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Daikenchuto (TJ-100) is a Japanese traditional herbal medicine that enhances postoperative enterokinesis and increases the intestinal blood flow. Daikenchuto has historically played a positive role in the perioperative management of gastrointestinal surgery. However, the effect of Daikenchuto on improving nutrition after cardiac operation has never been reported. This study evaluated the effect of Daikenchuto administration after cardiac operation. Eighty-four patients who underwent isolated first aortic valve replacement (AVR) at our department from May 2008 to December 2014 were enrolled in this study and retrospectively examined. We administered Daikenchuto when patients started their water intake. Blood tests were performed before and seven days after AVR. We prescribed Daikenchuto for 21 patients (group D). The reductions in the albumin level and prognostic nutritional index (p = 0.045, p = 0.008, respectively, multivariate analysis of variance) after the operation were significantly lower in group D (3.75 ± 0.3 to 3.33 ± 0.4 and 44.7 ± 4.8 to 41.3 ± 6.7 mg/dl, respectively) than in the group without Daikenchuto (group N, 63 patients) (3.74 ± 0.5 to 3.13 ± 0.4 and 44.6 ± 6.3 to 37.7 ± 5.3 mg/dl, respectively). There were no significant differences in the incidence rates of postoperative complications or hospitalization duration between the two groups. Postoperative Daikenchuto administration is considered to be safe and effective for improving the postoperative nutritional status after simple AVR as well as digestive surgery.

Objective: To evaluate limb-salvage surgery including vascular resection for lower-extremity soft-tissue sarcomas and carcinomas for adult patients. Materials and Methods: Eight consecutive patients (median age, 59 years) who underwent vascular replacement during surgery for malignant tumors in the lower limbs between November 2006 and March 2018 were evaluated. Patient data were retrospectively obtained in a computerized database. Arterial and venous reconstructions were performed for seven patients, with one additional patient receiving venous reconstruction only. Autologous-vein (n=6) and synthetic bypasses were used for arterial repairs, whereas only autologous veins were implanted for venous repairs. Results: Morbidity was 62.5%, and in-hospital mortality was 12.5%. At a median follow-up of 24 months, the primary patency rates of arterial and venous reconstructions were 85.7% and 62.5%, respectively. Limb salvage was achieved in all cases. Conclusion: Early and mid-term bypass patency rates, the high percentage of limb salvage, and the oncologic outcome underline the efficacy of en bloc resection of soft-tissue tumors involving major vessels of the lower limbs. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma and carcinoma resections. However, efforts to achieve better control over systemic spread are required for long-term survival.

Haptoglobin exerts renal protective function by scavenging free hemoglobin from the urine and blood stream in patients with hemolytic disorders. Recent studies elucidate the relationships between haptoglobin and inflammation. In addition, coagulopathy is often induced by systemic inflammation characterized by the presence of vascular endothelial damage. We hypothesize that haptoglobin might have an anti-inflammatory effect and affect hypercoagulability using rat burn model. Thirty anesthetized rats of six-weeks of age received over 30% full-thickness scald burn on the dorsal skin surface. All rats were injected with either haptoglobin (Hpt) or normal saline (NS) intraperitoneally. The rats were divided into three groups: 1) control group (NS 20 mL/kg); 2) low concentration of Hpt group, L-Hpt, (Hpt 4 mL (80 U) /kg+NS 16 mL/kg); and 3) high concentration of Hpt group, H-Hpt, (Hpt 20 mL (400 U) /kg). While under anesthesia, all rats were euthanized by exsanguination at 6 hours (N=5) and 24 hours (N=5). Inflammatory and anti-inflammatory cytokines were measured and whole-blood viscoelastic tests were performed by thromboelastometry (ROTEM). Haptoglobin significantly reduced free hemoglobin 24 hours after the injury. Improvement of hematuria was confirmed in the H-Hpt group. There were no differences in thrombin-antithrombin complex and plasmin-α2 plasmin inhibitor complex. The haptoglobin tended to decrease interferon-gamma (IFN-γ) in H-Hpt group. ROTEM findings of the L-Hpt group showed significantly higher clot firmness and shorter time to maximum clot formation velocity than the control group. Haptoglobin reduced INF-γ, and accelerated speed of clot formation in acute phase of severe burn.

A 67-year-old woman with recurrent gastrointestinal bleeding and aortic valve stenosis presented with spurting bleeding from angiodysplasia of the upper jejunum. As electrophoresis revealed decreased levels of high-molecular-weight (HMW) von Willebrand factor (VWF) multimers, she was diagnosed with Heyde's syndrome. After aortic valve replacement, her HMW VWF levels quickly recovered to normal, and the gastrointestinal bleeding ceased. However, capsule endoscopy still revealed gastrointestinal angiodysplasia six months later. This case shows that minute analyses of VWF multimers enable the diagnosis and confirmation of the resolution of Heyde's syndrome, and implies that gastrointestinal angiodysplasia can be attributed to unknown factors other than decreased VWF multimers.

Background The optimal management of a retrograde type A aortic dissection (RAAD) is controversial, and few reports have discussed the long-term outcomes of surgical strategies. To determine the most appropriate strategy, we studied the early and late outcomes of RAAD cases. Methods From 1998 to 2014, 44 patients with RAAD (mean age of 63 ± 11 years) underwent surgical repair. Ascending aortic replacement (AAR) was performed in 21 patients and ascending and total arch replacement (TAR) was performed in 23 patients. Eight of the patients who received TAR underwent complete resection of the primary tear in the distal arch or descending aorta (TAR-R[+]), whereas the remaining 15 patients received elephant trunk implantation as an alternative procedure for tear resection (TAR-R[–]). The early and late outcomes (mean follow-up, 86.5 months) were evaluated. Results Hospital mortality occurred in 4 of the 44 (9.1%) patients, with no mortalities among the patients undergoing TAR-R[–]. There was a tendency toward a higher incidence of late aorta-related events in the AAR group, with a significantly higher patency rate of the false lumen in the proximal site of the residual aorta compared with the TAR group ( p = 0.009). Furthermore, the 5-year rate of freedom from aortic growth greater than 50 mm was significantly lower after AAR than after TAR ( p = 0.04). A multivariate analysis indicated that the initial ascending aortic diameter (odds ratio [OR], 1.5; p = 0.02) and AAR (OR, 29.1; p = 0.01) were independent predictors of late aortic expansion. Conclusions The surgical outcomes were acceptable in both the AAR and TAR groups. The long-term outcomes potentially support the aggressive adoption of TAR in relatively younger patients with significant ascending aortic enlargement at presentation.

We evaluated a 49-year-old man with severe tricuspid valve regurgitation and coronary artery disease who had undergone congenital ventricular septal defect repair four decades previously. We found an enlarged, prolapsed commissure between the anterior and septal leaflets and a ruptured septal leaflet chorda. Two mattress sutures closed the commissure, with the leaflets' height matched by inverting the prolapsed site ventricularly. After implanting the annuloplasty band, we undertook chordal replacement using expanded polytetrafluoroethylene sutures. Artificial chorda length was determined using a small tourniquet and the saline test. Two coronary artery bypass grafts were also implanted. Postoperative echocardiography demonstrated no tricuspid regurgitation.

Background The aim of our study was to develop a completely scaffold-free, viable, contractile cardiac tissue capable of being grafted into the damaged native heart. Methods Our technology is based on the fundamental characteristics of the self-assembling nature of cells. We created contractile cardiac spheroids by plating a mixture of rat neonatal ventricular cardiomyocytes, human dermal fibroblasts, and human coronary microartery endothelial cells in ultralow attachment plates. First, the optimal cell ratios for the 3 cell sources were determined. Next, approximately 1 × 10 4 optimal spheroids were fused into a patch-like construct, and the morphologic characteristics and mechanical functions of these patches were evaluated. Finally, the cardiac patches were grafted into the hearts of F344 nude rats, and histologic studies were performed after transplantation. Results Synchronous beating of the cardiac patch was confirmed electrophysiologically and mechanically. A micronetwork of endothelial cells was also demonstrated in the construct, and the histologic study performed 5 days after transplantation showed the grafts to be viable, with functioning microvascular structures inside the graft tissue. Conclusions We consider the application of our scaffold-free 3-dimensional tissue engineering technology to cardiac regeneration therapy is feasible and expect that this technology will become a promising tool for the treatment of end-stage heart failure.

The aim of this study was to investigate the effects of exposure to whole-body vibration (WBV) and the ISO 2631/1-1997 frequency weighting on gastric motility. The gastric motility was measured by electrogastrography (EGG) in nine healthy volunteers. Sinusoidal vertical vibration at a frequency of 4, 6·3, 8, 12, 16, 31·5, or 63 Hz was given to the subjects for 10 min. The magnitude of exposure at 4 Hz was 1·0m/s2 (r.m.s.). The magnitudes of the other frequencies gave the same frequency-weighted acceleration according to ISO 2631/1-1997. The pattern of the dominant frequency histogram (DFH) was changed to a broad distribution pattern by vibration exposure. Vibration exposure had the effect of significantly reducing the percentage of time for which the dominant component had a normal rhythm and increasing the percentage of time for which there was tachygastria (p

Introduction: Small caliber synthetic vascular grafts are not clinically available. We developed a novel method to create scaffold-free tubular tissue from multicellular spheroids (MCS) using a “Bio-3D printer”-based system, which enables the creation of various three-dimensional structures pre-designed using a computer system. With this system, we created a tubular structure (Fig. 1), and studied its biological features. Methods: We made 1.5 mm in diameter scaffold-free tubular tissues from MCS (1.25 x 10[[Unable to Display Character: ⁷]] cells) composed of human umbilical vein endothelial cells (40%), human aortic smooth muscle cells (10%) and normal human dermal fibroblasts (50%) using a Bio-3D printer. The vessels were cultured in a perfusion system. We implanted grafts into the abdominal aortas of F344 nude rats, and assessed the flow by ultrasonography and performed histological examinations on the second (N=5) and fifth (N=5) days after implantation. Results: All grafts were patent. Remodeling of the vessel (enlargement of the lumen area and thinning of the wall) was observed (Fig. 2). A layer of endothelial cells was developed after implantation of the graft (Fig. 3). Conclusions: The scaffold-free vascular grafts made of MCS using a Bio-3D printer showed biological features comparable to native vessels. Further studies are warranted toward the clinical application of this novel technology.

As society ages, the composition of the diseases that occur within it changes accordingly. With that in mind, we examined the characteristics and trends in the recent inpatients and compared these recent inpatients with those of a previous report to identify the changes that accompany the aging of society. Subjects were 1,534 cases (men 56.9%, female 43.1%, average age 47.1 years) who were hospitalized at Kurume University Hospital for treatment during the 5-year period from January 1st, 1994 through December 31st, 1998. The ratio of inpatients over 65 years old was about 1.8 times higher than in the previous study, showing a clear trend toward an increased overall age of inpatients. As for the types of disease observed, the most common malignancies were epithelial tumor, followed by other benign tumors, as well as 76 cases which included diseases resembling tumor (epulis and exostosis etc.). A majority of the patients (55.6%) were directed to the Hospital by their dentist, a finding similar to that of the previous report. As for geographical distribution, 93.3% of the inpatients lived within 40 km of the center of Kurume City where our oral surgery is located, an increase of about 10% from the last report. In other words, our results showed a reduction in the sphere of treatment distribution.

The aim of the experiments was to observe whether or not there is an immune system reaction to vibration stress. Three vibration frequencies were randomly given to 6 male volunteers. The 63 Hz vibration frequency produced a significant decrease in the ratio of CD4 T-cell to CD8 T-cell. This finding suggests that acute vibration stress suppresses the immune system activity in humans body.

Objectives This study was carried out to determine the effects of the frequency of whole-body vibration on palmar sweating response and the activity of the central sympathetic nervous system. Methods Palmar sweating volume was measured on the right palm of six healthy men before and during 3 minutes of exposure to sinusoidal whole-body vibration at three different frequencies (16, 31.5, and 63 Hz). The whole-body vibration had a frequency-weighted, root mean square (rms) acceleration magnitude of 2.0 m/s 2 . As the index of the activated central sympathetic nervous system, saliva level of 3-methoxy-4-hydroxyphenylglycol (MHPG) was analyzed before and immediately after each vibration exposure. Results Each vibration frequency induced a palmar sweating response, that of 31.5 Hz being the largest. However, no significant difference was found between the three vibration conditions. Saliva MHPG increased in all the vibration exposures, and the largest change was observed at 31.5 Hz, the difference being significant. Conclusions Acute exposure to whole-body vibration induced a palmar sweating response and activated the central sympathetic nervous system. The effects on the central nervous system were found to be dependent on the frequency of the vibration.

Objectives This study attempted to elucidate the effects of hand-arm vibration frequency on palmar sweating response. Methods Palmar sweating was measured before and during vibration exposure on the right palm of six healthy men. The left hand was exposed for 3 minutes to the following root mean square (rms) acceleration magnitudes and frequencies of vibration: 5 m/s 2 at 31.5 Hz, 10 m/s 2 at 63 Hz, 20 m/s 2 at 125 Hz, 40 m/s 2 at 250 Hz, and 50 m/s 2 at 315 Hz. According to international standard ISO 5349, these vibration levels generate the same frequency-weighted acceleration magnitude of 2.5 m/s 2 rms. A control condition consisted of grasping a handle without vibration. As the index of the activated central nervous system, plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) was measured before and immediately after each vibration exposure.´ Results Each condition of vibration induced a palmar sweating response. Among the six vibration conditions, vibration of 125 Hz and 63 Hz caused large palmar sweating responses compared with those of 315 Hz and the control condition. Plasma MHPG did not increase significantly after either vibration exposure. Conclusions The palmar sweating response to vibration with the same frequency-weighted acceleration magnitude suggested dependency on frequency. The study suggests that the somatosympathetic reflex is associated with different palmar sweating responses.

Purpose The aim of our study is to develop completely scaffold-free, viable, contractile cardiac tissue which can be grafted to the damaged native heart. Methods and Materials Our technology is based on the fundamental characteristics of self-assembling nature of cells. We called these self-assembled spherical cell aggregates as “spheroids”. We created contractile cardiac spheroids by plating a mixture of 800 cells of rat neonate ventricular cardiomyocytes (RNVCM), 100 cells of human normal dermal fibroblasts (HNDFB), and 100 cells of human coronary micro-artery endothelial cells (HCMEC) in ultra-low-attachment plate. After 24 hr cultivation, prevascularized contractile cardiac spheroids were fabricated. Next, 10000 spheroids were fused into patch like construct with a maximum diameter of 1cm with 200μm in thickness. We evaluated morphological characteristics, and electro- and mechanical function. We also grafted the cardiac patch onto the heart of F344 nude rats, and performed histological study 3 weeks after transplantation. Results We confirmed synchronous beating of the cardiac patch electro-physiologically, and mechanically (video-motion analysis). Expression of connexin 43 (a component of gap junction) and micro network of endothelial cell in the construct were demonstrated. Histological study performed 3 weeks after transplantation showed that the grafts were viable with functioning micro-vascular structure inside the graft. [ figure 1 ] Conclusions We consider that applying our scaffold-free 3-Dimensinal tissue engineering technology to cardiac regeneration therapy is feasible. We expect that this technology will become a promising tool to treat end-stage heart failure.