A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.

Afatinib is an oral tyrosine kinase inhibitor (TKI) approved for treating advanced non-small cell lung cancer. It is necessary to develop a simple quantification method for TKIs in order to facilitate therapeutic drug monitoring (TDM) in clinical settings. This study sought to develop a simple and sensitive com-petitive enzyme-linked immunosorbent assay (ELISA) to quantify afatinib in plasma for routine phar-macokinetic applications. An anti-afatinib antibody was obtained using (S)-N-4-(3-chloro-4-fluor-ophenyl)-7-(tetrahydrofuran-3-yloxy)-quinazoline-4,6-diamine (CTQD), which has the same sub-structure as afatinib, as a hapten. Enzyme labeling of afatinib with horseradish peroxidase was similarly performed using CTQD. A simple competitive ELISA for afatinib was developed based on the principle of direct competition between afatinib and the enzyme marker for the anti-afatinib antibody, which had been immobilized on the plastic surface of a microtiter plate. Plasma afatinib concentrations below the limit of quantification of 30 pg/mL were reproducibly measurable. Also, the values of plasma afatinib levels measured from 20 patients were comparable with those measured by high-performance liquid chromatography, and there was a strong correlation between the values determined by both methods (Y = 0.976X – 0.207, r = 0.975). As indicated by its specificity and sensitivity, this newly developed ELISA for afatinib is an important tool for TDM and studies of the pharmacokinetics of afatinib.

An 84-year-old man, who had been given a diagnosis of advanced aortoventricular block 2 years previously, underwent implantation of a pacemaker (PM) through the left subclavian vein. However, 7 months later a skin ulcer developed at the implantation site, but without any evidence of bacterial infection. Therefore, a PTFE-covered PM battery was reimplanted at the same site. Three months later, the skin ulcer recurred and he received a third implantation in the right side. However, another skin ulcer with infection developed in the right side. He was then transferred to our hospital for another PM reimplantation. We covered the battery and the entire lead with PTFE, then placed the PM lead directly into the cardiac muscle, and implanted the PM battery below the rectal muscle under general anesthesia. A patch test 4 months later revealed a positive reaction to nickel and silicon. Finally, we diagnosed pacemaker dermatitis. The patient has remained free of skin ulcers for over 1 year.

A 66-year-old woman with aortic stenosis and idiopathic thrombocytopenic purpura (ITP) underwent concomitant splenectomy and aortic valve replacement (AVR). High-dose trans-venous gamma-globulin therapy (400mg/kg/day) was performed for five days before surgery. The number of platelet, which was 6.0×10⁴/mm³ on admission slighty increased to 7.0×10⁴/mm³ before surgery. The aortic valve was replaced by an ATS 19mm prosthesis using cardiopulmonary bypass. Platelets were transfused postoperatively. Perioperative hemorrhage was moderate, and the postoperative course was uneventful. This was the second case we treated by concomitant cardiac surgery and splenectomy. It was safely performed after high-dose trans-venous gamma-globulin therapy.

A 63-year-old man suffered from type A acute aortic dissection associated with descending thoracic aortic aneurysm and coronary stenosis. He was treated surgically 49 days after onset of acute aortic dissection. Deep hypothermic selective cerebral perfusion was carried out for brain protection. It revealed the aneurysm, 51mm in diameter, located just distal to the aortic arch, and an intimal tear of the dissection located posterior wall of aneurysm. The total arch was replaced with 24mm vascular graft and CABG (LITA-to-seg. 8) was carried out. The postoperative course was uneventful and he was discharged on the 18th postoperative day.

A 42 year-old woman with Marfan syndrome, who had replacement of the ascending aorta for acute aortic dissection several years ago, was found to have distal aortic arch aneurysm. The aneurysm had small entries at cervical arterial branches and large re-entry at the left external iliac artery. It was necessary to perform two-staged operation Bentall procedure with total arch replacement and abdominal aortic replacement with re-entry closure. It was usually performed with a primary entry closure for chronic aortic dissection, but massive invasion was expected. We performed catheter angiography for entry and re-entry, and decided to perform preceding re-entry closure. First, we underwent replacement of the abdominal aorta, and then successfully performed the Bentall procedure with total aortic arch replacement. The catheter angiography was useful for decision-making for medical treatment.

Background/Aims: Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS.The aim of this study is to determine this issue in young people. Methods: A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria.Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. Results: The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Conclusion Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.
1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.
2）This program may increase the number of research colleagues that can discuss clinical research.
3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.

Background/Aims: Evidence regarding the association between body mass index (BMI) and functional dyspepsia (FD) in the Asian population is limited.Further, no study has evaluated this issue in young people in Asian and Western populations. Thus, we aim to investigate this issueamong young Japanese people. Methods: The study subjects comprised of 8923 Japanese university students. BMI was divided into 4 categories (quartiles) on the basis of thestudy subjects’ distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, overweight, and obesewas BMI < 18.5 kg/m2 , 18.5 ≤ BMI < 25 kg/m2 (reference), 25 kg/m2 ≤ BMI < 30 kg/m2 , and 30 kg/m2 ≤ BMI, respectively. The definition of FD was based on the Rome III criteria. Results: The prevalence of FD was 1.9% in this cohort. The lowest BMI was independently associated with FD after adjustment (adjusted odds ratio [OR], 2.88; 95% confidence interval [CI], 1.46-3.67); P for trend = 0.001). The lowest BMI was independently associated with FD in women but not in men (OR, 2.94; 95% CI, 1.59-5.77; P for trend = 0.001). Leanness was independently associated with FD in total and in women but not in men (total: adjusted OR, 2.01; 95% CI, 1.40-2.86) and women (OR, 2.19; 95% CI, 1.35-3.45). However,interaction analysis showed no significant difference for sex. Conclusions Among young Japanese people, BMI may be independently inversely associated with FD. Leanness may be an independent associated factor for FD in the young Japanese women.