We report the Lampshade Technique : a new technique using Carbo-Seal Valsalva (Sorin Biomedica, Saluggia, Italy) to facilitate preparation of a composite graft. A Bentall operation and an ascending aorta replacement were performed with a composite graft using a Carbo-Seal Valsalva. This new technique can be considered useful as it can reduce the time required for preparing a composite graft, and create a skirt portion for continuous suturing to prevent bleeding.

This study was designed to assess the correlation of brain natriuretic peptide (BNP) levels with cardiac function and to determine the usefulness of BNP as a prognostic marker in patients undergoing cardiac valvular surgery. We measured plasma levels of BNP in 53 patients who had undergone aortic valve replacement (AVR) or aortic and mitral valve replacement (DVR) more than 1 year earlier. These cases were divided into the aortic stenosis (AS) group and an aortic regurgitation (AR) group. Fifty-two patients were in NYHA class I, and 43 (82.7%) of them had plasma levels of BNP above the normal range. There were significant correlations between the plasma levels of BNP and ejection fraction (EF) in both the AS and AR groups (r=-0.460, p<0.05; r=-0.529, p<0.01). In the AR group, BNP showed significant correlations with LVMI and LVDd (r=-0.469, p<0.05; r=0.680, p<0.0001), whereas, in the AS group, BNP showed no significant correlation with these factors. The most remarkable finding was the development of heart failure in 3 patients whose plasma levels of BNP were over 80pg/ml, despite remaining in NYHA I during follow-up. We concluded that plasma levels of BNP in a late phase after AVR or DVR can be an excellent biochemical marker for predicting of heart failure and overall prognosis.

Medical statistics need to be properly understood and used in order to assess the significance of results obtained in clinical practice. To clarify whether the medical staff in our hospital appropriately understands medical statistics, this study conducted a questionnaire survey with an objective assessment of basic medical statistics. Of 1498 hospital staff, 464 responded to the questionnaire on medical statistics, which included the following items considered important for the evaluation and use of hypothesis testing: interpretation of p-values, reasons for using different tests (t-test and Mann-Whitney U-tests), presentation of test results for the Mann-Whitney's U-test, and selection of a statistical method to use as a measure of independence. The percentage of correct answers was 20.5%, 16.2%, 6.3%, and 15.1% for the interpretation of p-values, reasons for using different tests, presentation of test results, and choice of statistical method, respectively. The percentage of correct answers for each question was significantly higher for those with research and writing experience than for those without such experience. The number of correct answers was also significantly higher for those with research and writing experience than for those without such experience. Additionally, 20 of the 464 respondents were able to correctly answer all four questions. Multiple regression analysis showed that the number of correct answers was associated with experience in research, experience in writing papers, and job title (multiple regression analysis: R2=0.429758). Our medical staff’s understanding of medical statistics was low, and we were able to identify some of the factors that influence this understanding. These results suggest the importance of learning from clinical research and writing experience in order to improve understanding of medical statistics in the future.