.513, respectively). Conclusions: The J-HBR score is highly correlated with the PRECISE-DAPT score. A J-HBR score ≥1.5 can identify high bleeding risk patients without an increased risk of ischemic events.

DOI： 10.1253/circrep.CR-22-0059

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Language：English   Publishing type：Research paper (scientific journal)  

An 84-year-old woman presented with dyspnea in the sitting position. Platypnea-orthodeoxia syndrome (POS) was suspected based on arterial desaturation when her posture changed from the supine to the sitting position. Transesophageal echocardiography showed right-to-left shunting enhancement through a patent foramen ovale (PFO) in the sitting position. Three-dimensional (3D) cardiac CT in the sitting position revealed that the elongated ascending aorta compressed the right ventricular inflow tract, resulting in restricted blood flow to the right ventricle and increased right-to-left shunting. This case highlights the role of 3D-CT in the sitting position in the management of POS.

DOI： 10.2169/internalmedicine.8868-21

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12928-021-00785-4

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English  

Pulmonary arteriovenous fistulae (PAFs) occur congenitally or are acquired. A PAF can cause hypoxemia, sudden death from rupture, abscess formation, and embolism. Treatment for PAF is transcatheter embolization or surgery. Transcatheter embolization is the first choice of treatment; however, this treatment is impossible to perform if a patient has had tricuspid or pulmonary valve replacement. In this paper, we describe a case of PAFs complicated with tricuspid valve replacement with a ball valve (which had been performed 40 years earlier) that was treated with transcatheter embolization. <Learning objective: Although the ball valve was discontinued more than 40 years ago, it is still the only mechanical valve that allows catheter passage. We report a case of successful treatment of pulmonary arteriovenous fistula by passing a catheter through a ball valve.>.

DOI： 10.1016/j.jccase.2021.05.006

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Language：English   Publishing type：Research paper (scientific journal)  

Immunoglobulin-G4-related disease (IgG4-RD) is a multi-organ systemic inflammatory disorder. The ideal treatment of coronary artery involvement in IgG4-RD remains uncertain due to its rarity. We herein report a case of coronary artery involvement with IgG4-RD, wherein mass lesions surrounded the coronary arteries with a moderate stenosis lesion in the right coronary artery (RCA). The fractional flow reserve (FFR) of the RCA was 0.76. After steroid therapy, the mass lesions around the coronary arteries improved. The FFR of the RCA also improved from 0.76 to 0.86. These findings suggest the efficacy of using steroid therapy for coronary artery involvement with IgG4-RD.

DOI： 10.2169/internalmedicine.7880-21

PubMed

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は54歳女性。20XX年4月、左半側空間無視と左片麻痺を主訴に前医へ救急搬送された。入院後の造影CTとMRI/MRA検査で右内頸動脈起始部閉塞による脳梗塞と深部静脈血栓症(DVT)、粘液性卵巣癌を認めた。経胸壁心エコー(TTE)と経食道心エコー(TEE)では心腔内血栓を指摘できなかったが、心原性脳梗塞・奇異性脳塞栓の可能性が否定できず、直接経口抗凝固薬(DOAC)内服が開始された。この際に指摘された卵巣癌に対して7月、当院で卵巣摘出術を施行した。血栓イベント高リスクであるため、術中TEEを施行し、僧帽弁前尖および後尖に10mm程度の可動性を有する構造物を認めた。形態より感染性心内膜炎を疑い抗生剤投与を開始したが複数回にわたる血液培養はすべて陰性であり感染徴候を示唆する臨床所見も認めなかった。疣腫の外科的切除も検討したが、非細菌性血栓性心内膜炎(NBTE)の可能性を考慮してヘパリンの投与を施行した。1週間後のTEEでは疣腫の縮小を認め、2週間後のTTEでは疣腫の消失を確認しNBTEと診断した。NBTEは悪性腫瘍などを基礎疾患に持ち、無菌性の血栓が弁膜に付着する。悪性腫瘍合併の疣腫ではNBTEの可能性を考慮する必要がある。(著者抄録)

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

ファロー四徴症術後遠隔期に右心不全が多いことは知られているが,高度の肺うっ血を生じた症例を経験したので報告する.症例はファロー四徴症の37歳女性.14歳時に心内修復術,35歳時に肺動脈弁逆流のため肺動脈弁置換術を受けた.今回肺うっ血で初めて循環器内科に入院し,心エコーで心室中隔が扁平,三尖弁逆流圧較差が高値(88mmHg)であった.利尿薬静注を開始し翌日造影CTを行うと喉部絞扼感と低酸素血症がみられ,アナフィラキシーとして治療し肺うっ血が増強したが,非侵襲的陽圧換気と利尿薬追加で改善した.後日心臓カテーテル検査で,右室収縮期圧は72mmHgと高値で,肺動脈弁狭窄,肺血管抵抗高値,高心拍出の所見があったが,肺動脈楔入圧は13mmHgと境界高値にすぎず,肺うっ血の病態不明なため,食塩水負荷試験を行った.わずか75ml(2分間)で胸部不快がみられ,両心室の拡張末期圧が上昇した(14→19mmHg).成人先天性心疾患では解剖学的修復術後にも複雑な病態を呈し,複数の要因で肺うっ血をきたすことがあり,診断・治療いずれの面でも複数科や業種間での連携が必要である.(著者抄録)

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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Language：English  

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. Treatment for SCAD includes conservative approaches, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery. Although the success rate of PCI is low, conservative treatment often leads to a good clinical course. Three patients with SCAD who were conservatively treated with intra-aortic balloon pumping without coronary intervention are presented. All three patients continue to do well. <Learning objective: The treatment for spontaneous coronary artery dissection (SCAD) has not yet been established. Intra-aortic balloon pumping (IABP) is a potential conservative treatment for SCAD that increases coronary blood flow. However, IABP could worsen the dissection. In this report, IABP was safely used for SCAD and patients had a good clinical course without worsening the dissection.>.

DOI： 10.1016/j.jccase.2021.01.004

PubMed

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：Japanese   Publisher：新潟医学会  

症例は83歳、男性。X-1年9月、うっ血性心不全の診断でA病院に入院した。精査にて高度大動脈弁狭窄症と冠動脈高度狭窄を認め、外科的手術(大動脈弁置換術+冠動脈バイパス術)の方針となった。X年9月某日、手術目的に当院心臓血管外科に入院したが、肺炎を発症し心不全が増悪したため手術困難となった。人工呼吸器管理に移行しカテコラミン持続静注を要し、入院10日目に心不全加療目的に循環器内科に転科した。入院11日目に大動脈内バルーンパンピング(IABP)補助下に経皮的冠動脈形成術(PCI)を施行、ロータブレータ併用の上薬剤溶出性ステントを留置した。抜管やIABP離脱に向け入院16日目に経皮的バルーン大動脈弁形成術を施行し、大動脈弁口面積は0.50cm2から0.80cm2に改善した。術後IABPを離脱、その後カテコラミン静注からも離脱した。全身状態の改善後大動脈弁置換術施行を検討することとし、入院82日目にA病院へ転院した。本症例のように外科的大動脈弁置換術が困難な高度大動脈弁狭窄症例に対して経カテーテル大動脈弁留置術が考慮されるが、非実施施設であっても大動脈弁置換術へのブリッジ目的に経皮的バルーン大動脈弁形成術を施行することは可能である。また、それらは時に高度な冠動脈石灰化病変を伴いPCI施行の危険性が大きいが、機械的、薬剤的循環補助を併用することで完遂し得る可能性がある。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

The long-term prognosis for up to 20 years of patients who have undergone percutaneous transvenous mitral commissurotomy (PTMC) for mitral stenosis (MS) is unknown.We examined 77 of 93 patients (83%) with MS and who underwent PTMC from 1989 to 2002 at our institute, as well as the occurrence of either one of the following clinical endpoints until September 1, 2018: all-cause death or repeat intervention for the mitral valve.The mean follow-up duration was 20.5 ± 7.3 years. The mean age was 51 ± 11 years. Overall, the 20-year survival rate was 71% ± 5%; without any intervention, the 20-year survival rate was 40% ± 6%. In patients who achieved good immediate results (i.e., mitral valve area (MVA) of ≥ 1.5 cm2 without mitral regurgitation (MR) of > 2/4 after PTMC), the 20-year survival rate was 80% ± 6%; without any intervention, the 20-year survival rate was 54% ± 7%.In our 20-year observational study, patients who have undergone PTMC for MS had favorable prognosis, especially in those who achieved good immediate results. In those who had poor immediate results, careful follow-up is needed because they might have more clinical event and any intervention for the mitral valve.

DOI： 10.1536/ihj.20-082

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1253/circj.CJ-20-0530

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Language：English   Publishing type：Research paper (scientific journal)  

Background:
Spontaneous coronary artery dissection (SCAD) is a rare disease that is often misdiagnosed, except in typical cases. Although intracoronary imaging and multislice coronary computed tomography angiography (CCTA) are useful in establishing dissection, they may not be feasible in all instances, especially in small vessels.
Methods and Results:
We describe a series of 7 patients with acute coronary syndrome secondary to small vessel SCAD that was detected only upon repeat coronary angiography (CAG). This cohort had a mean (±SD) age of 50±6 years, was predominantly female (n=6; 86%), and had few coronary risk factors. Three patients (43%) had dissection of the distal segment of the right coronary artery, 3 (43%) had distal left circumflex artery dissection, and 1 patient (14%) had a diagonal branch dissection. None of the patients required percutaneous coronary intervention, and received conservative therapy only, because the infarct area was sufficiently small. No definitive diagnosis of SCAD could be established in any of the patients at first admission because CAG alone or CCTA did not reveal the presence of a flap or intraluminal hemorrhage. However, in such patients without a definitive diagnosis, repeat CAG in the chronic stage showed enlargement of vessels, suggesting the healing of an SCAD.
Conclusions:
Repeat CAG may be useful for suggesting the occurrence of SCAD.

DOI： 10.1253/circrep.CR-20-0100

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12928-020-00724-9

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s12928-019-00635-4

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Language：English   Publishing type：Research paper (scientific journal)  

We herein report a case of pulmonary artery sarcoma (PAS) in a 64-year-old woman. She was admitted to our hospital because of massive genital bleeding from endometrial cancer. Contrast-enhanced computed tomography (CT) revealed a left pulmonary artery mass and deep vein thrombosis. She underwent anticoagulant therapy for one year. However, the mass lesion gradually expanded. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT showed a positive uptake of FDG by the mass. An endovascular catheter biopsy was performed for the differentiation of endometrial cancer metastasis or primary sarcoma. The biopsy specimen tissue comprised spindle-shaped cells. Thus, the patient was diagnosed with PAS.

DOI： 10.2169/internalmedicine.4738-20

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は27歳女性。頭痛、嘔吐、意識障害のため入院し、pial arteriovenous fistulae(pial AVF;脳軟膜動静脈瘻)に伴うくも膜下出血が認められた。降圧薬使用下に経動脈的塞栓術を施行した後に肺水腫をきたし、利尿薬に加え人工呼吸管理を要した。神経原性肺水腫も考えられたが、心臓カテーテル検査を行うと心拍出量は熱希釈法で14.55L/分、平均肺動脈楔入圧は17mmHgであり、高心拍出性心不全と診断した。このとき、上大静脈ばかりでなく、下肢から下大静脈にかけても静脈血酸素飽和度が90%以上と高く、高心拍出はpial AVFによるシャント血流に加え、末梢血管拡張により全身で血流が増加しているためと考えられた。β遮断薬に続き、再度経動脈的塞栓術を行うことで心拍出量が正常化し、以後心不全の再発はみられなかった。pial AVFに起因した高心拍出性心不全の成人症例はこれまで報告がなく、病態についての考察を交えて報告する。(著者抄録)

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は59歳男性。半月前からの左下腿浮腫を主訴に近医を受診した。造影CTで左大腿静脈から膝窩静脈にかけての深部静脈血栓症と末梢の肺塞栓を認め同院に入院となった。明らかな血栓素因は認めなかった。未分画ヘパリンによる抗凝固療法が開始されたが、第9病日の造影CTで肺塞栓の増悪を認めたため回収可能型下大静脈(IVC:inferior vena cava)フィルターが挿入された。第12病日の造影CTではIVCフィルターの血栓閉塞と右大腿まで連なる深部静脈血栓の悪化を認めたため当科へ転院となった。未分画ヘパリン治療の強化を行ったが浮腫・疼痛の増悪を認めた。第21病日からウロキナーゼ72万単位/日の全身投与を開始したがそれでも改善を認めなかった。第23病日に右内頸静脈よりパルススプレーカテーテルをIVCフィルター部まで挿入し、ウロキナーゼ48万単位/日を3回に分けて連日局所投与したところ第28病日の造影CTで血栓の消退を認めた。第29病日にIVCフィルターは抜去し、第35病日自宅退院した。血栓溶解薬の全身投与で改善しないIVCフィルターの血栓閉塞に対してカテーテル的血栓溶解療法(CDT:catheter directed thrombolysis)が有用であった1例を報告する。(著者抄録)

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞Point ●高血圧はわが国において約4,000万人が罹患している頻度の高い疾患であり,心電図検査による高血圧とそれに伴う心肥大のスクリーニングは有用性が高い.●左室肥大の心電図基準としてSokolow-Lyon診断基準の"V1誘導のS波+V5もしくはV6誘導のR波>35mm"が頻用されている.●左室肥大の特徴的心電図所見として,"左室側誘導のR波増高","QRS時間の延長","再分極異常"が挙げられる.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01541&link_issn=&doc_id=20191119100017&doc_link_id=10.11477%2Fmf.1542202229&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1542202229&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(公財)日本心臓財団  

症例は67歳、女性。労作時呼吸困難を主訴に来院した。心エコーでは典型的な大動脈弁狭窄症の所見を認め、連続波ドプラ法では左室大動脈間の圧較差が71mmHgであった。また、左室肥大および僧帽弁収縮期前方運動を認め、左室流出路狭窄を合併していると考えられた。心臓カテーテル検査ではシベンゾリン負荷にて左室流出路狭窄を軽減させた状態で、左室大動脈間平均圧較差は59mmHg、大動脈弁口面積は0.47cm2であった。冠動脈造影では右冠動脈近位部に高度狭窄を認め、冠動脈疾患と左室流出路狭窄を合併した重症大動脈弁狭窄症と診断した。心臓血管外科にて大動脈弁置換術、心筋切除術、冠動脈バイパス術を施行した。術後、心電図は完全左脚ブロックへ変化し、労作時の呼吸困難が残存した。心エコーでは左室流出路に50mmHgの圧較差が残存し、僧帽弁収縮期前方運動も認められた。心臓カテーテル検査の再検ではドブタミン負荷にて左室流出路の圧較差は84mmHgまで上昇した。左室流出路狭窄の残存に対して経皮的中隔心筋焼灼術を施行し、術中に完全房室ブロックとなったが、術後の圧較差はドブタミン負荷でも20mmHgまで低下し、労作時呼吸困難は軽快した。左室流出路狭窄合併の重症大動脈弁狭窄症に対する根治的非薬物治療は、大動脈弁置換術および中隔心筋切除術であるが、左室流出路狭窄の残存に対して経皮的中隔心筋焼灼術が有用である可能性が示唆された。(著者抄録)

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DOI： 10.1253/circj.CJ-18-1229

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The occurrence of stent malapposition and coronary artery aneurysm (CAA) during the early phase of drug-eluting stent (DES) implantation is rare. This report presents the case of a 55-year-old man who underwent DES implantation to the left circumflex artery with full-arc severe calcified lesion owing to inferior acute myocardial infarction. Coronary angiography and optical coherence tomography (OCT) at 17 days following percutaneous coronary intervention (PCI) revealed stent malapposition and CAA of diameter 6.5 mm in the distal part of the stented vessel. OCT findings at 5 months following PCI revealed a dilated CAA of diameter 7.5 mm and a luminal structure outside the stent. Based on these findings, it was suggested that the cause of CAA in the early phase following DES implantation to the severe calcified lesion was related to coronary sequelae of Kawasaki disease. <Learning Objective: This was a case of coronary artery aneurysm (CAA) in the stented lesion at early phase post percutaneous coronary intervention (PCI). Despite the patient's young age and low coronary risk, there was full-arc severe calcification lesion. Optical coherence tomography after PCI showed luminal structure outside of the stent. It was similar to recanalized CAA of Kawasaki disease (KD). These findings suggested that CAA in early phase following PCI might be related to the sequelae of coronary arteritis, especially KD.>.

DOI： 10.1016/j.jccase.2019.02.006

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：日本成人先天性心疾患学会  

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Pulmonary arterial hypertension (PAH) is characterized by remodeling and narrowing of the pulmonary arteries, which lead to elevation of right ventricular pressure, heart failure, and death. Proliferation of pulmonary artery smooth muscle cells (PASMCs) is thought to be central to the pathogenesis of PAH, although the underlying mechanisms are still being explored. The protein p53 is involved in cell cycle coordination, DNA repair, apoptosis, and cellular senescence, but its role in pulmonary hypertension (PH) is not fully known. We developed a mouse model of hypoxia-induced pulmonary hypertension (PH) and found significant reduction of p53 expression in the lungs. Our in vitro experiments with metabolomic analyses and the Seahorse XF extracellular flux analyzer indicated that suppression of p53 expression in PASMCs led to upregulation of glycolysis and downregulation of mitochondrial respiration, suggesting a proliferative phenotype resembling that of cancer cells. It was previously shown that systemic genetic depletion of p53 in a murine PH model led to more severe lung manifestations. Lack of information about the role of cell-specific p53 signaling promoted us to investigate it in our mouse PH model with the inducible Cre-loxP system. We generated a mouse model with SMC-specific gain or loss of p53 function by crossing Myh11-Cre/ERT2 mice with floxed Mdm4 mice or floxed Trp53 mice. After these animals were exposed to hypoxia for 4 weeks, we conducted hemodynamic and echocardiographic studies. Surprisingly, the severity of PH was similar in both groups of mice and there were no differences between the genotypes. Our findings in these mice indicate that activation or suppression of p53 signaling in SMCs has a minor role in the pathogenesis of PH and suggest that p53 signaling in other cells (endothelial cells, immune cells, or fibroblasts) may be involved in the progression of this condition.

DOI： 10.1371/journal.pone.0212889

PubMed

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DOI： 10.1253/circj.CJ-18-0332

PubMed

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は82歳の女性。2年前に大動脈弁狭窄症(弁口面積1.0cm2)と診断され、経過観察されていた。今回、心不全を合併した前壁中隔の急性心筋梗塞を発症した。心エコーでは前壁中隔から心尖部の左室壁運動は低下し、左室-大動脈弁の最大圧較差は50mmHgであり、low-flow low-gradientと考えられた。緊急冠動脈造影では左前下行枝の完全閉塞を認め、経皮的冠動脈形成術にて再灌流を得た。クレアチンキナーゼは13109IU/Lまで上昇、心不全、循環動態の管理に難渋し、人工呼吸器や大動脈内バルーンパンピングを要した。集中治療室入室より数時間後に心破裂による心タンポナーデを生じ、外科的修復術を施行した。血行動態の改善を年的に、第5病日に経皮的大動脈弁形成術を施行、平均圧較差は29→24mmHgへ低下し、以後の循環状態は安定した。大動脈弁狭窄症を伴う急性心筋梗塞は心破裂の危険性が大きく、注意が必要である。また、大動脈弁狭窄症を合併した急性心筋梗塞において、大動脈弁に対する介入方法、時期の検討が必要である。(著者抄録)

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は60歳、男性。幼少期にMarfan症候群と診断され、25歳時にStanford Aの急性大動脈解離に対してCabrol手術を施行された。6年前に施行したCTでgraftと両側冠動脈の吻合部狭窄を指摘されたが無症候であり経過観察となった。半年前より労作時呼吸困難を自覚、うっ血性心不全を発症し入院となった。心不全の治療後に冠動脈造影検査を施行し、graftと両側冠動脈の吻合部に99%狭窄を認めた。graftが胸骨の後面に位置していること等から再開胸術による危険性を考慮し、段階的に経皮的冠動脈形成術(PCI)を施行する方針となった。最終的には両側冠動脈の吻合部へそれぞれ3.5×14mmのバイオリムス溶出性ステントを留置し、良好に開大した。Cabrol graftと両側冠動脈の吻合部狭窄に対する待機的PCIの報告はなく、文献的考察を交えて報告する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内科学会  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本赤十字社医学会  

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Language：Japanese   Publisher：日本赤十字社医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Hypertension is well known to increase atrial fibrillation (AF) and the development of AF is associated with atrial chamber remodeling. Although mineralocorticoid receptor (MR) inhibition provides cardiovascular protection, the role of MR on atrial structural remodeling and inducibility of AF in hypertension remains unclear. Here, we investigated roles of the MR on atrial structural remodeling and inducibility of AF in hypertensive rats by using MR antagonist eplerenone (EPL). Dahl salt-sensitive (DS) rats were fed a normal-salt or a high-salt (HS) diet from 7 weeks, and a non-antihypertensive dose of EPL or vehicle was administrated from 13 weeks, at which time myocytes hypertrophy, interstitial fibrosis in the atrium and AF inducibility had increased, until 20 weeks. There was no significant difference in systolic blood pressure between DS+HS (186 ± 4 mm Hg) and DS+HS+EPL (184 ± 5 mm Hg) at 20 weeks. Burst atrial pacing demonstrated decreased AF inducibility in DS+HS+EPL (0 of 10) compared with DS+HS (7 of 10). Fibrosis and myocytes hypertrophy in the atrium were decreased in DS+HS+EPL with the reduction of atrial inflammatory cytokines. These beneficial effects of EPL were associated with less atrial oxidative stress, as assessed by 4-hydroxy-2-nonenal staining, and reduced activation of the Rho GTPase Rac1 in the atrium. Thus, MR has important roles in atrial structural remodeling and AF inducibility in Dahl rats. The effects of MR are associated, at least in part, with activation of Rac1-oxidative stress/inflammatory axis.

DOI： 10.1038/hr.2010.277

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Homing of cardiac myosin-specific CD4-positive T cells into the myocardium is the initial pathologic event of experimental autoimmune myocarditis (EAM). Subsequently, various bystander inflammatory cells are recruited into the myocardium crossing vascular endothelial cell walls. Sulfated polysaccharide fucoidan binds selectin nonselectively and blocks its function. Therefore, this study was designed to evaluate whether in vivo fucoidan treatment can improve EAM. A 21-day infusion of physiological saline or fucoidan was administrated intraperitoneally to the rats with sham operation (sham-saline, n = 5; sham-fucoidan, n = 6) or those with cardiac myosin injection (EAM-saline, n = 10; EAM-fucoidan, n = 10). After 3 weeks, fucoidan treatment improved left ventricular ejection fraction (79.04 ± 2.81 vs 65.94% ± 3.22%; P < .01 vs EAM-saline) with a reduced ratio of heart weight to body weight (4.016 ± 0.239 vs 4.975 ± 0.252 mg/g; P < .05 vs EAM-saline) in EAM. Furthermore, fucoidan treatment decreased serum levels of BNP (292.0 ± 53.4 vs 507.4 ± 89.2 ng/mL; P < .05 vs EAM-saline) and the myocarditis area (31.66 ± 1.53 vs 42.51% ± 3.24%; P < .01 vs EAM-saline) in EAM. These beneficial effects of fucoidan were accompanied by inhibition of both macrophage and CD4-positive T-cell infiltration into the myocardium. Fucoidan, a nonselective selectin blocker, attenuates the progression of EAM. This observation may be explained, at least in part, by blocking the extravasation of inflammatory cells into the myocardium.

DOI： 10.1177/1074248410378751

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Adequate evaluation of the nature of the residual failing myocardium, as well as the severity of myocardial injury, is important for managing patients with heart failure. The aim of this study was to investigate the myocardial function and the prognosis of patients with heart diseases using the force-frequency relationship (FFR). We enrolled 76 patients with sinus rhythm who had miscellaneous heart diseases and performed incremental right atrial pacing at the time of diagnostic cardiac catheterization. The first derivatives of left ventricular pressure (dP/dt) were recorded using a micro manometer-tipped catheter during the study. To represent properties of FFR, two parameters-the peak force rate (PFR) and force gain (FG)-were estimated. PFR was defined as the heart rate at which dP/dt became maximum. FG was defined as the difference between dP/dt at PFR and dP/dt at the basal heart rate. FG decreased as the severity of left ventricular (LV) dysfunction increased (372.0 ± 110.7, 209.5 ± 29.1 and 116.3 ± 13.1 mmHg/s for normal LV function, mild LV dysfunction and severe LV dysfunction groups, P < 0.05, respectively). PFR correlated with cardiac index (r = 0.375, P = 0.001). FG correlated with LV end systolic volume index (r = -0.297, P = 0.010) and LV ejection fraction (r = 0.539, P < 0.001). Furthermore, pulmonary arterial wedge pressure [hazard ratio (HR) 1.126, P < 0.01] and FG (HR 0.992, P = 0.061) tended to be independent predictors for cardiovascular death. Analysis of FFR, especially FG, seems to be useful to evaluate the nature of the failing myocardium and the prognosis of patients with heart diseases.

DOI： 10.1007/s00380-010-0040-1

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.carpath.2009.07.002

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Language：Japanese   Publisher：(一社)日本不整脈心電学会  

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BACKGROUND: Most patients with Takotsubo cardiomyopathy show a favorable outcome. Although several complications have been reported, the frequency of thromboembolism has not been clarified. METHODS: Clinical characteristics and complications of 21 consecutive patients (18 female, aged 72 years) with Takotsubo cardiomyopathy during the past 9 years were investigated. RESULTS: The most major complication was heart failure (52%). Thromboembolism was found in 3 patients (14%) and this was the second most frequent cardiovascular complication. One of the 3 patients showed left ventricular thrombus and the other 2 experienced cardioembolic stroke. All 3 patients visited the emergency department more than 48 h after initial chest pain occurred. CONCLUSIONS: This study indicates that thromboembolism is a common complication in the acute phase of Takotsubo cardiomyopathy, and anticoagulation therapy should be performed in all patients until wall motion abnormalities improve. Takotsubo cardiomyopathy should be considered one of the important causes of cardioembolic stroke.

DOI： 10.1016/j.ijcard.2008.06.089

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Language：Japanese   Publisher：新潟医学会  

背景:炎症と心房細動の関連を支持する報告が増えてきている。しかし、心房細動発症における炎症の直接的な役割については不明な点が多い。方法・結果:自己免疫性心筋炎(EAM)感作14日目(n=7)および56日目(n=7)のラットに対し、経頸静脈的に電極カテーテルを右心房へ挿入し、心房頻回刺激による心房細動の誘発を試みた。EAM感作14日目では心房細動は誘発されなかった。EAM感作56日目のラットでは心房細動が誘発され(15匹中11匹)、心房の著明な線維化と心筋細胞の肥大を伴っていた。さらに、EAM感作28日目から55日目にかけてアンギオテンシンIIタイプI受容体遮断薬(ARB)を投与したところ、心房細動は誘発されなくなり(8匹中0匹)、心房における間質の線維化と心筋細胞肥大は改善を認めた。結論:心筋炎急性期には心房細動は誘発されなかった。心房の器質的リモデリングを認めた心筋炎慢性期では心房細動が誘発され、ARBの使用によって心房の器質的リモデリング、心房細動の誘発はともに抑制された。炎症後心不全に伴う器質的リモデリングが、心房細動発症に重要な役割を果たしていると考えられた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

The effect of carperitide, recombinant human atrial natriuretic peptide, on chronic heart failure (HF) has not been clarified. We investigated the beneficial effects of chronic carperitide treatment in rats with HF after experimental autoimmune myocarditis. A 28-day infusion of carperitide (n = 14) or vehicle (n = 14) was administrated to the rats 4 weeks after experimental autoimmune myocarditis induction. After 4 weeks, the myocardial levels of cyclic guanosine monophosphate (cGMP), left ventricular function, myocyte hypertrophy, interstitial fibrosis, myocardial capillary vessel density, and activity of one prominent substrate of cGMP, vasodilator-stimulated phosphoprotein (VASP) that may enhance angiogenesis, were measured. Carperitide treatment increased the myocardial levels of cGMP and attenuated the functional severity along with a decreased myocyte cross-sectional area, interstitial fibrosis, and an increased capillary to myocyte ratio. Furthermore, carperitide treatment enhanced the phosphorylation of VASP at Ser239, which was preferentially phosphorylated by cGMP-dependent protein kinase but not Ser157, which was preferentially phosphorylated by cyclic adenosine monophosphate-dependent protein kinase. Long-term carperitide treatment attenuates ventricular remodeling and ameliorates the progression of chronic HF. The effects of carperitide treatment are associated with increased neovascularization among the residual myocytes and an increase of VASP activation.

DOI： 10.1097/FJC.0b013e3181b0cf50

PubMed

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本不整脈心電学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The impact of isolated diastolic dysfunction (IDD) and systolic dysfunction (SD) on health-related quality of life (HRQOL) is unknown. METHODS AND RESULTS: To evaluate HRQOL in patients with IDD and SD under treatment, information on outpatients aged 60-84 years was extracted from the records of 4,500 consecutive individuals who underwent echocardiographic examination at Sado General Hospital. The medical records of these patients were reviewed and a questionnaire, including the Medical Outcome Study Short Form 36, was mailed to 71 IDD and 99 SD patients; answers were obtained from 66 and 91 patients, respectively. The HRQOL of patients with cardiac dysfunction was impaired even when echocardiographic parameters improved with treatment. Patients with IDD showed an impairment of HRQOL similar to those with SD. Compared with males, female patients had a larger and more significant reduction in the physical and mental components of the HRQOL score. These scores correlated positively with exercise capacity in patients with IDD or SD. CONCLUSIONS: Impaired HRQOL, in both its mental and physical components, is a serious problem for IDD and SD patients under treatment. Because exercise intolerance may underlie the reduced HRQOL, improving exercise capacity could be an important target for managing outpatients with heart failure.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Determining the type of cardiac dysfunction is important for implementing therapeutic strategies and for prognostic insights. We characterized systolic dysfunction (SD) and isolated diastolic dysfunction (IDD) in adults referred for echocardiographic evaluation, and compared their clinical and other characteristics. In the present work, we studied 218 patients (137 males) with cardiac dysfunction (mean age, 66.3 +/- 8.3 years). SD was defined as a left ventricular ejection fraction (LVEF) of < 45%, whereas IDD was defined as a LVEF >or= 45% in addition to the standard Doppler-echocardiography diagnostic criteria for IDD. Approximately 68% of subjects had SD (70% males). The proportions of hypertension, diabetes, and dyslipidemia were 44%, 26%, and 22%, respectively, without significant association with the type of dysfunction. Myocardial infarction (MI) was found in 31% of patients, and was significantly (P < 0.001) more prevalent among SD compared with IDD cases. Cerebral stroke (18%) and malignancy (16%) were significantly associated with IDD (29% versus 13% for SD in the case of stroke, and 26% versus 11% for SD in the case of malignancy; P = 0.008 for each). In multivariately-adjusted logistic regression analysis, the following variables were found to be significantly (P < 0.05) and independently associated with IDD: female gender (odds ratio [OR] = 2.207 [95% CI = 1.302-4.608]), stroke (OR = 2.009 [1.119-3.980]), and malignancy (OR = 2.016 [1.230-4.010]). On the other hand, previous MI (OR = 2.075 [1.769-4.808]) was independently associated with SD. In conclusion, some factors/comorbidities were more likely to associate with IDD (female gender, stroke, and malignancy) or SD (previous MI) when IDD and SD were compared with each other.

PubMed

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(株)メディカルレビュー社  

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00990&link_issn=&doc_id=20080229090053&doc_link_id=%2Fdg3nigta%2F2007%2F012112%2F053%2F0708-0709%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2007%2F012112%2F053%2F0708-0709%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Impaired renal function is associated with poor outcomes among patients with chronic heart failure (CHF). However, the long-term changes in renal function in CHF patients without renal insufficiency at initial diagnosis remain unclear. METHODS AND RESULTS: Retrospective analysis of patients presenting with idiopathic dilated cardiomyopathy (IDCM) from 1984 to 2003 and who had normal renal function defined as estimated creatinine clearance (eCcr)>or=60 ml/min at the first diagnosis. Cumulative event proportions and renal insufficiency defined as eCcr<60 ml/min were calculated by the Kaplan-Meier method. The predictors of renal insufficiency were evaluated by logistic regression analysis. Impaired renal function developed in 20% during an 8-year follow-up and in 50% during a 20-year follow-up. Advanced age at the first diagnosis, high frequency of admissions, and hypotension during the clinical course were associated with the occurrence of impaired renal function. Beta-blocker therapy was a negative predictor of renal insufficiency. CONCLUSIONS: In patients with IDCM without renal insufficiency at initial diagnosis, worsening renal function occurred during the follow-up period. Frequent admissions, hypotension, and lacking beta-blocker therapy were associated with a poor prognosis in renal function.

PubMed

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00990&link_issn=&doc_id=20080212080019&doc_link_id=%2Fdg3nigta%2F2007%2F012111%2F019%2F0654-0655%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2007%2F012111%2F019%2F0654-0655%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00990&link_issn=&doc_id=20071130070033&doc_link_id=%2Fdg3nigta%2F2007%2F012109%2F033%2F0540-0541%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2007%2F012109%2F033%2F0540-0541%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：Japanese   Publisher：新潟医学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Dynamic intraventricular obstruction is a less well-known mechanical complication of acute myocardial infarction (AMI). Its hallmark is the development of a new systolic murmur, and echocardiography is necessary for diagnosis. We describe a case of a 74-year-old woman with dynamic intraventricular obstruction complicating AMI. Serial echocardiography suggested that the intraventricular gradient was a consequence of basal hyperkinesis, which was a reciprocal response to akinesis of the apical wall. Cilostazol, which was administered to prevent subacute stent thrombosis after percutaneous coronary intervention, might have contributed to the transient intraventricular obstruction.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The role of the angiopoietin (Ang)/Tie-2 system in coronary collateral growth is not well understood, so the purpose of this study was to investigate and elucidate the relationship of this system to coronary collateral formation in patients with coronary artery disease (CAD). METHODS AND RESULTS: Fifty-nine patients with CAD were recruited. Blood samples from the left ventricle (LV) and coronary sinus (CS) were obtained during cardiac catheterization, and serum concentrations of Ang-1, Ang-2, and Tie-2 were measured by enzyme-linked immunosorbent assay. Patients were then classified as mild CAD (n=30), defined as </=90% stenosis of the coronary arterial luminal diameter, or severe CAD (n=29), which was total (or near total) coronary occlusion requiring coronary collateral growth. Ang-1, Ang-2, and Tie-2 in the LV and CS sera were not significantly different between groups. In the severe CAD group, spillover of Tie-2 (CS-LV value) from the coronary circulation was found in comparison with the mild CAD group (3.43+/-2.22 vs -3.29+/-1.54 ng/ml, p=0.01), whereas the CS-LV values of Ang-1 and Ang-2 did not differ between groups. Tie-2 production was markedly increased in patients with well-developed collaterals. A positive and significant correlation was found between coronary Ang-2 and Tie-2 levels (r=0.44, p<0.001). CONCLUSIONS: Tie-2 is probably produced in the coronary circulation and may induce the development or maintenance of coronary collaterals in CAD patients. Furthermore, the role of Ang-2 in the formation of coronary collaterals may be more important than that of Ang-1.

PubMed

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00990&link_issn=&doc_id=20060828250018&doc_link_id=%2Fdg3nigta%2F2006%2F012006%2F019%2F0348-0348%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2006%2F012006%2F019%2F0348-0348%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：Japanese   Publisher：(有)科学評論社  

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A 53-year-old Japanese man with fulminant myocarditis was referred. Percutaneous cardiopulmonary support (PCPS) was introduced immediately and intravenous immunoglobulin (IVIG) therapy followed for 2 days. Cardiac function showed signs of recovery on the 4th hospital day and the patient was weaned from PCPS on the 7th hospital day. Creatine kinase-MB peaked at 12 h after admission and was 176 ng/ml. Endomyocardial biopsy showed active myocarditis. A marked increase of the neutralizing antibody titer suggested coxsackievirus B3 infection. Plasma concentrations of cytokines and neurohumoral factors were analyzed. Proinflammatory cytokines, such as interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNF-alpha), and anti-inflammatory cytokines, such as IL-1 receptor antagonist, soluble TNF receptor-1 and IL-10, were elevated on admission and all had decreased on the 7th hospital day. Brain natriuretic peptide and noradrenaline were already elevated upon admission (1,940 pg/ml and 4.6 ng/ml, respectively) and decreased thereafter. Although IVIG therapy under PCPS is a common treatment for fulminant myocarditis, the immunological response in vivo remains unclear. This case demonstrated suppression of serum cytokines after IVIG and PCPS treatment. Immunological parameters in those who have been treated with IVIG and PCPS and survived without complications are of great value for evaluation of the therapy. Further analysis with more cases in a multicenter study is necessary.

PubMed

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：新潟医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2003&ichushi_jid=J00990&link_issn=&doc_id=20040130440088&doc_link_id=%2Fdg3nigta%2F2003%2F011711%2F088%2F0671-0671%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2003%2F011711%2F088%2F0671-0671%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

Language：English   Publishing type：Research paper (scientific journal)  

We describe a patient with acute necrotizing eosinophilic myocarditis who recovered rapidly after pericardial drainage and without corticosteroid therapy. The 25-year- old man was referred to our hospital with suspected acute myocardial infarction on the basis of severe epigastralgia, abnormal Q waves and ST elevation on electrocardiography, and an increase in cardiac enzymes. Echocardiography disclosed pericardial effusion that compressed the right ventricle, left ventricular dysfunction in conjunction with posterolateral hypokinesis, and a thickened ventricular wall but no mural thrombus. The eosinophil count in the peripheral blood was slightly increased. Coronary angiography showed normal arteries and thus prompted an endomyocardial biopsy. The patient was transferred to the intensive care unit with a clinical diagnosis of myocarditis associated with cardiac tamponade. Emergency pericardiocentesis relieved symptoms immediately. The cells in the pericardial effusion were mainly eosinophils; interleukin 5 and interleukin 13 levels were predominantly elevated, and the effusion was drained for 5 days. The biopsy specimen revealed necrotizing eosinophilic myocarditis. Left ventricular function recovered within a week without corticosteroid therapy. No relapse was observed as of 8 months after diagnosis.

PubMed

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(株)診断と治療社  

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Language：Japanese  

J-GLOBAL

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00679&link_issn=&doc_id=20220721320009&doc_link_id=20220721320010%2C20220721320011&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20220721320010%2C20220721320011&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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J-GLOBAL

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J-GLOBAL

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Language：English   Publisher：(一社)日本循環器学会  

J-GLOBAL

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Language：English   Publisher：日本成人先天性心疾患学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本心臓病学会  

J-GLOBAL

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は82歳の女性。2年前に大動脈弁狭窄症(弁口面積1.0cm2)と診断され、経過観察されていた。今回、心不全を合併した前壁中隔の急性心筋梗塞を発症した。心エコーでは前壁中隔から心尖部の左室壁運動は低下し、左室-大動脈弁の最大圧較差は50mmHgであり、low-flow low-gradientと考えられた。緊急冠動脈造影では左前下行枝の完全閉塞を認め、経皮的冠動脈形成術にて再灌流を得た。クレアチンキナーゼは13109IU/Lまで上昇、心不全、循環動態の管理に難渋し、人工呼吸器や大動脈内バルーンパンピングを要した。集中治療室入室より数時間後に心破裂による心タンポナーデを生じ、外科的修復術を施行した。血行動態の改善を年的に、第5病日に経皮的大動脈弁形成術を施行、平均圧較差は29→24mmHgへ低下し、以後の循環状態は安定した。大動脈弁狭窄症を伴う急性心筋梗塞は心破裂の危険性が大きく、注意が必要である。また、大動脈弁狭窄症を合併した急性心筋梗塞において、大動脈弁に対する介入方法、時期の検討が必要である。(著者抄録)

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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Language：English   Publisher：Japanese Circulation Society  

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Language：English   Publisher：Japanese Circulation Society  

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Language：English   Publisher：Japanese Circulation Society  

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Language：English   Publisher：Japanese Circulation Society  

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Language：English   Publisher：Japanese Circulation Society  

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Language：English   Publisher：Japanese Circulation Society  

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Event date： 2019.9

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Event date： 2019.9

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Event date： 2019.9

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Event date： 2019.3

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Event date： 2019.3

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Event date： 2019.3

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