We present the case of a 56-year-old man who had undergone a total debranched TEVAR for a distal arch aneurysm in an other hospital 7 years eariler. One year after the surgery, a graft infection occurred and the left subclavian artery graft was removed and an axillo-axillary bypass was done. However, the infection persisted and two cutaneous fistulae at the left neck and median sternotomy were recognized. Preoperative FDG-PET CT revealed a high uptake of FDG in the left common carotid artery graft, the stent graft in the ascending aorta, and the left neck wound and median sternotomy site. After we exposed the left common carotid artery, the left chest was entered through a posterolateral thoracotomy. The cardiopulmonary bypass was initiated by cannulating the left common femoral vessels and main pulmonary artery, and core cooling was done to 23℃. The descending aorta was clamped at the Th10 level, and the proximal descending aorta to arch was opened to remove the infected stent graft. Selective antegrade cerebral perfusion was started and antegrade cardioplegia was given. The ascending-arch-descending aorta was replaced with a rifampicin-soaked Dacron graft, followed by left common carotid artery reconstruction using an 8 mm Gore-Tex graft. The new graft was wrapped with a pedicled omental flap. Postoperative antibiotic therapy was continued for 6 weeks and the fistulae were surgically closed. The patient was discharged and is back to the normal life.

We investigated the relationship between renal function assessment based on cystatin C (CsyC) and serum creatinine levels and the status of chemotherapy use in patients with gynecological cancer undergoing paclitaxel and carboplatin therapy. A significant positive correlation was found between estimated glomerular filtration rate from creatinine (eGFRcre) and eGFR from CsyC (eGFRcys) in the 98 patients included in the study. When eGFRcre and eGFRcys values were grouped according to GFR categories in the CKD severity classification, severe cases (eGFRcys < eGFRcre) were of more advanced age (P < 0.05) and had lower albumin levels (P < 0.01) than matched cases. Although no clear relationship was found between renal function assessment and chemotherapy status, the CysC and eGFRcys values tended to be higher and lower, respectively, in patients whose chemotherapy was deferred (P < 0.01 for CysC, P = 0.07 for eGFRcys). These results suggest that eGFRcre-based renal function assessment is overestimated compared with eGFRcys-based assessment in patients with gynecological cancer and may lead to carboplatin overdose or treatment deferral in elderly patients and patients with hypoalbuminemia.

A 47-year-old woman was incidentally found to have a thoracic aortic aneurysm by CT scan. There was an aneurysm in the ascending aorta and aortic arch, and the Valsalva sinus was enlarged. Echocardiography showed a severe aortic regurgitation. Valve-sparing aortic root replacement and total arch replacement was performed. The pathology of the ascending aorta was consistent with giant cell arteritis. Her postoperative course was straightforward, and she was discharged 23 days after surgery. In Japan, there are few reports of valve-sparing surgery for patients with giant cell aortitis, and we report our experience of a rare case.

Purpose: General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons. Methods: An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants. Results: There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons. Conclusion A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.

Objective : In 2011, the Ishikawa Prefectural Joint Committee of Blood Transfusion Therapy was organized in Ishikawa Prefecture. Since 2012, pharmacists have promoted educational activities regarding the appropriate use of albumin products for different occupations based on a survey involving all medical institutions in Ishikawa Prefecture. We examined the effects of these activities with respect to the usage of albumin products. Methods : A questionnaire survey regarding blood transfusion therapy, including the total usage of albumin products, departments responsible for the management of albumin products, and health care professionals’ awareness of issues on the appropriate use of albumin products, was conducted from 2011 until 2014 involving all medical institutions where blood transfusion preparations were used in Ishikawa Prefecture. Results : The questionnaire collection rate was ≥70%. The results showed that, in middle- or small-scale medical institutions, departments/physicians other than the Department of Pharmacy were responsible for the management of albumin products. Furthermore, some health care professionals did not recognize/understand problems regarding the appropriate use of albumin products. Pharmacists newly increased educational activities by study meetings for various occupations or panel discussions involving participants. The participants’ occupations varied, and the number of institutions to which they belonged was 20 to 24. The total usage of albumin products in Ishikawa Prefecture decreased by approximately 20% between 2011, when these attempts were started, and 2014. Discussion : This study suggests that the educational activities by pharmacists and other health care professionals at the prefectural level reduced the total usage of albumin products.

Objective: We conducted a meta-analysis on the suppressive effect of resistant maltodextrin on post-prandial blood glucose elevation, which is approved in Japan as food for specified health use, and the following is allowed to be indicated on the label “it is suitable for consumption by those who are concerned about their post-prandial blood glucose levels because the absorption of sugars is abated by the action of dietary fiber (resistant maltodextrin).”
Method: Our literature search covered Ichushi-Web (Japan Medical Abstracts Society), Japan Science and Technology Information Aggregator, Electronic (J-stage), Google Scholar, and PubMed databases and extracted English and Japanese publications on randomized, double-blind, controlled studies comparing resistant maltodextrin and a control in Japanese subjects for the reduction of areas under the blood glucose response curves at 30, 60, and 120 min after eating as an efficacy index.
Result: Among these publications, four articles with a Jadad score (an assessment of the quality of randomized controlled studies) of ≥ 3 were included in the meta-analysis.  Significant inhibitory effects were confirmed from areas under the blood glucose response curves at 30, 60, and 120 min after eating in the meta-analysis that was performed to evaluate the effects of resistant maltodextrin on post-prandial blood glucose elevation in Japanese individuals.
Conclusion: However, we were not able to test for publication bias because the number of extracted publications was small, and thus, additional research and case studies are warranted.

The purpose of the present study was to examine the importance of the agonist muscle activity of the post-impact 30 ms phase during drop jump (DJ) for effective rebound performance by comparing those of sprint runners and swimmers. The eight sprint runners (SPRINT) and twelve swimmers (SWIM) were participated in this study. They performed DJ from a 0.3-m height box with maximal rebound efforts. Electromyograms (EMG) of the lower leg muscles (medial gastrocnemius [MG], soleus [SOL] and tibialis anterior [TA]), and vertical ground reaction force together with kinematic data were measured simultaneously during DJ. In addition, the onsets of fascicle stretching of the MG and SOL muscles were measured by using high-speed ultrasonography (521Hz) during DJ. The onsets of the fascicle stretching of SOL during DJ were not significantly different between SPRINT and SWIM (15 ± 7 ms and 16 ± 6 ms, respectively). During DJ, SPRINT showed onset of the SOL EMG before the ground contact (-26 ± 19 ms). Meanwhile, SWIM showed the onset of the SOL EMG after the ground contact of DJ (16 ± 19 ms). These results suggest that the SOL muscles for SWIM cannot be fully-activated during the braking phase. Consequently, the rate of force development during the braking phase of DJ and subsequently rebound height could be reduced in SWIM.

A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently. We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.

Objective:We successfully treated a patient suffering from pain and numbness in the waist and lower limbs with phobia. Sedative acupuncture treatment was performed in addition to somatic treatment.
Case:A 64-year-old woman complained mainly of pain and numbness in the right waist and the lower limbs and had a sense of fear. Following the postoperative pain of lumbar disk herniation (L4-L5) in X-14 year, dorsal positioning without grasping anything frequently triggered a sense of fear with a scary feeling that her body was suspended in midair, which could not be alleviated by medication. As the symptoms in the waist and lower limbs recurred due to a fall in January of X year, she consulted an orthopedist in April. She was given a diagnosis of lumbar disk hernia (L5-S1) and hospitalized. Since the symptoms sustained, she consulted the department of acupuncture attached to the Kansai University of Health Sciences Clinic in November. The sense of fear triggered by dorsal position in the acupuncture treatment interfered with the treatment. When she was referred to the department of psychosomatic medicine, the diagnosis of "Other types"of the DSM-IV "300.29 specific phobia"was given. While low-frequency acupuncture electrotherapy on the same side and the same level as the hernia was provided, we applied sedative acupuncture treatment once a week 30 times using the following acupuncture points:GV23;PC6;CV17;and CV6. Before and after every acupuncture treatment after the 10th, the symptoms were evaluated with Finger Floor Distance (FFD), Visual Analogue Scale (VAS) of pain and mood (feelings) and State-Trait Anxiety Inventory (STAI).
Results:The sense of fear during the acupuncture treatment slowly decreased after the 14th treatment. Decreases in FFD, VAS for pain and mood (feelings), and state anxiety score of STAI were observed. The pain and the numbness in the waist and the lower limbs decreased in parallel with the sense of fear. Furthermore, the dosage of hypnotic agent decreased gradually as sleep improved.
Conclusion:Pain and numbness in the waist and the lower limbs with phobia were relieved by sedative acupuncture treatment.