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actor VII (FVII) is the first enzyme in the extrinsic pathway of the blood coagulation system. Activation of the extrinsic coagulation pathway plays a key role in hemostasis, 1 and thus FVII contributes to the occurrence of thrombotic events. Although most FVII circulates in plasma in the zymogen form, small but significant amounts of activated FVII (FVIIa) also are present, and appear to serve as a primer for triggering the extrinsic cascade. [2][3][4][5] The Northwick Park Heart Study suggested that FVII coagulant activity is independently associated with risk of coronary events in middle-aged men, 6,7 and several additional studies have linked elevated concentrations of FVII in plasma to coronary heart disease. [8][9][10][11][12][13][14] Thus, FVII has become recognized as a hemostatic coronary risk factor.Plasma FVII concentrations are influenced by both genetic and environmental factors. Green et al reported a strong association between a common polymorphism in exon 8 of the FVII gene (R353Q polymorphism) and plasma FVII, 15 which has been confirmed by several other studies, 8,9,[16][17][18][19][20][21][22][23] especially with respect to FVIIa. 24 However, the association between R353Q polymorphism of the FVII gene and myocardial infarction (MI) remains controversial. The contribution of the coagulation system to the pathogenesis of MI can be studied most readily in patients with premature MI, who have less atherosclerotic coronary stenosis than elderly patients. [25][26][27][28] We performed a case -control study to determine whether plasma FVIIa concentrations and R353Q polymorphism are associated with risk of premature MI. Methods Study PopulationWe investigated 129 consecutive Japanese male patients treated as outpatients at Kagoshima Coronary Care Unit Network (2000)(2001)(2002)(2003), with a first MI occurring before the age of 45 years (mean ± SD, 40.4±4.5 years old) and giving informed consent. We angiographically confirmed occlusion or significant stenosis of a coronary artery in all patients. Of the 129 patients, 2 patients, one had Kawasaki disease and another had a coronary artery anomaly, were excluded. The remaining 127 patients (premature MI patients) had a mean age of 43.9±5.1 years at study entry, 3.3±3.8 years after initial MI. Coronary angiography showed single-vessel disease in 93 (73.2%), and multivessel disease in 34 (26.8%). Oral anticoagulant agents were administered to 33 patients. Control subjects were 150 consecutive age-matched healthy Japanese men (43.8±5.1 years old at entry), who underwent a medical checkup at Kagoshima Prefectural Comprehensive Health Center and

Background In second- and third-generation drug-eluting stent (DES) era, in-stent restenosis (ISR) is not commonly seen. However, a few patients still need repeat revascularizations for recurrent ISR even after second- and third-generation DES implantation. Methods From January 2012 to March 2017, 2339 lesions underwent second- and third-generation DES (Nobori, Promus Element, Resolute Integrity, Xience, Ultimaster and Synergy) implantation, of which 95 lesions (4.1%) underwent revascularization for first ISR. All lesions were divided into two groups of recurrent ISR group and non-recurrent ISR group. After successful optical coherence tomography (OCT) guided revascularization for all lesions, we investigated characteristics of recurrent ISR, and 2 years follow-up were completed. Results The mean age was 70.8 ± 11.7 years, and 73.2% were males. Among 56 DES-ISR lesions which were assessed by OCT, recurrent ISR was seen in 33.9% (N = 19) at 2 years follow-up after revascularization for first ISR. Serum low-density lipoprotein-cholesterol (LDL-C) level was higher in recurrent ISR group compared with non-recurrent ISR group (114.1 ± 53.9 mg/dl vs. 90.9 ± 27.8 mg/dl, P = 0.04) and heterogeneous tissue pattern was more frequently found in recurrent ISR group compared with non-recurrent ISR group (63.2% vs. 27.0%, P = 0.03). Multivariate analysis identified a heterogeneous tissue pattern (odds ratio 3.71; 95% confidence interval 1.09–12.59; P = 0.03) as an independent predictor of recurrent restenosis. Conclusion Recurrent ISR of second- and third-generation DES was associated with heterogeneous tissue pattern of first ISR, and high LDL-C level was associated with recurrence.

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Portal gas is relatively rare, and the majority of reported cases have shown it to have a close relation to bowel diseases. At present, portal exploration usually begins with color Doppler sonography, and clinicians now possess a good understanding of color Doppler findings of a wide spectrum of portal abnormalities. However, the color Doppler sign we present in this article has not been reported before. We report two cases of ischemic bowel disease in which B-mode ultrasound showed multiple hyperechoic spots moving in the portal vein; the color Doppler appearance was as if the portal vein was on fire (flaming portal vein sign). Knowledge of this simple color Doppler sign helps to improve the diagnostic strategies in patients with portal gas.