Bypass grafting from the ascending thoracic aorta to the common iliac artery was performed to manage proximal hypertension in a patient with atypical coarctation of the thoracic aorta. The patient's history was significant for an acute aortic thrombosis at the level of the diaphragm for which she underwent an axillo-bifemoral bypass grafting as an emergency operation. Although she was doing well following the initial bypass grafting, the second bypass grafting was required to treat proximal hypertension refractory to medical management. The axillo-femoral bypass graft had a smaller diameter and a longer subcutaneous distance, and the blood supply to the abdominal viscera may have been insufficient. The proximal hypertension was well controlled following ascending thoracic aorta to common iliac bypass, because the diameter (16mm) of the graft is larger than that of the axillo-bifemoral bypass graft (8mm).

As a method of agility measurement under wide current use, the repeated side step is well-known. At present in Japan, a duration of 20 seconds is employed to test agility ; but it is often reported that the factor of endurance is included in this. When a diagnosis involving agility is made based on the performance of exercise, the duration of the time of measurement was controlled in order to avoid the mixing of other factors and to ensure measurement of as few factors as possible. The distance of step was made flexible according to the age. Since a constant distance makes the longitudinal tracing easier, the distance of step was also studied.
Side steps were tested and duration of measurement was examined based on determinations in 1857 subjects, Junior and Senior school boys and girls and male university students. During the 20 seconds of measurement, scores were recorded every 5 seconds to study the time course of the fluctuations of scores. Taking into consideration factors of endurance such as the endurance of the lower extremity system, the knee test was conducted to see the relationship between scores of the repeated side step and knee test values. As to the distance of the step, 200 high school girls were tested over a distance of 100cm ×2 and 120cm ×2, for 10 seconds each.
As to the time of measurement, the average score during the first 10-15 seconds after start tended to decrease. In the time course of fluctuations of the scores in each subject, a decrease in the fall of scorse was seen about 10 seconds after the start in approximately 55% of the test subjects.
Based on the assumption that the endurance of the lower extremity system participates in this, high and low groups with a significant difference in the endurance of the lower extremity at the level of P<0.001 were compared. While no difference was seen in the slope of the score increase over a 10-second period from the start, changes of scores were distinctly different between 10 and 20 seconds, the lower values in the low group being obvious. The endurance of the lower extremity system was then studied in the two groups with high and low scores in the side step between 10 and 20 seconds. In the group with high scores, the endurance of the lower extremity was high : and a significant difference at P<0.01 was noted in this index.
These results would definitely indicate that mixing of other factors is unavoidable under the current measurement duration of 20 seconds
As to the distance of the step, scores are apparently different even in the same test subject, depending upon the distance of the step. The scores are also different depending upon the body length.
In both of the two groups, however, the scores for each different distance of the step showed a high correlation between each other, giving a correlation coefficient of γ= 0.88 in the group with high body length and γ= 0.82 in the group with low body length, indicating a high correlation.
Based on the diagnosis of agility and performance of exercise, in order to obtain the results of measurement of as simple a factor as possible, the agility time measurement is corrected to 10 seconds ; and the distance of the step is made constant at 100cm×2 regardless of the age, to a distance without unnatural effort even by a primary school pupil, in order to obtain a better diagnosis and tolerance for exercise for the desirable development and maintenance of agility.
The influence of body height on the score should be studied in the future.

A simple method of evaluation and measurement of endurance of the whole body for exercise prescription for sportsmen was previously reported. In the present study, a method of loading for general population was deviced and is the subject of the present communication.
The site of loading was divided into relatively localized portions of the lower extremity, upper extremity and trunk.
By substituting the kneeling exercise with step test, individual difference in body height was corrected.

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.

BACKGROUND: There is little data on the association between the lower nutrition represented by serum albumin levels and related factors in a general population. The present study aimed to determine whether the albumin level positioned as some kind of biomarker with frailty measures, trace elements, and an inflammation marker. METHODS: In 2018, we performed an epidemiological survey in 1368 subjects who resided in Tanushimaru, Japan, in which we examined the blood chemistry including albumin, trace elements, hormone levels, and carotid ultrasonography. Albumin levels were categorized into 4 groups (G1 [3.2-3.9 mg/dL], G2 [4.0-4.3 mg/dL], G3 [4.4-4.6 mg/dL], and G4 [4.7-5.3 mg/dL]). The participants underwent measurements of handgrip strength and were tested by asking to walk 5 m. Their cognitive functions were evaluated by the mini-mental state examination (MMSE). RESULTS: Multiple stepwise regression analysis demonstrated that albumin levels were significantly and independently associated with age (inversely), systolic blood pressures, estimated glomerular filtration rate (eGFR), MMSE score, frailty measures (handgrip strength), an inflammation marker (high-sensitivity C-reactive protein), hormones (growth hormone (inversely) and insulin-like growth factor-1), and trace elements (calcium, magnesium, iron, and zinc), with a linear trend. CONCLUSIONS Lower albumin levels, even in the normal range, were found to be related factors of frailty measures, trace elements, and an inflammation marker in a general population.
Aged ; Albumins/metabolism* ; Biomarkers/blood* ; Cross-Sectional Studies ; Female ; Frailty/physiopathology* ; Hand Strength/physiology* ; Humans ; Inflammation/blood* ; Japan ; Male ; Trace Elements/blood*