[Objectives] It has been demonstrated that HMG-CoA reductase inhibitors (statins) effectively reduce the low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels in the blood, and currently, statins are most widely used for the treatment of hyperlipidemia.  On the other hand, it has been demonstrated that fibrates more effectively reduce the blood triglyceride level (TG).  However, concomitant use of statins and fibrates is contraindicated.
  Therefore, practical and situational use of fenofibrate (fibrate therapy) and atorvastatin (statin therapy) was investigated in patients with high TG and LDL-C levels in consideration of cost effectiveness.
[Method] Baseline TG and LDL-C levels were stratified, and a table of combination was prepared for TG and LDL-C values.  Effectiveness was measured by the number of patients who were able to achieve treatment targets.  Treatment targets were set referring to the reduction rate of serum lipid levels in dose finding studies of fenofibrate and atorvastatin and the target lipid levels identified in 2007 Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases.  Costs were measured by annual drug treatment costs, and the incremental cost effectiveness ratio of atorvastatin to fenofibrate was then estimated.  According to the actual patient distribution, the incremental cost effectiveness ratio of atorvastatin to fenofibrate in patients with TG level over 150 mg and LDL level over 140 mg was also estimated.
[Results] Fenofibrate was dominant over atorvastatin where effectiveness was higher and costs were lower in fenofibrate treatment in two patient groups; patients with LDL-C level under 160 mg patients with TG level over 170 mg and LDL-C level between 160 mg and 170 mg patients with TG level over 190 mg and LDL-C level between 170 mg and 180 mg patients with TG level over 230 mg and LDL-C level between 180 mg and 190 mg patients with TG level over 250 mg and LDL-C level between 190 mg and 200 mg patients with TG level over 290 mg and LDL-C level between 200 mg and 210 mg patients with TG level over 350 mg and LDL-C level over 210 mg.  In an analysis made according to the actual patient distribution, 571 fenofibrate patients and 534 atorvastatin patients were able to achieve the treatment targets, and fenofibrate was dominant over atorvastatin where effectiveness was higher and costs were lower in fenofibrate treatment.

Objective: This study aimed to clarify changes in planter pressure at the 1, 2, 5 metatarsal head, and muscle activities resulting from exercise of the peroneus longus (PL) or tibialis posterior (TP) muscles. Method: Nine subjects (3 male, 6 female) were recruited. Before and after exercise, planter pressure at the metatarsal heads and the activities of PL, TP, tibialis anterior, and soleus muscles were recorded during heel raising using electromyography and a foot sensor. The first exercise was a maximal isometric contraction of the PL and peroneus brevis (PB). The second was contraction of the TP, and the third was of all three, the PL, PB, and TP. Result: The amount of planter pressure at the first metatarsal head increased after PL exercise. The standard deviation at the second metatarsal head decreased after PL and TP exercise, but showed no change after PL exercise. Conclusion: After PL and TP exercise, heel raises were possible with few perturbations at the metatarsal head. After PL exercise, the amount of planter pressure at the first metatarsal head increased, but there was no change in perturbations. The results show that it is necessary to consider the effect of short time exercise.

A 75-year-old woman underwent endovascular stent-grafting for a descending thoracic aortic aneurysm, followed by video-assisted thoracoscopic right upper lobectomy for concomitant lung cancer in a later procedure. Two custom-made endovascular spiral Z stents covered with woven Dacron (DuPont Co., Wilmington, DE, USA) were delivered via the femoral artery under local anesthesia using pull-through technique. Intraoperative angiograms showed successful exclusion of the aneurysm without any endoleakage. Conventional surgical treatments for both diseases in this patient would have required bilateral thoracotomy either in a simultaneous or staged fashion and entail risks of postoperative pulmonary dysfunction and progression of the cancer. Endovascular stent-grafting offered potential superior operative results and quality of postoperative life in this patient with concomitant descending thoracic aortic aneurysm and cancer of the right lung.

Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, n=31) and an OPCAB group (off, n=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, p=0.01), respiratory failure (on=58.1% : off=29.3%, p=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, p=0.01), and necessary inotropic support (on=51.6% : off=17.1%, p=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.

Introduction : Catheter which strays in the ascending lumbar vein during femoral vein catheterization can cause complications such as retroperitoneal hematoma. However, not much is known of this phenomenon.
Methods : We retrospectively studied 107 patients who had indwelling femoral vein catheter in our hospital between March 2013 and April 2011.
Results : The catheter went straying in the ascending lumbar vein 11/110 times (10.0%) , 5/34 times (14.7%) on the left side, and 6/76 times (7.9%) on the right side. The possibility of the catheter straying was maximum when the catheter was displaced laterally or raised sharply towards the caudal side, as seen through abdominal radiographic examination.
Conclusion : Femoral central venous catheter misplacement in the ascending lumbar veins is fairly common. Tests such as additional abdominal CT or radiographs should be conducted if misplacement is suspected.

Pulmonary blastoma is rare and its prognosis very poor. A 6-year-old boy was referred to our hospital with chest pain. Computed tomography demonstrated that the left pleural cavity was filled with a tumor. Cardiac echocardiography demonstrated that the tumor had invaded through the pulmonary vein into the left atrium and that the tumor extended into the left ventricle. Part of the tumor was adhered to the anterior leaflet of the mitral valve. To increase operative radicality, an autotransplantation technique was performed concomitantly with resection of the original lesion. Through a median sternotomy, a moderate hypothermic cardiopulmonary bypass was established to obtain cardiac arrest. First, longitudinal incision of right-sided of the left atrium was made. The tumor invaded into the left atrium through the left superior pulmonary orifice. The ascending aorta, the main pulmonary artery, and both caval veins were transected. The left atrium was incised along the pulmonary venous orifices. The heart was completely removed from the mediastinum and transferred to another table. Resection of the intracardiac metastatic lesion and mitral valve replacement was accomplished. During this time, thoracic surgeons performed a left pneunectomy. The left atrial wall around the left pulmonary venous orifices was resected in combination with the left lung. After the deficit of the left atrial wall was repaired with a Gore-Tex patch, the heart was replaced and we reconstructed the great arteries and caval veins. The autotransplantation technique is a useful procedure for combined lesions of the heart and lung.

We developed pancreatic and duodenal homeobox1 (Pdx1) knockout mice to improve a compensatory hyperinsulinemia, which was induced by hyperplasia in the beta cells or Langerhans' islands, as the diabetic model mice. For targeting of Pdx1 gene by homologous recombination, ES cells derived from a 129(+Ter)/SvJclxC57BL/6JJcl hybrid mouse were electroporated and subjected to positive-negative selection with hygromycin B and ganciclovir. As these results, one of the three chimeric mice succeeded to produce the next or F1 generation. Then, the mouse fetuses were extracted from the mother's uterus and analyzed immunohistologically for the existence of a pancreas. The fetuses were analyzed at embryonic day 14.5 (E14.5) because Pdx1 knockout could not alive after birth in this study. Immunohistochemical staining revealed that 10 fetuses out of 26 did not have any PDX1 positive primordium of the pancreas and that the PDX1 expresses in both the interior and exterior regions of intestine. In particular, one the exterior of the intestine PDX1 was expressed in glands that would be expected to form the pancreas. The result of PCR genotyping with extracted DNA from the paraffin sections showed existence of 10 Pdx1-knockout mice and corresponded to results of immunostaining. Thus, we succeeded to establish a Pdx1-knockout (Pdx1-/-) mice.
Animals ; DNA ; Fetus ; Ganciclovir ; Homologous Recombination ; Hygromycin B ; Hyperinsulinism ; Hyperplasia ; Intestines* ; Islands ; Mice ; Mice, Knockout* ; Pancreas ; Paraffin ; Parturition ; Polymerase Chain Reaction ; Uterus

In order to carry out mass examination for detection of stomach ailments effectively and improve screening accuracy, the Nagano Prefectural Welfare Federation of Agricultural Cooperatives, with its mass gastric examination committee as a driving force, has made every endeavor in close collaboration with Federation-affiliated hospitals.
The ratio of those receiving detailed examination to the total number of those who have undergone mass screenings, and the detection ratio of gastric cancer cases, especially those in early stages, have increased steadily over the past years.
This is due in the main to untiring effort exerted by public health nurses and other persons concerned with health problems.
However, the results of X-ray examination made on the basis of the diagnostic standards prepared by the Federation show that there is much need of improving examiners' ability to read mass miniature radiographs correctly.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To assess bone mineral density (BMD) and bone metabolism ≥27 years after surgery in female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) during adolescence and to determine their associations with physical performance. OVERVIEW OF LITERATURE: There are no studies investigating postsurgical BMD in middle-aged AIS patients. METHODS: This study included 23 patients who provided informed consent among 229 female patients with AIS who underwent spinal fusion from 1968 until 1988. Average age at the time of observation was 48.8 years. BMD was measured at the left femoral neck, and the levels of two bone metabolism markers–procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase 5b (TRACP-5b)–were measured from blood samples. Physical performance was measured using grip strength, sit-ups, sit-and-reach, side step, and standing long jump. RESULTS: Mean BMD was 0.784 g/cm2. According to the World Health Organization diagnostic criteria, one subject (4.3%) had osteoporosis, whereas nine subjects (39.1%) had osteopenia. In patients with osteoporosis or osteopenia, P1NP and TRACP-5b levels were high, and BMD loss was because of high metabolic turnover. All calculated standard scores for physical performance were lower in the study cohort than in healthy individuals. There was a positive correlation between BMD and the standard score for grip strength, whereas there were weak positive correlations between BMD and the standard scores for side step and standing long jump. CONCLUSIONS: In female AIS patients who underwent spinal fusion in adolescence, 4.3% and 39.1% had osteoporosis and osteopenia, respectively, ≥27 years after surgery. Exercise performance of these patients was poor compared with the national standards. In these patients, increased physical activity should be encouraged to prevent BMD loss in middle age.
Acid Phosphatase ; Adolescent* ; Bone Density* ; Bone Diseases, Metabolic ; Cohort Studies ; Female* ; Femur Neck ; Hand Strength ; Humans ; Informed Consent ; Metabolism ; Middle Aged ; Motor Activity ; Osteoporosis ; Retrospective Studies ; Scoliosis* ; Spinal Fusion ; World Health Organization