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Plant architecture is a major determinant of planting density, which enhances productivity potential for crops per unit area. Genomic prediction is well positioned to expedite genetic gain of plant architectural traits since they are typically highly heritable. Additionally, the adaptation of genomic prediction models to query predictive abilities of markers tagging certain genomic regions could shed light on the genetic architecture of these traits. Here, we leveraged transcriptional networks from a prior study that contextually described developmental progression during tassel and leaf organogenesis in maize (Zea mays) to inform genomic prediction models for architectural traits. Since these developmental processes underlie tassel branching and leaf angle, 2 important agronomic architectural traits, we tested whether genes prioritized from these networks quantitatively contribute to the genetic architecture of these traits. We used genomic prediction models to evaluate the ability of markers in the vicinity of prioritized network genes to predict breeding values of tassel branching and leaf angle traits for 2 diversity panels in maize and diversity panels from sorghum (Sorghum bicolor) and rice (Oryza sativa). Predictive abilities of markers near these prioritized network genes were similar to those using whole-genome marker sets. Notably, markers near highly connected transcription factors from core network motifs in maize yielded predictive abilities that were significantly greater than expected by chance in not only maize but also closely related sorghum. We expect that these highly connected regulators are key drivers of architectural variation that are conserved across closely related cereal crop species., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Genetics Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Microelectrode arrays (MEAs) have applications in drug discovery, toxicology, and basic research. They measure the electrophysiological response of tissue cultures to quantify changes upon exposure to biochemical stimuli. Unfortunately, manual addition of chemicals introduces significant noise in the recordings. Here, we report a simple-to-fabricate fluidic system that addresses this issue. We show that cell cultures can be successfully established in the fluidic compartment under continuous flow conditions and that the addition of chemicals introduces minimal noise in the recordings. This dynamic cell culture system represents an improvement over traditional tissue culture wells used in MEAs, facilitating electrophysiology measurements., Competing Interests: Conflict of interestThe authors declare no conflicts of interest., (© The Author(s) 2024.)

Astrocytes are diverse brain cells that form large networks communicating via gap junctions and chemical transmitters. Despite recent advances, the functions of astrocytic networks in information processing in the brain are not fully understood. In culture, brain slices, and in vivo, astrocytes, and neurons grow in tight association, making it challenging to establish whether signals that spread within astrocytic networks communicate with neuronal groups at distant sites, or whether astrocytes solely respond to their local environments. A multi-electrode array (MEA)-based device called AstroMEA is designed to separate neuronal and astrocytic networks, thus allowing to study the transfer of chemical and/or electrical signals transmitted via astrocytic networks capable of changing neuronal electrical behavior. AstroMEA demonstrates that cortical astrocytic networks can induce a significant upregulation in the firing frequency of neurons in response to a theta-burst charge-balanced biphasic current stimulation (5 pulses of 100 Hz × 10 with 200 ms intervals, 2 s total duration) of a separate neuronal-astrocytic group in the absence of direct neuronal contact. This result corroborates the view of astrocytic networks as a parallel mechanism of signal transmission in the brain that is separate from the neuronal connectome. Translationally, it highlights the importance of astrocytic network protection as a treatment target., (© 2023 The Authors. Advanced Science published by Wiley-VCH GmbH.)

A 37-year-old man who had been on bromvalerylurea (BU) medication for 11 years at a maximum dose of 2,400 mg per day for headache therapy was admitted to our hospital due to gait disturbance. He had weight loss and exanthema all over his body. Cognitive dysfunction, intellectual deterioration, attention disturbance, decreased muscle strength, and decreased vibratory sense in the lower limbs were observed. Brain MRI showed diffuse brain atrophy, and a peripheral nerve conduction examination revealed decreased nerve conduction velocity and action potential amplitude in the extremities. We diagnosed him with chronic BU intoxication based on pseudohyperchloremia, BU detected in the blood, and bromide elevation. By discontinuing BU and performing intravenous infusion, neurological symptoms and exanthema were improved, and peripheral nerve conduction examination findings also improved. There are few reports of peripheral neuropathy cases of chronic BU intoxication; herein we report one such case along with previously reported cases.

Purpose: To evaluate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) and rectus sheath (RS) blocks in pain management and recovery after gynecological single-incision laparoscopic surgery (SILS)., Materials and Methods: Abilateral TAP block (Group A, n = 9), bilateral TAP and RS blocks (Group B, n = 10), and a bilateral RS block (Group C, n = 9) with 40 ml ropivacaine per patient were conducted in 28 patients undergoing SILS for ovarian tumors. A pain score and walking distance in a 6-minute walk test (6MWT) were examined., Results: Pain scores were significantly lower on postoperative day (POD) 3 than on POD 1 in Groups B (p = 0.03) and C (p = 0.02). The walking distance on POD 3 was comparable with that before surgery in Group C (p = 0.75), but shorter in Groups A (p = 0.004) and B (p = 0.02)., Conclusions: The RS block alone was the most effective in relieving pain and accelerating general recovery after gynecological SILS.

A 64-year-old man without any psychiatric disease, including Parkinson's disease underwent aortic valve replacement and mitral valve replacement for rheumatic valvular disease. One day after the cardiac surgery, he developed hyperthermina, muscle rigidity, coma and delirium, and his serum creatine kinase (CK) level was elevated. In spite of his negative brain computed tomography(CT), his consciousness remained unclear. He had received diazepam, flunitrazepam and buprenorphine after the cardiac surgery because of his hyper-reactivity. Although these drugs were not typical antipsychotics' causing neuroleptic malignant syndrome (NMS), NMS was strongly suspected because of his clinical appearance. Dantrolene was administered in a dose of 60 mg per day and he recovered consciousness and his CK level began to decrease. We reported a case of neuroleptic malignant syndrome after cardiac surgery.

Objectives: Adalimumab, a fully human anti-tumor necrosis factor monoclonal antibody, was retrospectively evaluated for its effect on musculoskeletal manifestations and health-related quality of life in patients with psoriatic arthritis (PsA) during daily clinical practice., Methods: Patients who initiated adalimumab therapy after March 2010 were followed for at least 24 weeks with the clinical outcome measures. Eleven patients, all men with a mean age of 45.4 years, had mean psoriasis durations of 16.2 and 8.4 years at baseline., Results: After 24 weeks, 72.7, 63.6, and 45.5 % of the patients met the ACR 20, 50, and 70 response criteria, respectively, while 81.8 % achieved the PsA response criteria. Disease Activity Score using the 28-joint count and CRP declined from 3.2 ± 1.2 at baseline to 1.3 ± 0.4 at week 24 (P < 0.01). The Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index scores also decreased significantly (both P values were <0.01). After 24 weeks, three out of eight dimensions of the Medical Outcomes Study 36-Item Short Form Health Survey and Physical Component Summary were significantly improved (all P values were <0.05)., Conclusions: Adalimumab exerted its effect as early as week 4, and it was sustained until the end of the 24-week observation period in the PsA patients.

We previously showed that carbon ion irradiation can inhibit the expression of the anillin (ANLN) gene, which is regulated by the activation of the phosphatidylinositol-3-kinase (PI3K)/Akt signaling pathway associated with metastasis. The purpose of this study is to compare the effects of carbon ion irradiation on the PI3K/Akt signaling pathway to those of photon irradiation. Our study showed that carbon ion irradiation of human lung adenocarcinoma cells A549 decreased their invasion more effectively than photon irradiation did. We found that carbon ion irradiation reduced the nuclear localization of ANLN at lower dose, but did not affect its expression. Low-dose carbon ion irradiation also reduced the level of phosphorylated Akt compared to untreated controls, whereas photon irradiation did not. These results suggest that carbon ion irradiation effectively suppresses the metastatic potential of A549 cells by suppressing the PI3K/Akt signaling pathway.

Abnormal reactions accompanied by bone formation in the osteoarticular region induced by long-term administration of etretinate have been reported. We treated a patient who received continuous treatment of psoriatic erythroderma with etretinate for 7 years, and who had an osseous bridge that extended across the acetabulum over the femur on both sides. The patient experienced a major gait disturbance and eventually was unable to walk. Functional gait was restored by resecting the ossified regions and radiotherapy. Histologic sections of the ossified lesions showed enchondral ossification in the ligament attachment site in the joint margin, with advancing ossification along the articular capsule; the pattern was similar to that in diffuse idiopathic skeletal hyperostosis. This is the first report of an osseous bridge associated with long-term administration of etretinate extending across the acetabulum over the femur on both sides.

Purpose: Control of cancer metastasis is one of the most important issues in cancer treatment. We previously demonstrated that carbon particle irradiation suppresses the metastatic potential of cancer cells, and many studies have reported that photon irradiation promotes it. The purpose of this study was to investigate the effect of carbon beam on non-small-cell lung cancer (NSCLC) cell aggressiveness and gene expression., Methods and Materials: A549 (lung adenocarcinoma) and EBC-1 (lung squamous cell carcinoma) cells were treated with 290 MeV/nucleon carbon ion beam at the Heavy Ion Medical Accelerator in Chiba or with 4-MV X-ray at Osaka University. We tested proliferative, migratory, and invasive activities by cell proliferation assay, Boyden chamber assay, and Matrigel chemoinvasion assay, respectively. cDNA microarray and reverse transcription polymerase chain reaction were also performed to assess mRNA expression alteration., Results: X-irradiation increased cell proliferation of A549 cells at 0.5 Gy, whereas high-dose X-ray reduced migration and invasion of A549 cells. By contrast, carbon beam irradiation did not enhance proliferation, and it reduced the migration and invasion capabilities of both A549 and EBC-1 cells more effectively than did X-irradiation. Carbon beam irradiation induced alteration of various gene expression profiles differently from X-ray irradiation. mRNA expression of ANLN, a homologue of anillin, was suppressed to 60% levels of basal expression in carbon beam-irradiated A549 cells after 12 h., Conclusion: Carbon beam effectively suppresses the metastatic potential of A549 and EBC-1 cells. Carbon beam also has different effects on gene expressions, and downregulation of ANLN was induced only by carbon beam irradiation.

It is well known that mobile or large left atrial myxoma may lead to valve obstruction and insufficiency, and affect transmitral valve flow. A 50-year-old woman with a huge left atrial myxoma occluding the mitral valve was reported. The tumor was diagnosed by preoperative echocardiogram and mitral regurgitation was minimum. During the operation and after the myxoma resection, a severe mitral regurgitation, which was not observed during the preoperative echocardiogram, was noticed. Mitral valve defect was corrected by an annuloplasty ring, and the patient had an uneventful recovery. Our case suggests that careful evaluation of mitral valve during a myxoma resection operation is recommended.

Non-steroidal anti-inflammatory drugs (NSAIDs) are known to be risk factors for a systemic inflammatory syndrome in viral infections. Innate immune cells are likely to represent the preferential targets for the deleterious effects of NSAIDs in patients with viral infections. We therefore examined whether various classes of NSAIDs could selectively inhibit cytokine production by innate immune cells. NSAIDs selectively inhibited interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha production by natural killer (NK) and gammadelta T cells with each NSAID displaying its own unique pattern of inhibition, while sparing that by acquired immune cells. These inhibitions were independent on cyclooxygenase inhibition. These NSAIDs directly inhibited the cytokine production by the purified gammadelta T-cell population without involving other cell populations. The selective inhibition of the early generation of IFN-gamma and TNF-alpha from NK and gammadelta T cells by NSAIDs may serve to drive the subsequent acquired immune responses towards a Th2 phenotype, leading to the aggravation of allergic symptoms. Our results provide a mechanism to explain the deleterious effects of NSAIDs on clinical symptoms of viral infections and allergic diseases and suggest more targeted use depending on the type of disease.

Innate immune cells mediate a first line of defense against pathogens and determine the nature of subsequent acquired immune responses, mainly by producing profound amounts of cytokines. Given these diverse tasks, it is predictable that defective NK and gammadelta(+) T cell responses could be the underlying mechanism for the immunological alterations observed in atopic dermatitis (AD). Indeed, the frequencies of circulating NK cells and gammadelta(+) T cells were profoundly reduced in AD patients. They also displayed a defective ability to sustain TNF-alpha and IFN-gamma, but not IL-4, production after in vitro stimulation, and the defect was restricted to innate immune cells. Surprisingly, on the depletion of CD14(+) monocytes, this selective impairment of TNF-alpha and IFN-gamma production was restored to levels comparable to that observed in controls. Release of IL-10 from monocytes was not a major mechanism of the NK and gammadelta(+) T cell dysfunction. Apoptosis as revealed by annexin V binding, was preferentially observed in NK and gammadelta(+) T cells from AD patients when stimulated in the presence of monocytes, and depletion of monocytes significantly protected these cells from apoptotic cell death. Preferential apoptosis of NK cells by activated monocytes in AD patients was cell-contact-dependent. These results indicate that, once NK and gammadelta(+) T cells in AD patients are in immediate contact with activated monocytes, these cells are specifically targeted for apoptosis, leading to the reduced type 1 cytokine production, thereby directing subsequent acquired immune responses toward a type-2 pattern and increasing susceptibility to infection.

A relationship between viral infections and the simultaneous or subsequent development of allergic inflammation has often been observed in various clinical situations. Recent studies suggest an intimate relationship between reactivations of herpesviruses including human herpesvirus 6 (HHV-6) and the development of a severe systemic hypersensitivity reaction referred to as drug-induced hypersensitivity syndrome (DIHS). This syndrome has several important clinical features that cannot be solely explained by drug antigen-driven oligoclonal expansion of T cells: they include paradoxical worsening of clinical symptoms after discontinuation of the causative drug. In view of the similarity to GVHD or immune reconstitution syndrome (IRS) in clinical manifestations and emergence of viral infections, the clinical symptoms observed during the course of DIHS and GVHD are likely to be mediated by antiviral T cells that can cross-react with the drug and alloantigens, respectively. In considering common intrinsic properties of the causative drugs to potentially induce immunosuppression, reconstitution of a valid immune response to these viruses, which is typically observed in IRS, may be the most crucial process that takes place after withdrawal of the causative drug in patients with DIHS. Thus, this syndrome should be regarded as a reaction induced by a complex interplay among several herpesviruses (EB virus, HHV-6, HHV-7, and cytomegalovirus), antiviral immune responses, and drug-specific immune responses. This review includes discussion of the pathomechanism, the clinical symptoms, laboratory findings, pathological findings and therapy.

Drug-induced hypersensitivity syndrome (DIHS) is a severe multi-organ system reaction caused by specific drugs. Many reports have revealed that human herpesvirus 6 (HHV-6) reactivation contributes to the development of DIHS. In addition, recent articles have shown that reactivation of other herpesviruses such as human herpesvirus 7 (HHV-7), Epstein-Barr virus (EBV), cytomegalovirus (CMV) might be also implicated in the development of DIHS. These observations suggest that not only HHV-6 but also other herpesvirses might reactivate from the latency and play an important role in the appearance of clinical manifestations of DIHS. Several patients with DIHS were treated with intravenous immunoglobulin (IVIG) in addition to systemic corticosteroids. The results have been encouraging although virus reactivation could not be suppressed. Although the pathomechanism of IVIG treatment in patients with DIHS remains unknown, the therapeutic effects of IVIG could be dependent, in part, on functional capabilities of anti-virus IgG contained in IVIG.

Viral infections are frequently followed by an increased risk of allergic disorders. We have recently demonstrated an intimate relationship between human herpesvirus 6 (HHV-6) reactivation and drug-induced hypersensitivity syndrome (DIHS). Kano et al. have demonstrated that a dramatic decrease in circulating B and NK cells as well as serum immunoglobulin levels was observed in DIHS at the onset but not in controls. Although these alterations returned to normal on full recovery, NK cells in patients with DIHS displayed a defective ability to express CD122 (IL-2/15R beta) even long after recovery. To test the effect of NK cells, we next investigated NK-depletion experiments. A significant increase in HHV-6 DNA was only detected in NK-depleted cultures of PBMC from DIHS patients in the presence of the causative drug. Because gamma delta-T cells play an important role in viral infections, we investigated whether gamma delta-T cells are also important for preventing HHV-6 reactivation. Expansion of gamma delta-T cells was only observed in undepleted cultures of PBMC, not in NK-depleted cultures, from patients in the presence of the causative drug. Thus, cross-talk between NK cells and gamma delta-T cells or B cells would represent a first line of defense against latent virus, such as HHV-6.

Background: Anticonvulsant hypersensitivity syndrome (AHS) is a life-threatening, drug-induced, multiorgan system reaction. The identification of predisposing factors is clearly needed to predict the incidence and outcome of AHS; attention has recently been focused on reactivation of human herpesvirus 6 (HHV-6)., Objective: To determine whether immunosuppressive conditions that can allow HHV-6 reactivation could be specifically detected in association with the onset of AHS., Design: We analyzed patients with AHS who were treated during 1997-2002. Two groups of patients receiving anticonvulsants served as controls., Setting: Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan. Patients Ten patients with AHS., Main Outcome Measures: The results of serologic tests for antibody titers for various viruses, including HHV-6, HHV-6 DNA detection by real-time polymerase chain reaction, immunoglobulin levels by turbidimetric immunoassay, IgG subclass levels by nephelometry, and CD19(+) B-cell counts by flow cytometric analysis, were sequentially assessed., Results: Serum IgG levels (mean, 745 mg/dL) and circulating B-cell counts (mean, 88/ micro L) in patients with AHS were significantly decreased at onset compared with control groups (P<.001 and P =.007, respectively). These alterations returned to normal on full recovery. Reactivation of HHV-6 as judged by a greater than 4-fold increase in HHV-6 IgG titers was exclusively detected in most patients with AHS associated with decreased IgG levels and B-cell counts., Conclusions: A decrease in immunoglobulin levels and B-cell counts can be associated with HHV-6 reactivation and the subsequent onset of AHS. These immunological alterations might be a useful predictor of the development of AHS.

An unusual case is reported here of a patient with internal iliac artery aneurysm who developed massive hematuria after cystoscopic examination. A 75-year-old man presented with asymptomatic gross hematuria. Cystoscopic examination revealed that the bladder neck was congested and that the right-side wall was being pressed on by an extrinsic mass. Computed tomography showed a right internal iliac artery aneurysm and tortuous perivesical vessels. Three days after the cystoscopic examination the patient suffered massive hematuria. Hemorrhage due to an arteriovesical or arterio-ureteral fistula secondary to rupture of the internal iliac artery aneurysm was suspected, and an emergency operation was performed. At operation the aneurysm had not ruptured but overswelling perivesical vessels were found to have developed, and these fed a high blood flow to the bladder neck. In the present case cystoscopic examination injured the mucosa and led to massive hemorrhage from the bladder neck.

Rupture of type III aortic dissection into the bilateral pleural space is very rare. A 62-year-old man was transferred to our department because of aortic dissection for emergency operation. computed tomography (CT) scan revealed rupture of type III aortic dissection into the bilateral pleural space. He underwent successful prosthetic graft replacement through left thoracotomy and removal of a massive amount of blood from the right pleural space by chest tube drainage. The postoperative course was uneventful after 2 days of respiratory support.

We describe a patient with eosinophilic pustular folliculitis (EPF) who initially responded to oral indomethacin, the most often-used therapy for EPF, but eventually became refractory to continuous administrations. Treatment with metronidazole resulted in complete clearance of the lesion.

Successful simultaneous operation for cardiac and lung disease was performed in a 71-year-old man with lung carcinoma and ischemic heart disease. Chest CT scan revealed a mass in the right lower lobe and absence of mediastinal lymphadenopathy. Coronary angiography revealed significant stenosis of the left anterior descending artery, circumflex artery and right coronary artery. We performed concomitant video-assisted right lower lobectomy with mediastinal lymph node dissection as a form of less invasive surgery and triple coronary artery bypass grafting under cardiopulmonary bypass. Curative surgery for lung carcinoma and complete revascularization for ischemic heart disease were completed. The postoperative course was uneventful.

We performed posterior lumbar interbody fusion (PLIF) on 7 patients with rheumatoid spondylitis (RA) of the lumbar spine with severe low-back pain and/or cauda equina symptoms, and evaluated the effectiveness of PLIF for the lumbar spinal instability in RA secondary to destruction of the anterior elements, including vertebral endplates and the apophyseal joint. The subjects were 7 patients with classic RA, 2 men and 5 women, mean age 65 years old, and the mean duration of RA was 21 years. All had severe low-back pain and difficulty with walking. According to the ARA classification, the patients were at stage 3 or worse and in class 3. Diagnostic imaging including magnetic resonance imaging (MRI), tomography, myelography, and computed tomographic myelography (CTM) of the lumbar spine clearly delineated pathology, destruction of the vertebral endplate, subluxation, and cauda compression which can be well treated with PLIF. We performed L4/5PLIF (5 cases), L3/4 and L4/5 PLIF (2 cases), and posterior fixation with instruments for anterior column repair and stabilization and posterior decompression. Autografts (all cases) and Brantigan IF cage (2 cases) were used. Stable fixation of the lumbar spine was achieved after surgery, and improvement in gait and activities of daily living were achieved through the relief of low-back pain and radicular pain; the mean duration of follow-up was 22 months. Postoperative, plain radiography, CT, and MRI revealed the enlargement of the lumbar canal and fusion and incorporation of grafted bone, but in some cases, collapse of graft, migration of pedicle screw, instability of adjacent level, and collapse of adjacent vertebra were noted. PLIF with spinal instruments is a preferred treatment for rheumatoid spondylitis of the lumbar spine, but in the mutilating type of RA with severe osteoporosis, PLIF in combination with a long fixation system and/or augmentation of the vertebral bodies might be needed.

Background: Linear supralymphatic eruptions with epidermal involvement have rarely been reported., Objective: A search was made for apparent anatomical reasons and for external factors to explain the unique distribution pattern and clinical course in three cases in which the linear lesions occurred shortly after a minor injury., Methods: Efforts to search for its etiology include careful outlining of the localization, bacterial culture from the site of traumatic injury, patch tests, and skin biopsies., Results: Linear lesions developed along superficial lymphatic vessels and the presence of eczematous conditions around the injured sites and isolation of Staphylococcus aureus from the site were observed concomitantly. The histopathological findings showed interface dermatitis., Conclusion: Our cases provide a unique example of the combined effects of a bacterial infection and contact allergens in the development of the linear supralymphatic eruptions., (Copyright 2001 S. Karger AG, Basel)

Protochlorophyllide contents and the spectral properties together with photoactivities of native protochlorophyllide forms have been studied in dark-forced stems of 26 and epicotyls or hypocotyls of 9 plant species. The 77 K fluorescence emission spectra show that a form emitting at 629-631 nm is general in these organs. Besides this short-wavelength form, other protochlorophyllide forms emitting at 636, 645 and around 650-655 nm are found with various relative amplitudes. The pigment contents show good correlation with the ratio of short- to long-wavelength forms, i.e., the higher this ratio is, the less protochlorophyllide is detected. In addition to protochlorophyllide, several dark-grown plants also contain chlorophylls. In some cases only one chlorophyll form appears with emission maximum at 678-680 nm; other plants have forms characteristic of the fully developed photosynthetic apparatus (with maxima at 685, 695 and 730-740 nm). Flash illumination can transform only the 645 and 650-655 nm protochlorophyllide forms, the shorter-wavelength-emitting forms being inactive. Plant species with dominating 629-636 nm protochlorophyllide forms cannot accumulate chlorophyll on continuous illumination of natural intensity, and they became photodamaged. The structural or molecular background of the appearance of the different protochlorophyllide and chlorophyll forms and the reasons for their photosensitivity are discussed.

This study was performed to evaluate the advantages of video-assisted minithoracotomy over conventional posterolateral thoracotomy for performing lobectomy of lung carcinomas. Thirty-two patients with clinical T1N0M0 non-small cell lung carcinoma underwent lobectomy with R2a mediastinal lymphadenectomy. Of these, sixteen patients underwent posterolateral thoracotomy (between April 1994 and November 1995: T group), and sixteen patients underwent video-assisted thoracic surgery (between December 1997 and April 1999: V group). No significant differences were found in the two groups with respect to the total number of mediastinal lymph nodes dissected (T group: 16.9 +/- 8.7. V group: 14.3 +/- 7.2) or operative time (T group: 182.3 +/- 48.8 min, V group: 174.9 +/- 28.8 min). The intraoperative blood loss was significantly less in the V group (T group: 222.3 +/- 107.1 ml, V group: 143.3 +/- 92.6 ml, p < 0.05), and the postoperative max CPK was also less (T group: 1,484 +/- 496, V group: 785 +/- 327, p < 0.0001). Duration of chest tube drainage (T group: 11.3 +/- 3.6 days, V group: 7.9 +/- 2.7 days) and the requirement of epidural analgesia (T group: 6.7 +/- 2.2 days, V group: 5.0 +/- 0.8 days) were less in the V group (p < 0.01), and the length of postoperative hospitalization as also shorter in the V group (T group: 26.3 +/- 8.3 days, V group: 20.6 +/- 4.1 days, p < 0.05). In conclusion, video-assisted minithoracotomy is less invasive than posterolateral thoracotomy for performing lobectomy of lung carcinomas, and has an advantage in that it improves the postoperative quality of life.

We sought to demonstrate a correlation between low-back pain (LBP) and the plain radiographic findings of the lumbar spine in the general population based on an analysis of 838 persons, 387 of whom presented with complaints of low-back pain. The incidence of intervertebral narrowing and irregular ossification of the vertebral end-plate image increased consistently with age and was higher in the presence of LBP in any age or gender group. Multiregression analysis was performed with the imaging factors as multivariates. As a result, multiregression equations with irregular ossification of the vertebral end-plate image, intervertebral narrowing, spondylolisthesis and abnormal lumbar lordotic angle combined as variates showed the highest significance as predictors of a relationship with LBP. The discrimination analysis was performed using the linear discriminant function, resulting in a true discrimination rate of 65%. Plain radiography of the lumbar spine is thus significant as it provides information which can be evaluated as meaningful findings in the investigation of LBP. In addition, while the significance can be increased by considering multiple factors, it is important to understand the limits of the accuracy of this prediction.

Twenty-six nonrandomized patients undergoing emergent coronary artery bypass operation were assigned to either the cold group (traditional intermittent cold blood cardioplegia and slight hypothermic cardiopulmonary bypass (n = 7) or the warm group (intermittent warm blood cardioplegia and normothermic cardiopulmonary bypass) (n = 19). Preoperative variables were similar in both groups except the number of renal dysfunction patients were greater in the cold group. The time from removal of the aortic crossclamp to discontinuation of cardiopulmonary bypass was significantly shorter in the warm group and the incidence of heartbeat spontaniously converted to normal sinus rhythm after removal of the aortic crossclamp was higher in the warm group. The warm group showed good results concerning postoperative blood loss volume, change of base excess, time required for awakening and extubation. Significant differences were found in the hospital mortality rates between the groups (cold: 57.1%, warm: 5.3%). This study suggested a beneficial influence of warm heart surgery on postoperative hemodynamics, metabolic recovery and hospital mortality in emergent coronary artery bypass grafting.

A 77-year-old woman was admitted to our hospital with congestive hepatic dysfunction and combined valvular disease. In addition to aortic stenosis, mitral stenosis, and tricuspid regurgitation, multi-organ dysfunction consisting of hepatic cirrhosis, pulmonary dysfunction and renal dysfunction were found. In consideration of the patient's anxiety for surgical treatment, we performed aortic valve replacement, open mitral commissurotomy and tricuspid annuloplasty. Although the patient required hemofiltration for 2 days and an assist of catecholamines for 1 month, she improved better and was discharged at 2 months after surgery. As preoperative assessment of preliminary function of other organs is difficult in the elderly, indications for surgery and optimal surgical procedures must be investigated in each case.

A 72-year-old man underwent a three-stage operation for aneurysms of the distal aortic arch, descending thoracic aorta, and infrarenal abdominal aorta. Graft replacement of the abdominal aortic aneurysm was performed as an emergency because of suspicion of impending rupture. Operations for the aneurysms of the thoracic descending aorta and distal aortic arch were performed 2 months and 4 months later, respectively. The patient was well 16 months after discharge from the hospital. This is the first report of the successful three-stage surgical treatment of three isolated aortic aneurysms. The therapeutic principles for multifocal aortic aneurysms remain controversial. The strategy of surgical treatment for multifocal aortic aneurysms is discussed and previous literature is reviewed.

The use of mitral valvuloplasty for the repair of mitral valve prolapse in members of a family has been reported only rarely. Patient 1 was a 71-year-old man, and patient 2 the son of patient 1 was a 47-year-old man. Both patients had a grade 3/4 mitral valve regurgitation due to tendon rupture of the posterior leaflet. The procedure was quadrangular resection of the posterior leaflet with annulorrhaphy and ring annuloplasty. The results were good in both cases. Histopathological analysis of a specimen resected from the mitral valve revealed myxomatous degeneration in both cases. These case reports suggest that there is a genetic basis for mitral valve prolapse.

A 81-year-old man was admitted to our hospital because of hoarseness. Chest CT scan and aortogram showed distal arch aneurysm measuring 7.5 cm in diameter. Under deep hypothermia and selective cerebral perfusion, the distal aortic arch aneurysm was completely replaced with a woven Dacron graft with three limbs for the arch vessels. After the aortic cross clamp was released, severe low output syndrome (LOS) continued because of perioperative myocardial infarction. Then, a coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD) was performed, after which the cardiopulmonary bypass was easily weaned under intra-aortic balloon counterpulsation (IABP) assistance. The postoperative course was uneventful. The perioperative myocardial infarction was thought to be induced by left coronary spasm, as comparison of the preoperative and postoperative coronary arteriograms showed no change.

Descending necrotizing mediastinitis (DNM) is extremely rare and one of the most lethal forms of mediastinitis, even in the era of antibiotics. We have recently treated a 65-year-old man who was diagnosed as having a fistula to the right main bronchus caused by DNM secondary to a peritonsillar abscess. Surgical treatment consisted in closing the right bronchial fistula and covering it with the latissimus dorsi muscle flap and mediastinal drainage through thoracotomy. Postoperative course was uneventful. This is the second known reported case of a successful operation for DNM with bronchial fistula.

A 52-year-old woman was diagnosed by echocardiography to have a fistula of the right coronary artery (RCA) and the right atrium (RA). Aortography demonstrated a remarkably dilated and undulating fistulous tract originating from the region corresponding to the orifice of the normal RCA. The fistulous tract detoured to the posterior wall of the RA, and forming 2 aneurysms there, opened to the RA. A RCA of normal size originating midway of the fistulous tract was also observed. The patient was operated on under cardio-pulmonary bypass. Aortocoronary saphenous vein graft to the RCA having normal diameter was performed, and the RCA was ligated in the proximal side of the anastomosis. The orifice of the fistulous tract from the aorta was closed with a patch and the entrances into the RA were also closed by pledgetted mattress sutures. The post operative course was uneventful and the patient is now doing well without any complaints.

Mucoepidermoid carcinoma of the lung presenting in childhood is extremely uncommon. A 7-year-old girl was referred to our hospital with complaint of persistent cough and abnormal shadow on the chest roentgenogram. Bronchoscopic biopsy revealed a bronchial mucoepidermoid carcinoma and a left pneumonectomy was performed. The histopathological examination revealed intermediate grade malignancy without any metastasis in mediastinal lymph nodes. She is now doing well without any evidence of recurrence 2 years after the operation.

A 47-year-old man who had undergone surgery of a dissecting thoracic aortic aneurysm was admitted for a localized, dissecting abdominal aortic aneurysm. Preoperative coronary arteriogram incidentally showed a coronary artery aneurysm (CAA) of the left main trunk. Prior to the operation for abdominal aortic aneurysm, that for the CAA was performed under standard cardiopulmonary bypass conditions with antegrade and retrograde coronary sinus cold blood cardioplegia. A longitudinal incision of the aneurysmal wall was made for the removal of a small thrombus and, the ostia of the left anterior descending artery (LAD), circumflex artery (LCX), intermediate artery (IM) and main trunk were closed from the inside of the aneurysm. The aneurysmal wall was closed without resection of the whole aneurysm. Finally, coronary artery bypass grafting to LAD, LCX and IM was performed. Postoperative course was uneventful with patency of all grafts. The retrograde coronary sinus cardioplagia is effective to prevent thromboembolism of distal coronary arteries due to the antegrade cardioplagia.

We evaluated the residual false lumen of type I and IIIb dissecting aneurysm by CT, MRI and angiography postoperatively. The 19 patients with type I dissecting aneurysm were included eleven men and eight women, the average age was 55.8 +/- 10.2 years old. The 20 patients with type IIIb dissecting aneurysm were included sixteen men and four women, the average age was 56.2 +/- 8.5 years old. The rate of distal patent false lumen was 52.6% of type I and 35% of type IIIb dissecting aneurysm after graft replacement surgery. In type I dissecting aneurysm, the rate of distal patent false lumen was 40% of acute stage vs 66.7% of chronic stage, 66.7% of ascending and partial arch replacement vs 46.2% of ascending and total arch replacement, and 90% of graft inclusion technique vs 11.1% of graft exclusion technique. The distal patent false lumen was the lowest (12.5%) with type I dissecting aneurysm of ascending and total arch replacement using graft exclusion technique. In type IIIb dissecting aneurysm, the rate of patent false lumen was 66.7% of acute stage vs 29.4% of chronic stage, 30% of graft exclusion technique vs 40% of graft inclusion technique. The size of false lumen preoperatively were larger (11.1 +/- 4.5 cm2) in patients with distal patent false lumen than that (6.7 +/- 3.2 cm2) of in patients with distal occlusive false lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

Between March 1991 and August 1991, six consecutive patients underwent the replacement of the both ascending aorta and total aortic arch using a prosthetic graft with three branches for acute type A aortic dissection involving the aortic arch. Preoperative complications included cardiac tamponade in 5 cases, aortic regurgitation in 2, and shock state in 3. All operations were performed with the aid of extracorporeal circulation, selective cerebral perfusion, and open aortic anastomosis within 3 days after the onset. One patient died of rupture of the aortic anastomosis secondary to mediastinitis two weeks after the operation. All patients gained their own consciousness after the operation without any serious cerebral complications. The present data suggest that acute type A aortic dissection involving the aortic arch could be treated by replacing both the ascending aorta and aortic arch using a prosthetic graft with three branches with an aid of the extracorporeal circulation, selective cerebral perfusion and open distal anastomosis.

The in vitro percutaneous transport of thiamine disulfide (TDS), an oxidized dimer of thiamine, from propylene glycol through excised abdominal rat skin was studied. The application of saturated, long-chain fatty acids [stearic acid (18:0), myristic acid (14:0), and lauric acid (12:0)] as enhancers to the system was also studied. TDS permeated through rat skin from propylene glycol with a flux of 2.5 +/- 0.8 micrograms/cm2/min. The flux was enhanced 31 times by 12:0 and 1.4 times by 14:0 and was suppressed to 80% of its original value by 18:0. The absorption of TDS could not be explained by TDS permeating across a dialysis membrane, but the interaction between TDS and fatty acids may influence the system. The results show the possibility of developing a transdermal thiamine delivery system.

A 36-year-old women with pure unroofed coronary sinus syndrome was reported. The anomalies of the cardiovascular system were absence of the coronary sinus, coronary sinus ASD and persistent left superior vena cava (PLSVC) draining into the left atrium. In this case, the PLSVC was ligated in the pericardium and the atrial septal defect was closed with a Dacron patch. There was no cerebral complication due to the increased intracranial pressure after ligation of the PLSVC. Postoperative coronary arteriography revealed absence of the coronary sinus in the venous phase.

This report is concerned with results of surgical treatment for Marfan's syndrome combined with annulo-aortic ectasia (AAE) and mitral regurgitation (MR). Of the 23 patients with Marfan's syndrome who received Bentall's procedure during 14 year period, seven (30%) of these patients had both AAE and MR. The MR grade of seven patients by cardiac Doppler or left ventriculographic studies were grade 1 in 2, 2 in 1, 3 in 1, and 4 in 3. Atrial fibrillation was present in 4 patients. New York Heart Association Functional Class on admission in these 7 patients were II in 1, III in 4, and IV in 2. The mitral valve was replaced with mechanical valve in 4 patients by left atrial approach whose MR grade were over 3. In the 4 patients the mitral annuli were extremely dilated, both valve leaflets were massively redundant, and all chordae were elongated and turned chordae and vegetation were detected due to infective endocarditis. Only Bentall's procedure was performed in 3 patients whose MR were minimal. There were no early death, but two late deaths. One of them died of cardiac failure 2.3 years after Bentall's procedure because grade 2 MR was increased. Another one died from ventricular arrhythmia 1.6 years after MVR and Bentall's procedure. The remaining 5 patients are doing well for 3 months to 11.5 years after operation. For Marfan's syndrome combined with AAE and MR, early operation is recommended before left ventricular impairment. Mitral valve repair was not performed, both to save time and because anticoagulant therapy was need for aortic valve replacement. Concomitant MVR was to be done for moderate to severe MR.

We report 14 consecutive patients who have undergone ReCABG during the last 7 years (1984-1990). There were 11 males and 3 females with a mean age of 56.8 years. All bypass conduits used were saphenous vein grafts. Angiographic indications for ReCABG included primary bypass graft failure, progressive coronary arteriosclerosis, and both of them. Successful ReCABG is mainly dependent on careful attention to special surgical technical considerations such as heart exposure especially in the existence of functioning bypass graft, cardiopulmonary bypass technique and myocardial protection and choice of available bypass conduits. We used arterial grafts in 6 cases (ITA in 4 and GEA in 2 cases). There was only one hospital mortality in our series. Symptomatic relief of angina pectoris was obtained in all surviving patients.

Long term results were compared in 81 operative survivors with MVR using Hancock valve (Hancock group) and 83 using St. Jude Medical valve (SJM group). The cumulative follow-up was 709.0 patients-year (p-y) and 175.2 p-y in the Hancock and SJM groups. Twenty-four percent of the patients in the Hancock group was permanently anticoagulated, while 100% of patients in the SJM group anticoagulated. The 7-year actuarial survival rate including early mortality was 79.3 +/- 4.6% for the Hancock and 93.9 +/- 3.0% for the SJM group (p less than 0.01). The survival rate was significantly higher in the SJM group than that in the Hancock group. The 7-year actuarial event free rate of the valve-related complications in the Hancock and SJM groups were as follows; thromboembolism 88.6 +/- 3.8% vs 95.0 +/- 2.8% (NS), hemorrhage, 94.0 +/- 3.0% vs 98.7 +/- 1.8% (NS), paravalvular leak 92.6 +/- 3.2% vs 97.4 +/- 1.8% (NS), infection 93.9 +/- 3.0% vs 100% (p less than 0.05), valve malfunction 78.0 +/- 5.2% vs 100% (p less than 0.001), overall valve related complications 58.9 +/- 5.9% vs 91.1 +/- 3.5% (p less than 0.001), reoperation for valve-related complication 83.1 +/- 4.6% vs 100% (p less than 0.01). The event free rate of reoperation for valve related complication in the Hancock group was significantly lower than that in the SJM group. The Hancock valve had the acceptable antithrombogenicity, but had the limited long-term durability.(ABSTRACT TRUNCATED AT 250 WORDS)