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Heart rate variability (HRV), especially increased high frequency (HF), has been reported to provide clinically useful prognostic information regarding cardiovascular disease. Napping is an excellent sleep management strategy in older adults. This study was conducted to clarify the effect of napping on HRV in older adult patients with cardiovascular risk factors. The patients were divided into two groups: one group of 32 patients who reported napping (nap group) and another group of 45 patients who did not report napping (nonnap group). The HRV was calculated in terms of the HF component over 24 hr during wakefulness, sleep, and 1 hr after sleep onset. The HF in the nap group was significantly higher than that in the nonnap group during all times measured. In addition, napping was a significant predictor of increased HF. This study shows the effectiveness of napping in the daily lives of patients with cardiovascular risk factors.

This study evaluated the effect of increased physical activity on high-frequency (HF) heart rate variability (HRV) during the first hour after sleep onset in patients with hypertension and/or stable angina pectoris. Physical activity and HF were measured using activity monitors and 24-hour Holter monitors at baseline and 6 months later. The physical activity increased in 28 patients (increase group) and decreased in 20 patients (decrease group) after 6 months. In this study, after 6 months, compared to the decreased physical activity group, the increased physical activity group showed a significant increase in the HF index during the first hour after sleep onset. Therefore, the increase in the HF index may have been due to the increase in physical activity. An increase in physical activity suggests that the quality of sleep early in the sleep cycle may be improved, which may affect the patient’s prognosis.

AIMS AND OBJECTIVES The present study investigated whether morning or afternoon activity is more effective at increasing the high-frequency (HF) index, a parasympathetic index, in patients with cardiovascular risk factors. BACKGROUND A decreased HF index, a heart rate variability (HRV) parameter, is a well-established marker of poor cardiovascular prognosis. Because blood pressure and sympathetic tone are higher in the morning, physical activity and exercise in the afternoon has been recommended for patients with cardiovascular diseases. However, there have been no reports concerning the superior effects of afternoon exercise on parasympathetic activity and sleep. DESIGN This observational study was a post hoc comparison. METHODS Patients' physical activity was measured for 1 month to determine their habits. Patients' HF index was measured by 24-h Holter electrocardiography. The study enrolled 56 patients. Each patient's morning step count (before lunch) and afternoon step count (between lunch and dinner) were compared. We adhered to the STROBE guidelines in the present study. RESULTS Thirty-one patients took more steps in the morning, and 25 patients took more steps in the afternoon. The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and during sleep than those who took more steps in the morning (p = .003, .047). CONCLUSIONS The present study showed that those who took more steps in the afternoon had a significantly higher HF index during the first hour after sleep onset and a higher HF index during sleep than those who took more steps in the morning. RELEVANCE TO CLINICAL PRACTICE Exercise in the afternoon may improve the prognosis in patients with cardiovascular disease by not only preventing excessive blood pressure, afterload, and sympathetic tone but also positively influencing the parasympathetic system and sleep.

Aim The purpose of the present study was to elucidate the relationship between high-frequency heart rate variability (HF HRV) and continuous daytime sitting time in patients with cardiovascular risk factors such as mild hypertension and/or stable angina pectoris. Background Decreased HF HRV precedes the progression and worsening of cardiovascular diseases. Continuous sitting behavior is a major risk factor for developing metabolic syndrome and is associated with cardiovascular disease, diabetes mellitus, renal failure, sarcopenia and osteoporosis. Risk factors for cardiovascular disease can be affected by continuous daytime sitting behaviors. Design The present study design was a post-hoc comparison. Methods Patients treated at two different primary care clinics from 2014 to 2018 were enrolled in this study (n = 53). We assessed HF HRV and continuous sitting time using 24-hour Holter electrocardiography and an activity meter at baseline and 6 months. HF HRV was calculated during sleep. Results Sitting time had decreased in 22 patients (decreased group) and increased in 31 patients (increased group) after 6 months. The mean patient ages were 73.1 and 72.0 years in the decreased and increased sitting time groups, respectively (p = 0.503). HF HRV during sleep had increased after 6 months in the decreased sitting time group. Compared with the increased group, the decreased group showed significantly higher HF HRV during sleep after 6 months by two-way repeated-measures ANOVA after adjustment for age, sex and change in activity (p = 0.045). Conclusion These results suggest that a decrease in sitting time might induce parasympathetic activity during sleep. Therefore, reducing continuous sitting time during the day might contribute, in part, to improving the prognosis of patients with cardiovascular risk factors not only by avoiding muscle loss but also by providing positive influences on parasympathetic tone during sleep.

Aims and objectives To determine the effects on heart rate variability of home-based daily activity in patients with mild hypertension and/or stable angina pectoris and to clarify the relationship between daily activity and sympathovagal balance. Background Several prior studies have assessed the ability of exercise training to improve functional capacity and produce beneficial effects on mortality and physical capacity in patients with cardiovascular disease. Design A non-randomised six-month prospective longitudinal study. Methods This study consisted of 41 patients (59–83 years old) with mild hypertension and/or stable angina pectoris. The home-based daily activity and heart rate variability were measured at the start of the study (BASE) and six months after the start of the study (6MoA). At 6MoA, the active mass increased in 23 patients (the IC group), while it decreased in the remaining 18 patients (the DC group). Results There were significant increases in the high-frequency component in the IC group between the data at BASE and 6MoA. There were significant decreases in the low frequency to high-frequency ratio (low frequency/high-frequency) during sleep in the IC group between the data at BASE and 6MoA. The active mass was classified into life activities and walk activities in terms of intensity of activity. In a multivariate model, increased life activitiesrevealed a trend towards an association with increased high-frequency. Conclusions In patients with mild hypertension and/or stable angina pectoris, an increase in active mass improved heart rate variability outcomes with increased high-frequency and decreased low frequency/high-frequency during sleep. To increase life activitiesmight improve heart rate variability and prognosis in patients. Relevance to clinical practice This study demonstrated that the potential importance of low-intensity daily activities in patients with mild hypertension and/or stable angina pectoris.

比較的稀だが重大な合併症である術後肺軸捻転の1例を経験したので報告する．症例は52歳の男性．経気管支肺生検にて腺癌と診断し，T2N1M0 c-Stage II Bのため左上葉切除術と縦隔リンパ節郭清術を施行した．術後1日目より胸部X線上左肺野の透過性低下を認め，術後3日目には発熱と炎症反応の異常高値を示した．気管支内視鏡検査にて左下幹の狭窄を認め，残存下葉の肺軸捻転を疑い再開胸術を施行した．肺は暗赤色で緊満し，気管支を軸に約180度捻転を起こしていた．残存肺の温存はできないと判断し，残存肺全摘を施行した．肺軸捻転を起こした要因として，肺靭帯の切離，縫合方向を考慮しない自動縫合器による気管支切離，および閉胸時に残存肺の位置確認を十分留意しなかったことが考えられた．

To determine if Noguchi's classification can be evaluated accurately by frozen-section diagnosis before limited surgery.We performed frozen-section diagnosis in 31 of 343 patients who underwent excision of primary lung cancer at our hospital between 1993 and 2004. All 31 patients had pulmonary adenocarcinoma, with a tumor diameter ofor = 20 mm. There were 20 men and 11 women, ranging in age from 42 to 79 years (mean, 63.2 years). We assessed the rate of correct Noguchi's classification by categorizing all lesions into the following three groups on the basis of tumor diameter:or = 10 mm, 11-15 mm, and 16-20 mm.The overall rate of correct frozen-section diagnosis during surgery was 67.7%; being 100%, 41.7%, and 70% in theor = 10 mm, 11-15 mm, and 16-20 mm groups, respectively.Limited surgery for primary lung cancer can be performed when the tumor diameter isor = 10 mm, by confirming it as either type A or B according to Noguchi's classification, using frozen-section diagnosis. Thus, examination of frozen sections might be an important diagnostic procedure before intentional limited surgery for lung cancer.

In recent years, tumors producing granulocyte-colony-stimulating factor have been reported in an increasing number of patients, the majority of which have lung cancer. We experience a case of lung carcinoma producing granulocyte-colony-stimulating factor treated by resection and chemotherapy. He remains well 2 years and 10 months after surgery, with no recurrence of the carcinoma.

患者は東南アジア渡航歴の多い58歳の男性である. 軽度耐糖能低下を指摘されていた. 平成6年11月から平成7年7月に2度の東南アジア渡航を経験し, 渡航先で高熱を発し, 帰国後肺炎で入院した. 腹部CTで傍腎動脈部に非定型の腹部大動脈瘤がみられ, 遷延する発熱の原因として細菌性腹部大動脈瘤が疑われた. 経過観察中に, 発熱に引き続いて, CTで瘤の急速な増大を認めたため, 平成8年3月21日, 動脈瘤切除人工血管置換術を施行した. 術後12日目に発熱し, 血液培養で Burkholderia pseudomallei を検出した. メリオイドーシスと診断し, 感受性試験に基づき抗生剤の長期投与を行った. 術後55日目に感染の再燃徴候なく退院した.

This paper presents a patient surviving for a long time after hepatectomy and pneumonectomy for heterochronous metastases to the liver and lung following an operation for an ovarian cancer. The patient was a 62-year-old woman. In 1985 she underwent total hysterectomy and excision of bilateral uterine supports for a left ovarian cancer (in Stage III; endometrioid adenocarcinoma), followed by systemic chemotherapy. In 1990 metastatic lesions were detected in the S6-S7 and S8 regions of the lateral lobe of the liver. Right lobectomy was carried out. In 1992 multiple metastatic lesions (left S3, S4, S5, and S6, and right S6) were found in the bilateral lobes of the lung. Pneumonectomies were performed by a two-step approach. Furthermore, in 1993 a recurrence in the right lung (S2) occurred which was cured by additional resection. There has been no sign of recurrence, as of 9 years and 2 months after the first operation for the ovarian cancer; 4 years and 5 months after the hepatic resection; and one year and 9 months after the last pneumonectomy. Recurrence of ovarian cancer to the liver or lung has been hardly considered as a possible candidate for operation, and we rarely see such an operated case report. This case, however, indicates that aggressive surgical operation appears to contribute to a prolonged prognosis and improved quality of life.

Primary cardiac leiomyosarcomas are very rare. A 19-year-old man was admitted to a local hospital with dyspnea and hemoptysis. He was later transferred to our hospital because of his worsening dyspnea. An enhanced chest computed tomography scan demonstrated a large mass in the left atrium. A transthoracic echocardiogram showed a large mobile mass in the left atrium. The tumor was totally resected. The pathohistological examination showed leiomyosarcoma. The tumor rapidly recurred. and a second and third operation were performed. After the third operation, the patient was treated with radiotherapy. There was no local recurrence but multiple distant metastases were found 2 months after completion of radiation therapy.

The patient was an 11-year-old boy whose chief symptoms were cough, fever, and pain in the left side of the chest when he visited our hospital. A chest x-ray film revealed a left pulmonary cyst and fluid accumulation in the cyst. An elevated inflammatory response was observed, including a leukocyte count of 13,000/L and C-reactive protein concentration of 0.9 mg/dL. Computed tomographic (CT) scans revealed a sequestered lung segment in the left upper lobe, in which a pulmonary cyst was observed. Fluid accumulation was also observed in the cyst (Figure 1). Administration of an antibacterial agent reduced the fever immediately, and the inflammatory response was normalized. Three-dimensional CT scans of the chest revealed an afferent vessel from the pulmonary artery in the sequestered lung segment and reflux of the pulmonary vein into the innominate vein (Figure 2). The diagnosis was pulmonary sequestration accompanied by partial anomalous pulmonary venous return. VATS for pulmonary sequestration was performed because of the risk of secondary infection. Ports were inserted via a 3-cm skin incision in the midaxillary line in the fourth intercostal space, 1-cm incisions in the anterior axillary line in the fifth intercostal space, and 1-cm incisions in the posterior axillary line in the seventh intercostal space. The entire operation was carried out with a monitor, without use of a rib retractor. The sequestered lung segment was covered with visceral pleura and was thus diagnosed as an extralobar sequestration. As seen in the preoperative 3-dimensional CT findings, an afferent vessel from the left main pulmonary artery and reflux of the pulmonary vein into the innominate vein were observed by ablation of the hilar region. The afferent vessel of the pulmonary artery and the pulmonary vein were severed with an endoscopic linear cutter. In addition, the sequestered lung segment was dissected. The operation lasted 3 hours 20 minutes, and 15 g of blood was lost. No complications were observed and the patient was discharged from the hospital 4 days after the operation. Discussion Extralobar sequestration is believed to mostly affect male subjects and occurs between the diaphragm and lower lobe of the lung. The aberrant arteries commonly originate in the descending aorta or abdominal aorta. Previous studies have demonstrated that afferent vessels from the pulmonary artery are observed in 5% of all cases of extralobar sequestration. Most vein refluxes from extralobar sequestrations involve the hemiazygos vein, of which 80% flow into systemic veins, including the azygos vein and the inferior vena cava. 1,2 The present patient had a sequestered lung segment in the left upper lobe without aberrant arteries, which is a rare clinical condition. The patient also had the complication of a pulmonary cyst. Therefore, we suspected that the patient had congenital cystic adenomatoid malformation (CCAM). CCAM is often observed in patients with extralobar sequestration. Previous studies have demonstrated that malignant diseases often develop in patients with CCAM, and thus early excision is recommended. 3