coronary angiography (CAG) added to the rate of repeat PCI without clinical benefit, 2 routine follow-up CAG is not recommended in Japan.Supporting that, the insurance coverage/reimbursement requirement was also changed in 2018 in Japan.In general, proof of functional ischemia be completed prior to PCI.Moreover, there was no difference in the frequency of OPTIVUS criteria having been met in all stented lesions between the groups (refer-I n this issue of the Journal, Yamamoto et al 1 report the effect of optimal intravascular ultrasound (IVUS)guided percutaneous coronary intervention (PCI) compared with standard PCI.They retrospectively compared two cohorts (2011-2013 and 2019-2021) using propensity score-matching.However, it would be difficult to truly compare the effect of optimal IVUS-guided PCI on any coronary revascularization (a component of the primary endpoint) because clinical practice methodologies were quite different between the cohorts.Following a report demonstrating that performing follow-up invasive
Reducing near-fatal asthma exacerbations is a critical problem in asthma management.To determine patterns of factors preceding asthma exacerbations in a real-world setting.In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the 2-week period before admission.Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low Body mass index and tendency to depression who had stopped anti-asthma medications, smoked, and hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly rapid worsening within 48 hours, mostly middle-aged and older, relatively good inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist (LABA) compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these 3 clusters.To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increase usual therapy, or new anti-type 2 response-targeted therapies should be considered for cluster C.
Critical limb ischemia (CLI) is commonly caused by atherosclerotic arterial obstruction or stenosis in the leg, as demonstrated by rest pain, skin ulcers and gangrene (Fontaine III or IV), often fails to respond to conservative treatments, and carries a high risk for limb amputation, with a particularly dismal prognosis. Although surgical revascularization techniques may be used for certain CLI patients, such techniques are not indicated for most CLI patients due to the diffuse nature of the responsible lesions, distal location of the obstruction, or coexisting systemic comorbidities. For such CLI patients with no alternative treatments, the potential utility of cell therapies has been investigated. Indeed many clinical trials are being carried out by academic sectors, and their achievements will facilitate clinical development by pharmaceutical companies.In order to understand the situation regarding competitive international R&D of revascularization seeds for CLI, we surveyed the status of clinical trials. As a result, we identified 58 clinical trials on revascularization for CLI, with the majority in the early phase (
