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Purpose:To measure and explore complex cardiac anatomy in research and preoperative simulation, a virtual imaging technology-the Vesalius 3D suite (PS Medtech, Amsterdam, Netherlands)-combines Vesalius three-dimensional (3D) image-processing software with an optic-tracking navigation system running PST-Client software. We present a novel method of evaluating dynamic aortic root geometry in vivo using this visualization system., Description:Based on electrocardiography-gated cardiac computed tomography data in systole and diastole, images of the aortic root in a healthy adult were reconstructed for 3D visualization. Virtual interaction tools were used to explore and measure the aortic root structures., Evaluation:Virtually reconstructed images revealed the aortic root internal structures in exquisite detail. Highly accessible 3D interpretation promptly permitted precise measurements of repair-relevant anatomic parameters, including geometrically complex curves of the aortic root wall and dynamic changes in the aortic valves. Measurement accuracy examined against a known prosthesis showed within 1 mm of error (less than 0.5%)., Conclusions:This technology may promote understanding of aortic root form and function, and facilitate valve-sparing surgery, and seems valuable for 3D exploration and measurement of cardiac anatomy in vivo.

Perivascular adipose tissue (PVAT) secretes large amounts of inflammatory mediators and plays a certain role in atherosclerosis formation from the exterior of the vessel. In the present study, we examined the expression level of inflammation-related mediators using adipose tissue samples harvested from patients with and without coronary artery disease (CAD). The subjects were 23 patients who underwent elective coronary bypass surgery (CAD group) and 17 patients who underwent elective mitral valve surgery (non-CAD group) between January 2017 and March 2018. The adipose tissue was harvested from three sites: the ascending aorta (AO), subcutaneous fat (SC), and pericoronary artery (CO) for the measurement of the expression levels of interleukin (IL) -1β, IL-6, IL-10, tumor necrosis factor (TNF) -α, interferon (INF) -γ, and arginase (Arg) -1. In both the non-CAD and CAD groups, the expression levels of all mediators, except Agr-1, which showed a tendency to have higher levels in the SC than in the AO and CO, tended to upregulate in the AO than in the SC and CO. The CAD group had higher values of almost all mediators, except Arg-1. Most importantly, the expression levels of IL-1β, IL-6, and IL-10 in the coronary artery were significantly higher in the CAD group. The expression levels of inflammatory mediators in the pericoronary adipose tissue were significantly higher in the CAD than in the non-CAD group. The adipose tissue appears to influence atherosclerosis formation from the exterior of the coronary artery.

Background Acute coronary artery involvement (ACI) is a lethal complication of acute type A aortic dissection. Although ACI has been reported as one of the prognostic factors of acute type A aortic dissection, it does not always cause coronary ischemia. The extent of myocardial damage varies from case to case. Moreover, since the definition of ACI varies from paper to paper, it is unknown what the difference is between ACI with and without myocardial necrosis. In general, it can be assumed that cases with myocardial infarction have worse results. However, it is unknown how poor ACI is with myocardiac ischemia and how optimistic it is without it. This study compared the surgical results between the two groups of ACI with or without myocardiac ischemia. Methods Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation) and compared both groups. Results Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 minutes in the MI group, 250 minutes in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p=0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis). Conclusions Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% of them had myocardial ischemia with CK-MB elevation. As expected, the MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevationg.

Background Approximately 60% of adrenocortical carcinomas (ACC) are functional, and Cushing’s syndrome is the most frequent diagnosis that has been revealed to have a particularly poor prognosis. Since 30% of ACC present steroid hormone-producing disorganization, measurement of steroid metabolites in suspected ACC is recommended. Previous reports demonstrated that steroid hormone precursors or their urine metabolites, which can be assessed using liquid chromatography tandem mass spectrometry (LC-MS/MS) or gas chromatography mass spectrometry (GC-MS) respectively, are useful for distinguishing ACC from cortisol-producing adenomas (CPA); however, despite high precision, LC-MS/MS and GC-MS require a highly trained team, are expensive and have limited capacity. Methods Here, we examined 12 serum steroid metabolites using an immunoassay, which is a more rapid and less costly method than LC-MS/MS, in cortisol-producing ACC and CPA. Further, the correlation of each steroid metabolite to the classification stage and pathological status in ACC was analyzed. Results Reflecting disorganized steroidogenesis, the immunoassay revealed that all basal levels of steroid precursors were significantly increased in cortisol-producing ACC compared to CPA; in particular, 17-hydroxypregnenolone (glucocorticoid and androgen precursor) and 11-deoxycorticosterone (mineralocorticoid precursor) showed a large area under the ROC curve with high sensitivity and specificity when setting the cut-off at 1.78 ng/ml and 0.4 mg/ml, respectively. Additionally, a combination of androstenedione and DHEAS also showed high specificity with high accuracy. In cortisol-producing ACC, 11-deoxycortisol (glucocorticoid precursor) showed significant positive correlations with predictive prognostic factors used in ENSAT classification, while testosterone showed significant positive correlations to the Ki67-index in both men and women. Conclusion Less expensive and more widely available RIA and ECLIA may also biochemically distinguish ACC from CPA and may predict the clinicopathological features of ACC.

Objective:The aim of this study was to evaluate our surgical treatment outcomes of active infective endocarditis (IE) of mitral valve in relation to the patients' complexity scores., Methods:We reviewed 51 patients who underwent surgical treatment for active IE on the mitral valve, in our hospital between September 2002 and November 2016. We adapted a complexity scoring scale to describe the range of parts suffering vegetation and damage, assigning the following weighting: weight 1 for each posterior segment; weight 2 for each anterior segment, commissural segment, left atrium, or left ventricle; weight 3 if the annulus was involved or if pathology extended to a prior mitral operation site. A total of 51 patients were identified and categorized by complexity score into two groups: 1-2: Simple (n = 19); ≥ 3: Complex (n = 32)., Results:MV repair was achieved in 18 patients (95%) in the Simple group and 26 patients (81%) in the Complex group. In the Complex there were 2 in-hospital deaths (6%). There were none in the Simple. The 5-year survival rates were 100% in the Simple and 79.6% in the Complex (P < 0.05). The 5-year rates of freedom from mitral regurgitation were 77.8% in the Simple and 91.5% in the Complex (P = 0.63). The 5-year rates of freedom from recurrence of IE were 93.3% in the Simple and 92.2% in the Complex (P = 0.76)., Conclusions:We found consistent outcomes in terms of recurrent mitral regurgitation and recurrence of IE, regardless of lesion complexity.

A 19-year-old woman developed hypotension and abdominal distension during lumbar discectomy. Computed tomography revealed a right common artery injury and a large retroperitoneal hematoma. She was transferred to our hospital and brought to an angiography room directly. Endovascular balloon occlusion of the aorta was performed by cardiologists while surgeons were preparing for surgery. With the hemodynamics stabilized, the injured artery was repaired. In such a case, closing the artery as soon as possible, whether by clamping or by balloon occlusion, is vital. The ability to respond with a "Heart Team" is essential for a small-manpower hospital to rescue a patient with a serious condition.

This article describes the surgical techniques demonstrated in our video, “The Direct Aortic Cannulation for Acute type A Aortic Dissection”. Acute type A aortic dissection is a life-threatening condition requiring emergency operation. The choice of arterial cannulation sites to institute cardiopulmonary bypass is still a topic of controversy. Central cannulation directly through the ascending aorta has been reported (1,2). It has a theoretical advantage of not changing the natural antegrade blood flow, and in doing so avoiding intraoperative malperfusion. We believe that accurate positioning of the tip of an arterial cannula is best achieved with epiaortic echo guidance. We use the Seldinger method through the non-dissected part of the aortic wall in most cases, usually via the left side of the ascending aorta. In the current video presentation (Video 1), only the small posterior aspect was not dissected. The case was also complicated by intermittent myocardial ischemia, bicuspid aortic valve and significantly dilated ascending aorta. Video 1 The direct aortic cannulation for acute type A aortic dissection. Here we describe in detail our surgical technique for direct aortic cannulation by the Seldinger method with epiaortic guidance.

On March 11, 2011 at 14:46 (Friday), a massive magnitude-9.0 earthquake attacked large areas of northeastern Japan, including Sendai City. The huge earthquake generated catastrophic tsunamis, leading to unprecedented disasters in the seacoast areas of the Tohoku region (about 20,000 dead and missing persons). Upon this earthquake, in Tohoku University Medical Library, a 3-storey earthquake-resistant building, most of books fell down from bookshelves on the second and third floors, but the bookshelves remained steady because of the effective fixation. Many piles of fallen books blocked up the walkways and the narrow passages between the bookshelves; namely, books are easily transformed to dangerous weapons in a shaking building. Fortunately, all library staffs and users evacuated outside the building without even a scratch. Importantly, we were able to open the first floor of the Medical Library on March 14 (Monday), because the first floor has been used for the Learning Commons, with open space for group meetings. We thus provided students, medical staffs, and faculty members with the comfortable place during the early stage of the disasters. In fact, medical staffs and faculty members worked hard over weekend to deal with many patients and clear the post-quake confusions. Moreover, electricity, gas, or water supply was not yet restored in most areas of Sendai City. In the earthquake-prone zones, the Medical Library should function as a facility that not only enhances information gathering but also provides the place like an oasis of relaxation for students and medical staffs upon great earthquakes.

透析患者のESA反応性には，炎症，栄養状態，二次性副甲状腺機能亢進症，鉄代謝の状態等のさまざまな背景が影響を及ぼすと考えられている．近年，hepcidin-25が造血反応での鉄利用障害の要因の一つであるとの報告もあるがメカニズムに関しては不明な点も多い．本研究では，エポエチンベータ（EPO）による貧血治療中の透析患者のうち，過去半年間に2回以上，血清フェリチン値が100ng/mL以上を呈した29名を対象とし，患者をヘモグロビン（Hb）低値群（10g/dL未満）ならびにHb高値群（10g/dL以上）の2群に層別して，造血・鉄関連指標および炎症マーカーの群間比較を行い，造血反応に影響を及ぼす要因を検討した．その結果，hepcidin-25およびフェリチンはHb低値群で有意に高く（Hb低値群vs. Hb高値群，hepcidin-25：74.7±48.8 vs. 40.1±24.5ng/mL，p＝0.018；フェリチン：257±148 vs. 140±61ng/mL，p＝0.007），Hb低値群ではCRPが高い傾向を示し（0.41±0.55 vs. 0.14±0.23mg/dL，p＝0.074），CRPとHbとの間に有意な負の相関が認められた．またHb低値群では網状赤血球比率（RET‰）が高い傾向を示したが（12.9±4.5 vs. 9.9±4.2‰，p＝0.083），Hb上昇には反映されていなかった（9.4±0.6 vs. 10.5±0.5g/dL，p＜0.001）．本研究の結果，フェリチン100ng/mL以上のHb低値の透析患者では，高フェリチン・高hepcidin-25状態による鉄の囲い込み，またRET‰，CRPが高値を示す傾向から赤血球寿命の短縮，微小な炎症が起こっている可能性があり，それらがESA低反応の原因となっている可能性が示唆された．

Three dimensional capacitors of Pb(Zr,Ti)O3 [PZT] together with the Ru electrodes were tried to deposit by metal organic chemical vapor deposition for realizing high density ferroelectric random access memory (FeRAM). Good conformability was obtained for both of CVD-Ru and PZT layers on the trenched substrates by optimizing the deposition conditions. In addition, PZT films deposited on Ru bottom electrode showed the good compositional conformability. Finally we demonstrated the Ru/PZT/Ru three dimensional capacitor. These data accelerate the development of three dimensional PZT capacitors.

The efficacy of antimicrobial regimens for the treatment of uncomplicated gonococcal urethritis depends partially upon the period of time (therapeutic time) during which the drug concentration in the blood after the concentration peak is greater than four times the minimum inhibitory concentration for 90% of clinical isolates of Neisseria gonorrhoeae (MIC(90)). A therapeutic time of at least 10 h is suggested as an important determinant for elimination of 95% or more of the infection. In this study, therapeutic times for a single 400-mg dose of cefixime at various MIC(90)s were calculated, and pharmacokinetic profiles of double-dosing of 200 mg cefixime at various intervals were simulated. Subsequently, a dosing interval of 6 h was tested in 6 healthy Japanese men, and then 93 Japanese men with gonococcal urethritis were treated with a regimen of two 200-mg doses of cefixime given at a 6-h interval. For a single dose of 400 mg cefixime, therapeutic times were calculated to be 12.8, 9.1, 5.4, and 1.7 h for MIC(90)s of 0.06, 0.125, 0.25, and 0.5 microg/ml, respectively. In the simulation study of double-dosing of 200 mg cefixime at a 6-h interval, the therapeutic times for the MIC(90)s ofor =0.125 microg/ml were longer than 10 h. Of the 93 patients, 68 were evaluated for microbiological outcome, and N. gonorrhoeae was eradicated in 60 (88.2%). The MIC(90) of cefixime for the 61 isolates tested was 0.125 microg/ml. All strains with MICs ofor =0.06 microg/ml were eradicated, whereas 8 of 16 strains with MICs ofor =0.125 microg/ml persisted after treatment. This regimen would not be effective against infection by strains exhibiting cefixime MIC(90)s ofor =0.125 microg/ml. For such strains, a different regimen with a higher dose of cefixime would be required.

Even with curative surgery, renal cell carcinoma occasionally recurs in other organs, with fatal results. In this study, we identified independent prognostic factors for survival in patients with renal cell carcinoma after curative surgery.The records of 482 patients (mean age, 61.0 years; range, 17-90 years) who underwent curative surgery for renal cell carcinoma at Gifu University Hospital and its affiliated hospitals between 1991 and 2000 were reviewed. The average follow-up period was 42 months (range, 10-140 months). Clinical characteristics of the 482 patients were divided into three categories: patient factors (sex, age, performance status, and mode of tumor discovery), tumor factors (T classification, N classification, mode of infiltration, histological grade, and venous invasion), and treatment factor (whether or not adjuvant therapy with interferon-alpha was used). Stepwise multivariate Cox proportional hazards regression modeling was performed to identify independent determinants of survival.Of the patient factors, performance status and mode of tumor discovery were independent factors predicting survival. Of the tumor factors, venous invasion and mode of infiltration were independent factors predicting survival. Use or non-use of adjuvant therapy was not significantly associated with survival. Overall, performance status, venous invasion, mode of infiltration, and histological grade were shown to be independent prognostic factors, in descending order of importance.Performance status, venous invasion, mode of infiltration, and histological grade, in descending order, were the most important factors predicting survival after curative surgery for renal cell carcinoma.