Preservation of subvalvular mitral apparatus and maintenance of continuity between structures and annulus is recognized, and widely accepted as a significant factor for avoiding impairment to ventricular function and preventing left ventricular rupture during mitral valve replacement. However, we encountered a patient who developed posteromedial papillary muscle rupture following chordal sparing mitral valve replacement. The patient was a 67-year-old man who underwent mitral valve replacement with a porcine bioprosthesis 29M for acute mitral valve insufficiency due to several spontaneous chordal ruptures. The subvalvular apparatus of both leaflets was retained, the center of the anterior leaflet was excised elliptically, and the entire posterior leaflet was preserved. Although his postoperative course was uneventful, the transthoracic echocardiogram showed a floating structure prolapsing through the aortic valve in the left ventricle synchronizing with the cardiac cycle. The severed papillary muscle was removed successfully via an aortotomy through the native aortic valve on the 57th day after the first surgery. The patient recovered with no events. Surgeons should consider avoiding an excessive tension on the preserved chordae and delivering a cardioplegia sufficiently and uniformly during mitral valve replacement.

We report an interesting case of thoracic vascular graft infection treated by in situ replacement using bovine pericardial roll. A 65-year-old man who had undergone graft replacement of ascending aorta for acute type A aortic dissection 9 months prior was admitted to our hospital with purulent discharge from his chest wound. Fluid accumulation surrounding the vascular graft was detected by chest CT, and methicillin-resistant Staphylococcus aureus (MRSA) was positive from his blood culture. These findings led to a diagnosis of aortic graft infection. We gave the antibiotics intravenously, opened the abscess cavity around the infected graft, and irrigated with 0.04% gentian violet solution for 6 months, but failed to control the graft infection. Then we did redo replacement of the ascending aortic vascular graft using a bovine pericardial roll graft with a concomitant omental flap wrapping and obtained successful healing of the graft infection. During follow-up, no recurrent infection occurred, however he died of acute subdural hematoma 8 months after surgery. In situ replacement of the infected vascular grafts using a bovine pericardial roll graft with a concomitant omental flap wrapping may be an option for treating infected aortic grafts.

Side to side difference in tennis players' mid-radius and cross-sectional study on mid-tibia of jumpers and sedentary controls suggest that the improvement of mechanical properties of cortical bone in response to long-term exercise is related to geometric adaptation and not to volumetric bone mineral density. In the present study, geometric and mechanical properties of right tibia were estimated along 64 directions centering center of gravity of the bone on cross-sectional peripheral quantitative computed tomography (pQCT) images. The tibias of 17 jumpers (7 females, 10 males) and 15 controls (8 females, 7males), aged 18-23, were scanned at mid site using pQCT. Periosteal and endocortical radius were larger, cortical thickness was thicker, and mechanical properties (moment of inertia of area and strength strain index) were greater in jumpers compared to those of controls. The differences in cortical thickness between the two groups were dependent on direction of measurement. Defined a direction from tibia's center of gravity to fibula's as 0°, difference in the cortical thickness between jumpers and controls was the greatest at around 240°. Along this direction, differences in mechanical properties were also the most significant, suggesting that the site-specific adaptation of bone to long-term exercise is due to geographical relation of bone to muscle.

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.
Abscess ; Animals ; Capsule Endoscopy ; Comb and Wattles ; Comprehension ; Constriction, Pathologic ; Crohn Disease* ; Diffusion Magnetic Resonance Imaging ; Edema ; Fistula ; Humans ; Intestine, Small* ; Lymph Nodes ; Sensitivity and Specificity

Background/Aims: Endoscopic activity confirmed by enteroscopy is associated with poor clinical outcome in Crohn’s disease (CD). We investigated which of the existing biomarkers best reflects endoscopic activity in CD patients including the small bowel, and whether their combined use can improve accuracy. Methods: One hundred and four consecutive patients with ileal and ileocolonic type CD who underwent balloon-assisted enteroscopy (BAE) from October 2021 to August 2022 were enrolled, with clinical and laboratory data prospectively collected and analyzed. Results: Hemoglobin, platelet count, C-reactive protein, leucine-rich alpha-2 glycoprotein (LRG), fecal calprotectin, and fecal hemoglobin all showed significant difference in those with ulcers found on BAE. LRG and fecal calprotectin showed the highest areas under the curve (0.841 and 0.853) for detecting ulcers. LRG showed a sensitivity of 78% and specificity of 80% at a cutoff value of 13 μg/mL, whereas fecal calprotectin showed a sensitivity of 91% and specificity of 67% at a cutoff value of 151 μg/g. Dual positivity for LRG and fecal calprotectin, as well as LRG and fecal hemoglobin, both predicted ulcers with an improved specificity of 92% and 100%. A positive LRG or fecal calprotectin/hemoglobin showed an improved sensitivity of 96% and 91%. Positivity for LRG and either of the fecal biomarkers was associated with increased risk of hospitalization, surgery, and relapse. Conclusions The biomarkers LRG, fecal calprotectin, and fecal hemoglobin can serve as noninvasive and accurate tools for assessing activity in CD patients confirmed by BAE, especially when used in combination.

Behavioral and psychological symptoms were examined by psychiatric and cognitive functional evaluation in cognitive dysfunction patients who received weak ultrasound stimulation and drugs. We found great improving effects on motor symptoms for the first time in this study.

Background/Aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) was recently proposed as an alternative disease concept to nonalcoholic fatty liver disease (NAFLD). We aimed to investigate the prognosis of patients with biopsy-confirmed MASLD using data from a multicenter study. Methods: This was a sub-analysis of the Clinical Outcome Nonalcoholic Fatty Liver Disease (CLIONE) study that included 1,398 patients with NAFLD. Liver biopsy specimens were pathologically diagnosed and histologically scored using the NASH Clinical Research Network system, the FLIP algorithm, and the SAF score. Patients who met at least one cardiometabolic criterion were diagnosed with MASLD. Results: Approximately 99% of cases (n=1,381) were classified as MASLD. Patients with no cardiometabolic risk (n=17) had a significantly lower BMI than patients with MASLD (20.9 kg/m2 vs. 28.0 kg/m2, P<0.001), in addition to significantly lower levels of inflammation, ballooning, NAFLD activity score, and fibrosis stage based on liver histology. These 17 patients had a median follow-up of 5.9 years, equivalent to 115 person-years, with no deaths, liver-related events, cardiovascular events, or extrahepatic cancers. The results showed that the prognosis for pure MASLD was similar to that for the original CLIONE cohort, with 47 deaths and one patient who underwent orthotopic liver transplantation. The leading cause of death was extrahepatic cancer (n=10), while the leading causes of liver-related death were liver failure (n=9), hepatocellular carcinoma (n=8), and cholangiocarcinoma (n=4). Conclusions Approximately 99% of NAFLD cases were considered MASLD based on the 2023 liver disease nomenclature. The NAFLD-only group, which is not encompassed by MASLD, had a relatively mild histopathologic severity and a favorable prognosis. Consequently, the prognosis of MASLD is similar to that previously reported for NAFLD.

We describe the case of a 1-year and 7-month-old girl who was born at 36 weeks and 6 days of pregnancy weighing 1,351 g. In addition to the diagnosis of Cornelia de Lange syndrome and Tetralogy of Fallot, we confirmed shunt blood flow from the lesser curvature of the aortic arch to the main pulmonary artery. Thus, we additionally diagnosed ectopic patent ductus arteriosus (PDA). Ultrasonography showed interruption and retrograde flow of the diastolic blood flow in the anterior cerebral artery. Therefore, we made a diagnosis of blood stealing due to an ectopic PDA, and we performed surgical intervention via a median sternotomy at 25 days. When we ligated the shunt blood vessel, the percutaneous oxygen saturation decreased from the high 90% range to the low 70% range, thus we temporarily released the ligation. We narrowed the ectopic PDA so that the percutaneous oxygen saturation could be maintained the high 80% range. Postoperative ultrasonography showed improvement of the pressure waveform in the anterior cerebral artery. After discharge, oxygen demand increased gradually with weight gain, and we performed intracardiac repair using a monocusp valve patch at 1 year and 7 months. We report a rare case of Cornelia de Lange syndrome wherein we achieved intracardiac repair of Tetralogy of Fallot after ectopic PDA banding in the neonatal period.

We report a case of a 64-year-old woman who presented with symptoms for the common cold, for a medical examination. The chest X-ray showed enlargement of the heart, and echocardiography detected a mobile mass suggestive of a tumor 21×14 mm in the left ventricle. Because there was a risk of embolism, we decided to perform an operation. The tumor was elastic and soft and had a stalk arising from the wall of the left ventricle. We considered that it would be difficult to observe and expose the left ventricular tumor by direct vision. Therefore, we chose to perform a complete endoscopic resection. The tumor was determined histopathologically to be a papillary fibroelastoma. Here, we report the relatively rare benign tumor, a papillary fibroelastoma, and include a discussion of the literature.

OBJECTIVEThe custom-homebuilding company, Cosmic Garden Co. Ltd., located in Okayama City, Japan was established in 1997 and uses specific natural ore powder (SNOP) in wall materials and surveys customers in order to improve allergic symptoms.

METHODSTo investigate the biological effects of SNOP, patients with a pollen allergy were recruited to stay in a room surrounded by cloth containing SNOP (CCSNOP), and their symptoms and various biological parameters were compared with those of individuals staying in a room surrounded by control non-woven cloth (NWC). Each stay lasted 60 min. Before and immediately after the stay, a questionnaire regarding allergic symptoms, as well as POMS (Profile of Mood Status) and blood sampling, was performed. Post-stay minus pre-stay values were calculated and compared between CCSNOP and NWC groups.

RESULTSResults indicated that some symptoms, such as nasal obstruction and lacrimation, improved, and POMS evaluation showed that patients were calmer following a stay in CCSNOP. Relative eosinophils, non-specific Ig E, epidermal growth factor, monocyte chemotactic protein-1, and tumor necrosis factor-α increased following a stay in CCSNOP.

CONCLUSIONThis ore powder improved allergic symptoms, and long-term monitoring involving 1 to 2 months may be necessary to fully explore the biological and physical effects of SNOP on allergic patients.

Adult ; Chemokine CCL2 ; immunology ; Clothing ; Female ; Geologic Sediments ; chemistry ; Humans ; Immunoglobulin E ; immunology ; Japan ; Male ; Pollen ; immunology ; Rhinitis, Allergic, Seasonal ; immunology ; therapy ; Tumor Necrosis Factor-alpha ; immunology