A case of combined redo off-pump CABG (OPCAB) with right gastroepiploic artery and abdominal aortic aneurysm repair is reported. A 71-year-old man with a previous history of CABG was admitted for the operation of recurrent angina pectoris and known abdominal aortic aneurysm. Preoperative coronary angiograms showed obstruction of LITA graft for LAD. The operative procedure consisted of redo OPCAB using right gastroepiploic artery as a transdiaphragmatic graft under left antero-lateral thoracotomy and graft replacement of abdominal aortic aneurysm under median laparotomy simultaneously. This strategy has the advantage of avoiding the continuity of median sternotomy and laparotomy and contributes to the minimally invasive procedure in the combined operation.

We describe the first case of a patient with Japanese encephalitis suffering from central sleep apnea. The patient was a 58-year-old man who presented with high fever, semicomatose state, nuchal stiffness, and incontinence of feces. The patient had complication of severe pneumonia, and was ventilated with a respirator. After weaning from the respirator, desaturation of oxygen was observed during the night. Simplified polysomnography revealed a pure central apnea pattern. This case illustrates that Japanese encephalitis can result in central sleep apnea.

We report a case of unilateral tonic pupil in spinocerebellar ataxia without brainstem atrophy in a 42- year-old man. On neurological examination, he showed cerebellar symptoms and unilateral tonic pupil. Deep tendon reflexes were normal except for brisk patellar tendon reflexes. Brain MRI demonstrated cerebellar atrophy only. There was neither orthostatic hypotension nor bowel and bladder failure. The right pupil constricted from 5.0 mm to 1.7 mm 60 minutes after 0.125% pilocarpine administration, whereas the left pupil did not change, remaining at 3.7 mm. Although it is not proven that tonic pupil is causally related to spinocerebellar ataxia, physicians must remain aware of spinocerebellar ataxia as a disease that can demonstrate tonic pupil.

OBJECTIVETo examine adaptive changes in the shape of the upper airway during titrated mandibular advancement. Furthermore, to understand the mechanism of mandible-adjustable therapy to improve the ventilation.

METHODSFourteen non-apnea participated in the study. A custom-made oral device was used to keep the mandible in titrated advancement at 0% (F0), 50% (F50), 75% (F75), 100% (F100) of the maximum advancement. Magnetic resonance imaging was used to investigate the difference in the shape of upper-airway in these 4 positions. Changes in the anteroposterior direction (AP), lateral direction (Lat) and its ratio (AP/Lat) were calculated, which were transformed into the percentage of the original ones.

RESULTSThe dose-dependent decrease of AP/Lat was found when the mandible was advanced (P = 0.0001). Lateral change rate in percentage increased by degrees (P = 0.0023), while the increase of anteroposterior change rate in percentage showed no statistical significance.

CONCLUSIONThe shape of upper airway tended to be less round. The enlargement of upper airway during titrated mandibular advancement was mainly the result of enlargement in lateral direction.

Asian Continental Ancestry Group ; Humans ; Magnetic Resonance Imaging ; Male ; Mandible ; anatomy & histology ; Mandibular Advancement ; Palate, Soft ; anatomy & histology ; Pharynx ; anatomy & histology

　　The purpose of the present study was to reduce absorbed dose rates in air by means of the X-ray tube protector in the X-ray fluoroscopy room. We measured absorbed dose rates in air using an ionization chamber type survey meter, made the scatter radiation maps and worked out the reduction rate of absorbed dose rates in air. Absorbed dose rate in air reduced 75-90% with use of the X-ray tube protector. Especially, absorbed dose rate in air reduced 85-90% at the height of crystalline lens and thyroid gland of the X-ray technician near the patient. It was suggested X-ray protector could reduce the risk of radiation exposure of radiologists effectively.

Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD). Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing. Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids. Conclusions Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.