Biomedical subjects

Y Ueda

Publications and source records attributed to Y Ueda.

At least 109 records · Page 6Linked to original sources

PubMed2001

De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation.

BACKGROUND AND AIM OF THE STUDY: Residual or recurrent tricuspid regurgitation (TR) has been reported after several types of surgical repair. The development of late TR is an important complication of left heart surgery. The results of De Vega annuloplasty were compared with those obtained after Carpentier-Edwards ring (CE ring) annuloplasty in patients with secondary TR. METHODS: The records of 45 patients who underwent surgery for secondary TR between January 1995 and July 2000 were reviewed retrospectively. Twenty-eight patients underwent De Vega annuloplasty, and 17 had a CE ring annuloplasty. The groups were similar with respect to associated cardiac lesions. No significant preoperative differences were observed in NYHA functional class, TR grade, and pulmonary artery pressure between the two groups. RESULTS: One CE patient died of left ventricular dysfunction after postoperative bleeding. The 28 De Vega patients and remaining 16 CE patients had an uneventful recovery, and were discharged. Tricuspid ring size after repair was similar between groups. Mean (+/- SD) follow up in the entire patient cohort was 39+/-23 months (range: 6 to 75 months). TR recurrence was rated as grade II or III in 13 patients (45%) after De Vega annuloplasty, but was grade II or III in only one patient (6%) patient after CE ring annuloplasty. There was a significant difference in TR recurrence between the groups (p = 0.027), but no significant difference in NYHA class. CONCLUSION: CE ring annuloplasty significantly decreased the recurrence of TR; thus, CE ring annuloplasty is superior to De Vega annuloplasty in patients with secondary TR.

Aged↗

PubMed2001

[Regional cerebral blood flow values measured by Xe-CT during the attack of transient global amnesia: a case report].

A 50-year-old right-handed woman was referred to our hospital for further examination of sudden global amnesia. The patient had no history of epilepsy, head injury or cerebral vascular diseases. There were no neurological deficits except for recent memory disturbance. We examined her cerebral blood flow(CBF) immediately during transient global amnesia(TGA) by stable xenon enhanced CT scans(Xe-CT) and twice thereafter. Xe-CT during the attack showed a significant diminution of regional blood flow from the right posterior temporal lobe to the occipital lobe. Conventional MRI scans also had been performed serially but it could not detect the local ischemic event. The ischemic lesion was clearly divided and larger than those cases reported using PET, SPECT, and diffusion-weighted MRI. TGA happens suddenly, and recovery is immediate. It becomes very difficult to study CBF during TGA attack. However stable Xe-CT is capable of examining CBF easily, so we concluded that CBF examination by Xe-CT in TGA patients would be helpful to reveal the mechanism of TGA.

Amnesia, Transient Global↗

PubMed2001

[A case of urinary retention secondary to aseptic meningitis].

A case of a 37-year-old man with urinary retention secondary to aseptic meningitis is described. He was admitted to our hospital with complaints of fever, nausea, headache, and gait disturbance. He had begun treatment 1 week previously for high fever, headache and joint pain at an outpatient department. On admission, neurological examination revealed neck stiffness, spasticity and hyperreflexia of the extremities, hypesthesia of the lower extremities, and ataxic gait. A spinal fluid examination revealed aseptic meningitis. Disturbed consciousness, diplopia, aphasia, tetraparesis, and urinary retention appeared after admission. Computed tomography and magnetic resonance imaging (MRI) of the head revealed no abnormal lesions. On the 2nd day of hospitalization, a Foley catheter was inserted for urinary retention. The patient was treated with conservative therapy, and his symptoms gradually resolved. The Foley catheter was removed on hospital day 13, but bladder dysfunction was persisted. MRI of the lumbar spine revealed herniated lumbar discs at level L3-4, L4-5, and L5-S1, but the nerve roots were not compressed. The patient was managed with clean intermittent catheterization for more than two weeks. Cystometry revealed atonic bladder. Nineteen cases of urinary retention secondary to aseptic meningitis have been reported in the previous literature. We reviewed their clinical presentation and treatment.

Adult↗

PubMed2001

Expression of multidrug resistance protein and messenger RNA correlate with (99m)Tc-MIBI imaging in patients with lung cancer.

UNLABELLED: In vitro studies have shown that (99m)Tc-sestamibi (MIBI) is a transport substrate for the P-glycoprotein (Pgp) pump and the multidrug resistance-associated protein (MRP) pump. However, whether MRP and lung resistance protein (LRP) affect tumor accumulation and efflux of (99m)Tc-MIBI in lung cancer is not known. In this study, we explored whether Pgp and the other pumps, MRP and LRP, affect tumor accumulation and efflux of (99m)Tc-MIBI in lung cancer. METHODS: Thirty-four lung cancer patients who underwent surgery were examined. Before surgery, (99m)Tc-MIBI SPECT was performed 15 min and 180 min after injection, and early uptake, delayed uptake (L/Nd), and washout rate (L/Nwr) of (99m)Tc-MIBI were obtained. Pgp, MRP, and LRP expression were investigated by immunohistochemistry. The messenger RNA (mRNA) level of Pgp, MRP, and LRP was determined by real-time reverse-transcription polymerase chain reaction. The lung cancer (99m)Tc-MIBI images were correlated with protein and mRNA expression. RESULTS: The mean L/Nd of the Pgp (-) group was significantly higher than that of the Pgp (++) group (P = 0.0324). The Pgp (++) group had a higher L/Nwr than did the Pgp (-) group (P = 0.0269). The mean L/Nd of the Pgp mRNA low-expression group was significantly higher than that of the Pgp mRNA high-expression group (P = 0.0127). The Pgp mRNA high-expression group had a higher L/Nwr than did the Pgp mRNA low-expression group (P = 0.0825). No appreciable correlation was found between the lung cancer (99m)Tc-MIBI images and the expression of MRP or LRP on the level of protein or mRNA. CONCLUSION: These data suggest that an increased level of Pgp expression correlates with a low accumulation on delayed scans and a high L/Nwr of (99m)Tc-MIBI in lung cancer. Neither MRP nor LRP expression on the level of either protein or mRNA correlated significantly with tumor accumulation or efflux of (99m)Tc-MIBI in lung cancer.

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMed2001

Comparison of [(18)F]FDG PET and (201)Tl SPECT in evaluation of pulmonary nodules.

UNLABELLED: Recent reports have indicated the value of [(18)F]FDG PET and (201)Tl SPECT in diagnosing lung cancer. In this study, we compared the diagnostic value of FDG PET and (201)Tl SPECT in the evaluation of pulmonary nodules. METHODS: Sixty-three patients with 66 pulmonary nodules suspected to be lung cancer on the basis of chest CT were examined by FDG PET and (201)Tl SPECT (early and delayed scans) within a week of each study. For semiquantitative analysis, the standardized uptake value (SUV) or the tumor-to-nontumor activity ratio (T/N) (or both) was calculated. All of these lesions were completely removed thoracoscopically or by thoracotomy and were examined histologically. RESULTS: Fifty-four nodules were histologically confirmed to be malignant tumors, and 12 were benign. Both techniques delineated focal lesions with an increase in tracer accumulation in 41 of 54 lung cancers. (201)Tl SPECT on early or delayed scans (or both) identified 4 additional lung cancers that FDG PET images did not reveal: 3 bronchioloalveolar carcinomas and a well-differentiated adenocarcinoma. FDG PET identified 3 additional lung cancers that (201)Tl SPECT images did not reveal; 2 of these lung cancers were <2 cm in diameter. The mean FDG SUV and T/N of bronchioloalveolar carcinomas (2.06 +/- 0.76 and 3.49 +/- 1.03, respectively) were significantly lower than those of poorly differentiated adenocarcinomas (5.55 +/- 2.01 [P = 0.026] and 8.23 +/- 2.16 [P = 0.01], respectively). However, no significant difference was found in (201)Tl T/N on early and delayed scans between bronchioloalveolar carcinomas (1.64 +/- 0.29 and 1.87 +/- 0.42, respectively) and poorly differentiated adenocarcinomas (1.58 +/- 0.32 and 2.76 +/- 1.36, respectively). Of the 12 benign nodules, FDG PET and (201)Tl SPECT showed false-positive results for the same 7 benign nodules (58.3%) (4 granulomas, 1 sarcoidosis, 1 inflammatory pseudotumor, and 1 aspergilloma). Negative FDG PET findings and positive (201)Tl SPECT findings were obtained only for bronchioloalveolar carcinomas or a well-differentiated adenocarcinoma but not for other histologic types of lung cancers or benign pulmonary nodules. CONCLUSION: No significant difference was found between FDG PET and (201)Tl SPECT in specificity for the differentiation of malignant and benign pulmonary nodules. The degree of differentiation of lung adenocarcinoma correlated with FDG uptake but not with (201)Tl uptake. Bronchioloalveolar carcinoma (a well-differentiated, slow-growing tumor) findings typically were positive with (201)Tl but were negative with FDG. The combination of FDG PET and (201)Tl SPECT may provide additional information regarding the tissue characterization of pulmonary nodules.

Adenocarcinoma↗

PubMed2001

Characterization of human rotavirus serotype G9 isolated in Japan and Thailand from 1995 to 1997.

Serotyping of human rotavirus was conducted in 396 Japanese and 100 Thai rotavirus-positive fecal specimens collected from 1995 to 1997. Serotype G9 was found to be the third most common serotype with frequency of 16.2% in Thailand from 1996 to 1997. It was also detected in Japan with a low frequency (0.7%) in this year. The genetic analyses of VP4 and NSP4 genes of these G9 strains showed that 1 strain from Japan possessed P[8] genotype and NSP4 Wa-group with long electropherotype (e-type). In contrast, 5 strains from Thailand belonged to P[6] and 1 strain belonged to P[4]. All of the Thai strains were in the NSP4 KUN-group with a short e-type. Sequence analysis of their VP7 gene revealed that there was the highest homology among fecal G9 strains (> 96.3%, amino acid identity) and a relatively high degree of homology to standard viruses, F45 from Japan (95.4-96.3%, amino acid identity) and 116E from India (92-92.3%, amino acid identity). However, immunological analysis using G9 specific monoclonal antibodies (Mabs) against VP7 protein showed that the G9 strains isolated from the two countries had different antigenic specificity. It was confirmed further by intraserotypical phylogenetic analysis of VP7 amino acid. These results indicated that the prevalence of G9 rotavirus in 1996-1997 in Thailand was relative to the continuing recent emergence of it on a worldwide basis, while the Japanese G9 strain isolated in this survey was identified to have progenitors common to the F45 strain that was prevalent in 1985 in Japan. Phylogenetic analysis of VP7 amino acid of G1-14 prototype rotavirus showed that the G9 strains were most closely related to the equine G14 rotavirus FI23 strain but G3 strains, interserotypically. These findings suggest that G9 rotaviruses might be divided into two or more subtypes.

Adolescent↗

PubMed2001

[A surgical case of giant mediastinal neurilemmoma].

A 45-year-old male was admitted to Nagoya University Hospital with dyspnea. He was examined by chest X-ray, CT, MRI, and bronchofiberscope. The chest X-ray showed a large abnormal shadow in the right lung field. A large tumor mass pressing the right lung occupied a half of thoracic cavity on a chest CT and MRI. Bronchofiberscopic findings showed a stenosis of the right intermediate bronchus. The clinical diagnosis was posterior mediastinal tumor. He underwent a posterolateral thoracotomy and the tumor was removed smoothly. The size of resected specimen was 15 x 13 x 11 cm. Histopathological examination of the specimen revealed a mediastinal neurilemmoma. He has been well for 4 months postoperatively.

Dyspnea↗

PubMed2001

[Two cases of elderly patients with ruptured AVM with contrast medium extravasation during cerebral angiography].

Two cases are reported of elderly patients who experienced intracranial extravasation of contrast medium (CM) during carotid angiography (CAG) for ruptured cerebral arteriovenous malformations (AVM). The first patient, an 87-year-old male with no history of hypertension, was admitted immediately following a loss of consciousness after swimming in a pool. CT scan revealed a large intracranial hematoma in the left frontal lobe. CAG performed 1 hour after his arrival revealed a small AVM, fed by the left anterior cerebral artery with concomitant extravasation of CM. The patient's condition subsequently deteriorated and he died the following day. The second patient, a 71-year-old female, was admitted to our hospital in a comatose state after complaining of a severe headache. CT scan revealed a right parietal lobe hemorrhage extending into the ventricles. CAG was performed and demonstrated a small AVM in the right parietal lobe with extravasation of CM. Following emergency removal of the hematoma and AVM, the patient regained consciousness although some motor deficits persisted. A literature review revealed that only 6 cases of CM extravasation with ruptured AVM have been previously reported. The 4 previous cases involved patients 9, 15, 33 and 66-year-old, the younger three of which had a good outcome. The patients reported here were much older, and had a much less favorable outcome. Thus, AVM with CM extravasation may have a better prognosis in younger individuals.

Aged↗

PubMed2001

Retrograde cerebral perfusion with hypothermic circulatory arrest in aortic arch surgery: operative and long-term results.

METHODS: Clinical data were retrospectively collected for 207 consecutive patients who underwent aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) and hypothermic circulatory arrest (HCA) at Tenri Hospital (138 patients) from 1988 to 1999, and at Nagoya University Hospital (69 patients) from 1990 to 2000. One hundred and 3 patients (50%) were operated upon for aortic dissection, and 104 patients (50%) for atherosclerotic aneurysm. RESULTS: Hospital mortality was 12% (25 patients). HCA times were 44+/-20 minutes. Cardiopulmonary bypass time longer than 6 hours, low cardiac output syndrome, respiratory failure, and central nervous system (CNS) dysfunction contributed to hospital deaths. Late mortality was 16% (34 patients). The predictors of late deaths were age (>70 years), total arch replacement, HCA time >60 min., non-dissecting aneurysm, and postoperative CNS injury. CONCLUSIONS: Operative results of aortic arch surgery using CRCP was generally satisfactory. However, the long-term results of total arch replacement for patients older than 70 years, non-dissecting aneurysm (particularly ruptured), and postoperative CNS injury were poor. Although prolonged duration of HCA may contribute to these poor results, other factors such as emergent surgery, late death due to aging, and systemic atherosclerosis are also considered to be risk factors.

Adult↗

PubMed2000

X-Ray anomalous scattering study of a charge-ordered state in NaV2O5

Charge ordering of V4+ and V5+ in NaV2O5 has been studied by an x-ray diffraction technique using anomalous scattering near a vanadium K-absorption edge to critically enhance a contrast between the two ions. A dramatic energy dependence of the superlattice intensities is observed below T(C) = 35 K. The charge ordering pattern is the fully charged zigzag-type ladder with the unit cell 2ax2bx4c, but not the chain-type originally proposed for the spin-Peierls state. Charge disproportionation suggested in our model as the average valence V(4.5+/-delta(c)/2) is observed below T(C), showing continuous variation of delta(c) as a function of temperature.

Journal Article↗

PubMed2000

Collective singlet excitations and evolution of raman spectral weights in the 2D spin dimer compound SrCu2(BO3)(2)

Raman light scattering of the two-dimensional quantum spin system SrCu2(BO3)(2) shows a rich structure in the magnetic excitation spectrum, including several well-defined bound state modes at low temperature, and a scattering continuum and quasielastic light scattering contributions at high temperature. The key to the understanding of the unique features of SrCu2(BO3)(2) is the presence of strong interactions between well-localized triplet excitations in the network of orthogonal spin dimers realized in this compound.

Journal Article↗

PubMed2000

Activin A increases Pax4 gene expression in pancreatic beta cell lines.

Activin A, a member of the TGFbeta superfamily, has many physiological and developmental functions. In pancreatic beta cell cultures, activin promotes cell differentiation and insulin production. The author has found activin increases gene expression of the PAX4, one of the major transcription factors determining pancreatic beta cell differentiation. This effect was mediated, at least in part, by the type IB activin receptor (ALK4). Moreover, the activity of human insulin promoter-reporter system was controlled by PAX4 and its isoform PAX4 delta(G239-P251) in a unique fashion; positively by low concentrations, and negatively by high concentrations of these proteins. And the repression activities were different between these proteins. These findings confirm the importance of activin signal transduction in pancreatic beta cell development and function.

Activin Receptors, Type I↗

PubMed2000

Fas-mediated apoptosis in adriamycin-induced cardiomyopathy in rats: In vivo study.

BACKGROUND: The precise molecular mechanism of Adriamycin-induced cardiomyopathy (ADR-CM) is still unknown. We address the demonstration of apoptotic myocardial cell death and the apoptosis-inducing molecules in ADR-CM induced in rats. METHODS AND RESULTS: Until 8 weeks after the first administration of ADR, there was no increase in the number of labeled cells by terminal deoxynucleotidyl transferase assay (TUNEL method). Apoptotic indices increased significantly at weeks 9 and 10 in hearts of the ADR-treated group but not in those of the control group (0.42+/-0.12% versus 0.10+/-0.02% and 0.86+/-0.11% versus 0.09+/-0.04% at weeks 9 and 10, respectively). DNA ladder formation was also observed in the myocardial tissues during the late stages of the ADR-CM of rats. There was no significant difference in expression of p53 gene between the ADR group and the control group at either the message or the protein level. An overexpression of Fas antigen was shown in myocardial cells of ADR-treated hearts at weeks 9 and 10 by both Western blotting and immunofluorescent staining. Furthermore, we confirmed that neutralization of anti-Fas ligand antibody inhibited ADR-induced apoptosis. CONCLUSIONS: Apoptotic cell death was observed in the hearts of ADR-CM rats, and the number of apoptotic myocardial cells increased with the deterioration of morphological findings and cardiac function, indicating that apoptosis may be an important mechanism of loss of myocardial cells and cardiac dysfunction in ADR-CM. Apoptosis in ADR-CM rats is not p53-dependent but rather is executed through a Fas-mediated pathway.

Animals↗

PubMed2000

Hippocampal gamma-aminobutyric acid transporter alterations following focal epileptogenesis induced in rat amygdala.

To study the role of hippocampal gamma-aminobutyric acid (GABA) transporters in epileptogenesis, we induced chronic seizures by ferric cation injection into the rat amygdaloid body. We used western blotting to measure alterations in the expression of hippocampal GABA transporter proteins GAT-1 and GAT-3. GAT-1 increased bilaterally (from 150 to 250%) at 5 to 15 days after injection, but returned to control levels by 30 days. In contrast, GAT-3 also significantly increased bilaterally at 5 days and 15 days, but remained elevated bilaterally at 30 days after injection. Alterations in GAT-1 levels are apparently transient responses to seizure activity that occur during the acute phase of epileptogenesis. However, we propose that regulation of the GAT-3 subtype transporter was chronically elevated (at least 30 days), represents an effect of epileptogenesis induced by ferric ion injected into the amygdaloid body.

Amygdala↗

PubMed2000

Relationship between expression levels and atherogenesis in scavenger receptor class B, type I transgenics.

Both in vitro and in vivo studies of scavenger receptor class B type I (SR-BI) have implicated it as a likely participant in the metabolism of HDL cholesterol. To investigate the effect of SR-BI on atherogenesis, we examined two lines of SR-BI transgenic mice with high (10-fold increases) and low (2-fold increases) SR-BI expression in an inbred mouse background hemizygous for a human apolipoprotein (apo) B transgene. Unlike non-HDL cholesterol levels that minimally differed in the various groups of animals, HDL cholesterol levels were inversely related to SR-BI expression. Mice with the low expression SR-BI transgene had a 50% reduction in HDL cholesterol, whereas the high expression SR-BI transgene was associated with 2-fold decreases in HDL cholesterol as well as dramatic alterations in HDL composition and size including the near absence of alpha-migrating particles as determined by two-dimensional electrophoresis. The low expression SR-BI/apo B transgenics had more than a 2-fold decrease in the development of diet-induced fatty streak lesions compared with the apo B transgenics (4448 +/- 1908 micrometer(2)/aorta to 10133 +/- 4035 micrometer (2)/aorta; p < 0.001), whereas the high expression SR-BI/apo B transgenics had an atherogenic response similar to that of the apo B transgenics (14692 +/- 7238 micrometer(2)/aorta) but 3-fold greater than the low SR-BI/apo B mice (p < 0.001). The prominent anti-atherogenic effect of moderate SR-BI expression provides in vivo support for the hypothesis that HDL functions to inhibit atherogenesis through its interactions with SR-BI in facilitating reverse cholesterol transport. The failure of the high SR-BI/apo B transgenics to have similar or even greater reductions in atherogenesis suggests that the changes resulting from extremely high SR-BI expression including dramatic changes in lipoproteins may have both pro- and anti-atherogenic consequences, illustrating the complexity of the relationship between SR-BI and atherogenesis.

Animals↗

PubMed2000

Differential expression of B1-containing transcripts in Leishmania-exposed macrophages.

When the parasitic protozoan Leishmania infect host macrophage cells, establishment of the infection requires alteration in the expression of genes in both the parasite and the host cells. In the early phase of infection of macrophages in vitro, Leishmania exposure affects the expression of a group of mouse macrophage genes containing the repetitive transposable element designated B1 sequence. In Leishmania-exposed macrophages compared with unexposed macrophages, small (approximately 0.5 kilobase) B1-containing RNAs (small B1-RNAs) are down-regulated, and large (1-4 kilobases) B1-containing RNAs (large B1-RNA) are up-regulated. The down-regulation of small B1-RNAs precedes the up-regulation of large B1-RNAs in Leishmania-exposed macrophages. These differential B1-containing gene expressions in Leishmania-exposed macrophages were verified using individual small-B1-RNA and large B1-RNA. The differential expressions of the B1-containing RNAs at the early phase of Leishmania-macrophage interaction may associate the establishment of the leishmanial infection.

Animals↗

PubMed2000

Direct evidence for the localized single-triplet excitations and the dispersive multitriplet excitations in SrCu2(BO3)2.

We performed inelastic neutron scattering on the 2D Shastry-Sutherland system SrCu2(11BO3)2 with an exact dimer ground state. Three energy levels at around 3, 5, and 9 meV were observed at 1.7 K. The lowest excitation at 3.0 meV is almost dispersionless with a bandwidth of 0.2 meV at most, showing a significant constraint on a single-triplet hopping owing to the orthogonality of the neighboring dimers. In contrast, the correlated two-triplet excitations at 5 meV exhibit a more dispersive behavior.

Journal Article↗

PubMed2000

Relation of phasic coronary flow velocity characteristics with TIMI perfusion grade and myocardial recovery after primary percutaneous transluminal coronary angioplasty and rescue stenting.

BACKGROUND: A residual stenosis and/or microvascular damage have been proposed as mechanisms of TIMI 2 flow for acute myocardial infarction. Coronary flow dynamics were assessed in patients with TIMI 2 flow to predict whether additional intervention would improve TIMI grade. METHODS AND RESULTS: In 35 patients who had a successfully recanalized anterior acute myocardial infarction using angioplasty or rescue stenting, coronary flow patterns were compared with corresponding TIMI grade and regional left ventricular wall motion (LVWM) 1 month after the intervention. After angioplasty, the time-averaged peak velocity (APV) was lower in patients with TIMI 2 flow (n=22) than in those with TIMI 3 flow (n=13; 7.9+/-3.9 versus 20.6+/-5.1 cm/s; P<0.001). Two different flow patterns were recorded in patients with TIMI 2 flow (versus TIMI 3, P<0.001); patients with type 1 TIMI 2 flow (n=15) had a reduced diastolic APV (8.3+/-4.8 versus 24.2+/-7.4 cm/s), prolonged diastolic deceleration time (1176+/-455 versus 728+/-205 ms), and a small diastolic/systolic APV ratio (1.3+/-0.6 versus 2.1+/-0.7); patients with type 2 TIMI 2 flow (n=7) had systolic flow reversal (systolic APV, -7.9+/-4.6 versus 11. 7+/-4.5 cm/s), a rapid diastolic deceleration time (221+/-84 versus 728+/-205 ms), and a negative diastolic/systolic APV ratio (-2.1+/-1. 4 versus 2.1+/-0.7). A significantly lower mean chord LVWM (-3.0+/-0. 2 versus -1.9+/-0.8; P<0.001) and a greater number of chords <-2SD (50+/-2 versus 28+/-18; P<0.001) were present in patients with type 2 versus type 1 TIMI 2 flow. Stenting increased TIMI 2 flow to TIMI 3 flow more in patients with type 1 than type 2 flow (67% versus 0%; P=0.003). Patients with TIMI 2 flow after stenting continued to demonstrate a type 2 pattern, and they had poor LVWM recovery. CONCLUSIONS: The differentiation between 2 types of TIMI 2 flow can predict the improvement of TIMI grade and LVWM recovery after additional stenting.

Aged↗