Staged arterial switch operation without homologous blood transfusion was successfully performed in 5 patients weighing 4.1-11.0kg (double outlet right ventricle: 2 cases, transposition of great arteries: 3 cases). The postoperative hemodynamics and respiratory status were uneventful in all patients (initial central venous pressure after ICU admission: 9.0-14.5cmH₂O, mean 12.5cmH₂O, duration of intubation: 3.5-18.0h, mean 7.8h). Autologous blood donation immediately after induction of anesthesia and minimization of bypass circuit were effective methods for open heart surgery without homologous blood transfusion, particularly in staged arterial switch operation requiring prolonged cardiopulmonary bypass.

Approximately 14.1 million patients have dyslipidemia in Japan. Promotion of self-medication for the prevention of dyslipidemia is needed. After a change in law in 2014, residents of Japan are allowed to measure HbA1c, cholesterol, and triglyceride levels by self-blood sampling from the fingers under the guidance of pharmacists. In this study, we held an event to measure the lipid levels within a community and evaluated the usefulness of a simple measurement for the early detection of dyslipidemia. Furthermore, we surveyed community members’ knowledge of dyslipidemia by self-questionnaires. Of the 48 local residents who came to the event, 45 had their lipids measured and answered the questionnaires. In 12 applicants, HDL-cholesterol or non-HDL-cholesterol, which are not affected by meals, exceeded the standard range. In the questionnaire study, 89% of applicants selected arteriosclerosis as the main consequence of dyslipidemia. Additionally, over 82% of applicants selected blue-backed fish, dietary fiber, and soybeans as food items that inhibit the rise in lipid levels. However, only 31% of applicants recognized that fruits also affect lipid levels. Although it was disappointing that 60% of applicants did not know that they could measure HbA1c and lipids at community pharmacies, 62% desired measurement of those levels in the future. This study suggested that the simple lipid measurement is useful for the early detection of dyslipidemia but local residents need to be informed about it. Furthermore, improvement in the recognition of dyslipidemia by local residents is needed.

We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.

Methods: Among 399 patients who underwent ASD surgery, 62 (≥5 levels fused, >2-year follow-up) underwent fusion from T9–10 to L5 (group L, n=21) or to S2–alar–iliac (group S, n=41). Spinal alignments, Scoliosis Research Society (SRS)-22 scores, performance of activities (clipping toenail, wiping buttock, and wearing socks), proximal and distal junctional failure (PJF+DJF), rod fractures (RFs), and overall revision rates (RRs) were compared between the groups. Results: Group L included younger patients and had longer follow-ups when compared with group S. Although the preoperative pelvic incidence and SRS sagittal modifiers were better in group L, postoperative spinal restorations were nonpathological in both groups. Both groups showed similar deformity progression at the 2-year follow-up; however, group L had lower SRS-22 pain scores. Although “wiping buttocks” did not differ between the groups, the performance of “clipping toenails” and “wearing socks” was poorer in group S at 2 years (possible, group S; 40% vs. group L; 85%–90%). The RRs did not differ between the groups; however, the PJF+DJF rate was higher in group L. DJF was not observed in group S, but occurrence of RFs was noted. Conclusions Although poorer SRS-22 pain scores might be related to lumbosacral mobility, sufficient restoration, equivalent deformity progression, and similar RRs with better activity imply that lumbosacral preservation should be considered in younger patients with moderate deformities.

No abstract available.
Gastroenterostomy* ; Stents*

　　This case is a 56-year-old woman. With multiple bone metastases, she was referred to the Department of Palliative Care on the same day as core needle biopsy had just been performed in the Department of Surgery. Aggressively increased oxycodone was administered to relieve her significantly severe pains by bone metastases. After relief of the pains, cancer chemotherapy of EC and weekly PTX regimens were performed parallel to palliative care. In this case, chemotherapy could be performed after the pains had been sufficiently relieved with closer cooperation between the palliative care doctor and the attending surgeon. It is important for patient-focused medical care to be delivered by both the attending doctor administering cancer treatment and the palliative care doctor working for relief of the symptoms, while they are striving to foster their tie-up.

Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.
6-Mercaptopurine ; Adalimumab* ; Capsule Endoscopy ; Colitis, Ulcerative* ; Colon ; Enteritis* ; Gastrointestinal Tract ; Humans ; Ileum ; Inflammation ; Inflammatory Bowel Diseases ; Mesalamine ; Prednisolone ; Rectum ; Steroids ; Ulcer* ; Upper Gastrointestinal Tract ; Young Adult

OBJECTIVEIn this study, we used an intervention approach to examine the effects of physical exercise on elderly people living at home in a rural area.

METHODSTwo regions in a village were randomly assigned as the control and intervention regions. The subjects were 60 years of age or older and were able to carry out their activities of daily living independently. The numbers of subjects were 56 and 81 for the control and intervention regions, respectively. In the control region, lectures on health were provided twice. In the intervention region, instructions on ten types of physical exercise were provided six times during this three-month study. In addition, the subjects in the intervention region were instructed to do, exercises by themselves at home three days per week. The effects were compared by evaluating motor functions in maximum step length, 10-m full-power walking parameters, right knee extension torque, right hip flexion torque, and stepping time on a 40-cm staircase; data were obtained before and after the intervention.

RESULTSAnalysis of covariance (ANCOVA) showed significant improvements in right maximum step length, the mean of the right and left maximum step lengths, and right hip flexion torque in the intervention region.

CONCLUSIONThe three-month physical exercise program improves the motor functions of the elderly.

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.
Colitis, Ulcerative ; Drug Compounding ; Humans ; Medication Adherence ; Mesalamine ; Patient Acceptance of Health Care ; Patient Compliance ; Prospective Studies ; Recurrence ; Tablets ; Ulcer ; Visual Analog Scale

Objective: Breast cancer susceptibility gene 1 (BRCA1)-associated ovarian cancer patients have been treated with A poly (ADP-ribose) polymerase (PARP) inhibitor, extending the progression-free survival; however, they finally acquire therapeutic resistance. Interleukin (IL)-34 has been reported as a poor prognostic factor in several cancers, including ovarian cancer, and it contributes to the therapeutic resistance of chemotherapies. IL-34 may affect the therapeutic effect of PARP inhibitor through the regulation of tumor microenvironment (TME). Methods: In this study, The Cancer Genome Atlas (TCGA) data set was used to evaluate the prognosis of IL-34 and human ovarian serous carcinoma. We also used CRISPR-Cas9 genome editing technology in a mouse model to evaluate the efficacy of PARP inhibitor therapy in the presence or absence of IL-34. Results: We found that IL34 was an independent poor prognostic factor in ovarian serous carcinoma, and its high expression significantly shortens overall survival. Furthermore, in BRCA1-associated ovarian cancer, PARP inhibitor therapy contributes to anti-tumor immunity via the XCR1+ DC-CD8+ T cell axis, however, it is canceled by the presence of IL-34. Conclusion These results suggest that tumor-derived IL-34 benefits tumors by creating an immunosuppressive TME and conferring PARP inhibitor therapeutic resistance. Thus, we showed the pathological effect of IL-34 and the need for it as a therapeutic target in ovarian cancer.