Exposure of the surgical field and bleeding control are main problems of distal anastomosis during an operation for distal arch aneurysms. The open-stent technique and thoracic endovascular aortic repair (TEVAR) are useful techniques for the resolution of these problems. Recently, TEVAR has progressively expanded in the treatment of various complex thoracic aortic diseases. However, complications such as endoleaks and graft migrations have still remained an issue. Although some patients who have late distal endoleaks can be almost treated successfully with additional TEVAR, some of them cannot. We report 3 cases of graft replacement of descending aorta after open-stent technique due to stent migrations and endoleaks. All of them were previously performed by total arch replacement with open-stent technique for distal aortic arch aneurysms. The follow-up CT after the first operation revealed graft migrations and endoleaks. The open surgical repairs through left lateral thoracotomy were performed, followed by graft replacements. The stent grafts were easily clamped after the incision of the aneurysm. In 2 cases, grafts were directly anastomosed to the descending aorta after the removal of the stent. In 1 case, graft was extended with new graft and then anastomosed to the descending aorta. These procedures were technically successful ; there were no trouble to exfoliate aorta, to perform anastomosis and hemostasis, and neither patient developed major complications. These results indicate that open surgical repair of descending aorta could be one of the safety options for the treatment of endoleaks and stent migrations of thoracic aortic stent graft in the era of increasing endovascular therapy.

Objective: This study aimed to investigate the effect of incorporating tumor laterality into the International Federation of Gynecology and Obstetrics (FIGO) staging system for advanced ovarian cancer. Methods: The clinical data of 131 patients with advanced ovarian cancer treated between 2008 and 2018 were retrospectively reviewed. To investigate the prognostic significance of tumor laterality, we divided the patients into unilateral and bilateral groups. The prognostic significance of tumor laterality (bilateral vs. unilateral) was evaluated using univariate and multivariate analyses. The effect of incorporating tumor laterality into the FIGO staging system to predict survival outcomes was evaluated using the Kaplan-Meier method. Results: Both overall survival (OS) and progression-free survival (PFS) were longer in the unilateral group than in the bilateral group. Multivariate analysis demonstrated that tumor laterality was an independent predictor of OS (hazard ratio, 1.75; confidence interval, 1.05-2.92; P=0.032). In patients with stage III disease, the bilateral group had a shorter OS than the unilateral group, but it was comparable to the OS in stage IV patients (P=0.354). The incorporation of tumor laterality into the FIGO staging system improved the stratification of survival probabilities. Conclusion Tumor laterality can be an independent prognostic factor in patients with advanced ovarian cancer. The incorporation of tumor laterality may improve the predictive performance of the FIGO staging system in patients with advanced ovarian cancer.

  Introduction: We examined the thermophysiological effects of ultrafine bubble (UB) bathing in comparison with microbubble (MB) and freshwater (FW) bathing.   Subjects and Methods: Seven healthy women aged 35.6±2.9 years provided informed consent to participate in the study. After a 10-min rest, each subject engaged in UB, MB, and FW bathing (on separate days) at 40°C for 10 min. During the experiment, tympanic temperature, local sweat rate, local skin temperature, heat flow, and heart rate variability were continuously recorded. Subjective assessments of thermal sensation and comfort were rated on a visual analog scale between 0 to 100.  Results: Increases in tympanic temperature and mean body temperature were highest during MB bathing, and similar increases were observed during UB and FW bathing. Local sweating was highest during MB bathing and lowest during UB bathing. A significant interaction was observed between local sweating during bathing and bathing style (P<0.001). The increase in local sweat rate relative to body temperature was lowest during UB bathing and highest during MB bathing.  Discussion: During UB bathing, UBs and MBs that were generated in high concentrations in the bathtub decreased the flow of heat to the body, thereby suppressing an increase in tympanic temperature and yielding the lowest local sweat late. However, during MB bathing, in which a moderate concentration of UBs and MBs were generated, the increase in heat flow due to the convection of hot water exceeded the decrease in heat flow due to the bubbles.  Conclusions: The results suggest that bubble properties and convection characteristics altered the balance of heat flow, leading to differences in the thermoregulatory response during and after bathing.