Retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) is a lethal complication. A 54-year-old woman with bovine aortic arch presented with dilatation of the descending aorta due to chronic type B aortic dissection. She underwent TEVAR in zone 2 for closure of the entry site just below the origin of the left subclavian artery. On the day after TEAVR, she showed right hemiparesis, and was diagnosed with cerebral infarction on MRI and RTAD on CT. She underwent an emergent operation. The entry was at the proximal end of the bovine trunk, where the edge of the bare stent stuck out. We performed partial arch replacement with entry resection. Her postoperative course was uneventful. She was transferred to another hospital for rehabilitation 37 days after the surgery.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Background: In recent years, dexmedetomidine (DEX) has been proposed as a useful vasoconstrictor for local anesthesia because it is less effective in circulation than clonidine of antihypertensive drugs. In addition, DEX is expected to act as a vasoconstrictor during local anesthesia. However, histomorphometric studies demonstrating that DEX exerts vasoconstrictive effects are lacking. This study aimed to clarify whether DEX exerts a histomorphologically vasoconstrictive effect on blood vessels in the mandible of rats. Methods: A total of 12 male Wistar rats were used. General anesthesia was induced and maintained using sevoflurane. Normal saline (0.2 ml) was injected on the left side of the jaw (DEX (-) effect site) and 0.2 ml normal saline containing 12.5 µg/ml DEX was injected on the right side of the jaw (DEX (+) effect site).The puncture point was located on the mesial side of the first molar, 1 mm away from the gingival sulcus.Following decalcification, the specimens were paraffinized and sagittally sliced into 20 μm-thick sections, followed by staining with anti-α smooth muscle actin antibody. The intravascular lumen area was measured in the oral mucosa, periodontal ligament, mandibular bone above the root apex, mandibular bone below the root apex, and dental pulp. The unpaired t-test was used for statistical analysis, and a P value < 0.05 was considered statistically significant. Results: Compared to the DEX (-) effect site, the intravascular lumen area in the oral mucosa and periodontal ligament of the DEX (+) effect site was significantly decreased. No significant difference was observed in the intravascular lumen area between the DEX (-) and DEX (-) effect sites in the mandibular bone above and below the root apex and dental pulp. Conclusion A direct vasoconstrictive effect of DEX was not observed in the intravascular lumen of the mandibular bone above and below the root apex and dental pulp; however, it was observed in the oral mucosa and periodontal ligament.

Objectives: Approximately 17% of Japanese women have hemoglobin concentrations less than 12 g/dL. Therefore, anemia prevention and early intervention are crucial public health issues in Japan. This study aimed to identify the symptoms and characteristics of anemic individuals in the general adult population by comparing survey responses of individuals with anemia and without anemia visiting blood donation centers.Materials and Methods: This cross-sectional study used self-administered questionnaires. Individuals who visited two Japanese Red Cross Society blood donation centers in Fukushima Prefecture, Japan were included. Hemoglobin levels were measured at blood donation, and the levels of 13 g/dL for men and 12 g/dL for women were defined as anemia.Results: Of the 857 individuals analyzed, 530 were men and 327 were women, of whom 19 (3.6%) and 12 (3.7%) had low hemoglobin levels, respectively. Logistic regression analysis was performed in men, and the results showed that “lightheadedness” (odds ratio [OR]=8.4) and “depressive symptoms” (OR=3.6) were significantly associated with hemoglobin levels. None of the evaluated items were significantly associated with hemoglobin levels in women.Conclusion: Among healthy Japanese men, those who exhibit lightheadedness and depressive symptoms have an increased risk of anemia. Lightheadedness and depressive symptoms may be indicative of undiagnosed anemia in men, which necessitates greater clinical attention.

Background: We assessed the relationship between patient age and remifentanil dosing rate in patients managed under general anesthesia with spontaneous breathing using low-dose remifentanil in sevoflurane. Methods: The participants were patients with an American Society of Anesthesiologists Physical Status of 1 or 2 maintained under general anesthesia with low-dose remifentanil in 1.5-2.0% sevoflurane. The infusion rate of remifentanil was adjusted so that the spontaneous respiratory rate was half the rate prior to the induction of anesthesia, and γH 　(µg/kg/min) was defined as the infusion rate of remifentanil under stable conditions where the respiratory rate was half the rate prior to the induction of anesthesia for ≥ 15 minutes. The relationship between γH and patient age was analyzed statistically by Spearman's correlation analysis. Results: During dental treatment under general anesthesia using low-dose remifentanil in sevoflurane, a significant correlation was detected between γH and patient age. The regression line of y = − 0.00079 x + 0.066 (y-axis; γH , x-axis; patient's age) was provided. The values of γH provide 0.064 µg/kg/min at 2 years and 0.0186 µg/kg/min at 60 years. Therefore, as age increases, the dosing rate exhibits a declining trend. Furthermore, in the dosing rate of remifentanil when the patient's respiratory rate was reduced by half from the preanesthetic respiratory rate, the dosing rate provided was around 0.88 mL/h in all ages if the remifentanil was diluted as 0.1 mg/mL. EtCO2 showed 51.0 ± 5.7 mmHg, and SpO2 was controlled within the normal range by this method. In addition, all dental treatments were performed without major problems, such as awakening and body movement during general anesthesia, and the post-anesthetic recovery process was stable. Conclusion General anesthesia with spontaneous breathing provides various advantages, and the present method is appropriate for minimally invasive procedures.

Background/Aims: Transabdominal ultrasonography (US) helps evaluate Crohn’s disease (CD) activity. We investigated whether the US could predict subsequent adverse outcomes for patients with CD in clinical remission. Methods: This single-center retrospective study included patients with CD in clinical remission who underwent US between April 2011 and April 2021, focusing on the predictability of subsequent adverse outcomes within 5 years. We used the US-CD, which was calculated using multiple US findings. Predictive variables were assessed using Cox proportional hazards regression analysis, and the predictive value was evaluated using receiver operating characteristic curves. Results: Seventy-three patients were included. During a median follow-up of 1,441 days (range, 41–1,825 days), 16.4% (12/73) experienced clinical relapse, 9.6% (7/73) required endoscopic balloon dilation (EBD), 58.9% (43/73) required enhanced treatment, and 20.5% (15/73) underwent surgery. In the multivariate analysis, US-CD was significantly associated with clinical relapse (P= 0.038) and the need for enhanced treatment (P= 0.005). The area under the receiver operating characteristic curve for predicting clinical relapse and the need for EBD was 0.77 and 0.81, respectively, with US-CD (cutoff value = 11), and that for requiring enhanced treatment was 0.74 with US-CD (cutoff value = 6). Patients with US-CD ≥ 11 demonstrated a significantly higher occurrence of clinical relapse (P= 0.001) and EBD (P= 0.002) within 5 years. Patients with US-CD ≥ 6 experienced a significantly higher likelihood of requiring enhanced treatment (P< 0.001) within 5 years. Conclusions High US-CD is associated with subsequent adverse outcomes in patients with CD.

Background/Aims: The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis. Methods: We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) grade version 5. Results: Fourteen patients with IMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r=0.687, p=0.009) and CTCAE grade (r=0.628, p=0.035). Bowel wall thickness and UCEIS (r=0.628, p=0.020), as well as color Doppler signal grade and CTCAE grade (r=0.724, p=0.008), were significantly correlated. Conclusions US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of IMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC.