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type:text, The purpose of this study was to review short-term results of aortic arch aneurysm treatment that were performed with fenestrated stent grafts (Najuta stent grafts) in our hospital. Nine patients of aortic arch aneurysm were treated with Najuta stent grafts between January 2015 and March 2018. Eight patients had a saccular aneurysm and one a dissecting aneurysm. A Najuta stent graft was deployed in the aortic arch in each patient. If necessary, a non-fenestrated stent graft was added, and bilateral axillary artery bypass or left subclavian artery embolisation was performed. Computed tomography (CT) examination was performed postoperatively, at 6 months, and yearly. In all patients, the stent grafts were deployed as planned. The blood flow of the brachiocephalic artery and left common carotid artery was maintained through fenestrations of the stent graft. Eight patients required occlusion of the left subclavian artery to get a sufficient proximal sealing zone; five of them were reconstructed. All patients were treated with fewer branch reconstructions than would have been required with conventional stent grafts. In one patient, a lower limb embolism occurred during the operation. On postoperative CT, endoleaks were observed in three patients. Coil embolisation of the left subclavian artery was performed within a year for two patients. The clinical course was evaluated for up to 4 years. Aneurysms shrank slightly in five patients, remained unchanged in three patients, and expanded in one patient. Najuta stent grafts performed well and enabled treatment of aortic arch aneurysms with minimal aortic branch reconstruction.

The purpose of this study was to review short-term results of aortic arch aneurysm treatment that were performed with fenestrated stent grafts (Najuta stent grafts) in our hospital. Nine patients of aortic arch aneurysm were treated with Najuta stent grafts between January 2015 and March 2018. Eight patients had a saccular aneurysm and one a dissecting aneurysm. A Najuta stent graft was deployed in the aortic arch in each patient. If necessary, a non-fenestrated stent graft was added, and bilateral axillary artery bypass or left subclavian artery embolisation was performed. Computed tomography (CT) examination was performed postoperatively, at 6 months, and yearly. In all patients, the stent grafts were deployed as planned. The blood flow of the brachiocephalic artery and left common carotid artery was maintained through fenestrations of the stent graft. Eight patients required occlusion of the left subclavian artery to get a sufficient proximal sealing zone; five of them were reconstructed. All patients were treated with fewer branch reconstructions than would have been required with conventional stent grafts. In one patient, a lower limb embolism occurred during the operation. On postoperative CT, endoleaks were observed in three patients. Coil embolisation of the left subclavian artery was performed within a year for two patients. The clinical course was evaluated for up to 4 years. Aneurysms shrank slightly in five patients, remained unchanged in three patients, and expanded in one patient. Najuta stent grafts performed well and enabled treatment of aortic arch aneurysms with minimal aortic branch reconstruction.

The purpose of this study was to review short-term results of aortic arch aneurysm treatment that were performed with fenestrated stent grafts (Najuta stent grafts) in our hospital. Nine patients of aortic arch aneurysm were treated with Najuta stent grafts between January 2015 and March 2018. Eight patients had a saccular aneurysm and one a dissecting aneurysm. A Najuta stent graft was deployed in the aortic arch in each patient. If necessary, a non-fenestrated stent graft was added, and bilateral axillary artery bypass or left subclavian artery embolisation was performed. Computed tomography (CT) examination was performed postoperatively, at 6 months, and yearly. In all patients, the stent grafts were deployed as planned. The blood flow of the brachiocephalic artery and left common carotid artery was maintained through fenestrations of the stent graft. Eight patients required occlusion of the left subclavian artery to get a sufficient proximal sealing zone; five of them were reconstructed. All patients were treated with fewer branch reconstructions than would have been required with conventional stent grafts. In one patient, a lower limb embolism occurred during the operation. On postoperative CT, endoleaks were observed in three patients. Coil embolisation of the left subclavian artery was performed within a year for two patients. The clinical course was evaluated for up to 4 years. Aneurysms shrank slightly in five patients, remained unchanged in three patients, and expanded in one patient. Najuta stent grafts performed well and enabled treatment of aortic arch aneurysms with minimal aortic branch reconstruction.

Objective: Given the number of college students with a normal BMI decreases 9-12% throughout the college experience, we wanted to model the traits responsible for behaviors impacting body composition in college-age women. Participants: Participants (n = 141) were recruited from a freshman-level nutrition course between August 2016 and May 2018. Methods: We built a path analysis model using variables from online questionnaires and lab visits. We grouped participants by median split of aerobic fitness and evaluated model fit. We defined statistical significance as p < .05. Results: The model provided an adequate representation of the data (CFI = 0.921). Aerobic fitness was the strongest predictor of body fat (p < .001) in both high-fit (-0.440) and low-fit (-0.469) women. Body dissatisfaction demonstrated relationships with body fat previously established in athletes and clinical populations. Conclusion: Physical activity to improve aerobic fitness appears most effective at maintaining healthy body composition in this population.

type:text, Purpose: A treatment for chronic constipation is dietary fiber intake. This study aimed to determine the effects of different types of dietary fibers on the microbiota in the large intestine. Methods: Nine healthy volunteers participated in this study. Breath hydrogen test was used to determine the dietary fiber fermentations. The presence of hydrogen in the breath indicates intestinal bacterial activities. Participants fasted overnight and ate white bread (200 g) with 10 g of each type of dietary fiber: (1) cellulose, (2) soy fiber, (3) guar gum, and (4) control (without any dietary fiber). Samples were collected before and every 1 hour after eating, for 8 h. Another test compared the effects between cellulose and guar gum with a loaded food, which activates intestinal fermentation, and samples were collected using the same methods. Results: During 8 h of measurements, breath hydrogen concentration in the soy fiber group were higher than that of the control, but were not significantly different. Changes in the guar gum group were similar to those in the control. However, breath hydrogen concentrations in the cellulose group did not increase even after eating white bread that caused large intestinal fermentation 2.9 ± 0.7 ppm, which was significantly lower than that of the guar gum group (7.4 ± 1.7 ppm, p < 0.01). In the study with a well-fermented food intake, cellulose reduced breath hydrogen concentrations, but its difference with that of the guar gum group was statistically non-significant. Conclusion: Cellulose might have a suppressive effect on large intestinal fermentation. Therefore, this compound may be beneficial in treating chronic constipation.

type:text, A 64-year-old woman was evaluated for thoracoabdominal aortic aneurysms (TAAAs). Preoperative computed tomography showed a TAAA extending from the level of the diaphragm to the renal arteries. The Adamkiewicz artery (AKA) arose at the Th10 level, close to the aneurysm, and an abdominal aortic prosthesis and left iliac artery aneurysm were detected. Myogenic and neurogenic motor evoked potentials (MEPs) were monitored during the surgical repair of the TAAA, and there were differences between the two types of MEPs during surgery. Both MEPs fell below 50% of their baseline levels during surgery, which suggested critical ischemia, but the decrease in the myogenic MEP occurred at a different time from the decrease in the neurogenic MEP. A time-course analysis suggested that AKA reimplantation was unnecessary and all intercostal arteries were ligated. Both MEPs recovered completely by the end of surgery and there were no postoperative neurologic deficits. Our findings suggest that the combination of myogenic and neurogenic MEP monitoring is helpful in evaluating spinal cord injury during the surgical repair of TAAAs.

A 64-year-old woman was evaluated for thoracoabdominal aortic aneurysms (TAAAs). Preoperative computed tomography showed a TAAA extending from the level of the diaphragm to the renal arteries. The Adamkiewicz artery (AKA) arose at the Th10 level, close to the aneurysm, and an abdominal aortic prosthesis and left iliac artery aneurysm were detected. Myogenic and neurogenic motor evoked potentials (MEPs) were monitored during the surgical repair of the TAAA, and there were differences between the two types of MEPs during surgery. Both MEPs fell below 50% of their baseline levels during surgery, which suggested critical ischemia, but the decrease in the myogenic MEP occurred at a different time from the decrease in the neurogenic MEP. A time-course analysis suggested that AKA reimplantation was unnecessary and all intercostal arteries were ligated. Both MEPs recovered completely by the end of surgery and there were no postoperative neurologic deficits. Our findings suggest that the combination of myogenic and neurogenic MEP monitoring is helpful in evaluating spinal cord injury during the surgical repair of TAAAs.

Purpose: A treatment for chronic constipation is dietary fiber intake. This study aimed to determine the effects of different types of dietary fibers on the microbiota in the large intestine. Methods: Nine healthy volunteers participated in this study. Breath hydrogen test was used to determine the dietary fiber fermentations. The presence of hydrogen in the breath indicates intestinal bacterial activities. Participants fasted overnight and ate white bread (200 g) with 10 g of each type of dietary fiber: (1) cellulose, (2) soy fiber, (3) guar gum, and (4) control (without any dietary fiber). Samples were collected before and every 1 hour after eating, for 8 h. Another test compared the effects between cellulose and guar gum with a loaded food, which activates intestinal fermentation, and samples were collected using the same methods. Results: During 8 h of measurements, breath hydrogen concentration in the soy fiber group were higher than that of the control, but were not significantly different. Changes in the guar gum group were similar to those in the control. However, breath hydrogen concentrations in the cellulose group did not increase even after eating white bread that caused large intestinal fermentation 2.9 ± 0.7 ppm, which was significantly lower than that of the guar gum group (7.4 ± 1.7 ppm, p < 0.01). In the study with a well-fermented food intake, cellulose reduced breath hydrogen concentrations, but its difference with that of the guar gum group was statistically non-significant. Conclusion: Cellulose might have a suppressive effect on large intestinal fermentation. Therefore, this compound may be beneficial in treating chronic constipation.

A 64-year-old woman was evaluated for thoracoabdominal aortic aneurysms (TAAAs). Preoperative computed tomography showed a TAAA extending from the level of the diaphragm to the renal arteries. The Adamkiewicz artery (AKA) arose at the Th10 level, close to the aneurysm, and an abdominal aortic prosthesis and left iliac artery aneurysm were detected. Myogenic and neurogenic motor evoked potentials (MEPs) were monitored during the surgical repair of the TAAA, and there were differences between the two types of MEPs during surgery. Both MEPs fell below 50% of their baseline levels during surgery, which suggested critical ischemia, but the decrease in the myogenic MEP occurred at a different time from the decrease in the neurogenic MEP. A time-course analysis suggested that AKA reimplantation was unnecessary and all intercostal arteries were ligated. Both MEPs recovered completely by the end of surgery and there were no postoperative neurologic deficits. Our findings suggest that the combination of myogenic and neurogenic MEP monitoring is helpful in evaluating spinal cord injury during the surgical repair of TAAAs.

Purpose: The principle treatment of infectious aortic aneurysm is to remove the infected aneurysm and replace it with Rifampicin-soaked prosthesis by omentopecxy. This study aimed to clarify the efficacy of long-term antibiotics and subsequent thoracic endovascular aneurysm repair (TEVAR) for infectious thoracic aortic aneurysm. Methods: Between July 2011 and December 2015, 213 TEVARs were performed at Hiroshima University Hospital. Six patients (2.8%) had infectious aneurysm and received long-term antibiotic therapy and secondary TEVAR. L ong-term antibiotic therapy and subsequent TEVAR is paradoxical. This study aimed to clarify the timing of TEVAR for infectious thoracic aortic aneurysm. Results: All patients presented with fever and back pain, and had positive blood cultures; five patients had significant co-morbidities. Bacteraemia was caused by Methicillin Sensitive Staphylococcus Aureus (MSSA) (2), Streptococcus sanguinis (1), Methicillin Resistant Staphylococcus Aureus (MRSA) (1), Chryseobacterium meningosepticum (1), and Enterococcus faecalis (1). B lood examination at admission revealed a WBC count ranging from 10,470 to 16,170/μl and CRP ranging from 7.9 to 16.4 mg/dl. Long-term antibiotic therapy was continued until WBC and CRP were within the normal range. TEVAR was performed emergently in 3 cases and electively in 3 cases. The time from admission to TEVAR ranged from 7 to 26 days. One stent-graft was deployed in all 6 cases. All patients survived and were followed for an average of 48 months; they were free from re-infection. Conclusion: Long-term antibiotics and simple TEVAR may be a feasible treatment for infectious thoracic aortic aneurysms.

Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible.

type:text, Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible.

Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible.

type:text, While single nucleotide polymorphisms (SNP) have been extensively researched in atherosclerotic aortic aneurysms, there are too few data about acute aortic dissection (AAD). The matrix metalloproteinase regulation system has shown a high biological relevance to the development of aortic aneurysms and AAD. The TIMP-1 c.T372C (rs4898, nt+434) SNP was previously associated with the onset of abdominal aortic and other aneurysms. Therefore, we chose this SNP to search for a connection with AAD and to find its place among the other risk factors. 115 patients with AAD were studied for their TIMP-1 c.T372C genotype by means of conventional restrictase analysis. To confirm the biological relevance of our findings, immunohistochemistry for TIMP-1 was performed on tissue samples from the same patients with AAD and compared with a control group of 23 autopsy cases. The TIMP-1 c.T372C showed a significant difference in allele frequency in the AAD patients compared to the general population (p < 0.0001 for both sexes). This genotype did not show any association with any other co-morbid condition, nor with age. The immunohistochemistry results also showed significantly lower TIMP-1 expression in the dissected aortas. The C allele of TIMP-1 c.T372C shows a strong association with the onset of AAD.

While single nucleotide polymorphisms (SNP) have been extensively researched in atherosclerotic aortic aneurysms, there are too few data about acute aortic dissection (AAD). The matrix metalloproteinase regulation system has shown a high biological relevance to the development of aortic aneurysms and AAD. The TIMP-1 c.T372C (rs4898, nt+434) SNP was previously associated with the onset of abdominal aortic and other aneurysms. Therefore, we chose this SNP to search for a connection with AAD and to find its place among the other risk factors. 115 patients with AAD were studied for their TIMP-1 c.T372C genotype by means of conventional restrictase analysis. To confirm the biological relevance of our findings, immunohistochemistry for TIMP-1 was performed on tissue samples from the same patients with AAD and compared with a control group of 23 autopsy cases. The TIMP-1 c.T372C showed a significant difference in allele frequency in the AAD patients compared to the general population (p < 0.0001 for both sexes). This genotype did not show any association with any other co-morbid condition, nor with age. The immunohistochemistry results also showed significantly lower TIMP-1 expression in the dissected aortas. The C allele of TIMP-1 c.T372C shows a strong association with the onset of AAD.

type:text, Background: The pulmonary veins (PV) and posterior left atrium (LA) may contribute to the occurrence and maintenance of atrial fibrillation (AF). We evaluated whether simple epicardial electrophysiological mapping can predict elimination of chronic AF after the box PV isolation procedure. Methods and Results: Using a computerized 48-channel mapping system, we performed intraoperative atrial mapping in 16 patients with chronic AF associated with mitral valve (MV) disease. Patients' ages ranged from 48 to 76 years (mean, 61.4 years). AF duration ranged from 1 to 16 years (mean, 7.5 +/- 5.4 years). Simple box PV isolation was performed during the MV operation. Regular and repetitive activation was found in the LA of 12 of 16 patients, and irregular and chaotic activation was found in both atria in 4 of 16 patients; 12 patients with regular and repetitive activation of the LA were treated by box PV isolation and the other 4 patients with irregular and chaotic activation in both atria did not recover sinus rhythm after this procedure. AF-free rate was significantly higher in patients with regular and repetitive activation of the LA (P < 0.01). Conclusions: Box PV isolation was effective in the treatment of chronic AF associated with MV disease. Epicardial atrial mapping may predict elimination of AF after the box PV isolation. (Circ J 2012; 76: 852-859)

Background: The pulmonary veins (PV) and posterior left atrium (LA) may contribute to the occurrence and maintenance of atrial fibrillation (AF). We evaluated whether simple epicardial electrophysiological mapping can predict elimination of chronic AF after the box PV isolation procedure. Methods and Results: Using a computerized 48-channel mapping system, we performed intraoperative atrial mapping in 16 patients with chronic AF associated with mitral valve (MV) disease. Patients' ages ranged from 48 to 76 years (mean, 61.4 years). AF duration ranged from 1 to 16 years (mean, 7.5 +/- 5.4 years). Simple box PV isolation was performed during the MV operation. Regular and repetitive activation was found in the LA of 12 of 16 patients, and irregular and chaotic activation was found in both atria in 4 of 16 patients; 12 patients with regular and repetitive activation of the LA were treated by box PV isolation and the other 4 patients with irregular and chaotic activation in both atria did not recover sinus rhythm after this procedure. AF-free rate was significantly higher in patients with regular and repetitive activation of the LA (P < 0.01). Conclusions: Box PV isolation was effective in the treatment of chronic AF associated with MV disease. Epicardial atrial mapping may predict elimination of AF after the box PV isolation. (Circ J 2012; 76: 852-859)

Objective: Motor-evoked potential monitoring is used to prevent paraplegia during thoracic aortic surgery. Multidetector computed tomography has been used preoperatively to detect the Adamkiewicz artery, but the hemodynamic significance of the Adamkiewicz artery is controversial. This study aims to evaluate whether the multidetector computed tomography–defined Adamkiewicz artery is hemodynamically essential and needs to be reconstructed with cold blood spinoplegia under motor-evoked potential monitoring. Methods: From 2005 to 2008, both preoperative multidetector computed tomographic analysis and intraoperative neurogenic motor-evoked potential monitoring with cold blood infusion into the clamped segment of the aorta were done in 15 patients. A motor-evoked potential decrease to less than 50% of the initial value at 3 minutes after cold blood infusion determined the hemodynamic significance of the multidetector computed tomography–defined Adamkiewicz artery. Adamkiewicz arteries determined to be essential were reconstructed, and those determined to be nonessential were sacrificed. Results: The Adamkiewicz artery was involved in the clamped segment of the aorta in 11 cases. After cold blood infusion, 8 patients experienced no significant motor-evoked potential decrease, and Adamkiewicz artery ligation was undertaken, whereas a moderate motor-evoked potential decrease was noted in 1 patient, prompting reconstruction. None of these 9 patients had permanent neurologic deficits. In 2 patients, the Adamkiewicz artery was reconstructed based on motor-evoked potential findings, with paraparesis occurring in 1 patient. In 4 patients without Adamkiewicz artery involvement in the clamped segment, there was no neurologic deficit. Conclusions: Cold blood infusion accelerates motor-evoked potential changes and might enable decision making regarding the need for reconstruction of multidetector computed tomography–defined Adamkiewicz arteries. Cold blood–loaded motor-evoked potenti, 広島大学(Hiroshima University), 博士(医学), doctoral

Conjugated dienediynes and enediynes with definite geometry- have been prepared in a one-pot manner. This protocol involves two types of coupling reaction, a Suzuki-type coupling and either a Hay coupling or a Cadiot-Chodkiewicz coupling. Thus, the copper-mediated cross-coupling reaction of (E)-alk-1-enyldisiamylborane with (trimethylsilyl)ethynyl bromide is carried out in the presence of 1 M NaOMe to generate (E)-alk-3-en-1-yne, which is subjected to either palladium/copper-catalyzed homocoupling in the presence of DABCO or copper-catalyzed heterocoupling with 1-iodoalk-1-yne in the presence of TBD or pyrrolidine in a single reaction pot without isolating (E)-alk-3-en-1-yne. The homocoupling has realized the stereoselective construction of (1E,7E)-alka-1,7-diene-3,5-diynes, and the heterocoupling has achieved the formation of (E)-alk-1-ene-3,5-diynes. In addition, starting from (Z)-alk-1-enyldisiamylborane instead of the E-isomer, this series of reactions has led to the formation of (1Z,7Z)-alka-1,7-diene-3,5-diynes and (Z)-alk-1-ene-3,5-diynes, albeit limiting the scope of the substrate.

The main purpose of the study was to examine the effects of learning trials on young healthy untrained males, self-selected loads and ratings of perceived exertion for eight commonly used exercises during the circuit weight training. Twenty-one untrained healthy college-aged male subjects were recruited from the University of Nebraska-Lincoln campus community for this study. Prior to the experimental sessions, the subjects participated in a familiarization session to learn the operation of eight selectorized machines in a circuit fashion at a cadence of 40 beats/minute and the use of the OMNI perceived exertion scale chart. In addition, the subjects. OMNI perceived exertion scale of 6 or "Somewhat Hard" for active muscle weights and one repetition maximums for all eight exercises were determined. The subjects. OMNI perceived exertion scale of 6 or "Somewhat Hard" for active muscle weights and the subjects. 60% of their one repetition maximums for each exercise were used for their separate learning trials. To examine the effects between the two learning trials, the subjects' self-selected weights that they believed would improve their muscular fitness were obtained before and after each learning trial. Two 2 (order) x 5 (weights selected) and 2 (order) x 6 (perceived exertion scores) multivariate analysis of variance with repeated measures were performed separately. Multivariate tests revealed the factors had significant effects on the dependent variables for both weights selected and perceived exertion scores. The following conclusion statements were made within the limitations of the study. (1) Without a learning trial, young healthy untrained males' self-selected weights that were insufficient to improve muscular strength. (2) Young healthy novice male weight trainers are better able to self select optimal exercise resistance levels after they are exposed to heavier weights (60% 1RM) as a reference during a learning trial. (3) Learning trials do not affect young h

type:text, Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55°. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex viva ASD model as visualization is optimized by panel setting for guiding surgical procedures.

Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55°. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex viva ASD model as visualization is optimized by panel setting for guiding surgical procedures.

Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55°. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex viva ASD model as visualization is optimized by panel setting for guiding surgical procedures.

Background: Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that has negative implications on patient outcomes. This study aimed to evaluate the effect of abdominal aortic calcification, measured using the Agatston Score, on patients undergoing aortic valve replacement for aortic valve stenosis. Methods and Results: This study included 183 patients who underwent aortic valve replacement. Preoperative characteristics and Agatston scores for abdominal aortic calcification were compared between patients with (n = 108) and without (n = 75) postoperative atrial fibrillation. Multivariate analysis showed that a high Agatston Score (derived by a cutoff point of 2767.65; odds ratio, 2.314; 95% confidence intervals (CI) , 1.063–5.041; P = 0.035), left atrial volumes (LAV) (derived by a cutoff point of 69.95; odds ratio, 3.176; 95% CI, 1.459–6.914; P = 0.004), and age (derived by a cutoff point of 75.5 years old, odds ratio, 3.465; 95% CI, 1.588–7.557; P = 0.003) were significant predictors of postoperative atrial fibrillation in the second week after surgery. Conclusions: Age and left atrial volume could be independent predictors of postoperative atrial fibrillation in patients with aortic valve stenosis, while the severity of abdominal aortic calcification, as measured using the Agatston Score, independently predicted postoperative atrial fibrillation during the second week following aortic valve stenosis. Patients with an Agatston Score exceeding 2767.65 should be considered at high risk and should receive appropriate management to improve outcomes.

Vascular resection including portal vein resection and/or hepatic artery resection has rarely been reported in distal cholangiocarcinoma. This review aimed to elucidate the safety and oncological outcomes of surgery with vascular resection in patients with distal cholangiocarcinoma. The following data were extracted from the identified studies: type of vascular resection, surgical outcome, pathological findings, recurrence-free survival (RFS), and overall survival (OS). Six studies were identified, and patients were classified into the vascular resection (VR) group and non-VR group according to the presence or absence of vascular resection in each study. The vascular resection ratios ranged from 6.8% to 20.0% in the surgical cases. The most frequent tumor location in the VR group was the extrapancreatic common bile duct and the most frequent sites of vascular resection were portal vein and right hepatic artery. The ratios of T3 or T4 tumor were significantly higher in the VR group. The ratios of severe complications and postoperative mortality were not significantly different between the VR and non-VR groups. The median RFS time and OS time in the VR group were shorter than 1 year and 2 years, respectively, in all studies. In conclusion, the patients with distal cholangiocarcinoma in the VR group tended to show early recurrence and shorter survival, although vascular resection could be performed safely.

Purpose: This experimental study was designed to use the hydrogen (H2) breath test to investigate changes in the intestinal flora of patients that were administered prophylactic antibiotics for 48 hours after surgery. Methods: Altogether, 22 patients were divided into two groups and the antimicrobial prophylactics, cefazolin (3.0 g/day) or sulbactam/ampicillin (4.5 g/day), were administered on induction of anaesthesia for 48 hours after surgery. End expiratory breath samples were collected on the morning of the day of surgery and every morning for 1-6 days after surgery. Results: H2 breath concentration significantly decreased in each group on day 1 (cefazolin: 1.20 ± 0.39 ppm vs. sulbactam/ampicillin: 1.17 ± 0.34 ppm). On day 2, the H2 concentration in the sulbactam/ampicillin group was significantly lower than the cefazolin group (cefazolin: 6.4 ± 2.2 ppm vs. sulbactam/ampicillin: 1.0 ± 0.4 ppm, p < 0.05). H2 concentration was still lower in the sulbactam/ampicillin group (1.3 ± 0.3 ppm vs. 3.3 ± 1.0 ppm, p = 0.10) on day 3. On days 4-6, H2 concentration was essentially the same for both groups. Discussion: Colonic anaerobes are thought to be a reservoir of resistant organisms and prolonged antimicrobial treatment is a major cause for the development of resistance. Surgical prophylaxis is basically recommended for use within 24 hours after surgery. The breath H2 concentration in both groups significantly decreased 24 hours after administration. These results suggest that both antibiotics influence the activity of colonic anaerobes and the duration of surgical antibiotic prophylaxis should be as short as possible.

The purpose of this study was to review short-term results of aortic arch aneurysm treatment that were performed with fenestrated stent grafts (Najuta stent grafts) in our hospital. Nine patients of aortic arch aneurysm were treated with Najuta stent grafts between January 2015 and March 2018. Eight patients had a saccular aneurysm and one a dissecting aneurysm. A Najuta stent graft was deployed in the aortic arch in each patient. If necessary, a non-fenestrated stent graft was added, and bilateral axillary artery bypass or left subclavian artery embolisation was performed. Computed tomography (CT) examination was performed postoperatively, at 6 months, and yearly. In all patients, the stent grafts were deployed as planned. The blood flow of the brachiocephalic artery and left common carotid artery was maintained through fenestrations of the stent graft. Eight patients required occlusion of the left subclavian artery to get a sufficient proximal sealing zone; five of them were reconstructed. All patients were treated with fewer branch reconstructions than would have been required with conventional stent grafts. In one patient, a lower limb embolism occurred during the operation. On postoperative CT, endoleaks were observed in three patients. Coil embolisation of the left subclavian artery was performed within a year for two patients. The clinical course was evaluated for up to 4 years. Aneurysms shrank slightly in five patients, remained unchanged in three patients, and expanded in one patient. Najuta stent grafts performed well and enabled treatment of aortic arch aneurysms with minimal aortic branch reconstruction.

Purpose: A treatment for chronic constipation is dietary fiber intake. This study aimed to determine the effects of different types of dietary fibers on the microbiota in the large intestine. Methods: Nine healthy volunteers participated in this study. Breath hydrogen test was used to determine the dietary fiber fermentations. The presence of hydrogen in the breath indicates intestinal bacterial activities. Participants fasted overnight and ate white bread (200 g) with 10 g of each type of dietary fiber: (1) cellulose, (2) soy fiber, (3) guar gum, and (4) control (without any dietary fiber). Samples were collected before and every 1 hour after eating, for 8 h. Another test compared the effects between cellulose and guar gum with a loaded food, which activates intestinal fermentation, and samples were collected using the same methods. Results: During 8 h of measurements, breath hydrogen concentration in the soy fiber group were higher than that of the control, but were not significantly different. Changes in the guar gum group were similar to those in the control. However, breath hydrogen concentrations in the cellulose group did not increase even after eating white bread that caused large intestinal fermentation 2.9 ± 0.7 ppm, which was significantly lower than that of the guar gum group (7.4 ± 1.7 ppm, p < 0.01). In the study with a well-fermented food intake, cellulose reduced breath hydrogen concentrations, but its difference with that of the guar gum group was statistically non-significant. Conclusion: Cellulose might have a suppressive effect on large intestinal fermentation. Therefore, this compound may be beneficial in treating chronic constipation.

A 64-year-old woman was evaluated for thoracoabdominal aortic aneurysms (TAAAs). Preoperative computed tomography showed a TAAA extending from the level of the diaphragm to the renal arteries. The Adamkiewicz artery (AKA) arose at the Th10 level, close to the aneurysm, and an abdominal aortic prosthesis and left iliac artery aneurysm were detected. Myogenic and neurogenic motor evoked potentials (MEPs) were monitored during the surgical repair of the TAAA, and there were differences between the two types of MEPs during surgery. Both MEPs fell below 50% of their baseline levels during surgery, which suggested critical ischemia, but the decrease in the myogenic MEP occurred at a different time from the decrease in the neurogenic MEP. A time-course analysis suggested that AKA reimplantation was unnecessary and all intercostal arteries were ligated. Both MEPs recovered completely by the end of surgery and there were no postoperative neurologic deficits. Our findings suggest that the combination of myogenic and neurogenic MEP monitoring is helpful in evaluating spinal cord injury during the surgical repair of TAAAs.

While single nucleotide polymorphisms (SNP) have been extensively researched in atherosclerotic aortic aneurysms, there are too few data about acute aortic dissection (AAD). The matrix metalloproteinase regulation system has shown a high biological relevance to the development of aortic aneurysms and AAD. The TIMP-1 c.T372C (rs4898, nt+434) SNP was previously associated with the onset of abdominal aortic and other aneurysms. Therefore, we chose this SNP to search for a connection with AAD and to find its place among the other risk factors. 115 patients with AAD were studied for their TIMP-1 c.T372C genotype by means of conventional restrictase analysis. To confirm the biological relevance of our findings, immunohistochemistry for TIMP-1 was performed on tissue samples from the same patients with AAD and compared with a control group of 23 autopsy cases. The TIMP-1 c.T372C showed a significant difference in allele frequency in the AAD patients compared to the general population (p < 0.0001 for both sexes). This genotype did not show any association with any other co-morbid condition, nor with age. The immunohistochemistry results also showed significantly lower TIMP-1 expression in the dissected aortas. The C allele of TIMP-1 c.T372C shows a strong association with the onset of AAD.

Toward the establishment of suture closure procedures for atrial septal defect or patent foramen ovale under guidance of three-dimensional (3D) echocardiography but without use of cardiopulmonary bypass (off-pump surgery), an experimental study was conducted using a laparoscopic suture instrument, Maniceps. First, the panel setting of the 3D echo system which was optimal for precisely visualizing the surgical instruments on the image display with the least time delay was determined. The optimal setting was: 1) harmonic imaging, 2) no smoothing, 3) low scanning line density, and 4) a scanning range around 55°. Using an ex vivo model of atrial septal defect, 3D echo-guided surgical procedures were attempted in three steps. First, grasping of the edge of the defect with a forceps was attempted. It was feasible in every direction. Reverberation artifact occasionally disturbed imaging of the defect edge. Second, transfixion suture of the facing edges was attempted. Guided by 3D echo, serial sutures were feasible, but interlocking of the thread was a pitfall. Third, continuous suture of the defect was attempted under 3D echo guidance. Following the initial suture bite on one side, continuous suture could be performed under echo guidance. Deformity of the Maniceps needle after repeated sutures was a limitation. In conclusion, suture closure of the defect under 3D echo guidance using the Maniceps system is feasible in an ex viva ASD model as visualization is optimized by panel setting for guiding surgical procedures.

Background: The pulmonary veins (PV) and posterior left atrium (LA) may contribute to the occurrence and maintenance of atrial fibrillation (AF). We evaluated whether simple epicardial electrophysiological mapping can predict elimination of chronic AF after the box PV isolation procedure. Methods and Results: Using a computerized 48-channel mapping system, we performed intraoperative atrial mapping in 16 patients with chronic AF associated with mitral valve (MV) disease. Patients' ages ranged from 48 to 76 years (mean, 61.4 years). AF duration ranged from 1 to 16 years (mean, 7.5 +/- 5.4 years). Simple box PV isolation was performed during the MV operation. Regular and repetitive activation was found in the LA of 12 of 16 patients, and irregular and chaotic activation was found in both atria in 4 of 16 patients; 12 patients with regular and repetitive activation of the LA were treated by box PV isolation and the other 4 patients with irregular and chaotic activation in both atria did not recover sinus rhythm after this procedure. AF-free rate was significantly higher in patients with regular and repetitive activation of the LA (P < 0.01). Conclusions: Box PV isolation was effective in the treatment of chronic AF associated with MV disease. Epicardial atrial mapping may predict elimination of AF after the box PV isolation. (Circ J 2012; 76: 852-859)