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Key Clinical Message: Distal stent graft‐induced new entry may occur after stent grafting for aortic dissection. Four‐dimensional magnetic resonance imaging is useful for predicting outcomes, showing accelerated flow and increased wall shear stress, indicating further false lumen expansion. [ABSTRACT FROM AUTHOR]

Background: Many non–small cell lung cancer (NSCLC) tumors present complex histology with various components. The effects of the lepidic growth component (LGC) on the prognosis of NSCLC have not been investigated. Here, we investigated whether an LGC is a relevant prognostic factor for NSCLC. Methods: This study retrospectively investigated the clinicopathologic characteristics of 379 patients with NSCLC ≤3 cm who underwent complete surgical resection between 2004 and 2016 at the University of Yamanashi Hospital. The histologic subtypes were classified into NSCLC with or without an LGC. We evaluated the effect of an LGC on the clinicopathologic features and 5‐year overall survival of patients with NSCLC. Results: On final pathology, 214 (56%) of 379 patients had an LGC, and 165 (44%) did not. Sex, smoking history, ground‐glass opacity component, pathologic invasive size, lymph node metastasis, pleural invasion, vessel invasion, pathologic stage, and histologic type were significantly different between the groups. Multivariate analysis of 5‐year overall survival, identified age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.035–1.105; p < 0.001), pathologic invasive size (HR, 1.548; 95% CI, 1.088–2.202; p = 0.015) and LGC (HR, 2.11; 95% CI, 1.099–4.051; p = 0.025) as independent prognostic factors. When the pathologic invasive size was matched, the 5‐year overall survival of the LGC and non‐LGC groups was 93% and 77%, respectively (p = 0.006). Conclusions: LGC is a significantly favorable prognostic factor for NSCLC with a pathologic invasive size of ≤3 cm. [ABSTRACT FROM AUTHOR]

A 69‐year‐old man with non‐small cell lung cancer presenting with pericardial effusion and rapid progression of dyspnea achieved long‐term disease stabilization after radiation therapy and immunotherapy. This case shows that pembrolizumab may improve prognosis in advanced lung cancer, even when complicated by cardiac tamponade. Patients with advanced lung cancer who develop cardiac tamponade can be treated with pembrolizumab and achieve long‐term prognosis without any serious adverse events. [ABSTRACT FROM AUTHOR]

In situ follicular B cell neoplasm, previously known as follicular lymphoma in situ, is a neoplastic proliferation of follicular lymphoma‐like B cells confined to the germinal centers. Herein, we report a case of a woman in her 70s who initially presented with several enlarged abdominal lymph nodes. Seven months later during follow‐up, a solitary pulmonary nodule was detected. As it was close to the hilum, lobectomy was performed. The intraoperative frozen section showed fibrosis and a collection of lymphocytes and macrophages. Therefore, the lymph nodes were sampled. Station 4 and 10 lymph nodes exhibited similar tumor cells and were immunohistochemically positive for CD10 and BCL2. Thus, the patient was diagnosed with in situ follicular neoplasm and is currently under observation. In situ follicular neoplasm is typically a slowly progressive neoplasm; however, it can present as a rapidly enlarging pulmonary nodule complicated by pulmonary aspergillosis. [ABSTRACT FROM AUTHOR]

Fungal bioprosthetic valve endocarditis is regarded as a rare, fatal disease. Severe aortic valve stenosis due to vegetation in bioprosthetic valves was also rare. Because biofilm formation is a factor related to persistent infection, the best outcomes for endocarditis are achieved in patients treated surgically with concomitant antifungal medicine. The mortality rate of endocarditis caused by Candida parapsilosis is high. As the drug of the first choice, liposomal amphotericin B should be selected. The best outcomes are achieved in patients who are surgically treated with concomitant antifungal drugs. [ABSTRACT FROM AUTHOR]

Abstract: Immunoglobulin (Ig) G4‐related disease has various clinical signs and symptoms, and steroidal therapy with corticosteroids has been found to be effective for treatment. Few cases of IgG4‐related disease associated with paravertebral tumor have been reported, and there have been no reports on complete resection of such a tumor. Here, we report a case of IgG4‐related disease associated with a paravertebral tumor that was successfully resected without the need for postoperative medication. An 84‐year‐old woman was admitted to our hospital with a paravertebral tumor. She underwent thoracoscopic surgery, and pathological examination of the tumor specimen revealed that the tumor resulted from IgG4‐related disease. After resection, there was no need for postoperative medication. Our case indicates the rare possibility of a paravertebral tumor associated with IgG4‐related disease and the potential for complete resection as a treatment for such a tumor. [ABSTRACT FROM AUTHOR]

Key Clinical Message: It has been proven that the Tachosuture technique is effective for preventing prolonged air leaks caused by pulmonary resection. We successfully used the Tachosuture technique to treat intractable pneumothorax with interstitial pneumonia. This technique avoids pulmonary resection and contributes to acute exacerbations of interstitial pneumonia. It has been proven that the Tachosuture technique is effective for preventing prolonged air leaks caused by pulmonary resection. We successfully used the Tachosuture technique to treat intractable pneumothorax with interstitial pneumonia. This technique avoids pulmonary resection and contributes to acute exacerbations of interstitial pneumonia. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old healthy man presented with asymptomatic third-degree atrioventricular block detected at annual check. Transthoracic echocardiography showed left ventricular ejection fraction and solid mass with homogenous echogenicity arising from the tricuspid atrioventricular junction was diagnosed. Surgery was performed with cardiopulmonary bypass, and the tumor had a smooth surface. The patient had an uneventful post-operative course and was discharged.

Development requires cell proliferation, migration, differentiation, apoptosis, and many kinds of cell responses. Cells prepare intracellular conditions to respond to extracellular cues from neighboring cells. We have studied the development of the cardiovascular system ( CVS) by visualizing morphology and signaling simultaneously using zebrafish, which express probes for both. Endodermal sheet is required for the bilateral cardiac precursor cell ( CPC) migration toward the midline. Endothelial cells ( ECs) proliferate specifically in the certain regions of blood vessels. Bone morphogenetic proteins ( BMP) induce the remodeling of the caudal vein plexus ( CVP) to form the caudal vein ( CV). Our findings point to the pre-existing neighboring cells as the cells exhibiting certain responses during the development of CVS. In this review, we introduce recent results of our research on angiogenesis and cardiogenesis by spotlighting the mechanism by which ECs and CPCs are regulated by the cells next to themselves. In addition, we discuss the unanswered questions that should be clarified in the future in the field of CVS development. [ABSTRACT FROM AUTHOR]

We describe the case of a 4-year-old boy whose clinical course after Kawasaki disease resulted in coronary artery bypass grafting ( CABG) due to acute myocardial infarction ( AMI) causing cardiogenic shock. He had developed an ischemic cardiomyopathy due to severe localized stenosis of the left main coronary artery ( LCA) and went into cardiogenic shock due to AMI on the day before a scheduled operation. He underwent successful emergency CABG within 4 h of MI. Postoperatively his neurological status was intact. This is the first report of a successful emergency CABG in a small child with cardiogenic shock due to LCA occlusion. CABG should be undertaken in small patients when appropriate indications exist, if bodyweight is >10 kg. [ABSTRACT FROM AUTHOR]

This case report describes abrupt heart rate fallings below the lower pacing rate limit in a patient with cardiac resynchronization therapy (CRT). Interrogated information including stored episodes or data regarding the lead did not show any device problems and only simultaneous intracardiac electrogram revealed the cause, T-wave oversensing during biventricular pacing. At this moment, CRT has become an established modality for patients with severe heart failure. However, bradycardia below the lower rate limit during biventricular pacing due to T-wave oversensing would exacerbate heart failure in patients with CRT. We should notice this latent risk and correct the malfunction immediately. (PACE 2010; 1-4) [ABSTRACT FROM AUTHOR]

A STAT3 (signal transducer and activator of transcription 3)- and a MEK/Erk-mediated signal can be activated by cytokines, including IL-6 (interleukin-6), PDGF, and EGF. Recently, STAT3 and an ERK-signal were shown to co-operatively activate the c-fos gene. Activation of a truncated form of the IL-6 receptor subunit, gp130, that had only one YXXQ motif, induced both c-Fos and JunB in NIH3T3 cells through STAT3 without an apparent increase in the AP-1 (activator protein-1) activity. In contrast, concomitant stimulation of the STAT3 signal and a MEK/Erk-signal markedly increased AP-1 activity with enhanced c-Fos expression. Surprisingly, the c-Fos induced by the YXXQ-signal alone was localized to the cytoplasm, from which it translocated into the nucleus following TPA (12-O-tetradecanoyl-phorbol 13-acetate) treatment in a MEK/Erk-dependent manner. c-Fos that was expressed from a constitutive promoter localized to the nucleus and did not move into the cytoplasm in response to the YXXQ-signal. Rather, the YXXQ-signal was required during c-Fos production for it to be retained in the cytoplasm. Thus, the YXXQ-signal induces c-Fos expression through STAT3 and anchors the new c-Fos in the cytoplasm. In addition, the YXXQ-signal and an Erk signal co-operatively cause c-Fos activation in the nucleus. [ABSTRACT FROM AUTHOR]

Recently it has been realized that some invariant sets representing chaotic synchronization states may have a riddled basin, which is a newly discovered complicated domain of attraction. Herein we propose a model of a riddled basin in chaotic synchronization. This model is composed of a tent map and a piecewise-linear map which can approximate the identity map arbitrarily closely. Therefore, this is one of the simplest models for explaining the existence of the riddled basin in chaotic synchronization. © 1997 Scripta Technica, Inc. Electron Comm Jpn Pt 3, 80(11): 21–29, 1997 [ABSTRACT FROM AUTHOR]

This paper considers the learning of discrete dynamical systems using recurrent neural networks. The discussion is based on the theory of the probabilistic descent method, and the learning algorithms are compared by numerical experiment. In the discussion based on the theory of the probabilistic descent method, it is shown that, from the viewpoint of the learning speed in the early stage of the learning, is equivalent to the backpropagation method with a large learning constant. For the case where the variable is not constrained to the value of the teacher signal and a chaotic time series with a large Lyapunov exponent is to be learned, it is found that the effect of the recurrent connections is not manifest at the early stage of the learning but the learning is accelerated with the progress of the learning by the fluctuation caused by the chaos. [ABSTRACT FROM AUTHOR]

Objectives: We retrospectively evaluated graft patency in patients who underwent no-touch aortic arterial off-pump coronary artery bypass grafting to determine the optimal selection of target vessels for improved graft patency of composite and sequential radial artery I-grafts., Methods: The radial artery was anastomosed to the end of an in situ internal thoracic artery and was sequentially anastomosed to non-left anterior descending arteries. This composite graft was defined as an "I-graft." We evaluated 145 I-grafts with 2, 3, or 4 sequential anastomoses (437 graft segments). A graft segment with the final distal anastomosis of every I-graft was defined as the last graft segment (LGS). When a sequential anastomosis was initiated from the left coronary branch, the I-graft assumed a clockwise course (69.0%). When a sequential anastomosis was initiated from the right coronary branch, the I-graft assumed a counterclockwise course (31.0%)., Results: On multivariable analysis, right coronary branch (P < 0.001), moderately stenotic (50-75%) target vessel (P = 0.004), and LGS with moderately stenotic target vessel (P = 0.005) were predictors of mid-term graft occlusion. In situations where the LGS was anastomosed to a severely stenotic target vessel (>75%) with a clockwise course, when the number of moderately stenotic target vessels among sequential graft segments was 0, 1, or ≥2, the mid-term graft patency rates of I-grafts were 94.0%, 86.0%, and 81.4%, respectively., Conclusions: The selection of target vessels for severely stenotic lesions among sequential graft segments and the clockwise course enhance the mid-term graft patency of sequential radial I-grafts., (© 2017 Wiley Periodicals, Inc.)

Background: Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention (PCI) was reported to promote better coronary and myocardial reperfusion. However, long-term mortality benefit of TA remains controversial. The objective of this study is to investigate the clinical impact of TA on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI., Methods and Results: The CREDO-Kyoto AMI Registry is a large-scale cohort study of acute myocardial infarction patients undergoing coronary revascularization in 2005-2007 at 26 hospitals in Japan. Among 5429 patients enrolled in the registry, the current study population consisted of 3536 patients who arrived at the hospital within 12 hours after the symptom onset and underwent primary PCI. Clinical outcomes were compared between the 2 patient groups with or without TA. During primary PCI procedures, 2239 out of 3536 (63%) patients underwent TA (TA group). The cumulative 5-year incidence of all-cause death was significantly lower in the TA group than in the non-TA group (18.5% versus 23.9%, log-rank P<0.001). After adjusting for confounders, however, the risk for all-cause death in the TA group was not significantly lower than that in the non-TA group (hazard ratio: 0.90, 95% CI: 0.76 to 1.06, P=0.21). The adjusted risks for cardiac death, myocardial infarction, stroke, and target-lesion revascularization were also not significantly different between the 2 groups., Conclusions: Adjunctive TA during primary PCI was not associated with better 5-year mortality in STEMI patients., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

We report a patient with giant right atrium and severe pulmonary dysfunction who underwent successful surgical volume reduction with significant improvement of pulmonary function studies., (© 2014 Wiley Periodicals, Inc.)

We report a patient with cardiogenic shock due to severely dilated cardiomyopathy who underwent complex, but comprehensive left ventricle (LV) repair. Preoperative investigation showed marked LV dilatation, poor LV function, severe mitral and tricuspid regurgitation, and total occlusion of two coronary arteries. We urgently performed (1) modified Batista operation which preserves the LV apex, (2) septal anterior ventricular exclusion (SAVE) operation, (3) mitral annuloplasty, (4) tricuspid annuloplasty, and (5) coronary bypass. Postoperative evaluation revealed good graft flow, reduced LV dimension preserving the elliptical shape, improved LV function, and minimal MR. Twenty-six months postoperatively, the patient has minimum clinical symptoms (NYHA: I).