Here, we report a rare case of repeated cardiac trauma caused by self-harm with sewing needles and a literature review. The patient was a 48-year-old female, who repeatedly self-harmed when stressed by inserting a needle into her anterior chest. She had previously undergone three thoracotomy procedures and more than eight procedures for needle removal. In the current case, she visited the hospital due to persistent chest pain after inserting a needle into her left anterior chest. The needle was buried under the skin and could not be seen externally. Computed tomography revealed a 6 cm-long needle, located 1 cm under the skin reaching the right ventricle. Although the patient was hemodynamically stable with no pericardial effusion, emergency surgery was performed due to the possibility that cardiac motion would advance the needle, penetrating the left ventricle, as well as the possibility of additional cardiac injury. Because of repeated thoracotomies and needle-removal procedures, we expected that the patient would have extensive adhesions in the mediastinum, and there was a high risk of cardiac injury with thoracotomy. Therefore, thoracotomy was performed under cardiopulmonary bypass. We performed the thoracotomy while taking care not to advance the needle by monitoring its tip with transesophageal echocardiography. After confirming the position of the needle penetrating the right ventricle, 4-0 monofilament suture with pledget support was sutured around the needle in a U-shape, and the needle was removed. The procedure was completed after confirming the absence of ventricular septal perforation by transesophageal echocardiography.

PURPOSE: . The aim of this study was to introduce rating criteria to evaluate student performance in a newly developed, digital wax-up preclinical program for computer-aided design (CAD) of full-coverage crowns and preliminarily investigate the reliability and internal consistency of the rating system. MATERIALS AND METHODS: . This study, conducted in 2017, enrolled 47 fifth-year dental students of Okayama University Dental School. Digital wax-up training included a fundamental practice using computer graphics (CG), multipurpose CAD software programs, and an advanced practice to execute a digital waxup of the right mandibular second molar (#47). Each student’s digital wax-up work (stereolithography data) was evaluated by two instructors using seven qualitative criteria. The total qualitative score (0-90) of the criteria was calculated.The total volumetric discrepancy between each student’s digital wax-up work and a reference prepared by an instructor was automatically measured by the CAD software. The inter-rater reliability of each criterion was analyzed using a weighted kappa index. The relationship between the total volume discrepancy and the total qualitative score was analyzed using Spearman’s correlation. RESULTS: . The weighted kappa values for the seven qualitative criteria ranged from 0.62 - 0.93. The total qualitative score and the total volumetric discrepancy were negatively correlated (ρ = -0.27, P = .09, respectively); however, this was not statistically significant. CONCLUSION . The established qualitative criteria to evaluate students’ work showed sufficiently high inter-rater reliability; however, the digitally measured volumetric discrepancy could not sufficiently predict the total qualitative score.

Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position) in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5°hip external rotation and 17.5°hip abduction.Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.

Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position）in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5° hip external rotation and 17.5° hip abduction.Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.

The purpose of this study was to investigate the consciousness among young people (n = 1016) on training body part(s), using a questionnaire-based survey showing participants a picture of a single-joint exercise. The participants were shown a picture of knee-extension exercise (KNEE-EXT), and were asked to identify the body part(s) they felt were being trained. On seeing the picture, more than 90% of the participants felt that KNEE-EXT can train the anterior thigh part. However, more than 90% of the participants who had no experience doing KNEE-EXT felt that the exercise trained not only the anterior thigh part but also other parts, including the trunk, the posterior thigh, and the upper limb. Among those participants who had performed KNEE-EXT without the experience of strength-training under professional supervision, approximately 80% felt that the exercise was appropriate to train not only the anterior thigh but also other parts. These results suggest that performing exercises by referring to only a picture may result in the individuals not properly understanding how the body part(s) should be trained during exercise, even in single-joint exercises. Appropriate supervision is of even greater importance especially for strength-training beginners. Furthermore, even among participants who had an experience of exercise under professional supervision, approximately 60% had a similar response. Therefore, to enhance the benefits of exercises, individuals (even those who have had experience in training under professional supervision) should always be instructed under appropriate supervision on the correct technique and knowledge about the exercises.

We reported a rare case of aorto-left ventricular fistula with the unruptured aneurysm of the Valsalva sinus due to the infective endocarditis. Preoperatively trans-echocardiographic examination revealed the ruptured left sinus of Valsalva aneurysm protruded toward the left ventricule. Aorto-left ventricular fistula contiguous to the unruptured aneurysm of the right valsalva sinus, however, was detected at operation. Granulation tissue resembling healed infective vegetation was detected in the margin among the orifices of this fistula and Valsalva aneurysm. Pathological examination showed excessive accumulation of white blood cells, which suggested infective endocarditis.