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.

There is disagreement regarding the indications of surgery for cases of severe aortic stenosis (AS) with a decrease in left ventricular ejection fraction (EF) and a low aortic pressure gradient (PG), since there is a high perioperative risk associated with this condition. Hence, we investigated the surgical outcome of AS cases with impaired left ventricular function. Our department performed 144 aortic valve replacements (AVRs) for cases of AS and AS-dominant mild regurgitation (ASr) between January 2000 and September 2005. Among these cases, 9 patients had an EF under 35%, and these patients were selected as subjects and compared with a control group with an EF of more than 35%. Patients with accompanying coronary artery diseases that required treatment were excluded to avoid confounding effects on cardiac function. The mean age of the 9 subjects (4 men and 5 women) was 67.8±10.8 years old, with a range from 53 to 80 years old, and the subjects had the following mean background data: EF, 34.4±0.5%; left ventricular end-diastolic dimension (LVDd), 57.3±5.8mm; left ventricular end-systolic dimension (LVDs), 49.3±5.7mm; interventricular septum thickness (IVSth), 11.9±1.9mm; and left ventricular posterior wall thickness (LVPWth), 11.1±2.6mm. Characteristics such as left ventricular dilatation and thinning of the left ventricle myocardium were noted in these data. The cases were classified as severe AS because the mean aortic valve area (AVA) was 0.58±0.2cm², but the peak aortic pressure gradient (peak PG) (65.2±32.7mmHg) in the 9 subjects was lower than that of the control group (97.0±65.2mmHg). All 9 subjects underwent aortic valve replacements (AVRs), with simultaneous mitral annuloplasty (MAP) in 3 cases, mitral valve replacement (MVR) in 1 case and performance of a Maze procedure in 1 case. No deaths occurred while the patients were in hospital. Postoperative complications included 2 cases of transient atrial fibrillation and 1 case of postoperative bleeding requiring rethoracotomy for hemostasis. The EF in the late postoperative period showed improvement in 8 cases and was unchanged in the remaining case; the mean postoperative EF was 56.9% for the 9 subjects. All cases were rated as improved based on the NYHA classification of cardiac performance, and the significant improvement in EF in 8 of the 9 cases suggests that surgery is safe and can improve prognosis for patients with advanced AS with myocardium thinning and decreased EF.

Although western medical treatment for heart failure has dramatically improved, limitation still exists where such treatment together with mechanical support fails to manage heart failure. It is unclear whether the addition of Kampo medicine to standard recommended therapy can improve clinical manifestations. To address this issue, we retrospectively evaluated the effects of Mokuboito used in 12 consecutive heart failure patients from April 2013 to April 2015 by analyzing endpoints such as symptoms, BNP concentration, and left ventricular ejection fraction (LVEF). Mokuboito significantly decreased plasma BNP concentration from 796.8 ± 830.8 to 215.6 ± 85.5 pg/ml (p < 0.01) and improved symptoms. There were no significant differences in other parameters including LVEF. In conclusion, the present study suggests that Mokuboito is a useful treatment on top of the standard heart failure medication in severe heart failure patients.

Objective: Monitoring the incidence of atypical femoral fractures (AFFs) using medical claim databases is useful to assess the safety of long-term bisphosphonate exposure. Therefore, we aimed to validate the relationship between clinically-defined suspected AFFs and the candidate patients obtained from claims data at three hospitals in Japan.

Design: A cross-sectional study involving three hospitals that perform bone fracture surgery and from which electronic medical record databases of diagnoses and procedures are available.

Methods: Candidate patients were at the medical databases using two International Classification of Diseases, 10th Edition (ICD-10) codes (subtrochanteric fracture and fracture of shaft of femur) in the claims databases. These potential cases by claim-based definition were validated using clinically-confirmed information such as, the patient operation records, the discharge records, or radiographic imaging findings as suspected AFFs.

Results: Among fracture cases in the hospitals, and 9 cases with subtrochanteric fracture and 23 cases with femoral shaft fracture were identified based on the ICD-10 codes in the claims databases. Clinically confirmed subtrochanteric fracture had a sensitivity of 81.8% (95% CI: 48.2-97.7%), and a specificity of 100.0% (95% CI: 99.9-100.0%). For femoral shaft fracture, the sensitivity was 82.1% (95% CI: 63.1-93.9%), and the specificity was 100.0% (95% CI: 99.9-100.0%). In subgroup analyses, the sensitivities in patients over the age of 50 years with a single fracture site and with osteoporosis were relatively higher than in other subgroups.

Conclusion: The claims-based definitions of suspected AFFs are accurate, indicating the value of pharmacoepidemiological studies using the National Receipt Database.

OBJECTIVESThe 5-year survival rate for pancreatic cancer is known to be lower than that for cancer at any other site in the body, and the proportion of pancreatic cancer deaths among all cancer deaths has been increasing in Japan. The aim of this study was to investigate pancreatic cancer mortality in the light of temporal and geographical trends in the 47 prefectures of the country between 1968 and 2002.

METHODSTo survey the geographical aspects of pancreatic cancer mortality, we mapped the direct age-adjusted mortality rates of persons aged 40 years and older by sex in seven 5-year periods (1968-1972 to 1998-2002). We also evaluated the changes in period and birth cohort trends using estimable functions based on the age-period-cohort models in each prefecture.

RESULTSDuring the observation period the Hokkaido and Tohoku regions had high mortality rates for both sexes. No significant increase in period trends was observed from 1973 to 2002, but significant increases in cohort trends were observed from 1913 to 1962-in two prefectures, for males, and in four prefectures, for females.

CONCLUSIONSThe results of this study reveal a combination of time trends in pancreatic cancer mortality and changes in period or birth cohort trends. The changes in cohort trends in each prefecture were more variable than the period trends. This finding probably indicates the need for further investigation of the cohort-related factors involved in the prevalence of pancreatic cancer. Further research on mortality in the 47 prefectures needs to be conducted while taking the two time effects into account.

Background: In the Latarjet procedure, the subscapularis is divided at the superior two-thirds junction. It has been believed that this subscapularis split approach resulted in better internal rotation strength rather than an L-shaped subscapularis tenotomy. However, there are few studies demonstrating the preserved function of the subscapularis after the Latarjet procedure. The aim of the present study was to clarify the subscapularis activity using positron emission tomography (PET) in patients after the Latarjet procedure. Methods: Six men who had undergone the Latarjet procedure were enrolled. The internal rotation exercise with elastic bands was performed with the arm at 0° and 90° of abduction. After the exercises, the patients had an intravenous injection of fluorine 18 fluorodeoxyglucose ( 18 F FDG). Each PET image was fused to the corresponding computed tomography image to calculate the standardized uptake value (SUV). The internal rotation muscle strength was measured by a dynamometer. Results: At 0° of abduction, the subscapularis SUVs of the involved side were significantly lower than those of the uninvolved side (p = 0.010), although there was no significant difference at 90° of abduction. The SUVs of the involved subscapularis were significantly lower at 0° of abduction than at 90° (p = 0.034). The internal rotation strength of the involved side was 81.1% ± 12.1% of the uninvolved side at 0° of abduction. Conclusions After the Latarjet procedure with the subscapularis split approach, subscapularis activity was well preserved at 90° of abduction. However, internal rotation strength was reduced by 19%.

Background: In the Latarjet procedure, the subscapularis is divided at the superior two-thirds junction. It has been believed that this subscapularis split approach resulted in better internal rotation strength rather than an L-shaped subscapularis tenotomy. However, there are few studies demonstrating the preserved function of the subscapularis after the Latarjet procedure. The aim of the present study was to clarify the subscapularis activity using positron emission tomography (PET) in patients after the Latarjet procedure. Methods: Six men who had undergone the Latarjet procedure were enrolled. The internal rotation exercise with elastic bands was performed with the arm at 0° and 90° of abduction. After the exercises, the patients had an intravenous injection of fluorine 18 fluorodeoxyglucose ( 18 F FDG). Each PET image was fused to the corresponding computed tomography image to calculate the standardized uptake value (SUV). The internal rotation muscle strength was measured by a dynamometer. Results: At 0° of abduction, the subscapularis SUVs of the involved side were significantly lower than those of the uninvolved side (p = 0.010), although there was no significant difference at 90° of abduction. The SUVs of the involved subscapularis were significantly lower at 0° of abduction than at 90° (p = 0.034). The internal rotation strength of the involved side was 81.1% ± 12.1% of the uninvolved side at 0° of abduction. Conclusions After the Latarjet procedure with the subscapularis split approach, subscapularis activity was well preserved at 90° of abduction. However, internal rotation strength was reduced by 19%.

Background: In the Latarjet procedure, the subscapularis is divided at the superior two-thirds junction. It has been believed that this subscapularis split approach resulted in better internal rotation strength rather than an L-shaped subscapularis tenotomy. However, there are few studies demonstrating the preserved function of the subscapularis after the Latarjet procedure. The aim of the present study was to clarify the subscapularis activity using positron emission tomography (PET) in patients after the Latarjet procedure. Methods: Six men who had undergone the Latarjet procedure were enrolled. The internal rotation exercise with elastic bands was performed with the arm at 0° and 90° of abduction. After the exercises, the patients had an intravenous injection of fluorine 18 fluorodeoxyglucose ( 18 F FDG). Each PET image was fused to the corresponding computed tomography image to calculate the standardized uptake value (SUV). The internal rotation muscle strength was measured by a dynamometer. Results: At 0° of abduction, the subscapularis SUVs of the involved side were significantly lower than those of the uninvolved side (p = 0.010), although there was no significant difference at 90° of abduction. The SUVs of the involved subscapularis were significantly lower at 0° of abduction than at 90° (p = 0.034). The internal rotation strength of the involved side was 81.1% ± 12.1% of the uninvolved side at 0° of abduction. Conclusions After the Latarjet procedure with the subscapularis split approach, subscapularis activity was well preserved at 90° of abduction. However, internal rotation strength was reduced by 19%.

Background: In the Latarjet procedure, the subscapularis is divided at the superior two-thirds junction. It has been believed that this subscapularis split approach resulted in better internal rotation strength rather than an L-shaped subscapularis tenotomy. However, there are few studies demonstrating the preserved function of the subscapularis after the Latarjet procedure. The aim of the present study was to clarify the subscapularis activity using positron emission tomography (PET) in patients after the Latarjet procedure. Methods: Six men who had undergone the Latarjet procedure were enrolled. The internal rotation exercise with elastic bands was performed with the arm at 0° and 90° of abduction. After the exercises, the patients had an intravenous injection of fluorine 18 fluorodeoxyglucose ( 18 F FDG). Each PET image was fused to the corresponding computed tomography image to calculate the standardized uptake value (SUV). The internal rotation muscle strength was measured by a dynamometer. Results: At 0° of abduction, the subscapularis SUVs of the involved side were significantly lower than those of the uninvolved side (p = 0.010), although there was no significant difference at 90° of abduction. The SUVs of the involved subscapularis were significantly lower at 0° of abduction than at 90° (p = 0.034). The internal rotation strength of the involved side was 81.1% ± 12.1% of the uninvolved side at 0° of abduction. Conclusions After the Latarjet procedure with the subscapularis split approach, subscapularis activity was well preserved at 90° of abduction. However, internal rotation strength was reduced by 19%.

Objective: Human papillomavirus subtypes are predictive indicators of cervical intraepithelial neoplasia (CIN) progression. While colposcopy is also an essential part of cervical cancer prevention, its accuracy and reproducibility are limited because of subjective evaluation. This study aimed to develop an artificial intelligence (AI) algorithm that can accurately detect the optimal lesion associated with prognosis using colposcopic images of CIN2 patients by utilizing objective AI diagnosis. Methods: We identified colposcopic findings associated with the prognosis of patients with CIN2. We developed a convolutional neural network that can automatically detect the rate of high-grade lesions in the uterovaginal area in 12 segments. We finally evaluated the detection accuracy of our AI algorithm compared with the scores by multiple gynecologic oncologists. Results: High-grade lesion occupancy in the uterovaginal area detected by senior colposcopists was significantly correlated with the prognosis of patients with CIN2. The detection rate for high-grade lesions in 12 segments of the uterovaginal area by the AI system was 62.1% for recall, and the overall correct response rate was 89.7%. Moreover, the percentage of high-grade lesions detected by the AI system was significantly correlated with the rate detected by multiple gynecologic senior oncologists (r=0.61). Conclusion Our novel AI algorithm can accurately determine high-grade lesions associated with prognosis on colposcopic images, and these results provide an insight into the additional utility of colposcopy for the management of patients with CIN2.