P2805Initial pathological responses of third-generation everolimus-eluting stents implantation: comparison with second-generation everolimus-eluting stents

Background

Third-generation drug-eluting stent (3rd DES) is commonly used now in percutaneous coronary intervention, and it has not only thinner struts, easier delivery than second-generation drug-eluting stent (2nd DES), but also abluminal biodegradable polymer. Clinical superiority of 3rd DES has been demonstrated compared to 1st and 2nd DESs. However, pathological response after 3rd DES implantation remains unclear.

Purpose

Pathological study of coronary artery after 3rd DES implantation have not been reported as far as we have referred to the previous studies. This study aimed to examine the initial tissue response after 3rd DES and 2nd DES implantation within one year.

Methods

Using specimens obtained by autopsy, we compared the histology between 3rd DES (n=3, 8 histological sections) and 2nd DES (n=6, 41 histological sections) lesions within 1 year after stent implantation to evaluate early tissue reaction. Stent segments were fixed with 10% buffered formalin and embedded in plastic, followed by hematoxylin–eosin, Masson's trichrome and elastica van Gieson. Ratio of covered stent struts by neointima was calculated. The thickness of neointima and the area of fibrin deposition were morphometrically evaluated. The degree of inflammation around struts was examined semi-quantitatively (score 0–3).

Results

The ratio of covered struts and thickness of neointima of 3rd DES were 0.84±0.04 and 68.2±10.3μm, while those of 2nd DES were 0.69±0.05 and 30.4±4.8μm respectively. The inflammation score was similar between two groups (1.00±0.14 vs. 1.02±0.16). The area of fibrin deposition around the struts was larger in 3rd DES compared with 2nd DES (1276.6±490.3μm2 vs. 658.0±173.4μm2). These results suggest that the 3rd DES may obtain prompt as well as rich covering of struts in the initial term after DES implantation. Although the biological feature of the polymers in 3rd and 2nd DESs is different, the inflammatory responses after both 3rd and 2nd DESs implantation were similar, at least within one year after deployment. The degree of inflammation was mild, less than approximately 50 inflammatory cells (score 1) around the struts.

Conclusions

Our pathological analysis showed advanced healing process in 3rd DES compared with 2nd DES lesions in the viewpoint of strut coverage by neointima. Observation of long-term pathological response may be required to evaluate the superiority of bioabsorbable polymer in 3rd DES.

Health indicators as moderators of occupational commitment and nurses' intention to leave

AIM

This study examined the hypothesis that health indicators moderate the relationship between occupational commitment and intention to leave among nurses, using a large sample in Japan.

METHODS

A self-administered questionnaire was distributed to all registered nurses (N = 11,171) working in group hospitals in western Japan in 2014. The questionnaire evaluated intention to leave, occupational commitment, psychological distress, cumulative fatigue, and demographic variables. After a preliminary analysis of the bivariate and multivariate associations between variables and intention to leave, we tested the interactions between occupational commitment and health indicators on intention to leave.

RESULTS

Of the 5,768 returned questionnaires, data from 5,505 (49.3%) participants were analyzed. Participants' mean age was 36.27 years (SD = 10.37). Most (95.14%) were women. According to a generalized estimating equation, the interaction of continuance occupational commitment and cumulative fatigue was significantly related to intention to leave (b = -0.0055). Additionally, the interaction of affective occupational commitment and psychological distress was significantly related to intention to leave (b = 0.0079).

CONCLUSIONS

This study clarified that the relationship between occupational commitment and intention to leave was robust for nurses in good health. Interventions aimed at reducing fatigue and improving psychological distress should be implemented to prevent the protective effects of occupational commitment on nurses' intention to leave from being compromised.

Antibody-mediated Remyelination: Relevance to Multiple Sclerosis

Intravenous immunoglobulin (IVIG) is widely used for treatment of autoimmune neurological disorders and is currently in clinical trials as a therapy for multiple sclerosis. We have previously demonstrated that certain mouse monoclonal antibodies of the IgM isotype, promote significant remyelination when administered to mice with chronic Theiler's murine encephalomyelitis virus-induced demyelinating disease. These IgM antibodies bind to antigens expressed on oligodendrocytes. We now demonstrate that polyclonal human IgG (IVIG) and polyclonal human IgM also promote remyelination in this system. Although both polyclonal human IgG and IgM promote remyelination, IgM is more potent Polyclonal human IgM also differs from human IgG in its ability to bind strongly to antigens expressed in the CNS and by oligodendrocytes. We propose that polyclonal IgG and polyclonal IgM may function to promote remyelination by different mechanisms. IVIG may function based on its immunomodulatory activity, while the activity of IgM is critically dependent upon its reactivity with CNS antigens. This possibility has clear relevance to the use of antibodies as a therapy for multiple sclerosis, suggesting that combined treatment with antibodies exerting immunomodulatory activity, in concert with antibodies that function through direct binding to CNS antigens, may synergize to enhance the efficacy of the therapy.

Determinants Strengthening Japanese Nurses' Intention to Stay at Their Current Hospital

In order to retain nursing staff, it is crucial to have a comprehensive understanding of the factors that motivate nurses to stay at an institution. Toward this aim, we identified a variety of factors that strengthen nurses' intention to stay at their current hospital. A cross-sectional questionnaire survey was conducted at 12 hospitals in the Tohoku and Kanto regions of Japan. Of the 1,034 nurses working in those hospitals, 713 returned the questionnaire (response rate: 69.0%). Of these, we analysed the data of 485 nurses (17.42 ± 9.83 years of clinical experience, 95.3% female) (valid response rate: 46.9%) who met the inclusion criteria of planning to stay at their current hospital and completing all questionnaire items. An exploratory factor analysis indicated that variables strengthening intention to stay at the current hospital could be grouped into five factors: "comfortable workplace environment," "passive motivational factors," "convenience of hospital location," "favorable work-life balance," and "fulfilment in nursing." Nurses who were married or had children placed a higher priority on a "favorable work-life balance" in remaining at their current workplace. Regular employees or nurses working in the smaller cities tended to display higher "passive motivational factors," which comprised various extrinsic factors. Though extrinsic factors are considered to make only short-term contributions to employee retention, they could generate positive synergistic effects when combined with intrinsic motivations such as "fulfilment in nursing." Effective nurse-retention strategies should be developed by capitalizing on the interaction among the five factors that strengthen nurses to stay at their current hospital.

Generation-Common and -Specific Factors in Intention to Leave among Female Hospital Nurses: A Cross-Sectional Study Using a Large Japanese Sample

An understanding of the conditions that determine the factors affecting nurses' intention to leave is important for countries suffering from nurse shortage.

AIM

to examine factors influencing intention to leave among female hospital nurses in a large Japanese sample, classified into four generations by age and considering economic conditions.

METHODS

a cross-sectional survey with convenience sampling was conducted. Anonymous self-administered questionnaires were distributed to all nurses in 30 hospitals. To assess intention to leave, basic attributes, life conditions, work characteristics, and factors of psychosocial work environment were addressed. After classifying data into four generations based on age cohorts, we conducted multivariate logistic regression analysis using the completed data (N = 5074, mean age = 36.24 years).

RESULTS

regardless of the generational characteristics influenced by economic conditions, effort and monetary reward were generation-common factors. Over-commitment, social support, and the presence of a role model were generation-common factors in three generations. While having children increased intention to leave in the generation born in 1965⁻1979, having family members in need of caregiving other than children decreased the risk in the generation born in the 1980s.

CONCLUSION

generational countermeasures considering factors of psychosocial work environment and life conditions are needed to avert female nurse turnover.

Effect of CT digital image compression on detection of coronary artery calcification

Purpose: To test the effect of digital compression of CT images on the detection of small linear or spotted high attenuation lesions such as coronary artery calcification (CAC).

Material and Methods: Fifty cases with and 50 without CAC were randomly selected from a population that had undergone spiral CT of the thorax for screening lung cancer. CT image data were compressed using JPEG (Joint Photographic Experts Group) or wavelet algorithms at ratios of 10:1, 20:1 or 40:1. Five radiologists reviewed the uncompressed and compressed images on a cathode-ray-tube. Observer performance was evaluated with receiver operating characteristic analysis.

Results: CT images compressed at a ratio as high as 20:1 were acceptable for primary diagnosis of CAC. There was no significant difference in the detection accuracy for CAC between JPEG and wavelet algorithms at the compression ratios up to 20:1. CT images were more vulnerable to image blurring on the wavelet compression at relatively lower ratios, and "blocking" artifacts occurred on the JPEG compression at relatively higher ratios.

Conclusion: JPEG and wavelet algorithms allow compression of CT images without compromising their diagnostic value at ratios up to 20:1 in detecting small linear or spotted high attenuation lesions such as CAC, and there was no difference between the two algorithms in diagnostic accuracy.

Effects of JPEG and wavelet compression of spiral low-dose CT images on detection of small lung cancers

Purpose: To compare the effect of compression of spiral low-dose CT images by the Joint Photographic Experts Group (JPEG) and wavelet algorithms on detection of small lung cancers.

Material and Methods: Low-dose spiral CT images of 104 individuals (52 with peripheral lung cancers smaller than 20 mm and 52 control subjects) were used. The original images were compressed using JPEG or wavelet algorithms at a ratio of 10:1 or 20:1. Five radiologists interpreted these images and evaluated the image quality on a high-resolution CRT monitor. Observer performance was studied by receiver operating characteristic (ROC) analysis.

Results: There was no significant difference in the detection of cancers measuring 6 to 15 mm in uncompressed images and in those compressed by either of the algorithms, although the quality of images compressed at 20:1 with the wavelet algorithm was somewhat inferior. A lower diagnostic accuracy was noted using images compressed by the JPEG or wavelet algorithms at 20:1 in detecting lung cancers measuring 6 to 10 mm and cancers measuring from 6 to 15 mm with ground-glass opacity.

Conclusion: Compression of low-dose CT images at a ratio of 10:1 using JPEG and wavelet algorithms does not compromise the detection rate of small lung cancers.

The Development of the Attitude Toward Professional Autonomy Scale for Nurses in Japan

This study's aim was to develop and test the psychometric properties of the Attitude toward Professional Autonomy Scale for Nurses in Japan. In Study 1, the initial (26-item) version of the scale was pilot tested on 454 Japanese nurses; item analysis and exploratory factor analysis were performed. In Study 2, the revised version of the scale (19 items) was administered to 802 Japanese nurses. The scale had good internal consistency (α = .85). Correlations with the scale of the desire of self-determination supported its concurrent validity. The scale could facilitate the assessment of cognitive aspects of professional autonomy among nurses and contribute to assessment of the propensity to behave autonomously among nurses in various clinical settings.

Structure determination of the rutile-TiO2(110)-(1 × 2) surface using total-reflection high-energy positron diffraction (TRHEPD)

Detailed structure of the rutile-TiO₂(110)-(1 × 2) has been determined using the newly developed technique of total-reflection high-energy positron diffraction (TRHEPD).

Three-dimensional positioning and control of colloidal objects utilizing engineered liquid crystalline defect networks

Topological defects in liquid crystals not only affect the optical and rheological properties of the host, but can also act as scaffolds in which to trap nano or micro-sized colloidal objects. The creation of complex defect shapes, however, often involves confining the liquid crystals in curved geometries or adds complex-shaped colloidal objects, which are unsuitable for device applications. Using topologically patterned substrates, here we demonstrate the controlled generation of three-dimensional defect lines with non-trivial shapes and even chirality, in a flat slab of nematic liquid crystal. By using the defect lines as templates and the electric response of the liquid crystals, colloidal superstructures are constructed, which can be reversibly reconfigured at a voltage as low as 1.3 V. Three-dimensional engineering of the defect shapes in liquid crystals is potentially useful in the fabrication of self-healing composites and in stabilizing artificial frustrated phases.

Topological defects can be used not only to modify the properties of liquid crystals but also as scaffolds to build new structures by trapping particles. Here, Yoshida et al. construct three-dimensional colloidal superstructures in a nematic host, which are reconfigurable in an electric field.

Inverse association between dietary habits with high total antioxidant capacity and prevalence of frailty among elderly Japanese women: a multicenter cross-sectional study

OBJECTIVE

To examine the association of dietary habits with high total antioxidant capacity (TAC) with frailty among elderly Japanese women.

DESIGN

Cross-sectional multicenter study.

SETTING

Thirty-five of 47 prefectures in Japan.

PARTICIPANTS

2121 grandmothers or acquaintances of dietetic students aged 65 and older.

MEASUREMENTS

Dietary TAC and food intakes were calculated using a validated brief-type self-administered diet history questionnaire. The TAC value of each food was assigned using four different assays, ferric reducing ability of plasma (FRAP), oxygen radical absorbance capacity (ORAC), Trolox equivalent antioxidant capacity (TEAC), and total radical-trapping antioxidant parameter (TRAP). Frailty was defined as the presence three or more of the following four components: slowness and weakness (two points), exhaustion, low physical activity, and unintentional weight loss.

RESULTS

The number of subjects with frailty was 486 (23%). Multivariate adjusted ORs (95% CI) for frailty in the highest compared to the lowest quintile were 0.35 (0.24, 0.53) for FRAP, 0.35 (0.23, 0.52) for ORAC, 0.40 (0.27, 0.60) for TEAC, and 0.41 (0.28, 0.62) for TRAP. The intakes of green tea, coffee, vegetables, and fruits which contribute to dietary TAC were also associated with lower odds of frailty (the range of multivariate adjusted OR: 0.47 for vegetables to 0.77 for green tea), although the odds ratios were less marked than those of dietary TAC.

CONCLUSIONS

Dietary habits with high TAC showed a stronger inverse association with frailty in elderly Japanese women than the individual foods examined.