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Nonadiabatic Excited-State Molecular Dynamics Techniques: Comparability and Unity.
However, the occurrence of this mutation in Asian populations is very rare. This is the second reported case of the ATTR Val122Ile variant in Japan and the first case tested including familial genes. .We present a case of a Japanese patient with familial hypercholesterolemia (FH) caused by a low-density lipoprotein (LDL) receptor gene mutation. A 47-year-old female was referred to our hospital due to her systemic xanthomatosis associated with elevated LDL-cholesterolemia (292 mg/dl). She was diagnosed with heterozygous FH, and started to be treated with simvastatin 10 mg. During her clinical course, she underwent percutaneous coronary intervention (PCI) (at 69 years), coronary artery bypass grafting (CABG) twice (at 62 years, and 75 years), femoral popliteal bypass surgery (at 67 years), together with intensification of lipid-lowering therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. She was admitted to our hospital due to dyspnea on effort, caused by severe aortic valve stenosis as well as sick sinus syndrome at the age of 78 years. transcatheter aortic valve implantation (TAVI) using balloon expandable valve was successfully performed after DDD pacemaker implantation. She was discharged from our hospital without any symptoms. During more than 30 years of treatment period in our institute, we have introduced the latest therapeutic strategies, and treated her intensively. We are proud that we can save life even in this severe case through multiple strategies developed over the decades; however, this case clearly suggests that lipid-lowering therapies should be started much earlier in patients with FH. .Advances in microcatheters (MCs) enables the establishment of retrograde systems for the treatment of chronic total occlusion (CTO). However, there are still cases in which establishing a retrograde system is difficult because the guidewire or MC cannot pass through due to calcification, stenosis, or tortuosity. We present a case of a 56-year-old man with angina. Coronary angiography revealed a CTO of the right coronary artery (RCA). Although we started an antegrade approach at first, the guidewire went to subintimal lumen. We switched to a retrograde approach. selleck kinase inhibitor Although the guidewire passed through posterolateral (PL) channel, the MC could not pass due to a stenosis at the junction of the main RCA trunk. Therefore, we negotiated the septal channel; however, it could only be guided in the peripheral direction. When the guidewire was more advanced in the peripheral direction, it crossed the guidewire that had previously passed through the PL channel. Then, when a balloon was delivered via the septal channel and trapped the guidewire from the PL channel, the MC was successfully delivered via the PL channel. After establishing the retrograde system, revascularization succeeded smoothly. In conclusion, this technique can be one option for the treatment of CTO patients. .A 22-year-old male had a dual chamber permanent pacemaker (PPM) implanted for complete heart block following aortic valve replacement for Shone's syndrome 3 months previously. He presented with acute shortness of breath due to severe para-valvular leak with aortic valve dehiscence following a motor vehicle accident. He was scheduled for redo sternotomy and a pre-operative PPM check was undertaken. A programmer wand (Model 2067, Medtronic Inc., Minneapolis, MN, USA) was applied to the patient's PPM site to perform interrogation. During initialization, asynchronous DOO pacing at the magnet rate of 85 bpm was initiated with evidence of both atrial and ventricular capture. Competition from intrinsic rhythm resulted in functional loss of capture. Competitive pacing initiated a narrow complex supraventricular tachycardia at 180 bpm. The tachycardia persisted to result in clinical deterioration until reversion with urgent intravenous metoprolol. Programmer wands from Medtronic (Model 2067 & Encore) and Biotronik (Renamic, Biotronik Inc., Berlin, Germany) have in-built magnets that can cause asynchronous pacing during initialization of interrogation. Removing the magnet in future iterations of PPM programmer wands will mitigate inadvertent arrhythmia induction. .Mitral valve replacement (MVR) using a prosthesis of transcatheter aortic valve implantation for mitral annular calcification (MAC) is an alternative procedure which is very different from a conventional MVR and is safe. Acceptable results including mortality and morbidity have been reported. We report the case of a male patient treated with this procedure. There was a risk of left ventricular rupture due to extensive decalcification, so we performed transcatheter mitral valve implantation (TMVI). Since he had a history of surgical aortic valve replacement (AVR), we chose open-heart transseptal approach so as not to interfere with the aortic prosthesis. TMVI has a risk of an iatrogenic left ventricular outflow tract (LVOT) obstruction. Using open-heart transseptal approach, we could easily check an anterior commissure of mitral annulus to prevent LVOT obstruction. .Pulmonary vein stenosis (PVS) is a rare, severe, and potentially fatal complication most often arising from pulmonary vein ablation for medication refractory, symptomatic, and permanent atrial fibrillation. At present, the optimal approach for the management of PVS remains to be defined. Here, we describe a unique case of bifurcation pulmonary venoplasty and stenting in a patient with recalcitrant PVS after surgical reconstruction of her pulmonary veins. To our knowledge, this is the first such report of its kind. .SARS-CoV-2, and the disease it causes, COVID-19, is sweeping through the world, disrupting human activities everywhere. The consequences of this on-going event on societies are yet to be fully understood. The emergence of SARS-CoV-2 illustrates how human-environment interaction should be framing research on pathogen spillover. Furthermore, the geography of human contacts at various scales in our globalized and urbanized world affects its diffusion. Both elements plead for a robust backbone of geography of health, including land use, to understanding disease emergence and diffusion.
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