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.

The purpose of this cross-sectional study is to investigate the difference in physical activity among elderly living in different areas in Japan (“Bunkyo Ward in Tokyo” (Bunkyo) and “Fuchu City in Tokyo” (Fuchu) as urban areas, and “Oyama Town in Shizuoka” (Oyama) as a non-urban area). Participants were 1859 community-dwelling residents aged 65-74 years, randomly selected from the residential registry (response rate: 68.9%). A mail survey using self-administered questionnaires was conducted. Multivariate logistic regression analyses were used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (95% CI) of various types of physical activity (eg, walking (Walking), going out (Going-out), bicycling (Bicycling), exercise habits (Exercise)), according to residential areas (reference category: Fuchu), stratified by gender, adjusting for socio-demographic variables. There was a significant difference in Going-out (ORs = 0.61 (95% CI: 0.44-0.86) for men, 0.48 (0.33-0.69) for women)), and Bicycling (0.04 (0.03-0.07) for men, 0.04 (0.02-0.07) for women) in Oyama compared to Fuchu. Furthermore, for women, there was a significant difference in Walking (0.56 (0.38-0.81)) and Exercise (0.59 (0.41-0.85)) in Oyama compared to Fuchu. There was a significant difference in Bicycling and Going-out for men in Bunkyo compared to Fuchu, but there was not a significant difference in other items. Low physical activity levels were observed in the elderly in the non-urban area compared to urban areas. The association was stronger in women. Regional difference might need to be taken into account for an effective physical activity intervention.

Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.