A 67-year-old male was referred to our department for surgical treatment of a left ventricular mass after myocardial infarction. The left ventricular aneurysm was 50×20 mm and the papillary muscles were close to each other. To avoid displacement of the papillary muscles and its effect on the mitral valve, a double-patch closure was performed. A bovine pericardial patch was placed on the endocardial side and a Dacron patch on the epicardial side, and fibrin glue was injected between the two patches. Mitral valvuloplasty and coronary artery bypass grafting were also performed, and the patient had an uncomplicated postoperative course and was discharged home on the 27th postoperative day. Histopathological findings showed no myocardial cells in the wall of the mass, and a diagnosis of pseudoaneurysm was made. Double-patch closure is considered effective for left ventricular masses with a large opening and close proximity to the papillary muscle, as in this case.

Objective: To investigate the effect on early mobilization in patients undergoing extra-corporeal membrane oxygenation (ECMO) and acute blood purification therapy in the intensive care unit (ICU). Methods: We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU, aged ≥18 years, and received mechanical ventilation for >48 hours were eligible. The analyzed were divided into two groups: ECMO/blood purification or control group. Clinical outcomes; time to first mobilization, number of total ICU rehabilitations, mean and highest ICU mobility scale (IMS); and daily barrier changes were also investigated. Results: A total of 204 patients were included in the analysis, 43 in the ECMO/blood purification group and 161 in the control group. In comparison of clinical outcome, the ECMO/blood purification group had a significantly longer time to first mobilization: ECMO/blood purification group 6 vs. control group 4 (p=0.003), higher number of total ICU rehabilitations: 6 vs. 5 (p=0.042), lower mean: 0 vs. 1 (p=0.043) and highest IMS: 2 vs. 3 (p=0.039) during ICU stay. Circulatory factor were most frequently described as barriers to early mobilization on days 1 (51%), 2 (47%), and 3 (26%). On days 4 to 7, the most frequently described barrier was consciousness factors (21%, 16%, 19%, and 21%, respectively) Conclusion The results of this study comparing the ECMO/blood purification group and the untreated group in the ICU showed that the ECMO/blood purification group had significantly longer days to mobilization and significantly lower mean and highest IMS.

Background/Aims: Several studies have assessed the effect of cool temperature on colonic peristalsis. Transient receptor potential melastatin 8 (TRPM8) is a temperature-sensitive ion channel activated by mild cooling expressed in the colon. We examined the antispasmodic effect of cool temperature on colonic peristalsis in a prospective, randomized, single-blind trial and based on the video imaging and intraluminal pressure of the proximal colon in rats and TRPM8-deficient mice. Methods: In the clinical trial, we randomly assigned a total of 94 patients scheduled to undergo colonoscopy to 2 groups: the mildly cool water (n = 47) and control (n = 47) groups. We used 20 mL of 15°C water for the mildly cool water. The primary outcome was the proportion of subjects with improved peristalsis after treatment. In the rodent proximal colon, we evaluated the intraluminal pressure and performed video imaging of the rodent proximal colon with cool water administration into the colonic lumen. Clinical trial registry website (Trial No. UMIN-CTR; UMIN000030725). Results: In the randomized controlled trial, after treatment, the proportion of subjects with no peristalsis with cool water was significantly higher than that in the placebo group (44.7% vs 23.4%; P < 0.05). In the rodent colon model, cool temperature water was associated with a significant decrease in colonic peristalsis through its suppression of the ratio of peak frequency (P < 0.05). Cool temperaturetreated TRPM8-deficient mice did not show a reduction in colonic peristalsis compared with wild-type mice. Conclusion For the first time, this study demonstrates that cool temperature-dependent suppression of colonic peristalsis may be associated with TRPM8 activation.

Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD). Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing. Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids. Conclusions Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

A laser endoscopy system was developed in 2012. The system allows blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI) to be performed as modes of narrow-band light observation; these modes have been reported to be useful for tumor detection and characterization. Furthermore, an innovative endoscopy system using four-light emitting diode (LED) multilight technology was released in 2016 to 2017 in some areas in which laser endoscopes have not been approved for use, including the United States and Europe. This system enables blue light imaging (this is also known as BLI) and LCI with an LED light source instead of a laser light source. Several reports have shown that these modes have improved tumor detection. In this paper, we review the efficacy of BLI and LCI with laser and LED endoscopes in tumor detection and characterization.
Colorectal Neoplasms ; Endoscopes ; Endoscopy ; Europe ; United States

BACKGROUND/AIMS: The presence of invasion is a diagnostic criterion of early gastric cancer (EGC) in Korea, whereas diagnosis in Japan is based on enlarged nuclei and prominent nucleoli. Moreover, the depth of invasion is the location of cancer cell infiltration in Korea, whereas it is the location of lymphovascular invasion (LVI) or cancer cell infiltration in Japan. We evaluated the characteristics of EGC with LVI to uncover the effects of different diagnostic criteria. METHODS: Consecutive T1-stage EGC patients who underwent complete resection were included after endoscopic or surgical resection. The presence of LVI was evaluated. RESULTS: LVI was present in 112 of 1,089 T1-stage EGC patients. LVI was associated with depth of invasion (p<0.001) and age (p=0.017). The prevalence of LVI in mucosal cancer was significantly higher in Korea (p<0.001), whereas that of submucosal cancer was higher in Japan (p=0.024). For mucosal EGC types, LVI was positively correlated with diagnostic criteria applied in Korea (p=0.017). For submucosal EGC types, LVI was positively correlated with Japanese criteria (p=0.001) and old age (p=0.045). CONCLUSIONS: The higher prevalence of LVI for mucosal EGC in Korea and for submucosal EGC in Japan indicates that different diagnostic criteria should be considered when reading publications from other countries.
Asian Continental Ancestry Group ; Diagnosis ; Humans ; Japan* ; Korea* ; Prevalence* ; Stomach Neoplasms*

Objective: We previously reported the immune-enhancing behavior of fucoidan, a sulfated polysaccharide extracted from Gagome kombu (GKF), both in vitro and in animal studies. In the present study, we evaluated the immune efficacy and safety of GKF in healthy Japanese adults.Methods: In this randomized, double blind, placebo-controlled study, 30 subjects who ingested GKF (200 mg/day) or placebo for 4 weeks were enrolled. For evaluation of efficacy, phytohemagglutinin-stimulated cytokine production in whole blood cells was measured. For evaluation of safety, blood chemistry analysis, hematological analysis, and urinalysis were conducted.Results: Almost all cytokine production decreased in samples from the placebo group during the test period. Ingestion of GKF for 4 weeks significantly suppressed the decrease in production of the T helper 1 (Th1)-type cytokines interferon-γ and interleukin-12 as well as the Th1:Th2 ratio. There were no adverse clinical changes in blood analysis and urinary analysis, and no serious symptom was observed.Conclusion: These results indicate that GKF is a useful and safe food ingredient to support immune function.

Background : Perioperative care in congenital heart surgery has evolved in recent years, and it was considered a contributive factor to improve surgical outcome and prognosis. Objective : To extract perioperative clinical protocols that have been applied in our hospital, then assess their usefulness for better clinical outcome. Methods : We retrospectively reviewed our patients' records to analyze representative perioperative protocols that might have contributed to surgical outcome, such as intraoperative transesophageal echocardiography (ITEE), extubation in the operating room on patients of atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF), Glenn procedure and Fontan procedure. We also assessed clinical pathway of ASD and VSD, and each protocol was individually explored to calculate achievement ratio in order to show its adequacy. Results : This study included 482 of on-pump surgery patients and 146 of off-pump surgery patients from June 2007 to June 2014. ITEE was performed in 474 of on-pump surgery patients and 102 of off-pump surgery patients. No case had a residual lesion immediately after operation. Extubation in the operating room was performed in cases without severe pulmonary hypertension (PH). The extubation ratio was 94.7% (ASD repair), 60.0% (VSD repair), 50.0% (TOF repair), 42.5% (Glenn procedure), and 45.2% (Fontan procedure), respectively. Clinical pathways of ASD and VSD included patients without severe PH. Achievement ratio of the clinical pathway was 98.2% in ASD and 94.2% in VSD patients, respectively. Four patients were excluded because of high c-reactive protein (CRP), and one patient because of familial circumstance. Conclusion : ITEE was useful in evaluation of cardiac function, residual issue and residual air at weaning of cardiopulmonary bypass. Reintubation did not occur in any clinical course of extubation in the operating room, but the extubation rate was not high because of safety concerns. Achievement ratio of the clinical pathways of both ASD and VSD was more than 90%, therefore, application of the clinical pathway was considered appropriate.

Introduction : Although there are various diagnostic tools like computed tomography, magnetic resonance imaging, and positron emission tomography, it is sometimes difficult to precisely diagnose cardiac tumors. Early pathological diagnosis is crucial for possible chemotherapy and/or radiation therapy in cardiac malignant lymphoma. Objectives : To assess the diagnostic value of pericardial excisional biopsy and cytology of pericardial effusion for the pathological diagnosis of cardiac lymphoma. Methods : Five patients had a clinical diagnosis of cardiac tumor with no pathological diagnosis. The pericardial biopsy and pericardial effusion were obtained without sternotomy through the subxyphoid by a small incision under local anesthesia. Results : All procedures were completed without complications. In 3 cases, the cytology of pericardial effusion yielded a diagnosis of malignant lymphoma. One patient who had a negative cytology result in whom surgical resection was performed for definitive diagnosis and tumor volume reduction was found to have malignant lymphoma. The remaining patient underwent tumor biopsy via a cardiac catheter and benign lymphoma was diagnosed. There were no specific findings in the pericardial excisional biopsy in 3 cases. Conclusion : The analysis of cytology of pericardial effusion obtained through the subxyphoid may be useful for the diagnosis of cardiac malignant lymphoma. Pericardial excisional biopsy may not be necessary for the diagnosis of cardiac malignant lymphoma.

Many patients with abdominal aortic aneurysm have coexisting coronary artery disease. There is no evidence regarding the safety or efficacy of surgery, or whether surgery should be done in 1 session or in more than 1 session. Single-stage surgery is generally more invasive. We performed single-stage surgery using minimally invasive direct coronary artery bypass graft surgery (MIDCAB) for revascularization in 4 patients with abdominal aortic aneurysm and coronary artery disease. The average operation time was 399 min. The average number of bypassed grafts was 1.75 per patient. All patients were extubated within 24 h after surgery. The average discharge time was 29.3 postoperative days. No patients died during surgery or during hospitalization. Multidetector-row CT scan showed all bypassed grafts to be patent. MIDCAB surgery is safe and effective for revascularization in performing single-stage surgery in patients with abdominal aortic aneurysm and coronary artery disease.