Rheumatoid arthritis and interstitial pneumonitis were diagnosed in a 72-year-old man and thoracic computed tomography revealed an aortic arch aneurysm 50mm in diameter. Steroid therapy gave symptomatic relief and improved laboratory findings, but hyperglycemia and hypertension developed. Two months later the thoracic aneurysm ruptured, and computed tomography revealed expansion of the aneurysm to 60mm in diameter and surrounding hematoma. Emergency total arch replacement was performed successfully with deep hypothermic cardiopulmonary bypass and selective cerebral perfusion. The steroid therapy was considered to be responsible for the rapid expansion and rupture of the thoracic aneurysm. When prescribing steroids for a patient who has a concomitant atherosclerotic cardiovascular disease, we should not only control the steroidal side effects strictly, but also carefully watch the course of the atherosclerotic lesion.

This study aimed to assess the effect of short-interval intracortical inhibition (SICI) before a jump off a platform (pre-set) on drop jump (DJ); the purpose was to investigate the relationship between this activity and performance, and the different effects of SICI on agonist and antagonist muscles during pre-set for jump athletes. Jump athletes (Jumper group, n=13) and Other athletes (Other group, n=9) performed DJ from drop heights of 0.30, 0.45, and 0.60 m). DJ performance was evaluated with DJ-index which was calculated from contact time and jump height. SICI was calculated from motor evoked potentials (MEP) recorded using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius (MG) and tibialis anterior (TA) muscles in 7 jump athletes. Significantly higher DJ performance was observed for the Jumper group at all drop heights, and the Jumper group exhibited greater performance for the highest drop height than the Other groups. Significant decreases in SICI for MG were observed for the Jumper groups, and this decrease in inhibition was more prominent for the highest drop height during pre-set. Furthermore, the correlation between SICI for MG and DJ-index was stronger for increased drop heights, and a significantly positive correlation between these variables was observed at a height of 0.60 m. However, the SICI during the pre-set for TA exhibited no significant change under any of the conditions. The results of the present study suggest the importance of selective disinhibition of brain areas associated with the agonistic muscles during pre-set for higher DJ performance.

Recently, with the advent of medical devices and minimally invasive operations, endoscopic saphenous vein harvesting (EVH) in coronary artery bypass grafting has been widely accepted. Although EVH has short-term advantages of less wound morbidity and better cosmetic results compared with open vein harvesting (OVH), several studies have demonstrated that the mid- and long-term patency rate of EVH veins is significantly lower than that of OVH veins, therefore the role of EVH is currently controversial. The purpose of this study was to investigate the early results of EVH compared with the OVH group. Between April 2011 and December 2012, 115 consecutive patients underwent coronary artery bypass grafting (CABG) in our institution. Of these, EVH was performed in 62 patients and OVH in 53. In EVH groups, all 50 patients were men, and mean age was 71.3±7.8 years. A total of 211 coronary anastomoses, 109 SVGs anastomoses were assessed for patency postoperatively by angiography or enhanced computed tomography before discharge. The mean vein harvesting time was 26.0±8.1 min, and the mean number of ostial branch tear was 0.34±0.59. The overall SVG patency rates at discharge were 95.4% in EVH and 92% in OVH, respectively (p=0.24). There was a significant reduction in the incidence of leg wound complications in the EVH group (EVH : 1.6% ; OVH : 13.2% ; p=0.038). In conclusion, the short-term result of EVH was satisfactory. EVH reduces leg wound complications compared with OVH.

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

Although the results of surgical treatment for acute type A dissection have improved because of progress in surgical techniques, the prognosis is still very poor and optimal therapeutic approach is still not clearly established for cases of acute dissection complicated with malperfusion. Of 134 patients who presented with acute aortic dissection between January 1986 and June 1999, 57 had acute type A dissection and 10 had acute type A dissection with malperfusion. Patient age ranged from 53 to 78 (average, 64.6) years. There were 6 men and 4 women. There was accompanying cerebral ischemia in 3 cases, coronary ischemia in 1, visceral ischemia in 5, renal ischemia in 2, ischemia of the extremities in 7, and multiple organ ischemia in 5. One patient died before surgery, and another patient died after sternotomy due to aortic rupture. The other 8 patients underwent surgical operations. The following surgical procedures were performed: bypass grafting to the superior mesenteric artery was performed in 1 patient, stent implantation to the right coronary artery followed by ascending aortic replacement (19th day after onset) was performed in 1, and aortic repair (5 ascending aortic replacements and 1 hemiarch replacement) in the acute phase was performed in 6. The mortality rates were 66.7% (2/3) in patients with cerebral ischemia, 0% (0/1) in the patient with coronary ischemia, 80% (4/5) in those with visceral ischemia, 100% (2/2) in those with renal ischemia, 42.9% (3/7) in those with ischemia of the extremities, 80% (4/5) in those with multiple organ ischemia, and 50% (5/10) in all cases. All patients whose base excess (B.E.) was less than -10mEq/l on admission died (4/4). We conclude that in order to improve surgical results in patients with acute type A dissection with malperfusion, different approaches may be required for each patient. The combination of aortic repair and percutaneous reperfusion are important. Arterial blood gas analyses were simple, and the values of B. E. at admission were useful to determine the surgical strategy in these patients and to predict their prognosis.

The aim of this study was to demonstrate a time-series relationship in drop jump (DJ) from a pre-set state with improved performance. Twelve male college athletes performed a DJ from a height of 0.60 m. DJ performance was assessed with a DJ-index (jump height/contact time). Short-interval intracortical inhibition (SICI) was assessed as intracortical inhibitory circuit excitability in a pre-set state, calculated by using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius muscle (MG). The H-reflex of the left MG and the ankle joint torque were calculated in the early phase of take-off. A significant correlation was shown between ⊿SICI during the pre-set state and the DJ index. Thus, we examined the relationships between phases, focusing on time-series relationships throughout the jump period. The results showed a significant correlation between ⊿SICI during the pre-set state and %H-reflex during the early phase of take-off, and peak ankle joint torque during take-off was also significantly correlated with %H-reflex during the early phase of take-off. A significant correlation was also demonstrated between ankle joint torque during take-off and the DJ-index. In conclusion, we observed a time-series relationship between DJ from a pre-set state and improved performance. A decrease of intracortical inhibitory circuit excitability in the pre-set state affects stretch-reflex facilitation during the early phase of take-off; stretch-reflex facilitation results in the development of a large force in the ankle joint during take-off, and this force develops ankle joint torque. These findings may be used to improve jump performance.

In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.

OBJECTIVE: The anti-epileptogenic drug levetiracetam has anticonvulsant and anti-epileptogenesis effects. Synergy between cell death and inflammation can lead to increased levels of apoptosis inhibitory factors and brain-derived neurotrophic factor, aberrant neurogenesis and extended axon sprouting. Once hyperexcitation of the neural network occurs, spontaneous seizures or epileptogenesis develops. This study investigated whether the anti-epileptogenic effect of levetiracetam is due to its alternate apoptotic activity. METHODS: Adult male Noda epileptic rats were treated with levetiracetam or vehicle control for two weeks. mRNA quantification of Bax, Bcl-2 and GAPDH expression were performed from prefrontal cortex and hippocampus tissue samples. RESULTS: The levetiracetam-treated group showed a significant increase of Bax/Bcl-2 mRNA expression ratio in the prefrontal cortex than the control group, but no change in the Bax/Bcl-2 mRNA expression ratio in hippocampus. CONCLUSION: Idiopathic generalized epilepsy including childhood absence epilepsy develop at childhood and recover spontaneously during adolescence. The aberrant neural excitable network is pruned by a neural-maturing action. This study suggests the mechanism of acquired anti-epileptogenesis by levetiracetam treatment may be similar to spontaneous recovery of idiopathic generalized epilepsy during adolescence.
Adolescent* ; Adult ; Animals ; Apoptosis ; Axons ; Brain-Derived Neurotrophic Factor ; Cell Death ; Epilepsy, Absence ; Epilepsy, Generalized* ; Hippocampus ; Humans ; Inflammation ; Male ; Neurogenesis ; Prefrontal Cortex ; Rats ; RNA, Messenger ; Seizures

BACKGROUND: Previous cardiovascular risk prediction models in Japan have utilized prospective cohort studies with concise data. As the health information including health check-up records and administrative claims becomes digitalized and publicly available, application of large datasets based on such real-world data can achieve prediction accuracy and support social implementation of cardiovascular disease risk prediction models in preventive and clinical practice. In this study, classical regression and machine learning methods were explored to develop ischemic heart disease (IHD) and stroke prognostic models using real-world data. METHODS: IQVIA Japan Claims Database was searched to include 691,160 individuals (predominantly corporate employees and their families working in secondary and tertiary industries) with at least one annual health check-up record during the identification period (April 2013-December 2018). The primary outcome of the study was the first recorded IHD or stroke event. Predictors were annual health check-up records at the index year-month, comprising demographic characteristics, laboratory tests, and questionnaire features. Four prediction models (Cox, Elnet-Cox, XGBoost, and Ensemble) were assessed in the present study to develop a cardiovascular disease risk prediction model for Japan. RESULTS: The analysis cohort consisted of 572,971 invididuals. All prediction models showed similarly good performance. The Harrell's C-index was close to 0.9 for all IHD models, and above 0.7 for stroke models. In IHD models, age, sex, high-density lipoprotein, low-density lipoprotein, cholesterol, and systolic blood pressure had higher importance, while in stroke models systolic blood pressure and age had higher importance. CONCLUSION Our study analyzed classical regression and machine learning algorithms to develop cardiovascular disease risk prediction models for IHD and stroke in Japan that can be applied to practical use in a large population with predictive accuracy.
Humans ; Cardiovascular Diseases/epidemiology* ; Prognosis ; Prospective Studies ; Japan/epidemiology* ; Stroke/etiology* ; Myocardial Ischemia/epidemiology* ; Risk Assessment/methods*

Movement control and muscle function for pelvic movement in the frontal plane (pelvic elevation) are important for various single-leg sports activities. We aimed to clarify mechanical characteristics of pelvic squat (P-Sq: single-leg squat exercise with emphasis on pelvic elevation, developed by our research group) compared with the double-leg squat (D-Sq) and single-leg squat (S-Sq). Twelve male track and field athletes performed D-Sq, S-Sq, and P-Sq exercises at various loads (90%, 75%, and 60% of 1-repetition maximum [1RM]), using maximum effort. Kinematic and kinetic data were calculated using data recorded with a motion capture system and force platforms. We observed the highest values with P-Sq, followed by S-Sq and D-Sq under all load conditions as follows: peak vertical ground reaction force and rate of force development (RFD), range of pelvic elevation, peak pelvic elevation velocity, peak powers associated with hip abduction torque and trunk lateral flexion torque. In P-Sq, RFD at 90% 1RM was smaller than under the other load conditions, whereas peak vertical ground reaction force at 90% 1RM was larger than under the other load conditions. There were no differences among load conditions with regard to hip abduction and trunk lateral flexion torques and powers. Therefore, characteristics of P-Sq compared to those of D-Sq and S-Sq are 1) larger and faster pelvic elevation, using related muscles (hip abductors and trunk lateral flexors) under all load conditions, 2) larger peak ground reaction force with pelvic elevation under large load conditions, and larger RFD in pelvic elevation under low load conditions.