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This study aimed to determine which instrumental activities of daily living (IADL) are associated with health deterioration from the "support level" to the "care level" among users of the long-term care insurance system in Japan. From April 2017 to March 2020, we conducted a retrospective follow-up survey on 178 Japanese community-dwelling older adults (64 men, 114 women) newly certified as support level. Independent variable was 8 IADL items and the outcome defined as the "support level maintenance time." Cox models were used to assess the risk of health deterioration, with adjustments for age group, family composition, dementia status, and frailty status by gender. Dependence on 5 items, "laundry" (hazard ratio [HR] =2.5; 95% confidence interval [CI]: 1.1-5.8), "cooking" (HR = 3.7; 95% CI: 1.1-12.2), "telephone use" (HR = 2.4; 95% CI: 1.2-4.7), "financial management" (HR = 2.5; 95% CI: 1.2-5.0), and "medication management" (HR = 2.4; 95% CI: 1.2-4.8), was independently associated with a worse outcome among men, whereas dependence on "financial management" (HR = 2.6; 95% CI: 1.5-4.7) and "medication management" (HR = 2.0; 95% CI: 1.1-3.5) was independently associated with a worse outcome among women. These findings suggest that difficulties in "financial management" and "medication management" are common factors associated with health deterioration from the support to the care level among both genders. An association with household tasks was also seen among men, indicating that a paradigm shift is needed to increase the participation of men in household tasks. [ABSTRACT FROM AUTHOR]

Objective: The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community‐dwelling older people. The purpose of this study was to evaluate the screening performance of a 100‐mL water swallowing test (WST). Methods: The study employed a cross‐sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community‐dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10‐item Eating Assessment Tool (EAT‐10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100‐mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut‐off value of swallowing time and number of swallows in the 100‐mL WST based on the Youden Index among participants without choking signs. Results: The sensitivity and specificity of choking signs in the 100‐mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was.76 and.72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut‐off was >10 s based on maximisation of the Youden Index. The 100‐mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively. Conclusions: The 100‐mL WST would be an adequate screening tool when compared to the EAT‐10. [ABSTRACT FROM AUTHOR]

To increase the prediction accuracy of positive oral food challenge (OFC) outcomes during stepwise slow oral immunotherapy (SS-OIT) in children with a hen's egg (HE) allergy, we evaluated the predictive value of the combination of antigen-specific IgE (sIgE) with antigen binding avidity and sIgG4 values. Sixty-three children with HE allergy undergoing SS-OIT were subjected to repeated OFCs with HE. We measured the ovomucoid (OVM)-sIgE by ImmunoCAP or densely carboxylated protein (DCP) microarray, sIgG4 by DCP microarray, and the binding avidity of OVM-sIgE defined as the level of 1/IC50 (nM) measured by competitive binding inhibition assays. The OFC was positive in 37 (59%) patients undergoing SS-OIT. Significant differences in DCP-OVM-sIgE, CAP-OVM-sIgE, I/IC50, DCP-OVM-sIgG4, the multiplication products of DCP-OVM-sIgE, and the binding avidity of DCP-OVM-sIgE (DCP-OVM-sIgE/IC50) and DCP-OVM-sIgE/sIgG4 were compared between the negative and positive groups (p < 0.01). Among them, the variable with the greatest area under the receiver operating characteristic curve was DCP-OVM-sIgE/IC50 (0.84), followed by DCP-OVM-sIgE/sIgG4 (0.81). DCP-OVM-sIgE/IC50 and DCP-OVM-sIgE/sIgG4 are potentially useful markers for the prediction of positive OFCs during HE-SS-OIT and may allow proper evaluation of the current allergic status in the healing process during HE-SS-OIT. [ABSTRACT FROM AUTHOR]

Multiple cancer patients who achieve long-term survival are sometimes encountered. Multiple carcinogenesis may occur due to genetic or environmental characteristics. We report the case of a 74-year-old woman who was diagnosed with synchronous double carcinoma of the duodenal papilla and gall bladder without clinical symptoms, who underwent postoperative follow-up for familiar adenomatous polyposis coli with multiple colonic adenocarcinomas, ileal adenocarcinoma, left urinary tract neoplasm, and left upper lobe lung adenocarcinoma. Computed tomography also showed an intraductal papillary mucinous neoplasm of the pancreas and a lesion that was suspected to be uterine body carcinoma; however, they did not show any clear malignant behavior. No metastatic lesions of either of these biliary cancers were observed. Based on preoperative diagnostic imaging, subtotal stomach preserving pancreaticoduodenectomy with gall bladder bed liver resection with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis showed early carcinoma of the duodenal papilla and gall bladder pyloric gland adenoma without node metastasis. The postoperative course was uneventful and the patient had a good prognosis without tumor recurrence or new malignant lesions for two years after the last operation, without adjuvant therapy. Six metachronous carcinomas of eight different organ neoplasms were diagnosed, which is rare. This represents the first reported case of ampullary carcinoma in a patient with sextuple cancer. [ABSTRACT FROM AUTHOR]

Copper slag fine aggregate (CUS) is 30% denser than normal aggregate is an effective material for port and harbor structures demanding high-density concrete is suggested from authors' research. This study investigated influence of transportation and pumping on the properties of concrete with a large amount of CUS for application in the actual construction of port and harbor structures. In particular, the following results were obtained in this study. In the case of W/C = 0.5 concrete and partial replacement of fine aggregate with CUS in concrete, workability was not changed by transportation and pumping—it was generally equivalent to that of concrete with normal fine aggregate. The mechanical properties and chloride resistivity of hardened concrete were also equivalent to those of the referenced concrete. In the case of W/C = 0.6 and absolute replacement of fine aggregate with CUS in concrete, the slump value increased owing to an increase in entrapped air with the time passage of transportation. The amount of bleeding also decreased after a certain time of transportation, similar to normal concrete. Therefore, a satisfactory compaction is necessary for the exhaust entrapped air to achieve the designed unit volume weight. Moreover, hardened concrete achieved equivalent mechanical properties and chloride resistivity to normal concrete. [ABSTRACT FROM AUTHOR]

Background: Multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma (DLBCL) are rare. Here, we report a case of advanced breast cancer and DLBCL managed with multidisciplinary therapy preceded by surgery with a successful outcome. Case presentation: During a medical examination, a 71-year-old woman was diagnosed with a right breast mass, enlarged lymph nodes throughout the body, and a splenic tumor. The results of the clinical examination and imaging were suggestive of widely spread breast cancer with lymph node metastasis and malignant lymphoma with systemic metastasis. The histological evaluation of the biopsied breast tissue revealed human epidermal growth factor receptor 2 (HER2)-positive breast cancer, whereas the histological evaluation of the excised inguinal lymph node revealed DLBCL. 18F-FDG PET/computed tomography was performed, and it was determined that both breast cancer and DLBCL were in an advanced stage. Thus, mastectomy was performed, and the axillary lymph nodes showed mixed metastasis of breast cancer and DLBCL. Soon after, the R-CHOP therapy was initiated (375-mg/m2 rituximab, 2-mg/m2 vincristine, 50-mg/m2 doxorubicin, 750-mg/m2 cyclophosphamide, and 125-mg methylprednisolone). After irradiation of the spleen, trastuzumab was administered for 1 year. Conclusions: We experienced a case of combined breast cancer and DLBCL, which was difficult to treat because both were in advanced stages. Thorough staging of the malignancy and discussion by a multidisciplinary team are necessary to determine the optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Multiple primary malignancies of breast cancer and diffuse large B-cell lymphoma (DLBCL) are rare. Here, we report a case of advanced breast cancer and DLBCL managed with multidisciplinary therapy preceded by surgery with a successful outcome. Case presentation: During a medical examination, a 71-year-old woman was diagnosed with a right breast mass, enlarged lymph nodes throughout the body, and a splenic tumor. The results of the clinical examination and imaging were suggestive of widely spread breast cancer with lymph node metastasis and malignant lymphoma with systemic metastasis. The histological evaluation of the biopsied breast tissue revealed human epidermal growth factor receptor 2 (HER2)-positive breast cancer, whereas the histological evaluation of the excised inguinal lymph node revealed DLBCL. 18F-FDG PET/computed tomography was performed, and it was determined that both breast cancer and DLBCL were in an advanced stage. Thus, mastectomy was performed, and the axillary lymph nodes showed mixed metastasis of breast cancer and DLBCL. Soon after, the R-CHOP therapy was initiated (375-mg/m2 rituximab, 2-mg/m2 vincristine, 50-mg/m2 doxorubicin, 750-mg/m2 cyclophosphamide, and 125-mg methylprednisolone). After irradiation of the spleen, trastuzumab was administered for 1 year. Conclusions: We experienced a case of combined breast cancer and DLBCL, which was difficult to treat because both were in advanced stages. Thorough staging of the malignancy and discussion by a multidisciplinary team are necessary to determine the optimal treatment strategy. [ABSTRACT FROM AUTHOR]

Concrete structures are susceptible to corrosion especially when exposed to marine environment. In order to minimize the corrosion in reinforced concrete, reduction of dissolved Oxygen (DO) in mixing water is recommended. The DO is the measurement of the amount of free Oxygen that is dissolved in water which is proportional to the corrosion rate of steel bars inside concrete. In this paper, the use of industrial waste/by-products, agricultural waste, natural minerals, and green inhibitors as additive for cement in reducing the DO level of the mixing water was explored. Candidate materials from different types of agricultural waste, industrial waste, natural minerals, and green inhibitors. The percentage difference of DO were computed for all types of materials as ash or powder or extract in room temperature. This is the percentage difference of DO level in distilled water and the solution mixed with the candidate material having a mass ratio of 3 : 2 and/or 3 : 1. Results showed that more than 90% reduction of DO level were achieved when mixed with ginger extract, ginger powder, aloe vera extract, ginger pulp, and rice hull ash. Future experimental studies using the candidate materials producing reinforced concrete specimens with high reduction of DO level in mixing water is recommended. [ABSTRACT FROM AUTHOR]

Purpose: We used a novel diagnostic Fourier transform (FT) algorithm of the entire extrahepatic bile duct (EHBD) measured by magnetic resonance cholangiography (MRC) to evaluate subtle deformation of bile duct lumen, indicating the malignant potential of EHBD, in patients with pancreaticobiliary maljunction (PBMJ) and in a comparative group of controls without PBMJ. Methods: From the workstation, the EHBD lumen was traced automatically and a 2D diagram cross section was measured at 0.5 mm-longitudinal intervals. The FT-based integrated power spectral density function value (FTPSDI) of the diameter or area (mm2 or mm4/Hz) and the phase value distribution entropy (PVDE) were also measured. Results: There were 16 patients with undilated PBMJ and 7 with dilated PBMJ. The control group comprised 10 patients with a normal bile duct, 20 with bile duct carcinoma (BDC), and 1 with primary sclerosing cholangitis. Both the diameter and area of the dilated bile ducts and the ducts with early- or advanced-stage BDC were significantly greater than those of the normal duct (p < 0.05). The undilated type of PBMJ tended to have a larger FTPSDI diameter than a normal bile duct, which had a smaller diameter than the dilated type of PBMJ or BDC. BDC had a significantly larger FTPSDI diameter (p < 0.05) and the cutoff value for accuracy was 168 mm2 Hz−1. Conclusion: The novel mathematical FTPSDI is a promising indicator of whether preventive EHBD resection is necessary for patients with PBMJ, which can be widely applied in the early diagnosis of other biliary diseases. [ABSTRACT FROM AUTHOR]

Purpose: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. Methods: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. Results: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. Conclusion: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy. [ABSTRACT FROM AUTHOR]

Background: Spontaneous common bile duct (CBD) perforation is an extremely rare disease in adults. We report an adult case of CBD perforation due to choledocolithiasis accompanied with pancreaticobiliary maljunction, which is, to our knowledge, the first such case report based on a search using PubMed. Case presentation: A 71-year-old woman with consciousness disorder was transported to the emergency department of another hospital. She was diagnosed as having severe peritonitis with septic shock and transferred to our hospital for emergency surgery. Enhanced computed tomography (CT) revealed supraduodenal CBD dilation similar to a diverticulum and a defect of bile duct wall continuity. Furthermore, CT showed a long common channel of the pancreaticobiliary duct, so she was diagnosed as having spontaneous CBD perforation with pancreaticobiliary maljunction. Emergency surgery was performed that revealed a necrotic diverticulum-like change on the supraduodenal part, and a 2.5 × 1 cm perforation was found on the anterolateral wall of the CBD. Peritoneal lavage was performed, and CBD perforation was resolved with a T-tube. The patient suffered refractory intra-abdominal and retroperitoneal abscess formation and bleeding from the abdominal wall, which required a long period of postoperative management. The T-tube was removed on day 136, and the patient was transferred on day 153. Conclusion: The cause of CBD perforation is commonly considered to be increased intraductal pressure or weakness of the bile duct wall. In this case, pancreaticobiliary maljunction may have significantly influenced onset and the postoperative course. This case suggests that early surgical intervention and appropriate drainage are important to ensure survival. [ABSTRACT FROM AUTHOR]

Objective: To investigate which domains of frailty are associated with dysphagia in community-dwelling elderly persons.Background: Dysphagia is a common cause of aspiration pneumonia in frail elderly persons in Japan. Although frailty is considered to be multidimensional, it is unclear which domains of frailty affect dysphagia.Methods: The participants were 3475 independent Japanese elderly persons (≥65 years; 1555 men and 1920 women). A self-report questionnaire with a frailty checklist consisting of several domains (lifestyle, physical function, nutrition, oral function, homebound status, cognitive function and depressive mood) was used to determine the participants' characteristics. Dysphagia was defined as impaired swallowing in the oral function domain. To determine the associations between dysphagia and age, sex and the other domains on the frailty checklist, adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were calculated using multiple logistic regression analysis.Results: The multiple logistic regression analysis showed that dysphagia was independently associated with female sex (AOR = 1.35; 95% CI = 1.08-1.68), chewing ability (AOR = 1.70; 95% CI = 1.32-2.18), oral dryness (AOR = 1.94; 95% CI = 1.48-2.54), physical function (AOR = 2.19; 95% CI = 1.66-2.90), cognitive function (AOR = 1.68; 95% CI = 1.34-2.12) and depressive mood (AOR = 1.82; 95% CI = 1.41-2.35).Conclusion: Dysphagia was independently associated with oral, physical, cognitive and psychological frailty. These results suggest that frailty prevention strategy including swallowing training might be useful for community-dwelling independent elderly persons aged ≥65 years. [ABSTRACT FROM AUTHOR]

Hepatocyte growth factor activator inhibitor‐1 (HAI‐1), encoded by the SPINT1 gene, is a membrane‐bound protease inhibitor expressed on the surface of epithelial cells. Hepatocyte growth factor activator inhibitor‐1 regulates type II transmembrane serine proteases that activate protease‐activated receptor‐2 (PAR‐2). We previously reported that deletion of Spint1 in ApcMin/+ mice resulted in accelerated formation of intestinal tumors, possibly through enhanced nuclear factor‐κB signaling. In this study, we examined the role of PAR‐2 in accelerating tumor formation in the ApcMin/+ model in the presence or absence of Spint1. We observed that knockout of the F2rl1 gene, encoding PAR‐2, not only eliminated the enhanced formation of intestinal tumors caused by Spint1 deletion, but also reduced tumor formation in the presence of Spint1. Exacerbation of anemia and weight loss associated with HAI‐1 deficiency was also normalized by compound deficiency of PAR‐2. Mechanistically, signaling triggered by deregulated protease activities increased nuclear translocation of RelA/p65, vascular endothelial growth factor expression, and vascular density in ApcMin/+‐induced intestinal tumors. These results suggest that serine proteases promote intestinal carcinogenesis through activation of PAR‐2, and that HAI‐1 plays a critical tumor suppressor role as an inhibitor of matriptase, kallikreins, and other PAR‐2 activating proteases. [ABSTRACT FROM AUTHOR]

The efficacy of adjuvant photodynamic therapy (PDT) using the new photosensitizer, talaporfin sodium (TPS) has been clinically examined in some patients with bile duct carcinoma (BDC). Based on our previous cohorts, a prospective clinical trial was attempted; however, only two cases were ultimately enrolled in 27 months. A 664-nm semiconductor laser (100 J/cm2) was applied through an endoscope to the tumor lesion within 6 h of an intravenous injection of 40 mg/m2 TPS according to the protocol for lung cancer. Case 1 was an 82-y.o. female patient with BDC at the left hepatic duct with biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) was achieved, and the patient did not consent to surgery. She was followed up for 15 months to search for non-surgical treatments and eventually received PDT. Although mild photosensitivity occurred, she was discharged without severe adverse events. Biliary stenosis markedly extended and a PTBD tube was scheduled at 1 month. However, cancer immediately metastasized to the liver and she died 155 days after PDT. Case 2 was a 70-y.o. female with perihilar BDC and multiple biliary stenoses. Multiple biliary stenting was considered to be difficult. She received PDT and no adverse events were observed. Biliary stenoses markedly improved and multiple stenting was successfully performed. On day 132, she died of cancer progression. These two cases demonstrated the safety and efficacy of biliary malignant stenosis soon after PDT; however, long-term survival and a sufficient quality of life were not achieved. The combination of the PDT protocol and system chemotherapy or brachytherapy needs to be examined in clinical trials for advanced stage BDC. [ABSTRACT FROM AUTHOR]

Objective: We previously reported the identification of monocarboxylate transporter 4 (MCT4) and glypican-3 (GPC3) as prognostic factors for hepatocellular carcinoma (HCC), which are now considered significant poor prognostic factors for the disease. This study aimed to clarify the detailed interaction of these two factors in HCC to improve our understanding of aggressive HCC phenotypes. A total of 225 Japanese patients with HCC from our previous study were subjected to immunohistochemical analyses. Results: The number of MCT4-positive (MCT4+) HCC cases was 47 (21%), and most MCT4+ HCC showed high GPC3 expression (94%, 44/47 cases). In 44 MCT4+/GPC3+ HCC cases, intratumoral heterogeneity of GPC3 or MCT4 expression was further evaluated. We observed reciprocal (inverse), synergistic, mixed reciprocal and synergistic, or irrelevant interaction of MCT4 and GPC3 expression in 29 (66%), 5 (11%), 1 (2%), and 9 cases (21%), respectively. The cases exhibiting reciprocal expression of both markers tended to have cirrhosis without a history of neoadjuvant therapy. In summary, although MCT4+ HCC cases are mostly GPC3+, intratumoral expression patterns of MCT4 and GPC3 are frequently reciprocal each other, suggesting that dual targeting of MCT4 and GPC3 may achieve a better antitumor effect for MCT4+ HCC cases. [ABSTRACT FROM AUTHOR]

The current study aimed to clarify the significance of the preoperative desacyl ghrelin (DG)-to-acyl ghrelin (AG) ratio in patients undergoing pancreaticoduodenectomy (PD). Ghrelin, a peptide hormone mainly produced in the stomach, possesses unique functions. Recently, studies have determined the involvement of plasma gherlin in certain postoperative outcomes, particularly in surgical resections of the stomach. Although PD involves gastric resection, few reports have determined the involvement of ghrelin following PD. From April 2003 to December 2011, 195 patients underwent PD for tumors of the pancreatic head, bile duct and ampulla of Vater at the Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine (Miyazaki, Japan). Of these, 83 patients were enrolled into the present study as their plasma gherlin levels were measured. AG, DG, total ghrelin (TG) and the DG-to-AG ratio (D/A) were subsequently assessed. Furthermore, the prognostic nutritional index (PNI) and high-sensitivity modified Glasgow Prognostic Score (HS-mGPS) were determined. Morbidity was examined in all 83 patients, but mortality was only determined in 69 individuals after 14 patients were excluded due to the presence of benign disease. The results revealed that the TG of patients undergoing standard PD (SPD) was significantly lower than that of patients undergoing pylorus-preserving PD or subtotal stomach-preserving PD. It was also determined that TG levels declined significantly in SPD patients at 2 weeks after surgery. Negative associations were identified between plasma ghrelin levels and PNI, and between serum albumin and HS-mGPS. Patient morbidity was determined to be 31.3% and the severe complications exhibited by patients included pancreatic fistula (14.5%), intra-abdominal abscess (15.7%), intra-abdominal bleeding (6.0%) and liver abscess (1.2%). Multivariate analysis revealed that disease location and low D/A were independent risk factors for severe complications. The 5-year overall survival (OS) rate was 41.5%. Multivariate analysis also demonstrated that diabetes mellitus, long postoperative hospital stay and low D/A were independent risk factors for OS. The present study revealed the D/A may serve as a useful predictive factor for postoperative complications and prognosis after PD. [ABSTRACT FROM AUTHOR]

Background: 2-Cl-C.OXT-A (COA-Cl) is a novel synthesized adenosine analog that activates Sphingosine-1-phosphate 1 receptor (S1P1R) and combines with the adenosine A1 receptor (A1R) in G proteins and was shown to enhance angiogenesis and improve the brain function in rat stroke models. However, the role of COA-Cl in hearts remains unclear. COA-Cl, which has a similar structure to xanthine derivatives, has the potential to suppress phosphodiesterase (PDE), which is an important factor involved in the beating of heart muscle. Methods and results: Cardiac organoids with fibroblasts, human induced pluripotent stem cell-derived cardiac myocytes (hiPSC-CMs), and hiPSC-derived endothelial cells (hiPSC-ECs) were cultured until they started beating. The beating and contraction of organoids were observed before and after the application of COA-Cl. COA-Cl significantly increased the beating rate and fractional area change in organoids. To elucidate the mechanism underlying these effects of COA-Cl on cardiac myocytes, pure hiPSC-CM spheroids were evaluated in the presence/absence of Suramin (antagonist of A1R). The effects of COA-Cl, SEW2871 (direct stimulator of S1P1R), two positive inotropes (Isoproterenol [ISO] and Forskolin [FSK]), and negative inotrope (Propranolol [PRP]) on spheroids were assessed based on the beating rates and cAMP levels. COA-Cl stimulated the beating rates about 1.5-fold compared with ISO and FSK, while PRP suppressed the beating rate. However, no marked changes were observed with SEW2871. COA-Cl, ISO, and FSK increased the cAMP level. In contrast, the level of cAMP did not change with PRP or SEW2871 treatment. The results were the same in the presence of Suramin as absence. Furthermore, an enzyme analysis showed that COA-Cl suppressed the PDE activity by half. Conclusions: COA-Cl, which has neovascularization effects, suppressed PDE and increased the contraction of cardiac organoids, independent of S1P1R and A1R. These findings suggest that COA-Cl may be useful as an inotropic agent for promoting angiogenesis in the future. [ABSTRACT FROM AUTHOR]

Dewatering of faecal sludge (FS) is indispensable for adequate FS management. However, comprehensive knowledge is lacking on FS dewatering performance. This study compared the dewatering performance of FS from different countries and onsite sanitation technologies, to assess influential characteristics on dewatering, and to compare dewatering performance of FS with wastewater sludge. We collected 73 FS samples from septic tanks, lined pit latrines, unlined pit latrines and johkasou tanks in Uganda, Vietnam and Japan, and 18 samples of wastewater sludge in Switzerland. Capillary suction time (CST) and total solids (TS) of centrifuged sludge (%TSfinal) were determined as metrics of dewatering rate and dewaterability, respectively, together with relevant sludge characteristics. Data were analysed by bootstrapping comparison of median results of each sample category and by bootstrapping multiple regression analysis to quantify the relative importance of sludge characteristics on dewatering performance. Results showed that the dewatering rate was significantly different between FS from different technologies, whereas dewaterability was significantly different within the same technology. FS had a significantly lower dewatering rate than wastewater sludge. In contrast, FS dewaterability was greater than wastewater sludge. However, this could be attributed to higher concentrations of sand in FS. Electrochemical properties such as NH4-N and surface charge had the strongest correlation to dewatering rate, and solid properties such as sand content and total volatile solids to dewaterability. The results identify potential characteristics that could explain and predict the high variability of FS dewatering performance that is observed in the field. [ABSTRACT FROM AUTHOR]

We report a case of a 66-year-old man who was diagnosed with severe aortic regurgitation, moderate tricuspid regurgitation and chronic atrial fibrillation. Preoperative computed tomography showed left lung agenesis. We performed aortic valve replacement, tricuspid valve annuloplasty and right pulmonary vein isolation via a left thoracotomy. This approach provided an adequate field of view. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated the long-term results of aortic valve replacement for bicuspid aortic valve patients with or without surgical treatment of the ascending aorta. Methods: A total of 145 bicuspid aortic valve patients had undergone aortic valve replacement since 1974 at our institution. No surgical treatment (Group-N; n = 115) was performed in the ascending aorta if the diameter was less than 40 mm. We wrapped an ascending aorta of 40-50 mm with an artificial graft (Group-W; n = 19), and performed replacement (Group-R; n = 11) if the ascending aorta measured more than 50 mm. Follow-up was completed for 144 patients (99.3 % of the cases). Results: The hospital mortality rate was 1.4 %. There were no significant differences among Groups N, W and R in the freedom from valve-related death and cardiac death at 10 years after surgery. The rates of freedom from aorta-related events in the three groups at 10 years after surgery were 98.3 % (Group-N), 100 % (Group-W) and 100 % (Group-R). Conclusions: The long-term survival was equivalent among the three groups, and the rates of freedom from aorta-related death or events were low. Our surgical protocol for the treatment of the enlarged ascending aorta associated with BAV is appropriate. [ABSTRACT FROM AUTHOR]

Laparoscopic multi-visceral resection in patients with T4 colorectal cancer remains controversial. A 73-year-old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long-term follow-up are required to resolve oncological outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Long-term results of Bentall operations with mechanical prostheses were analyzed and evaluated over 30 years. Methods: Seventy-one patients aged 50.2 ± 1.8 years old underwent an elective Bentall operation from 1975 to 2013 for chronic aortic root aneurysm, while 129 patients aged 51.6 ± 1.3 underwent isolated AVR with a mechanical valve for pure aortic regurgitation. The follow-up was completed for a total of 2,336-patient-years in 99.5 % of these patients. Results: No significant differences were observed in the hospital mortality (2.8 and 0.78 %), actuarial survival rate (43.3 ± 9.9 and 50.0 ± 9.2 %), freedom from valve-related death (84.9 ± 6.8 and 68.1 ± 11 %), and freedom from valve-related morbidity (43.7 ± 19 and 40.1 ± 15 %) at 30 years between the two groups. No significant differences were observed in the valve-related events; however, a higher incidence of rupture of aortic aneurysm was observed in the Bentall group ( P = 0.0005). Conclusions: Both our short- and long-term results of Bentall operation with mechanical prostheses were satisfactory at 30 years after the surgery and were comparable with those of simple AVR. However, to prevent rupture of the aortic aneurysm, special care should be taken after the primary Bentall operations. [ABSTRACT FROM AUTHOR]

A 23-year-old Japanese man presented with a history of sudden-onset right abdominal pain accompanied by nausea and vomiting. Contrast-enhanced CT showed a large cluster on the right side of the retroperitoneum, with most of the small bowel incarcerated. The patient was diagnosed with small bowel obstruction caused by a right paraduodenal hernia, and emergency laparoscopic surgery was performed. The large retroperitoneal cluster on the right side contained almost all segments of the small bowel, although the incarcerated bowel showed no evidence of volvulus or ischemia. The bowel was reduced, and the hernia orifice was closed. The patient made good progress and was discharged 7 days after surgery. We herein report an acute case of right paraduodenal hernia with small bowel obstruction that was successfully treated with emergency laparoscopic surgery. With an early preoperative diagnosis, laparoscopic surgery is appropriate for the treatment of right paraduodenal hernia. [ABSTRACT FROM AUTHOR]

The operative validity of aortic valve replacement (AVR) for high-risk patients with impaired left ventricular (LV) function is controversial. We measured LV contractility, afterload, and efficiency by use of transthoracic echocardiography data obtained before, after, and approximately 1 year after isolated AVR for 335 patients with aortic stenosis (AS group; n = 160), aortic regurgitation (AR group; n = 116), or aortic stenosis and regurgitation (ASR group; n = 59). Two subgroups were created: LV ejection fraction (EF) of ≥50 % (normal-EF subgroup) and <50 % (low-EF subgroup). Contractility decreased after AVR in the normal-EF AS and normal-EF AR subgroups, but did not change after AVR in the low-EF subgroups. Afterload decreased after AVR in the AS group and increased in the AR group. LV efficiency was unchanged after AVR in the normal-EF AS and ASR subgroups, worsened in the normal-EF AR subgroup, improved in the low-EF AS and ASR subgroups, and did not improve in the low-EF AR subgroup. LV contractility and efficiency improved during the 1-year period after AVR for all patients and subgroups, but the improvements in the low-EF AR subgroup were not as good as those in the low-EF AS and ASR subgroups. Improvements in LV contractility and efficiency after AVR can be expected for patients with low EF. However, contractility and efficiency did not improve after AVR for patients with AR and low EF. Low mortality and morbidity of AVR likely conceal a latent problem among patients with AR. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to achieve improvements in the work environment of Japanese surgeons and shortage of surgeons. Methods: Questionnaires were distributed to selected Japanese surgical Society (JSS) members. Retrospective analysis was conducted comparing the current 2011 survey with previous 2007 survey. To examine the influence of 2010 revision of the fee for medical services performed by surgeons, we distributed a second questionnaire to directors of hospitals and administrators of clerks belonging to official institutes in JSS. Collective data were analyzed retrospectively. Results: The main potential causes for the shortage of surgeons in Japan were long hours (72.8 %), excessive emergency surgeries (69.4 %), and high risk of lawsuit (67.7 %). Mean weekly working hours of surgeons in national or public university hospitals and private university hospitals were 96.2 and 85.6, respectively. Approximately 70 % of surgeons were forced to do hardworking tasks, possibly leading to death from overwork. Of note, approximately 25 % of surgeons had over time of more than 100 h a week, coinciding to the number of hours that might lead to death from fatigue, described in the Japanese labor law. Although the total medical service fee in hospitals, especially in large-scale hospitals with more than 500 beds, increased markedly after 2010 revision of the fee for medical services performed by surgeons, few hospitals gave perquisites and/or incentives to surgeons. Conclusion: To prevent and avoid collapse of the surgical specialty in Japan, an improvement in the work environment of surgeons by initiation of the JSS would be required as soon as possible. [ABSTRACT FROM AUTHOR]

Background: The various uses of biological valves for either aortic or mitral valve replacement have recently increased because of the growing proportion of elderly patients requiring surgery. Results: The durability of recent xenografts has been reported to be over 90 % at 10 years after aortic or mitral valve replacement for elderly patients more than 65 years of age, and therefore the guidelines now recommend the use of bioprostheses for patients over 65 years of age. Bioprostheses are also recommended for valve replacement of the right side of the heart by several authors; however, no clear guidelines are available. Trans-catheter aortic valve replacement and percutaneous pulmonary valve implantation are promising procedures for high-risk patients, although evaluation of the long-term durability of these valves is mandatory. Conclusions: This article will review the development of the tissue valve for valve surgery. [ABSTRACT FROM AUTHOR]

Purpose: Pulmonary valve replacement long after repair of tetralogy of Fallot can improve cardiac function, functional status, and arrhythmia propensity. This has not been reported in Japan. We aim to evaluate the effects of pulmonary valve replacement in repaired tetralogy of Fallot. Methods: Nineteen patients underwent pulmonary valve replacement after repair of tetralogy of Fallot, excluding Rastelli type operation, between August 1981 and August 2011. The results of the pulmonary valve replacement were assessed by analyzing preoperative and postoperative cardiothoracic ratio, cardiac function, functional status, QRS duration and durability of the prosthetic valves. Results: There were neither operative nor late deaths. The Cardiothoracic ratio significantly improved from 61.0 ± 5.2 % preoperatively to 56.2 ± 4.8 % postoperatively ( P < 0.001). The New York Heart association functional class significantly improved from 2.4 ± 0.8 preoperatively to 1.2 ± 0.4 postoperatively as well. Left ventricular ejection fraction showed significant improvement. QRS duration showed significant reduction. The freedom redo pulmonary valve replacement at 20 years was 100 %. Conclusion: Pulmonary valve replacement long after repair of previous tetralogy of Fallot had clinical benefits with low mortality. We recommend bioprosthesis for pulmonary valve replacement when adult-sized valve can be accommodated. [ABSTRACT FROM AUTHOR]

Ventricular assist devices are gaining ground in the therapeutic treatment of chronic heart failure. These devices are sometimes used as a bridge to recovery by unloading the left ventricle (LV) and restoring its function. It is therefore important to preserve the heart muscle and apply less invasive implantation methods. In this study ventricular unloading was achieved in 7 healthy sheep with a rotary blood pump at different pump flow levels. Ventricular cannulation via the left atrium (LA) and through the mitral valve was compared to atrial cannulation. The unloading of the heart was assessed with LV pressure-volume loops, derived energetic parameters, and an estimate of LV wall stress. No significant difference between the cannulations was found for any flow or pressure. LA cannulation, however, resulted in significantly lower stroke volumes and stroke work for all pump flow levels. Irrespective of cannulation site, LV volumes and energetic parameters showed a significant decrease with increasing pump flow. LV assist with a rotary blood pump can provide sufficient unloading with atrial cannulation. [ABSTRACT FROM AUTHOR]

Examines new test methods for measuring strength and chloride ion diffusion coefficient of minute regions in concrete. Design of the test methods; Process of developing compression test for minute specimens; Usefulness of the newly developed methods in understanding the complex structure of concrete.

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The aim of this study was to compare the long-term results with the Carpentier-Edwards pericardial bioprosthesis, a second-generation bioprosthesis, and the Hancock porcine valve in the aortic and mitral position. Long-term results of isolated valve replacement with the Carpentier-Edwards pericardial bioprosthesis (73 valves in the aortic position and 73 valves in the mitral position) were compared with those with the Hancock porcine bioprosthesis (41 valves in the aortic and 124 valves in the mitral position). In the aortic position, the mean follow-up period was 8.2±4.0 years with the Carpentier-Edwards pericardial bioprosthesis and 9.9±4.4 years with the Hancock porcine bioprosthesis. In the mitral position, the mean follow-up period was 7.5±4.3 years with the Carpentier-Edwards pericardial bioprosthesis and 10.0±5.3 years with the Hancock porcine bioprosthesis. The results showed that the mean age at implantation was significantly higher in patients with a Carpentier-Edwards pericardial bioprosthesis (58±13 years in the aortic and 51±15 years in the mitral) than in those with a Hancock bioprosthesis (42±13 years in the aortic and 45±10 years in the mitral). In the aortic position, actuarial freedom from structural deterioration of the Carpentier-Edwards pericardial bioprosthesis was significantly better (85±6% at 13 years) than that with the Hancock bioprosthesis (40±10%, P<0.02). In the mitral position, actuarial freedom from structural deterioration of the Carpentier-Edwards pericardial bioprosthesis was similar to that with the Hancock bioprosthesis (32±9% and 44±6% at 13 years, respectively). It is concluded that the durability of the Carpentier-Edwards pericardial bioprosthesis in the aortic position was satisfactory in the elderly patients. In the mitral position, the superior durability of the Carpentier-Edwards pericardial bioprosthesis against the Hancock bioprosthesis failed to be proved. [ABSTRACT FROM AUTHOR]

We investigated the hemodynamic effect of regurgitation (or back-flow) due to sudden failure of a rotary blood pump (diagonal pump). Seven healthy sheep (Group C) and 7 with chronic heart failure (Group F) were studied. Chronic heart failure was obtained by intracoronary injection of microspheres several weeks earlier. Left ventricular function and ventricular efficacy were assessed by the pressure–volume relationship. The back-flow through the stopped pump was significantly lower in Group F (2.3 ± 0.34 L/min) than in Group C (2.8 ± 0.33 L/min). Mean aortic blood pressure dropped significantly from 68.3 ± 9.65 to 61.9 ± 9.75 mm Hg in Group C and from 62.5 ± 9.12 to 51.5 ± 9.08 in Group F but remained stable during the 15 min period of pump stop. Parameters of left ventricular contractility (preload recruitable stroke work) dropped significantly in both groups, remained stable during the pump stop, and returned to baseline values 30 min after the end of back-flow. The ventricular efficacy (in terms of energy transfer) was tolerant against this acute volume overload even in the failing hearts. Sudden pump failure of a rotary blood pump leads to an acute depression of the hemodynamic state and myocardial contractility. However, this depression remained stable over 15 min, did not lead to further deterioration of the animals, and was completely reversible. [ABSTRACT FROM AUTHOR]

The differences in the cardioprotective effects of nucleoside transport inhibitor (NTI) which is known to accumulate endogenous adenosine, on moderate and deep hypothermic ischemia, were examined. Using the Langendorff model, isolated, perfused rat hearts were arrested with cold cardioplegia and subjected to 90 min of global ischemia followed by 40 min of reperfusion. The temperature during ischemia was maintained at either 10°C (groups 1 and 2) or 25°C (groups 3 and 4). In groups 2 and 4, NTI in the form of R75231, 1 mg/l, was added to the cardioplegic solution. The intramyocardial adenosine triphosphate content at the end of ischemia was significantly lower in the moderate hypothermia groups than in the deep hypothermia groups. In the moderate hypothermia groups, NTI significantly enhanced the adenosine accumulation at the end of ischemia. Moreover, the recovery of both the contractile function and coronary flow rate in group 4 was superior to that in group 3, and was similar to those in groups 1 and 2. The addition of NTI to the cardioplegic solution generated a sufficient cardioprotective effect in moderate hypothermic ischemia, but not in deep hypothermic ischemia. The mechanism of this discrepancy is attributed to the differences in the levels of endogenous adenosine accumulated during ischemia. [ABSTRACT FROM AUTHOR]

A case of active prosthetic valve infective endocarditis (PVE) due to Candida glabrata was successfully treated by the systemic administration of fluconazole. A 66-year-old Japanese man with infective endocarditis of unknown etiology underwent aortic and mitral valve replacement to treat severe aortic and mitral regurgitation associated with multiple organ failure. Postsurgical cultures of arterial blood were repeatedly positive for C. glabrata, and therefore fluconazole was administered either intravenously or orally at a dose of 400 mg/day for 46 days. During that time the signs of inflammation including fever such as an elevated white blood cell count and the presence of C-reactive protein (CRP) all improved while the blood cultures became negative. Fluconazole is thus considered to be effective in treating PVE caused by C. glabrata. When administering this treatment, it is also important to monitor the patient's renal and liver function. [ABSTRACT FROM AUTHOR]

A 26-year-old male suffering from sudden right lower abdominal pain and lumbago was referred to our hospital. Enhanced computed tomography demonstrated bilateral kidneys and spleen infarctions, and a large tumour was found occupying the aortic arch and thoracic descending aorta. We suspected that these infarctions were due to tumour embolization. The aortic arch and thoracic descending aorta were resected with the tumour and then reconstructed using the L-incision technique. A microscopic examination revealed the presence of an intimal sarcoma. The patient was treated with adjuvant chemotherapy and showed a good postoperative course. Neither recurrence nor metastasis has been observed during the 3 years since the operation. [ABSTRACT FROM AUTHOR]

Malnutrition is a core symptom of the frailty cycle in older adults. The purpose of this study was to investigate whether dysphagia influences nutrition or frailty status in community-dwelling older adults. The study participants were 320 Japanese community-dwelling older adults aged ≥65 years. All participants completed a questionnaire survey that included items on age, sex, family structure, self-rated health, nutritional and frailty status, and swallowing function. Nutritional status was categorized as malnourished, at risk of malnutrition, and well-nourished based on the Mini Nutrition Assessment-Short Form. The participants were then classified into a malnutrition (malnourished/at risk) or a well-nourished group (well-nourished). Frailty was assessed using the Cardiovascular Health Study criteria. The participants were then divided into a frailty (frail/pre-frail) or a non-frailty group (robust). Dysphagia was screened using the 10-item Eating Assessment Tool. Multiple logistic regression analysis was conducted to determine whether dysphagia was associated with nutritional or frailty status. The results revealed that dysphagia influenced both nutrition (odds ratio [OR]: 4.0; 95% confidence interval [CI]: 1.9–8.2) and frailty status (OR: 2.3; 95% CI: 1.0–5.2); therefore, the swallowing function would be an important factor for community-dwelling older adults on frailty prevention programs. [ABSTRACT FROM AUTHOR]

A 50-year-old man who was the victim of an accident during work was taken to the hospital. His chest radiograph and computed tomography (CT) scan showed pulmonary contusion, multiple rib fractures (left 5th to 11th ribs), hemopneumothorax, and splenic rupture. On the fourth posttrauma day, CT showed bone particles of the ninth rib migrating to the thoracic aorta. These bone particles were threatening to penetrate the thoracic aorta. He underwent operation to repair the flail chest by approximating the left ribs and partial lung resection. After the operation the flail chest improved, enabling extubation the first day after the operation. He was mobile and was discharged on the 17th postoperative day. A literature review revealed cases of sudden death when such rib fragments lacerated the aorta. We therefore propose an early operation for patients who have multiple bone fractures in the left chest. [ABSTRACT FROM AUTHOR]