Clinical studies have shown that Aggregatibacter actinomycetemcomitans(A.actinomycetemcomitans)is associated with aggressive periodontitis and can potentially trigger or exacerbate rheumatoid arthritis(RA).However,the mechanism is poorly understood.Here,we show that systemic infection with A.actinomycetemcomitans triggers the progression of arthritis in mice anti-collagen antibody-induced arthritis(CAIA)model following IL-1β secretion and cell infiltration in paws in a manner that is dependent on caspase-11-mediated inflammasome activation in macrophages.The administration of polymyxin B(PMB),chloroquine,and anti-CD11b antibody suppressed inflammasome activation in macrophages and arthritis in mice,suggesting that the recognition of lipopolysaccharide(LPS)in the cytosol after bacterial degradation by lysosomes and invasion via CD11b are needed to trigger arthritis following inflammasome activation in macrophages.These data reveal that the inhibition of caspase-11-mediated inflammasome activation potentiates aggravation of RA induced by infection with A.actinomycetemcomitans.This work highlights how RA can be progressed by inflammasome activation as a result of periodontitis-associated bacterial infection and discusses the mechanism of inflammasome activation in response to infection with A.actinomycetemcomitans.

Background: Common regional anesthesia approaches for video-assisted thoracoscopic surgery (VATS) include paravertebral block (PVB) and erector spinae plane block (ESPB). PVB is considered a deep nerve block which is contraindicated in antithrombotic therapy. ESPB is effective when administered as a bolus, as well as continuously. However, the recently proposed intertransverse process block (ITPB) ensures more effective diffusion of the local anesthetic into the paravertebral space.Case: We report cases of three patients who received bolus ITPB (costotransverse foramen block and mid-point transverse process-to-pleura block in one and two cases, respectively) combined with continuous ESPB when a deep nerve block could not be administered. Opioids were not required postoperatively, and all postoperative numerical rating scale scores (0–10) at rest were maintained below 4. Conclusions The combination of bolus ITPB and continuous ESPB may be an alternative analgesic method when deep nerve blocks are contraindicated in VATS.

Background/Aims: The Heart Failure Association (HFA)-PEFF score is recognized as a simple method to diagnose heart failure (HF) with preserved ejection fraction (HFpEF). This study aimed to evaluate the relationship between HFA-PEFF scores and cardiovascular outcomes in HFpEF patients. Methods: A total of 502 consecutive HFpEF patients were prospectively observed for up to 1,500 days. Cardiovascular outcomes were compared between two groups of patients, defined by their HFA-PEFF scores: those who scored 2–4 (the intermediate-score group) and those who scored 5–6 group (the high-score group). Overall, 236 cardiovascular events were observed during the follow-up period (median, 1,159 days). Results: Kaplan-Meier analysis showed that there were significant differences in composite cardiovascular events and HF-related events between the intermediate-score group and the high-score group (p = 0.003 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis showed that the HFA-PEFF scores significantly predicted future HF-related events (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.50; p = 0.014); receiver operating characteristic analysis confirmed this relationship (area under the curve, 0.633; 95% CI, 0.574 to 0.692; p < 0.001). The cutoff HFA-PEFF score for the identification of HF-related events was 4.5. Decision curve analysis revealed that combining the HFA-PEFF score with conventional prognostic factors improved the prediction of HF-related events. Conclusions HFA-PEFF scores may be useful for predicting HF-related events in HFpEF patients.

Abstract A large rubella epidemic is currently ongoing since 2018 in Osaka, Japan. The detected rubella viruses were classified into genotypes 1E lineage 2 and 2B lineage 1. These strains may have been imported from endemic countries, and these viruses spread within the susceptible population.

STUDY DESIGN: Cross-sectional study. PURPOSE: The purpose of this study was to evaluate the correlation between pelvic tilt (PT) and the sacro-femoral-pubic (SFP) angle, which is easier to identify than PT, in middle-aged and elderly Asian subjects from the general population. OVERVIEW OF LITERATURE: Measuring PT is important in the diagnosis and treatment of adult spinal deformity. However, identifying femoral heads, which are necessary to determine PT, using sagittal radiographs is often difficult. METHODS: Standing coronal and sagittal pelvic radiographs of individuals aged more than 50 years were taken during a local medical examination. The subjects were divided into female, male, and total groups at the time of evaluation. Linear regression analysis was performed to investigate the relationship between PT and the SFP angle, which were obtained from the X-rays. RESULTS: The present study included 291 subjects. There were no statistically significant differences between the left and right SFP angles, and there was gender difference regarding the SFP angle. However, a gender difference was observed regarding PT. The correlation between PT and the SFP angle was substantiated in each group. Pearson's correlation coefficients between PT and the SFP angle in the total, female, and male groups were 0.696, 0.853, and 0.619, respectively. In the linear regression analysis, PT was calculated as follows: PT=60.1−0.77×(SFP angle) in the total group, PT=62.8−0.80×(SFP angle) in the female group, and PT=51.5−0.64×(SFP angle) in the male group. CONCLUSIONS: A significant correlation between PT and the SFP angle was observed in middle-aged and elderly Asian subjects from the general population.
Adult ; Aged* ; Asian Continental Ancestry Group* ; Congenital Abnormalities ; Cross-Sectional Studies ; Diagnosis ; Female ; Head ; Humans ; Linear Models ; Male ; Pelvis ; Spine

Churg-Strauss syndrome is a rare form of systemic vasculitis that has been reported to involve the heart. However, co-existing involvement of cardiac valves and the conduction system is extremely rare. We present a patient with aortic regurgitation, mitral stenosis and complete heart block secondary to Churg-Strauss syndrome.

Objective: Monitoring the incidence of atypical femoral fractures (AFFs) using medical claim databases is useful to assess the safety of long-term bisphosphonate exposure. Therefore, we aimed to validate the relationship between clinically-defined suspected AFFs and the candidate patients obtained from claims data at three hospitals in Japan.

Design: A cross-sectional study involving three hospitals that perform bone fracture surgery and from which electronic medical record databases of diagnoses and procedures are available.

Methods: Candidate patients were at the medical databases using two International Classification of Diseases, 10th Edition (ICD-10) codes (subtrochanteric fracture and fracture of shaft of femur) in the claims databases. These potential cases by claim-based definition were validated using clinically-confirmed information such as, the patient operation records, the discharge records, or radiographic imaging findings as suspected AFFs.

Results: Among fracture cases in the hospitals, and 9 cases with subtrochanteric fracture and 23 cases with femoral shaft fracture were identified based on the ICD-10 codes in the claims databases. Clinically confirmed subtrochanteric fracture had a sensitivity of 81.8% (95% CI: 48.2-97.7%), and a specificity of 100.0% (95% CI: 99.9-100.0%). For femoral shaft fracture, the sensitivity was 82.1% (95% CI: 63.1-93.9%), and the specificity was 100.0% (95% CI: 99.9-100.0%). In subgroup analyses, the sensitivities in patients over the age of 50 years with a single fracture site and with osteoporosis were relatively higher than in other subgroups.

Conclusion: The claims-based definitions of suspected AFFs are accurate, indicating the value of pharmacoepidemiological studies using the National Receipt Database.

A 74-year-old woman underwent a triple CABG with saphenous vein grafts to the left anterior descending artery, left circumflex artery and right coronary artery (RCA) 17 years previously. Periodic echocardiography by primary care doctor showed a mediastinal mass. She was referred to our hospital and we diagnosed saphenous vein graft aneurysm (SVGA) by enhanced computed tomography. The aneurysm was 60 mm in diameter and originated from the SVG, extending to the RCA. Only around the proximal anastomosis was enhanced, while the other part of the aneurysm was filled with thrombus. Coronary angiography showed collateral circulation to RCA and the other 2 grafts were patent. Resternotomy was done under cardiopulmonary bypass and closure of the proximal anastomosis with aneurysm excision was successfully performed. The postoperative course was uneventful and she was discharged on the 26th post-operative day. We report our surgical strategy in this case.

Endovascular aortic aneurysm repair using stent graft (SG) for both thoracic and abdominal aortic aneurysms (SG therapy) rapidly became widespread in Japan because of its relatively low invasiveness. Pre- and postoperative contrast enhanced CT are mandatory in SG therapy and angiography is required during SG therapy. Therefore contrast induced nephropathy (CIN) might occur after SG therapy. In our hospital, a renal protection protocol (oral N-acetylcysteine, perioperative normal saline infusion and bicarbonate infusion during SG therapy) was introduced in June 2010. In this report, the effect of the renal protection protocol on renal function after SG therapy was evaluated. During May 2008 and March 2012, 229 patients underwent SG therapy in our hospital. Serum creatinine (CRTN) was higher than 1.5 mg/dl and estimated glomerular filtration rate (eGFR) was less than 50 ml/min/1.73 m² in 26 patients. In these 26 patients, the renal protection protocol was applied in 15 patients (group P) and group P was compared with the 11 patients without renal protection protocol (group N). Also the relationship between CIN occurrence and preoperative renal function was evaluated in 192 patients who did not receive the renal protection protocol. CIN was defined as more than 25% or 0.5 mg/dl increase of CRTN based on the European Guidelines. As renal protection protocol, N-acetylcysteine (600 mg) was given 4 times every 12 h. Normal saline infusion was started on the evening of the day before surgery at the rate of 50 ml/h and was continued until 1h before surgery. Sodium bicarbonate solution (151 mEq/l) was started 1 h before surgery at the rate of 180 ml/h and the infusion rate was decreased to 60 ml/h during surgery. After surgery, 1,000 ml of normal saline was given at a rate of 60 ml/h. In group N, CRTN increased 1 and 3 days after SG therapy and returned to baseline level 6 days after SG therapy. On the other hand, CRTN was lower than baseline after SG therapy in group P. At 3 days after SG therapy, the percent change of CRTN component with baseline level was significantly lower in group P (14.5±19.1% in group N, -3.7±15.8% in group P, p=0.014). CIN occurrence tended to be more in group N (45% in group N, 7% in group P, p=0.054). Among the 192 patients without the renal protection protocol, CIN occurred in 16 patients (29.1%) out of 55 patients with preoperative CRTN≥1.0 mg/dl and eGFR≤50 ml/min/1.73 m², however CIN occurred in only 1 patient (0.7%) among 137 patients with preoperative renal function out of this range (p<0.001). Renal protection protocol seemed to be effective to prevent CIN after SG therapy. Renal protection might be useful for patients with a CRTN≧1.0 mg/dl and eGFR≦50 ml/min/1.73 m².

We report a case of thoracic endovascular aortic repair (TEVAR) with a fenestrated stent graft for ulcer-like projection (ULP) of the proximal anastomosis after total arch replacement (TAR) for acute type A aortic dissection (DAA). A 73-year-old woman with a history of surgical resection of a left atrial myxoma in January 2009 underwent TAR for DAA in November 2011. The contrast enhanced CT (CE-CT) 72 days after TAR revealed two ULPs anterior and posterior to the proximal anastomosis. Surgical repair would be difficult because of the history of cardiac and aortic surgery, therefore TEVAR with a fenestrated stent graft was performed. The postoperative course was uneventful and she was discharged on the 8th postoperative day. The CE-CT 3 months after TEVAR showed almost completely thrombosed ULPs. Endovascular repair with fenestrated stent graft for the proximal anastomotic ULP can be a useful and effective treatment.