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Sumiyoshi T, Uchida H, Watanabe K, et al. Neuropsychiatr Dis Treat. 2022;18:2507–2517. The authors have advised there are errors in the text and Table 1 on page 2512 of the published paper. Table 1 Pearson Correlation Coefficients Between WPAI Subscale Scores and PDQ-D-5 Total Scores Validity of the PDQ-D-5 by Comparison with Other Measures section, fourth sentence, the text “PDQ-D-5 scores showed a moderate correlation with the presenteeism (rmcorr, 0.56, p < 0.0001), overall work impairment (rmcorr, 0.58, p < 0.0001), and impairment of general activity (rmcorr, 0.63, p < 0.0001) subscale scores on WPAI, while the correlation with absenteeism scores was weak (rmcorr, 0.21, p < 0.004) (Table 1)” should read “PDQ-D-5 scores showed a moderate correlation with the presenteeism (rmcorr, 0.51, p < 0.0001), overall work impairment (rmcorr, 0.51, p < 0.0001), and impairment of general activity (rmcorr, 0.54, p < 0.0001) subscale scores on WPAI, while the correlation with absenteeism scores was weak (rmcorr, −0.04, p = 0.31) (Table 1)”. The correct Table 1 is as follows. The authors confirm that they do not believe that the modifications detailed above affect the interpretation of the results and consider them to be numerical in nature only. The authors apologize for these errors.

Tomiki Sumiyoshi,1 Hiroyuki Uchida,2 Koichiro Watanabe,3 Masato Oosawa,4 Hongye Ren,5 Yoshiya Moriguchi,6 Keita Fujikawa,4 Jovelle Fernandez4 1Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; 2Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 3Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan; 4Japan Medical Office, Takeda Pharmaceutical Company Limited, Osaka, Japan; 5Medical Affairs, H. Lundbeck A/S, Copenhagen, Denmark; 6Medical Affairs, Lundbeck Japan KK, Tokyo, JapanCorrespondence: Tomiki Sumiyoshi, Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan, Tel +81-42-341-2711 ext. 6234, Fax +81-42-346-1979, Email sumiyot@ncnp.go.jpPurpose: To validate the five-item version of the Perceived Deficits Questionnaire for Depression (PDQ-D-5) for assessing subjective cognitive function in Japanese patients with major depressive disorder (MDD) using data from the PERFORM-J study.Patients and Methods: A total of 518 Japanese outpatients diagnosed with MDD were assessed on severity of depressive symptoms, cognitive function, social and work function, and quality of life (QoL) over 6 months following initiation of antidepressant therapy. This post hoc analysis evaluated the internal consistency and convergent validity of the PDQ-D-5 in relation to the original PDQ-D-20. Correlations of scores on these measures were examined at each time point and over time. The same set of analyses was explored between PDQ-D-5 and the Patient Health Questionnaire–nine-item (PHQ-9), Montgomery–Asberg Depression Rating Scale (MADRS), Digit Symbol Substitution Test (DSST), five-level version of EQ-5D (EQ-5D-5L), Sheehan Disability Scale (SDS), and Work Productivity and Activity Impairment (WPAI) questionnaire.Results: PDQ-D-5 scores showed good internal consistency. Strong positive correlations were observed between PDQ-D-5 and PDQ-D-20 at each time point (correlation coefficient: baseline, 0.94; month 1, 0.94; month 2, 0.96; month 6, 0.96) and over time (0.92) (all p < 0.0001). Longitudinally, there were positive correlations between PDQ-D-5 scores versus those on the PHQ-9, MADRS, and SDS. Similarly, negative correlations were noted between PDQ-D-5 scores and EQ-5D-5L and DSST scores to a variable degree. There were moderate positive correlations over time between PDQ-D-5 and all WPAI subscale scores except those on absenteeism.Conclusion: PDQ-D-5 scores rated in Japanese patients with MDD were found to adequately represent scores on the PDQ-D-20. The short version also showed associations with several measures of functional outcome, depression severity and QoL. This validates the PDQ-D-5 as a feasible and clinically reliable tool to assess subjective experience on cognition, which is applicable to time-limited consultations.UMIN Clinical Trials Registry for Primary Study: UMIN000024320.Keywords: PDQ-D-20, PDQ-D-5, cognition, functional impairment, major depressive disorder

Aims: To determine the prevalence and impact of emotional blunting (EB) in patients with major depressive disorder (MDD) in Japan, and identify treatment needs for EB using patients' perceptions and attitudes., Methods: Eligible patients in Japan (aged 18-59 years) who reported a diagnosis of MDD and antidepressant medication use for >3 months were eligible to complete an online survey. The primary outcome was the prevalence of EB, self-reported using a validated screening question. Secondary outcomes included the correlation between EB symptoms (measured by the Oxford Depression Questionnaire [ODQ]) and scores on the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), Work and Social Adjustment Scale (WSAS), and the EuroQol 5-Dimension 5-Levels questionnaire (EQ-5D-5L). Descriptive questions were used to explore patients' perceptions and attitudes toward EB., Results: In total, 3376 patients were included in the analysis (56% male; 48% aged 50-59 years). Overall, 67.1% of patients self-reported symptoms of EB, with 10% rating these as severe. The mean (SD) ODQ total score was 78.2 (21.5), which increased with worsening EB symptoms. There were correlations between ODQ total scores and the PHQ-9, GAD-7, WSAS, and EQ-5D-5L scores (correlation coefficients: 0.67, 0.55, 0.56, -0.51, respectively; all p < 0.0001). Descriptive analyses showed that one-third of patients reporting EB symptoms did not tell their physician, with two-thirds finding these symptoms distressing and likely to affect recovery., Conclusion: EB is an important clinical issue in Japan that needs to be considered alongside functional recovery when managing treatment of patients with MDD., (© 2024 Takeda Pharmaceutical Company Limited. Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

The only reliable factor that reduces the risk of colorectal carcinogenesis is physical activity. However, the underlying mechanisms remain unclear. In this study, we examined the effects of physical activity against gut microbiota, including mucosa-associated microbiota (MAM) on azoxymethane-induced colorectal tumors in obese mice. We divided the subjects into four groups: normal diet (ND), high-fat diet (HFD), ND + exercise (Ex), and HFD + Ex groups. The Ex group performed treadmill exercise for 20 weeks. Thereafter, fecal and colonic mucus samples were extracted for microbiota analysis. DNA was collected from feces and colonic mucosa, and V3-V4 amplicon sequencing analysis of the 16SrRNA gene was performed using MiSeq. The HFD group had significantly more colonic polyps than the ND group (ND 6.5 ± 1.3, HFD 11.4 ± 1.5, p < 0.001), and the addition of Ex suppressed the number of colonic polyps in ND and HFD groups (ND 6.5 ± 1.3, ND + Ex 2.8 ± 2.5, p < 0.05). The HFD group showed significantly lower concentrations of succinic, acetic, butyric, and propionic acids (mg/g) in feces, compared with the ND group (succinic acid HFD 0.59, ND 0.17; acetic acid HFD 0.63, ND 2.41; propionic acid HFD 0.10, ND 0.47; and N-butyric acid HFD 0.31, ND 0.93). In the case of ND, succinic acid and butyric acid tended to decrease with Ex (succinic acid ND 0.17, ND + Ex 0.12; N-butyric acid ND 0.93, ND + Ex 0.74 0.74). Succinic acid, acetic acid, butyric acid, and propionic acid levels in feces were significantly lower in the HFD group than in the ND group; in both feces and mucus samples, Butyricicoccus and Lactobacillus levels were significantly lower in the HFD group. Akkermansia was significantly increased in ND + Ex and HFD + Ex groups. Diet and exercise affected the number of colorectal tumors. Furthermore, diet and exercise alter intestinal MAM, which may be involved in colorectal tumor development., Competing Interests: The authors declare no conflicts of interest.

Background/aims: Intestinal strictures represent an important serious complication of Crohn's disease. Shear wave elastography is a promising noninvasive ultrasound technique for assessing tissue stiffness. This study aimed to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease using shear wave elastography and the changes in stiffness after biologics., Materials and Methods: We enrolled 21 Crohn's disease patients having intestinal stricture. The patients consisted of 3 groups, which were the infliximab naïve (n = 6) group, the ustekinumab naïve (n = 8), and the bio-switch from infliximab to ustekinumab (n = 7) group. Bowell wall thickness was examined by ultrasound sonography, and the stiffness of Crohn's disease stricture lesions was evaluated using Shear wave speed before and 1 year after anti-tumor necrosis factor-alpha antibody infliximab, anti-interleukin 12/23 antibody ustekinumab, and bio-switch from infliximab to ustekinumab., Results: Bowell wall thickness was significantly improved after infliximab, ustekinumab, and the bio-switch. However, shear wave speed indices only in the ustekinumab group significantly decreased after treatment (P = .028), but not in the other group., Conclusions: Shear wave elastography might be a useful method to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease treated with biologics. However, a prospective randomized study evaluating the development of obstruction after biological treatment is needed to validate the study findings.

Soluble forms of platelet membrane proteins are released upon platelet activation. We previously reported that soluble C-type lectin-like receptor 2 (sCLEC-2) is released as a shed fragment (Shed CLEC-2) or as a whole molecule associated with platelet microparticles (MP-CLEC-2). In contrast, soluble glycoprotein VI (sGPVI) is released as a shed fragment (Shed GPVI), but not as a microparticle-associated form (MP-GPVI). However, mechanism of sCLEC-2 generation or plasma sCLEC-2 has not been fully elucidated. Experiments using metalloproteinase inhibitors/stimulators revealed that ADAM10/17 induce GPVI shedding, but not CLEC-2 shedding, and that shed CLEC-2 was partially generated by MMP-2. Although MP-GPVI was not generated, it was generated in the presence of the ADAM10 inhibitor. Moreover, antibodies against the cytoplasmic or extracellular domain of GPVI revealed the presence of the GPVI cytoplasmic domain, but not the extracellular domain, in the microparticles. These findings suggest that most of the GPVI on microparticles are induced to shed by ADAM10; MP-GPVI is thus undetected. Plasma sCLEC-2 level was 1/32 of plasma sGPVI level in normal subjects, but both soluble proteins significantly increased in plasma of patients with acute coronary syndrome. Thus, sCLEC-2 and sGPVI are released by different mechanisms and released in vivo upon platelet activation.

The mucosa-associated microbiota is an important component in human microbiota. The aim was to investigate mucosa-associated microbiota using brush samples during endoscopic procedures and compare with fecal microbiota. Seven patients who were planning to undergo a routine colonoscopy were recruited. Mucosal brushing samples were taken from 3 sites (terminal ileum, ascending and sigmoid colon), and a fecal sample was taken on the morning of colonoscopy. The samples were immediately placed in microcentrifuge tubes containing DNA stabilization reagent and analyzed using the next generation sequencer. The individual differences in microbiota were more evident than the differences of the sampling sites. Actinobacteria was more abundant and Bacteroidetes was less in the brush samples than those in the fecal samples. Taxonomic composition at the genus level and the proportion of genes responsible for some functions in the brushing samples tended to be different from those in the fecal samples. Bulleidia and Oribacteriumi were significantly more abundant and the proportions of genes responsible for transcription factors and phosphotransferase system were higher in ileal mucous than those in fecal samples. Brushing during colonoscopic procedure instead of using feces samples might be useful to analyze mucosa-associated microbiota., Competing Interests: The authors have no conflict of interest to declare in this study. Co-authors, YK, SH, KO and MT belong to the Miyarisan Pharmaceutical Co., Ltd., (Copyright © 2019 JCBNCopyright © 2019 JCBN.)

Acid related diseases in Japan has changed during the past 50 years. Previously the prevalence of peptic ulcer, especially gastric ulcer was the most common acid related disease, and now reflux esophagitis is the most common diasease. Among peptic ulcer disease, the prevalence of drug-induced bleeding peptic ulcer is increasing. On the other hand, the prevalence of atrophic gastritis and gastric cancer is decreasing, because the infection rate of Helicobacter pylori had been decreasing, the eradication therapy for Helicobacter pylori is now popular, and the lifestyle has westernized. In the western countries, the same changes have happened during the long history.

Detection of platelet activation in vivo is useful to identify patients at risk of thrombotic diseases. Platelet factor 4 (PF4) and β-thromboglobulin (β-TG) are used for this purpose; however, they are easily released upon the minimal platelet activation that occurs during sampling. Soluble forms of several platelet membrane proteins are released upon platelet activation; however, the soluble form of C-type lectin-like receptor 2 (sCLEC-2) has not yet been fully investigated. Western blotting with an anti-CLEC-2 antibody showed that sCLEC-2 was released from washed human platelets stimulated with collagen mimetics. To detect sCLEC-2 in plasma, we established a sandwich enzyme-linked immunosorbent assay (ELISA) using F(ab')2 anti-CLEC-2 monoclonal antibodies. Although plasma mixed with citrate, adenosine, theophylline and adenosine (CTAD) is needed for the PF4 and β-TG assays, effects of anti-coagulants (EDTA, citrate and CTAD) on the sCLEC-2 ELISA were negligible. Moreover, while special techniques are required for blood sampling and sample preparation for PF4 and β-TG assay, the standard blood collections procedures used in daily clinical laboratory tests have shown to suffice for sCLEC-2 analysis. In this study, we found that two forms of sCLEC-2 are released after platelet activation: a shed fragment and a microparticle-bound full-length protein, both of which are detected by the sCLEC-2 ELISA. The average concentration of sCLEC-2 in the plasma of 10 healthy individuals was 97 ± 55 pg/ml, whereas that in the plasma of 25 patients with diabetes mellitus (DM) was 149 ± 260 pg/ml. A trend towards an increase in sCLEC-2 concentration in the DM patients may reflect in vivo platelet activation in the patients, suggesting that sCLEC-2 may have clinical significance as a biomarker of in vivo platelet activation.

This study aimed to evaluate the effect of a metal artifact reduction (MAR) algorithm using 1D linear interpolation on cone-beam CT (CBCT). We performed phantom and clinical qualitative studies with and without MAR application using 1D linear interpolation. In the phantom study, the standard deviation (SD) was estimated from the images obtained from the water phantom in which a metal coil was placed at the center, and observed the changes in the SDs before and after MAR application. In the clinical qualitative study, the clinical images after endovascular treatment (EVT) for cerebral aneurysms were visually evaluated before and after MAR application. In the phantom study, the SDs after MAR application decreased by 56 to 35% compared with that before MAR application. In the clinical qualitative study, the artifacts from the metal coil decreased or increased depending on locations, and the contrasts of gray matter and white matter were attenuated when MAR was applied. In conclusion, the metal artifact decreases when MAR using 1D linear interpolation is applied to cerebral CBCT. However, another artifacts increase or soft tissue contrast is changed in some cases. MAR largely contributes to the reduction of streaking artifacts, whereas it may induce cerebral parenchyma at distant metal body or quality deterioration of the image not including the metal body. This should be taken into account in the diagnosis of secondary hemorrhage or infarction.

We evaluated the relationship between colorectal neoplasms and visceral obesity using computed tomographic colonography and adipocytokine levels. We included 123 patients and classified them into four groups as per computed tomographic colonography: no lesion (NL; n=40), adenomatous polyp (polyp; n=41), early colorectal cancer (eCRC; n=21), and advanced CRC (aCRC; n=21). We also measured the patients' serum metabolic markers and adipocytokine levels. The visceral adiposity index in the polyp and eCRC groups was significantly higher than that in the NL group. Visceral obesity is an important risk factor for the development of colonic polyps. Computed tomographic colonography could be a useful examination technique not only for diagnosis of colorectal neoplasms but also for simultaneous evaluation of visceral obesity.

In the course of our study on selective nonsteroidal mineralocorticoid receptor (MR) antagonists, a series of novel benzoxazine derivatives possessing an azole ring as the core scaffold was designed for the purpose of attenuating the partial agonistic activity of the previously reported dihydropyrrol-2-one derivatives. Screening of alternative azole rings identified 1,3-dimethyl pyrazole 6a as a lead compound with reduced partial agonistic activity. Subsequent replacement of the 1-methyl group of the pyrazole ring with larger lipophilic side chains or polar side chains targeting Arg817 and Gln776 increased MR binding activity while maintaining the agonistic response at the lower level. Among these compounds, 6-[1-(2,2-difluoro-3-hydroxypropyl)-5-(4-fluorophenyl)-3-methyl-1H-pyrazol-4-yl]-2H-1,4-benzoxazin-3(4H)-one (37a) showed highly potent in vitro activity, high selectivity versus other steroid hormone receptors, and good pharmacokinetic profiles. Oral administration of 37a in deoxycorticosterone acetate-salt hypertensive rats showed a significant blood pressure-lowering effect with no signs of antiandrogenic effects., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Quality control of the platelet activation assays to diagnose heparin-induced thrombocytopenia (HIT), (14)C-serotonin release assay (SRA) and platelet aggregation test (PAT) has yet to be established due to lack of reference standards and the difficulty of obtaining significant amounts of HIT antibodies from patients with HIT. We prepared a murine monoclonal antibody to human platelet factor 4 (hPF4)/heparin complexes (HIT-MoAb) and investigated the platelet activating action of HIT-MoAb by using SRA and PAT. The HIT-MoAb activated human platelets at low heparin concentration and the platelet activations were inhibited at high heparin concentration in both SRA and PAT. The HIT-MoAb produced a concentration-dependent effect. Moreover, the platelet activation at low heparin concentration was inhibited by anti-FcγRIIa antibody. These results indicated that HIT-MoAb has characteristics similar to human HIT antibodies regarding heparin-dependent platelet activation. Therefore, it is suggested that HIT-MoAb has the potential to be a positive control or reference standard in platelet activation assays.

In protein structure prediction, such as template-based modeling and free modeling (ab initio modeling), the step that assesses the quality of protein models is very important. We have developed a model quality assessment (QA) program United3D that uses an optimized clustering method and a simple Cα atom contact-based potential. United3D automatically estimates the quality scores (Qscore) of predicted protein models that are highly correlated with the actual quality (GDT&#95;TS). The performance of United3D was tested in the ninth Critical Assessment of protein Structure Prediction (CASP9) experiment. In CASP9, United3D showed the lowest average loss of GDT&#95;TS (5.3) among the QA methods participated in CASP9. This result indicates that the performance of United3D to identify the high quality models from the models predicted by CASP9 servers on 116 targets was best among the QA methods that were tested in CASP9. United3D also produced high average Pearson correlation coefficients (0.93) and acceptable Kendall rank correlation coefficients (0.68) between the Qscore and GDT&#95;TS. This performance was competitive with the other top ranked QA methods that were tested in CASP9. These results indicate that United3D is a useful tool for selecting high quality models from many candidate model structures provided by various modeling methods. United3D will improve the accuracy of protein structure prediction.

A combination of oxaliplatin(L-OHP), folinic acid and 5-fluorouracil(5-FU)(mFOLFOX6)has been widely administered to treat advanced or recurrent colorectal cancer. In this regimen, a bolus of 5-FU is administered intravenously, followed by its 46-hr continuous intravenous infusion. For 12 patients who showed neutropenia during mFOLFOX6 chemotherapy at Itami City Hospital, we investigated neutrophil recovery by comparing a patient group treated by the withdrawal of the 5-FU bolus administration(n=6)with a patient group treated by total dose reduction of L-OHP, as well as both the bolus and continuous 5-FU administration(n=6). After two weeks, the neutrophil numbers in the bolus withdrawal group showed a relatively higher value than that in the total dose reduction group[p= 0.032]. For patients showing neutropenia related to mFOLFOX6 chemotherapy, withdrawal of 5-FU bolus administration is suggested to be an effective method of promoting the recovery of neutrophil numbers.

A 15-year-old boy presented with a history of medically refractory gelastic seizures and cognitive impairments. Neuroimaging demonstrated a sessile type hypothalamic hamartoma, which was treated by gamma knife surgery. However, the gelastic seizures only partially decreased and the frequency of seizures remained unchanged. One year later, angiography before surgery detected anterior paraclinoid aneurysm of the left internal carotid artery. Blood pressure and endocrinological examinations showed no abnormality. Direct surgery was performed to treat the aneurysm and hamartoma. No sclerotic changes were noted in the arterial wall. The aneurysm was treated with clipping, and the hamartoma was partially removed. Postoperative course was uneventful and the gelastic seizures disappeared. No evidence for a causal relationship between the hamartoma and aneurysm was found.

It has been suggested that whey acidic protein (WAP) may function as a protease inhibitor. However, the actual function of WAP remains obscure. We investigated the histological development of the mammary glands of transgenic mice ubiquitously expressing WAP and CAG/WAP transgene. Ubiquitous expression of WAP induced aberrant development of the lobular alveoli of the mammary glands: mammary alveoli that were either aberrantly large or small in size increased in number in the developing mammary glands of these transgenic females during pregnancy and lactation. The expression of beta-casein was precociously induced in the mammary glands of the transgenic females during early pregnancy and accompanying this was a histological observation that abnormally developed lobular alveoli filled with milk proteins appeared in the mammary glands of transgenic females during early pregnancy. However, during lactation, the development of mammary glands was impaired in transgenic females. To investigate the possible paracrine action of WAP associated with mammary gland aberration, we transplanted the mammary tissue of CAG/EGFP transgenic females into the fat pad of virgin CAG/WAP transgenic females and initiated pregnancy by mating. The development of mammary tissue transplanted to the recipient was histologically examined on day 3 of lactation. The results revealed that the development of grafted mammary tissues was impaired in a manner similar to that of the mammary glands of CAG/WAP transgenic females, indicating that the inhibitory effect of WAP acts via a paracrine mechanism. In vitro experiments using HC11 cells with forced expression of exogenous WAP demonstrated the inhibitory function of WAP on proliferation of mammary epithelial cells.

The vortex lattices in YNi2B2C under the magnetic fields H up to 3 T applied along both the a and the c axes have been studied by scanning tunneling spectroscopy at 4.2 K. The vortex lattice transition has been found to occur in different manners for H parallela and H parallelc; in H parallela a slightly distorted hexagonal vortex lattice has been found to transform to a nearly square one above 1.0 T with increasing H, while in H parallelc the transition occurs at a much lower field around 0.1 T. The unconventional steep increase of the quasiparticle density of states outside the vortex core has also been found well below H(c2).

A 57-year-old man underwent Bentall's procedure (Piehler's modification) and partial aortic arch replacement for Stanford type A chronic aortic dissection. Circumferential detachment of intima with intimal intussusception into the aortic arch was found at the time of operation. Preoperative findings did not show the intimal tear involving entire circumference of the ascending aorta. He was asymptomatic but coughing before consulting our hospital. He was discharged from the hospital 26 days after operation.

We experienced a case of dysfunction of Carpentier-Edwards pericardial bioprosthesis in the tricuspid position. Explanted bioprosthesis showed overgrowth of neointima from ring to cusps and adhesion to remnants of native cusps. This restricted the motion of the pericardial leaflets resulting in orifice stenosis. Care must be taken in such valve replacement by this prosthesis leaving native valve tissue.

Two cases of Carpentier-Edwards pericardial mitral valve malfunction due to neointimal overgrowth were reported. Case one was a 51-year-old female undergone redo mitral valve replacement at nine years after first operation. Removed valve showed remarkable overgrowth of neointima expanding to the valve cusps. Case two was a 67-year-old male. A valve removed at nine years after first operation and at 1.5 years after recovery of prosthetic valve endocarditis. Removed valve also showed neointimal overgrowth expanding to the valve cusps. Although we experienced only two cases of neointimal overgrowth, these findings were considered being important in durability of Carpentier-Edwards pericardial valve.

Sixty-eight patients have had mitral valve replacement with Ionescu-Shiley bovine pericardial bioprosthesis from 1981 to 1984. Thirty five patients were required reoperation due to primary tissue failure of the bioprosthesis, 10 (28.6%) were on emergency basis and 25 (71.4%) were on elective. Hospital deaths were two (20.0%) on emergency and four (16.0%) on elective. Clinical features of emergency cases were as follows: progressive congestive heart failure in eight, severe hemolysis with massive hemoglobinuria in eight and acute renal failure in four. Cusp tears were observed in all valves, 8.1 +/- 1.5 mm in emergency group and 4.2 +/- 3.6 mm in elective group. Neointimal ingrowth over Dacron cloth of the inner surface of the stent was absent in 29 valves (89.2%). Calcification was observed in seven valves, however these were not dominant causes of primary tissue failure. Clinical symptoms were correlated with structural deterioration of explanted valves. Structural deterioration of the bioprosthesis may occur suddenly and progressively. Our experience demonstrated that life-threatening prosthetic valve failure may occur with a relatively high incidence and that careful follow-up is needed for Ionescu-Shiley bovine pericardial bioprosthesis.

A 69-year-old man showed gradually developing thoracoabdominal aortic aneurysm (TAAA) after coronary artery bypass grafting. The patient underwent graft replacement of TAAA uneventfully under partial cardiopulmonary bypass with selective perfusion of major abdominal branches. The major abdominal branches and two pairs of intercostal arteries were reconstructed. The patient showed no organ failure or spinal damage postoperatively. Partial cardiopulmonary bypass with selective perfusion of abdominal branches successfully protected both the visceral organs and the spinal cord from ischemia in a TAAA surgery.

We reported a patient in whom slight congestive heart failure gradually developed 20 years after mitral valve replacement with a Delrin disc Björk-Shiley valve prosthesis. Although no evident cause of prosthetic valve malfunction could be detected preoperatively, the mitral prosthesis was excised and replaced uneventfully with a 29 mm St. Jude Medical valve prosthesis. At gross inspection, marked wears of the Delrin disc surface and strut shaped indentations were present. These disc variance, occurred much earlier than initially predicted by Dr. Björk, allowed prosthetic valve malfunction. The patient with this specific model should be carefully followed-up, if necessary, performed reoperation.

We experienced two cases of left atrial myxoma originating from mitral annulus. Mitral valve replacement and mitral valvulo-annuloplasty were performed in each case, because of the presence of mitral leaflet defect due to removal of the myxoma. Two dimensional echocardiography was a useful method to confirm the location and decide the surgical approach.

Twelve years ago, we reported a method of extrapericardial approach to the L-SVC. Since then we have used this approach and performed simple occlusion of L-SVC during cardiopulmonary bypass without any cerebral complications. We have been expecting for a long time and have believed that this method will be very valuable especially in repeat open heart surgery. A case of 49-year-old man successfully underwent a redo operation for mitral and tricuspid valve replacement using extrapericardial occlusion of the L-SVC and retrograde cardioplegia. Although there was a pitfall for retrograde cardioplegia in the persistent L-SVC and a possibility of steal of cardioplegic fluid through a branch of the accessory hemiazygos vein during retrograde cardioplegia for a case with persistent L-SVC, sufficient cardiac protection was obtained in the case presented.

A 68-year-old male who had previously undergone aorto-coronary artery bypass grafting was admitted for mitral valve surgery. Because of the presence of anteriorly placed intact coronary artery bypass grafts, we used right thoracotomy to replace the mitral valve. Cardiopulmonary bypass was established after cannulation of the femoral artery and bicaval cannulation, and continuous retorograde cardioplegia with cold blood was infused. Residual air was evacuated through left ventricular vent catheter and aortic air vent hole. Post operative course was uneventful.

A case of aortic and mitral regurgitation associated with aortitis syndrome was presented. The patient was a 36-year-old female who admitted for palpitation and dyspnea. Left ventriculography showed moderate MR. Aortography showed moderate AR and multiple occlusive lesion of the aortic arch branches. After the inflammation was controlled, aortic and mitral valve replacement was performed. Postoperative course was uneventful. Histologically, aortic and mitral valve showed capillary increase and infiltration of inflammatory cells, mainly lymphocytes.

We report 3 successful cases of postoperative sterno-mediastinitis treated with single-stage procedure. 2 of them were infected with MRSA (Methicillin resistant staphylococcus aureus), and the other was with klebsiella pneumoniae. Neither open drainage nor irrigation were performed previously, but only administrations of sensitive antibiotics. Intensive debridement, irrigation and omental transposition were performed at one time, between 6 and 15 days from the diagnosis. It could achieve decrease of hospitalization. We recommend early single-stage procedure with omental transposition for postoperative sterno-mediastinitis before extension and aggravation of the infection.

Two cases of subdural hematoma complicated after open heart surgery were successfully treated during thirty years history of the department. A 45 year-old woman underwent tricuspid valve replacement due to isolated congenital tricuspid insufficiency. On the 27th postoperative day, she was suddenly attacked by headache, and disturbance of consciousness was recognized with gradual deterioration. Brain CT scan showed a subdural hematoma on the right frontal region. Immediate irrigation of the hematoma was performed. Postoperative course was uneventful, and she was discharged without any complications. A 59 year-old woman underwent mitral valve replacement due to mitral re-stenosis. On the 3rd postoperative day, disturbance of consciousness was seen suddenly. Brain CT scan showed a subdural hematoma in the bilateral posterior cranial fossa. Immediate GL-YCEOL drip infusion was started. On the next day consciousness returned without operation and she was discharged without any neurological complications. Both patients did not have head trauma during pre and post operative period. It was important to consider the possibility of a intracranial hematoma, when the disturbance of consciousness was recognized after open heart surgery and/or during anticoagulant therapy.

A 52-year-old man treated by hemodialysis under the diagnosis of chronic renal failure admitted to our hospital due to aortic valve stenosis and complete A-V block. Aortic valve was severely calcified, and the cause of complete A-V block was considered caused by the progressive calcification invasing to conduction system. The aortic valve replacement and pacemaker implantation using myocardial lead were simultaneously. Postoperative course was uneventful. The efficacy of simultaneous operation of aortic valve and pacemaker implantation was emphasized. However the generator implantation was recommended to perform in the several days after the operation because of destruction of the pacemaker function by counter shock for arrhythmia in the early post operative period.

Two protocols were scheduled for in vitro fertilization and embryo transfer (IVF-ET) in patients with various stages of endometriosis who were resistant to conventional therapies. In the ultralong protocol (21 patients), gonadotropin releasing hormone agonist (Gn-RHa) was administered for at least 60 days prior to ovarian stimulation along with menotropin until human chorionic gonadotropin was injected. In the long protocol (11 patients), Gn-RHa was started at the midluteal phase and exogenous gonadotropin was commenced between the third and the seventh day of the menstrual cycle after pituitary suppression. The estradiol response and the number of retrieved oocytes, fertilized oocytes, cleaved oocytes, and transferred embryos were similar in both groups but the clinical pregnancy rate per transfer was superior in the ultralong protocol (67 vs 27%). The miscarriage rate was 14% (2/14) in the ultralong protocol. Prolonged Gn-RHa suppression of ovarian function before superovulation may overcome some causes of infertility in patients with endometriosis.

Five cases of hypernatremic hyperosmolar delirium after open heart surgery were reviewed. Minimum serum osmolarity at the time of developing delirium in these cases was 336 mOsm/l. Blood glucose level did not reached to the levels of the typical criteria of hyperosmolar hyperglycemic nonketotic diabetic coma in all cases. The authors have shown that it was difficult to recognize this unique disorder in early postoperative stage. Because of its non-specific symptoms and the postoperative courses which required the patients' cares with much more dry side in water balance. In order to treat the patients with hypernatremic hyperosmolar delirium, the correction of serum osmolarity should be done very slowly, because water intoxication should be prevented. In all five cases in this paper were recovered from delirium as the time when serum natrium level and serum osmolarity were restored to the normal state. We concluded that in order to get a good prognosis of this characteristic disorder, we have shown early recognition of serum hypernatremia and hyperosmolarity state and consequently adequate treatment mentioned above are primarily important.

A 12-year-old boy with absence of the right coronary cusp underwent aortic valve replacement with a 21 mm St. Jude Medical prosthetic valve. He was known to have noncyanotic congenital heart disease at the age of 2 months. The diagnosis of aortic insufficiency was first made when he was 1 1/4 years old. Intensive medical treatment was continued while he was growing up. Cardiac catheterization was performed repeatedly at ages 3 1/2 and 7. The findings on the fourth cardiac catheterization at 12 years of age were pulmonary arterial pressure of 90/60 mmHg, left ventricular end-diastolic pressure of 25 mmHg and poor contraction of the left ventricle. Although IABP support was necessary for treatment of severe low cardiac output state in the early postoperative period, he was discharged at 1 month after operation, Now, he goes to school under anticoagulant therapy. Intensive medical care followed by elective aortic valve replacement may be a useful treatment for isolated congenital absence of the aortic valve cusp.