We investigated preventive effects of chronic endurance exercise on the slow-to-fast fiber transition in the plantaris muscles of non-obese type 2 diabetic rats. Eleven-week-old male Spontaneously Diabetic Torii Rats were used as diabetic animals, and assigned to sedentary (DB) and exercise (DB+Ex) groups. Age matched male non-diabetic Sprague-Dawley rats were used as sedentary control (Cnt) group. DB+Ex group was trained on low-intensity treadmill running for 14 weeks. Although glucose level in DB group at 25 weeks of age was higher compared to Cnt group, that in DB+Ex group was significantly lower compared to DB group. DB group exhibited lower percentages of high-oxidative type IIA fibers and higher percentages of low-oxidative type IIB fibers compared to Cnt group in the superficial layer of muscles. While DB+Ex group exhibited higher percentages of type IIA fibers and lower percentages of type IIB fibers compared to DB group in the superficial and deep layers of muscles. Additionally, succinate dehydrogenase intensity in the deep layer of muscles in DB+Ex group was increased by endurance exercise. The present study indicated that endurance exercise could prevent the slow-to-fast fiber transition of the muscle fibers and enhance mitochondrial oxidative enzyme activity in the skeletal muscles of non-obese type 2 diabetic rats.

Case 1 of stuck valve was an 84 year old man, 25 years after mitral valve replacement (MVR) using a mechanical valve. Case 2 was a 67 year old woman, 18 years after the previous operation. These patients underwent re-do replacement of the prosthesis with a minimally invasive right thoracotomy approach using a microscope. Re-do cardiac surgery is commonly regarded high risk on account of difficulty in peeling the adhension, risk of injury to the heart, lung or large vessels, longer operation time, greater amount of transfusion, higher invasion and longer admission. In both cases however, because of microscope-assist and right thoracotomy MICS technique, we safely and successfully completed the operation without any unplanned troubles. We finally had a good course with a short admission, no perioperative transfusion or no perioperative complication.

A 41-years-old man with Marfan syndrome developed acute aortic dissection Stanford Type B. A new entry was located at the distal aortic arch. Medical treatment was given for a month, but the proximal descending aorta expanded to 50 mm. Because he had undergone partial arch replacement at the age of 36, thoracic endovascular aortic repair (TEVAR) using the synthetic graft as proximal landing zone was performed to close the entry. Six months after TEVAR, the false lumen around the stent graft disappeared. Distal stent graft-induced new entry (d-SINE) did not occur after TEVAR. Three years after TEVAR, we performed thoracoabdominal aortic replacement because of expansion of the residual false lumen without any complication. Endovascular therapy could be useful option for extensive aortic lesion even in Marfan syndrome.