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Biomedical subjects

T Sakamoto

Publications and source records attributed to T Sakamoto.

At least 919 records · Page 51Linked to original sources
PubMed1989

[Prevalence of mitral valve prolapse in patients with premature ventricular contractions and the relationship between the prolapse and the types of premature contractions].

To assess the prevalence of mitral valve prolapse (MVP) in patients with premature ventricular contractions (PVCs), 109 patients with PVCs (M: 69, F: 40, 42 +/- 20 years; mean +/- SD) and 50 control subjects (M: 38, F: 12, 47 +/- 10 years) were studied by echocardiography. MVP was diagnosed by two-dimensional echocardiography. The criterion for mitral valve prolapse by two-dimensional echocardiography is extension of the mitral leaflet to the left atrial side beyond the plane of the mitral annulus. In addition, 60 patients with PVCs were examined by 24-hour Holter ECG and scored by the Lown's classification. Results were as follows: 1) MVP was detected more frequently in patients with PVCs than in the control subjects (22/109, 20% vs 3/50, 6%, p less than 0.05) by echocardiography. 2) PVC patients with MVP were significantly younger than patients without MVP (34 +/- 14 vs 47 +/- 21 yrs, p less than 0.05), but there were no significant differences between these two groups as to sex, left atrial diameter and left ventricular dimension. 3) The 24-hour Holter ECG revealed that the high grade PVCs (Lown grade III & IV) was more closely related to the absence of MVP (20/45, 44% vs 4/11, 36%), though this trend did not reach statistical significance. It was suggested that MVP is not a major determinant of PVC, and life-threatening arrhythmias are more likely related to cases without MVP.

Adult↗
PubMed1989

[Case of temporomandibular joint ankylosis in childhood. Treatment and follow-up for 12 years].

An ankylosis of temporomandibular joint (TMJ), which may be defined as the disease with the limitation of the movement of TMJ resulted from inflammations or traumas followed by fibrosis or ossification, could lead to the disturbance of mandibular development in childhood. In this report, we have experienced a case of unilateral TMJ ankylosis suspected to be caused by forceps delivery in 7-years old boy. The patient called on our hospital suffering from severe trismus and facial asymmetry. Following the conservative treatment, the operative relief of the ankylosis was performed with the procedure of the amputation of coronoid processus and condylar neck at the age of 14. Then orthodontic treatment was carried out to build a stabilized occlusion at 7 months after the operation. Five years follow-up observation elucidated that mandible developed normally without any recurrence. Judging from both clinical aspects and cephalometric analysis the result is very satisfying not only functionally but esthetically.

Ankylosis↗
PubMed1989

Surgical consideration of aortitis involving the aortic root.

Most serious complications after aortic valve replacement (AVR) in Takayasu's and Behçet's diseases are repeated detachment of the prosthetic valve and formation of a false aneurysm. Therefore, special consideration of the surgical treatment of aortitis involving the aortic root is required. Fifteen patients (12 with Takayasu's disease and three with Behçet's disease) underwent various surgical procedures, depending on the pathological changes in the aortic valve and the aortic root and on the degree of involvement of the coronary artery. Group 1 patients had coronary artery involvement alone and underwent coronary artery bypass grafting (CABG) (n = 3); group 2 patients had aortic regurgitation with an intact coronary artery and underwent AVR or a modified Bentall procedure (n = 7); and group 3 patients had aortic regurgitation with coronary artery involvement and underwent AVR, a modified Bentall procedure, or translocation with CABG (n = 5). A prosthetic valve or composite graft with a Teflon felt flange at the sewing ring was fabricated during surgery by exact measurement of the sizes of the aortic annulus and distal aorta and treatment with fibrin glue before insertion. The double-fixation method with reinforcement by a Teflon felt strip was employed for anastomosis of the flanged prosthesis. The button-shaped coronary ostium was directly anastomosed to the composite graft. One patient required translocation with CABG because of a deteriorated annulus. There were no operative or hospital deaths. One patient died of a brain abscess at 6 months after surgery, and another patient who underwent CABG required CABG reoperation due to graft occlusion. We recommend postoperative steroid therapy in patients who are diagnosed as being in the active stage of the disease until inflammatory signs disappear.

Adult↗
PubMed1989

Anti-allergic action of glucocorticoids (II). Effect of glucocorticoids on cell mediated (type IV) allergic reactions.

The effects of three glucocorticoids (steroids; hydrocortisone, prednisolone and dexamethasone) on cell mediated hypersensitivity (type IV) reactions in rats and mice were studied. All the steroids inhibited both the induction and the effector phases of type IV reaction induced by sheep red blood cells (SRBC) in mouse footpads. The local graft vs host reaction induced by lymphocytes from Brown Norway rats into the footpads of (Lewis x Brown Norway) F1 rats was also clearly inhibited by steroids. The inhibitory action of steroids on footpad reactions induced by SRBC was clearly prevented by pretreatment with non-corticoidal steroids (17 alpha-methyltestosterone, androstenedione and progesterone). The release of lymphokines, macrophage chemotactic factor (MCF) and skin reactive factor (SRF) was inhibited by each steroid at a high concentration. Moreover, steroids inhibited the activity of MCF in vitro and SRF in vivo.

Animals↗
PubMed1989

[Simultaneous corrections Bentall procedure, mitral valve replacement and sternoplasty for a patient with Marfan's syndrome].

A successful case of simultaneous modified Bentall' procedure, MVR and sternoplasty was presented for a 42 years old man of Marfan's syndrome who had funnel chest, combined with mitral regurgitation, aortic regurgitation and annuloaortic ectasia. A few reports of one stage operation for the combination of funnel chest and heart disease in Marfan's syndrome has been published. A median sternotomy was made, with total cardiopulmonary bypass, heart was arrest and cor cooling hypothermia with crystalloid cardioplegic solution. Mitral valve was replaced with #31 B-S prosthetic valve. The ascending aorta proximal to the innominate artery and the aortic valve were replaced en-bloc with composite graft made of a vascular graft and aortic valve prostheses. Coronary artery orifices cut to the button-shaped, were sutured to the composite graft. Finally, sternoplasty was completed through modified Ravitch sterno-elevation. This is the first report in Japanese journals.

Adult↗
PubMed1989

[Percutaneous transluminal coronary angioplasty for treatment of acute myocardial infarction: comparison with percutaneous transluminal coronary recanalization].

Percutaneous transluminal coronary angioplasty (PTCA) was evaluated as a means of reperfusion of the infarct-related coronary artery, and the results were compared with those of percutaneous transluminal coronary recanalization (PTCR). There were no difference in sex, age, infarct location and time from the onset to start of treatment between 135 patients with evolving acute myocardial infarction treated with PTCA (PTCA group) and 113 patients treated with PTCR alone (PTCR group). Fifty-nine patients in the PTCA group underwent PTCA following PTCR; the remaining 76 patients were without prior PTCR. Successful PTCA, defined as a 20% or more reduction in percent luminal stenosis diameter, was achieved in 123 (90%) of the 135 patients in the PTCA group. The reperfusion rate was 93% in the PTCA group and 77% in the PTCR group (p less than 0.01). Residual stenosis immediately after the treatment was 30 +/- 13% in the PTCA group and 70 +/- 16% in the PTCR group (p less than 0.01). In the PTCA group, three cases developed serious complications which were associated with angioplasty: coronary perforation, side branch occlusion resulting in cardiogenic shock and exacerbation of cardiogenic shock. The latter two patients died, however, there was no difference in hospital mortality rate: 6% in the PTCA group versus 11% in the PTCR group. At follow-up angiography performed four weeks after admission, reocclusion of the successfully recanalized arteries was observed in 3% of the PTCA group and in 14% of the PTCR group (p less than 0.01). Regional wall motion was evaluated by left ventriculography using a wall motion score system which consisted of six grades; from normal counted as 0, to dyskinesis counted as 5. There was no difference in the wall motion score between the successful PTCA group and the successful PTCR group (2.6 +/- 1.4 versus 2.8 +/- 1.4), but the scores of both groups were better than those of the non-recanalized group (3.4 +/- 1.0: p less than 0.01). In conclusion, PTCA and PTCR have the same effect on hospital mortality rate and regional wall motion, but PTCA has a higher reperfusion rate and a lower reocclusion rate than does PTCR. Although PTCA has a potential disadvantage inducing serious complications, it appears to be a useful treatment for acute myocardial infarction.

Aged↗
PubMed1989

[The pain response of the tooth caused by placement of a labial archwire].

The incidence of pain and discomfort response of tooth caused by placement of a labial archwire was studied. The pain response was assessed in four degrees of pain index (score 0: no discomfort, score 1: discomfort, score 2: mild pain, score 3: severe pain). Materials consisted of 84 males and females with the permanent dentition from 10 years to 41 years. Results were as follows: 1) Of the 84 cases, 95.24 percent of them suffered from pain (mild pain: 26.19%, severe pain: 69.05%). 2) There was no significant difference in the pain response among the under 12 year old group, the 13 to 19 year old group and the over 20 year old group. 3) There was no significant difference in the pain response among the three kind of labial arch wire (0.014", 0.012" nickel titanium alloy wire and 0.015" braided wire). 4) The pain response was statistically higher in the female than in the male. 5) The pain response was observed in 8.75 percent of cases immediately after placement of archwire, and 31.25 percent 2 hours later, 41.25 percent by the end of the day. In 18.75 percent the pain response was observed next day. 6) Cases were sorted into 4 groups according to their highest score. In the severe pain group, the mean value of the severe pain response was 3.57 days, that of the mild pain response was 5.74 days and that of the discomfort response was 6.26 days. In the mild pain group, the mean value of the mild pain response was 3.68 days, and that of the discomfort response was 4.46 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Mitral valve prolapse in patients with surgically-closed atrial septal defect].

To evaluate the prevalence, causes and clinical significance of mitral valve prolapse (MVP) associated with surgically-closed atrial septal defect (ASD), 90 patients (M: 41, F: 49) were studied using two-dimensional and color-coded Doppler echocardiography. Among the 90 patients, preoperative echocardiograms were available in 27. MVP was found in 21 of the 27 patients (78%) preoperatively, but it was found in 59% (16/27) postoperatively. In total, MVP was detected in 50 of the 90 patients (56%) postoperatively. The postoperative MVP group had higher pulmonary-to-systemic flow ratios (3.6 +/- 1.9 vs 2.8 +/- 1.1, p less than 0.05) and higher mean pulmonary arterial pressures (21 +/- 11 vs 13 +/- 5 mmHg, p less than 0.01) at the time of surgery. Between the two groups with or without MVP postoperatively, there was no difference (p less than 0.05) in age at surgery, the postoperative duration and left ventricular (LV) deformity index both in pre- and postoperative states. A mitral regurgitant (MR) murmur was recorded in seven patients postoperatively. However, only two had clinically severe MR. It was concluded that MVP is frequently detected in patients with closure of ASD and it is related neither to degree of the LV deformity nor to age at operation; rather, it is related to the severity of the preoperative hemodynamic state. Clinically significant MR is rare in the postoperative period.

Adolescent↗
PubMed1989

[Clinical study of allergic granulomatous angitis (AGA) with accompanying gastrointestinal perforations--our case and other cases in Japanese literature].

We present here the case of a patient with allergic granulomatous angitis (AGA) who had two small intestine perforations in a short interval, and we reviewed 11 cases, including our own, of AGA with accompanying gastrointestinal perforations reported so far in Japan. Our case was a twenty-three year old man who had been treated with steroid hormone in an outpatient clinic. He re-entered our hospital complaining of severe abdominal pain. At first admission, there had been no evidence of parasite disease, and this time, we found severe duodenal erosion on upper gastrointestinal endoscopy. Abdominal angiography revealed stenotic and tapering changes probably due to angitis in both the superior and inferior mesenteric arteries. Steroid pulse therapy was not effective in reducing the severity of abdominal pain, but the administration of a large amount of PGE1 was very effective. In spite of the therapy, the patient had small intestine perforations on his 27th day in hospital and two months thereafter, and was operated on twice. The death rate in AGA patients with accompanying gastrointestinal perforations is relatively high in our country, and 2 out of 11 cases had recurrent perforations. Therefore, it is considered essential to pay great attention to abdominal manifestations in AGA patients.

Adult↗
PubMed1989

[Venous hum and innominate vein flow velocity in chronic anemia: a pulsed Doppler echocardiographic study].

To assess the hemodynamic correlates of the cervical venous hum in patients with chronic anemia, 14 patients (mean age; 49 years, mean hemoglobin (Hb); 7.3 g/dl) and 14 control subjects (mean age; 50 years, mean Hb; 14 g/dl) without cardiac disease were studied by auscultation, phonocardiography and Doppler echocardiography in two positions (supine and sitting). Venous hum was detected in the sitting position in 11 of the 14 anemic patients whose Hb was less than 9 g/dl, and in six anemic patients in the supine position, while venous hum was absent in the control subjects in both positions. Pulsed Doppler echocardiography with the transducer in the supraclavicular fossa revealed significantly (p less than 0.01) higher peak velocity in the innominate vein in the 11 anemic patients with venous hum (supine; 71 +/- 12, sitting; 111 +/- 24 cm/sec, mean +/- SD) than in the control subjects (supine; 46 +/- 15 sitting; 76 +/- 27 cm/sec) in both positions. Intensity of venous hum increased concomitantly with increased innominate vein flow velocity when the body position was changed from supine to sitting. Peak velocity in the innominate vein correlated significantly with Hb in all study subjects (r = 0.65, p less than 0.01). In conclusion, the cervical venous hum in patients with chronic anemia is related to the hemoglobin concentration and flow velocity in the innominate vein.

Adolescent↗
PubMed1989

[Delayed lung scintigraphy with N-isopropyl-I-123-p-iodoamphetamine in lung cancer and inflammatory disease].

Lung studies with N-Isopropyl-I-123-p-Iodoamphetamine (IMP) were performed on patients with lung cancer or inflammatory disease. In the present study, we evaluated the usefulness of the delayed scintigraphy. The subjects consisted of 27 patients with lung cancer (34 lesions), 3 with radiation pneumonitis, 2 with interstitial pneumonitis, 2 with old tuberculous lesion (tuberculomas), 1 with diffuse panbronchiolitis, 1 with pneumonia and 1 with lung abscess. The delayed scintigraphy was performed 24 hr after intravenous injection of 3 mCi IMP, in sitting position. In 10 patients, SPECT images were obtained following the delayed scintigraphy. Delayed scintigraphic appearances of lung cancer were classified into 5 types, high IMP uptake in the area congruent with the lesion of atelectasis and/or obstructive pneumonia (Type I), high IMP uptake in the area surrounded the tumor (Type II), a defect in the area consistent with the tumor and no high IMP uptake in the area surrounded the tumor (Type III), high IMP uptake in the area almost congruent with the tumor (Type IV) and no significant change (Type V). Excluding 10 lesions with Type IV or V, no IMP uptake was seen in the areas congruent with the tumors. Type II was the most frequently observed pattern. Normal scintigrams (Type V) were observed in 8 lesions, whose sizes were fairly small. There was no definite trend caused by difference in histological types of cancers. In 8 patients with viable inflammatory disease of the lung, the delayed scintigrams showed high IMP uptake in the areas congruent with the abnormalities on chest roentgenograms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Surgical management of squamous-cell carcinomas arising in burn scar of the scalp].

A series of seven patients with squamous-cell carcinoma that arose in the area of an old scalp burn is presented, and the patient's profiles, surgical procedures and results are reviewed. In six patients, burn scar of the scalp caused by direct exposure to fire in their infancy was a pathogenesis underlying the development of the malignancy, and the time interval was estimated to be an average of 53 years. In five patients there was evidence of intracranial invasion of the carcinoma involving the dura mater and cerebral parenchyma, as revealed by neuroradiological examinations and surgery. All patients were treated by extensive excision of the lesion, and to cover defects of the scalp and cranium, a variety of reconstructive techniques were used involving advancement, transposition or free latissimus dorsi musculocutaneous flaps combined with microvascular anastomosis. Radiochemotherapy was undertaken additionally in some patients either before or after surgery. Complete excision was accomplished in two patients, in whom the carcinoma was found localized within the layer of the scalp or in the depth of the periosteum. The survival time in these patients ranged from 73 to 87 months. In contrast, incomplete resection was performed in the remaining five patients, in whom the dura mater had been invaded with simultaneous involvement of the middle part of the superior sagittal sinus. The outcome resulted in poor prognosis, and all the patients except one died in 9 to 24 months after surgery due to continuous growth of the tumor in the intracranial cavity. Therefore, total resection facilitated by early detection prior to intracranial invasion is mandatory for successful treatment of such scalp carcinomas.

Aged↗
PubMed1989

[Amygdaloid kindling in weanling rat and rekindling upon maturization].

To understand the epileptic phenomenon in the immature brain and to investigate whether or not the epileptogenesis acquired in young age is retained after maturation, we carried out the amygdaloid kindling preparation (AM-K) on rat. Ten 3-week-old Wistar rats (3-week-old group) and ten 10-week-old rats (10-week-old group) were stimulated every 2 hours during 09:00-17:00, from five days after operation (Experiment 1). Nine kindled weanling rats (K-group) and ten weanling rats with no stimulation only electrodes implantation (non-K-group) were rekindled upon maturization (Experiment II). Stages of AM-K were classified according to the criteria of Racine. The results obtained were as follows: 1) The 3-week-old group needed significantly fewer stimulations and a shorter AD-durations during early stages (C0-2) of amygdaloid kindling, in comparison with the 10-week-old group. However, there was no significant difference between the two groups as to stimulations and AD-duration during later stages (C3-4) of the kindling. 2) The K-group were rekindled significantly fewer stimulations and a shorter AD-durations than non-K group during early stages. On the other hand, there was not significant difference between the two groups as to stimulation and AD-duration during later stages of the kindling. From the results, the following conclusions were made; The seizure susceptibility of weanling rat's limbic system is high and the epileptogenesis in the limbic system can be maintained even up to adulthood.

Age Factors↗
PubMed1989

[Coronary arteriographic findings in the patients with atrial septal defect and pulmonary hypertension (ASD + PH)--compression of left main coronary artery by pulmonary trunk].

The characteristic narrowing of left main coronary artery (LMCA) was found in 44% of patients (pts) with atrial septal defect and pulmonary hypertension (ASD + PH). The cause of the narrowing is thought to be the compression by pulmonary trunk (PT). Cardiac catheterization and coronary arteriography (CAG) were performed in 38 pts with ASD ranging in age from 15 to 62 years. We defined abnormal narrowing as 50% or more stenosis of AHA classification. Sixteen pts (42%) had PH, and of these pts 7 show the abnormal narrowing of LMCA. (18% of all pts with ASD, 44% of pts with ASD + PH). They had no signs of syphilis or aortitis. Of the pts with PH, those with abnormal LMCA revealed higher pulmonary artery mean pressure than those with normal LMCA (43.6 +/- 17.3 and 27.1 +/- 5.5 mmHg respectively. p less than 0.01). Other parts of coronary arteries are intact in all pts. These findings suggest that the LMCA abnormality relates to PH. In all cases with LMCA abnormality the narrowing revealed some special features indicate the cause of narrowing is compression. First, the most severe part of narrowing was the coronary ostium, and severity reduced gradually as distal LMCA. Second, the narrowing was estimated most severely in the view of LAO 20, but almost normal in the view of RAO 30. This finding suggests the narrowing is ellipsoid. Third, the shape of LMCA changed in the different phase of cardiac cycle. In the systole, the cranial border of LMCA was convex, but in the diastole it was concave. This indicates LMCA was soft and compressed.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1989

[Allergenic and antigenic activities of the osmophilic fungus Wallemia sebi asthmatic patients].

Recently large amounts of Wallemia sebi, a species of osmophilic fungi, have been detected in house dust by low water activity media. The allergenic activity of W. sebi was examined by skin prick tests and radioallergosorbent tests (RAST) in 74 asthmatic patients (mean age 11.7, range 6-32). Aspergillus fumigatus and house dust were used for comparison. In the skin prick tests, W. sebi extract, A. fumigatus extract and house dust extract elicited positive reactions in 4 (5.4%), 4 (5.4%) and 51 (68.9%) patients, respectively. RAST showed positive results in 14 subjects (18.9%) for W. sebi extract, in 8 (10.8%) for A. fumigatus extract and in 59 (79.7%) for house dust extract. These results indicated that some asthmatic individuals showed immediate type hypersensitivity to W. sebi, which means this fungal species may be important as a causative agent in atopic diseases. Additionally, the authors measured W. sebi-specific IgG by enzyme-linked immunosorbent assay in asthmatic (n = 28) and non-atopic patients (n = 28). W. sebi-specific IgG was found in sera from all subjects in each group. W. sebi-specific IgG in asthmatics (mean +/- SD = 0.686 +/- 0.160) was significantly higher than that in non-atopics (mean +/- SD = 0.572 +/- 0.188) (p less than 0.01).

Adolescent↗
PubMed1989

[Hemodynamic state at rest and during maximal bicycle exercise in university students with small cardiac silhouettes on chest radiography].

To clarify the hemodynamic state of an apparently small heart; i.e., a small cardiac silhouette on chest radiography, chest radiographic and echocardiographic studies, physical fitness tests (a battery of tests consisting of vertical jump, side step, floor push-up, and modified Harvard step test) and graded uninterrupted bicycle exercise test were performed. 1. The cardiothoracic ratio (CTR) in 3,461 newly-enrolled university students (18.7 +/- 1.2 years old: mean +/- SD) distributed normally and the mean value +/- SD was 40.2 +/- 3.6%. No difference was observed between male and female students. 2. A small heart was defined as one having a cardiothoracic ratio (CTR) less than or equal to 35% which comprised the lower 10% of the normal distribution. There was no significant difference in results of physical fitness tests between students with small heart (n = 134) and normal controls (n = 136, 45% less than or equal to CTR less than or equal to 50%). 3. A maximal bicycle exercise test was performed in 14 male students with small heart (S: CTR = 31.9 +/- 2.1%) and nine normal controls (C: CTR = 46.5 +/- 1.0%). a) Body weight (S: 57 +/- 7, C: 69 +/- 8 kg, p less than 0.001) were less in students with small heart; Body height was similar in both categories (S: 171 +/- 5, C: 175 +/- 7 cm, NS). b) All controls finished 200 W workload, whereas all students with small heart ceased exercise earlier than the control subjects (three at 125 W, three at 150 W, eight at 175 W). c) Resting heart rate was higher in cases with small heart (S: 92 +/- 14, C: 77 +/- 10 beats/min, p less than 0.02). Left ventricular end-diastolic dimension was smaller in small heart (S: 39 +/- 4, C: 48 +/- 4 mm, p less than 0.001). d) During exercise, blood pressure and oxygen intake at the same workload were similar in both groups, but peak oxygen uptake was higher in the controls (S: 43 +/- 5, C: 50 +/- 7 ml/kg/ml, p less than 0.05). Heart rate and blood lactate concentration were higher throughout exercise in students with small heart (lactate at 175 W; S: 12.7 +/- 1.6, C: 7.8 +/- 2.0 mmol/L, p less than 0.001) (heart rate at 175 W; S: 194 +/- 6, C: 173 +/- 21 beats/min, p less than 0.05). We concluded that hemodynamic conditions at rest and during low grade exercise are preserved in students with small heart.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[A clinical study of two cases with immediate hypersensitivity to apple-pulp and an investigation of cross-allergenicity between apple-pulp allergen and some other pollen allergens].

In Japan there are no case reports of immediate hypersensitivity to apple-pulp. Here, we report on two patients: a 23-year-old woman and a 14-year-old girl with 3-year and 7-year histories, respectively, of anaphylactic reactions to apple-pulp. In the first patient, eating raw apples immediately elicited itching and tingling of the lips and mouth with severe edema of the lips and tongue, irritation of the throat and slight colic in the upper abdomen. In the second, nausea and vomiting occurred after ingestion of apples. In skin prick tests, they showed positive reactions to apple-pulp extract prepared by the method of Björkstén et al. and to fresh apple juice. In addition, IgE antibody to the apple-pulp extract was detected in the sera of both patients. They also possessed IgE antibodies to some other species of both pollens and fruits/vegetables in their sera. In the present study, cross-allergenicity between apple-pulp and five pollen species, which consisted of birch, Japanese cedar, orchard grass, mugwort and ragweed pollen, was investigated by RAST inhibition. The apple-pulp extract effectively inhibited RASTs to all the pollens except Japanese cedar pollen. These results suggested that the four pollens might have shared allergen with the apple-pulp extract.

Adolescent↗