Pitching motion is made up by three-dimensional whole body movement. Pelvic and trunk rotation movement is important for the prevention of throwing injuries. Throwing is not a simple rotation movement. Evaluation should reflect muscle strength, coordination, and pitching motion characteristics. We have devised throwing rotational assessment (TRA) similar to throwing as the new evaluation of total rotation angle required for throwing. The purpose of this study was to introduce the new method and to examine the characteristics of players with throwing disorders. The subjects were 76 high school baseball pitchers who participated in the medical check. Pain-induced tests were elbow hyperextension test and intra-articular shoulder impingement test. Pitchers who felt pain in either test were classified as disorder group. TRA evaluation was performed as follows. In the positions similar to the foot contact phase, rotation angles of the pelvis and trunk were measured. In the position similar to follow through phase, the distance between the middle finger and the second toe was measured. All tests were performed in the throwing and opposite direction. Twenty five pitchers were classified as disorder group. All TRA tests in healthy group were significantly higher in the throwing direction than in the opposite direction, but there was no significant difference in the disorder group. Disorder group had significantly lower average rotation angles of the pelvis and trunk in the throwing direction and rotation angle of trunk in the opposite direction than the healthy group. Restrictions on TRA reflecting the complex whole body rotation movement may be related to the throwing disorder. This evaluation is a simple method. It would be useful early detection of throwing disorder and systematic evaluation in medical check, as well as self-check in the sports field.

The patient, a female in her 60s, was under anticoagulant therapy with direct oral anticoagulant (DOAC) for persistent atrial fibrillation. She suddenly presented with chest pain, prompting her emergency admission to our medical facility. Subsequently, she received a diagnosis of acute aortic dissection (Stanford A) and was referred to our department for urgent surgical intervention. The administration of Andexanet Alfa was initiated in the emergency department due to the markedly elevated risk of life-threatening hemorrhage associated with DOAC medications. Surgery was approached through a median sternotomy, and 20,000 units of unfractionated heparin were administered intravenously during cardiopulmonary bypass (CPB) preparation. However, the activated clotting time (ACT) exhibited suboptimal extension at 181 s (pre-heparin ACT: 124 s), necessitating supplementary heparin infusion. This resulted in the cumulative administration of 80,000 U of heparin before achieving an ACT exceeding 400 s. Suspecting heparin resistance, we maintained an ACT greater than 400 s during CPB through the continuous administration of nafamostat within the CPB circuit. Subsequently, we performed graft replacement of the ascending aorta, weaning from the CPB was smooth, hemostasis was good, and the operation was completed. The patient's postoperative recovery remained uneventful, leading to her discharge on the 11th day following the surgery. Notably, there were no instances of major bleeding or thromboembolic events during her hospitalization. Preoperative oral DOAC therapy presents a critical and potentially life-threatening concern due to its association with heightened intraoperative and postoperative bleeding risks. Currently, a Factor Xa inhibitor reversal agent, Andexanet Alfa (Ondexa®)，is available and expected to contribute to the treatment of critical bleeding in patients taking DOAC. However, further research is warranted to accumulate knowledge regarding its efficacy and optimal utilization. In this case, we present an instance of acute aortic dissection with heparin resistance following the preoperative administration of a DOAC antagonist, contributing to the existing literature on this matter.

A case of clinical1y unsuspected nonspecific inflammatory aortic regurgitation is reported. A 69-year-old female patient underwent aortic valve replacement for aortic regurgitation. Pathological examination of resected aortic valve showed abscess formation and inflammatory granulation tissue in the non-coronary cusp. Therefore, we diagnosed nonspecific inflammatory aortic regurgitation. It is generally considered that the use of prednisolone for vasculitis syndrome is effective ; however, for nonspecific inflammatory aortic regurgitation its use has not been established. Prednisolone treatment could be an option for nonspecific inflammatory aortic regurgitation.