Liver stiffness measured by noninvasive VTQ methods can be used to assess liver congestion and therapeutic effects in patients with HF. (Circ J 2016; 80: 1187-1195).

BackgroundAlthough rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients.Methods and resultsWe examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (≥14 inflammatory cells) and minimal (<14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CM-group samples.ConclusionsFrequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.

No abstract

SummaryAdaptive servo-ventilation (ASV) has been attracting attention as a novel respiratory support therapy for heart failure (HF). However, the acute hemodynamic effects have not been compared between ASV and continuous positive airway pressure (CPAP) in HF patients.We studied 12 consecutive patients with stable chronic HF. Hemodynamic measurement was performed by right heart catheterization before and after CPAP 5 cmH 2 O, CPAP 10 cmH 2 O, and ASV for 15 minutes each.Heart rate, blood pressure, pulmonary capillary wedge pressure (PCWP), and stroke volume index (SVI) were not changed by any intervention. Right atrial pressure significantly increased after CPAP 10 cmH 2 O (3.6 ± 3.3 to 6.7 ± 1.6 mmHg, P = 0.005) and ASV (4.1 ± 2.6 to 6.8 ± 1.5 mmHg, P = 0.026). Cardiac index was significantly decreased by CPAP 10 cmH 2 O (2.3 ± 0.4 to 1.9 ± 0.3 L/minute/m 2 , P = 0.048), but was not changed by ASV (2.3 ± 0.4 to 2.0 ± 0.3 L/ minute/m 2 , P = 0.299). There was a significant positive correlation between baseline PCWP and % of baseline SVI by CPAP 10 cmH 2 O (r = 0.705, P < 0.001) and ASV (r = 0.750, P < 0.001). ASV and CPAP 10 cmH 2 O had significantly greater slopes of this correlation than CPAP 5 cmH 2 O, suggesting that patients with higher PCWP had a greater increase in SVI by ASV and CPAP 10 cmH 2 O. The relationship between baseline PCWP and % of baseline SVI by ASV was shifted upwards compared to CPAP 10 cmH 2 O. Furthermore, based on the results of a questionnaire, patients accepted CPAP 5 cmH 2 O and ASV more favorably compared to CPAP 10 cmH 2 O.ASV had more beneficial effects on acute hemodynamics and acceptance than CPAP in HF patients. (Int Heart J 2015; 56: 527-532)

ASV reduced AHI and improved BNP. ASV might initially improve presynaptic cardiac sympathetic nervous function in HF patients after 6 months of treatment.

on behalf of the PACIFIC investigators Background: Optimal medical therapy (OMT) and the management of coronary risk factors are necessary for secondary prevention of major adverse cardiac and cerebrovascular events (MACCE) in post-acute coronary syndrome (ACS) patients. However, the effect of post-discharge patient adherence has not been investigated in Japanese patients.

It is possible to diagnose varicose vein from medical history and physical examinations including inspection and palpation. Non-contrast enhanced MRV (magnetic resonance venography) is becoming popular because it can be easily performed without being affected by the radiographer's skill. We thought that the use of MEDIC (multi echo data imaging combination) would enable us to delineate varicose veins within a short acquisition time and without need for synchronization or contrast enhancement. We used the SIEMENS MAGNETOM Avanto 1.5-Tesla unit to acquire images. Our subjects were five healthy volunteers and five patients with varicose vein. The signal strength of deep veins and muscles were measured. The SNR (signal-to-nose ratio) of deep veins and the CNR (contrast-to-noise ratio) between deep veins and muscles were also measured. 1. a) flip angle, b) fat suppression methods, c) MTC (magnetic transfer contrast) pulse, and d) combined echo. Using the optimum image acquisition protocol following our preliminary study with varicose vein patients, the ability of the 3D-MEDIC method to delineate varicose veins was compared with that of the ECG-synchronized 2D-TOF method. We found that the following settings would enable us to acquire images from a wide range=coronal, within short acquisition time and needless ECG-triggering. 1. a) flip angle=20 degrees, b) fat suppression method=water excitation, c) MTC pulse=ON, d) combined echo=2. 3D-MEDIC was better than the 2D-TOF method in delineating the varicose vein itself and the connection between the varicose vein and deep veins. It is expected that 3D-MEDIC may be useful in the clinical diagnosis of varicose veins. (Article in Japanese).

In addition to being a researcher, Dr Keiji Noguchi is a foster parent and so understands the importance of a support model to prevent disruption of foster children placement. Noguchi, Faculty of Education, Fukuyama City University, Japan, is leading a project focused on developmental research on practical models and manuals for foster parent support specialists. This builds on previous research from Osaka Prefecture University and seeks to show how best to support foster parents and prevent disruption. To achieve this goal, Noguchi is developing practical models and manuals to support foster parents. A key focus is on the role of specialists who are assigned to Residential Care Institutions for Children (RCIC). Noguchi believes these Institutions and foster parents both play an important role in the success of foster parenting but it is important to find an effective means to better understand the current situation regarding the support that foster parents receive from institutions, decipher what works and what doesn’t and develop recommendations in line with this. The most important aspect of this work is ensuring that the needs of foster children are realised and fulfilled and so their input is invaluable. Foster parents also need to be considered as if the needs of foster parents are being met it is more likely that the needs of foster children are, in turn, being met. As such, Noguchi and the team are conducting an interview survey on foster parent support for foster parents and professionals in RCIC that support foster parent care and have collected valuable data that has enabled them to create a manual for foster parent care support called the Foster Parent Programme.