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ChatGPT, a language-learning model chatbot, has garnered considerable attention for its ability to respond to users’ questions. Using data from 14 countries and 186 institutions, we compare ChatGPT and student performance for 28,085 questions from accounting assessments and textbook test banks. As of January 2023, ChatGPT provides correct answers for 56.5 percent of questions and partially correct answers for an additional 9.4 percent of questions. When considering point values for questions, students significantly outperform ChatGPT with a 76.7 percent average on assessments compared to 47.5 percent for ChatGPT if no partial credit is awarded and 56.5 percent if partial credit is awarded. Still, ChatGPT performs better than the student average for 15.8 percent of assessments when we include partial credit. We provide evidence of how ChatGPT performs on different question types, accounting topics, class levels, open/closed assessments, and test bank questions. We also discuss implications for accounting education and research.

We have developed a novel technique for the measurement of the size of avalanche fluctuations of gaseous detectors using a gating device (gating foil) prepared for the time projection chamber in the international linear collider experiment (ILD-TPC). In addition to the gating function, the gating foil is capable of controlling the average fraction of drift electrons detected after gas amplification. The signal charge width and shape (skewness) for electron-ion pairs created by a pulsed UV laser as a function of the transmission rate of the gating foil can be used to determine the relative variance of gas gain for single electrons. We present the measurement principle and the result obtained using a stack of gas electron multipliers (GEMs) operated in a gas mixture of Ar-CF$_4$(3%)-isobutane(2%) at atmospheric pressure. Also discussed is the influence of the avalanche fluctuations on the spatial resolution of the ILD-TPC., 39 pages including 11 figures

PurposeThis study aims to examine whether the pay gap between the chief executive officer (CEO) and non-executive employees affects the firm’s research and development (R&D) efficiency.Design/methodology/approachThe dependent variable is the firm’s R&D efficiency, defined as a percentage increase in revenue from a 1-per cent increase in R&D spending. The main independent variable is the CEO-employee pay gap, defined as the ratio of annual total compensation for the CEO to the average of non-executive employees of the firm. The authors estimate fixed-effects models to examine the association between R&D efficiency and the pay gap between CEO and non-executive employees.FindingsResults indicate a negative and significant association between R&D efficiency and CEO-employee pay gap, which suggests that a wider pay gap reduces employee motivation and effort, consistent with pay equity theory. We also find that the CEO-employee pay gap negatively moderates the relationship between employee pay growth and R&D efficiencyResearch limitations/implicationsRecently enacted pay gap disclosure requirements mandated by the Dodd-Frank Act will make the disparity between CEO and non-executive compensation more salient. This study provides evidence of a firm outcome associated with that disparity.Originality/valueThis study is among the first to investigate the impact of the pay gap on R&D efficiency, a firm outcome not previously explored in the literature. This study also investigates CEO-employee pay gap’s role as a factor that moderates the effects of employee pay growth and institutional ownership on R&D efficiency

This study addresses the issue of decreasing accounting student interest in the specialized taxation discipline. Using survey responses from accounting students around the United States, the authors find that one of the most important influences on the choice of a taxation specialization over other accounting fields is the fascination and interest created as part of the initial taxation course in the student’s undergraduate education. This finding echoes prior research on how to motivate pre-business students toward accounting as a major area of study. The authors find that the challenging nature of the initial tax course and potential differences in future career options do not deter students from taxation. Other driving forces for pursing taxation include perceptions of entry-level and long-term compensation, long-term career opportunities, and having an interesting and challenging career. This study can be of interest to academic institutions, public accounting recruiters, and the accounting profession in general as it highlights the meaningful role each can play in encouraging accounting students to pursue taxation as a profession.

Purpose This study aims to examine a firm’s disclosure properties subsequent to receiving a going-concern opinion. Design/methodology/approach A difference-in-difference research design was used to control for endogeneity issues. Annual report readability is used as a proxy for firm disclosure. Findings The results indicate a negative and significant association between issuance of a going-concern report to a firm and the firm’s readability index in the subsequent year. In other words, after receiving a going-concern opinion, a firm’s annual report exhibits increased readability. The results, when broken into subsamples of surviving and failing firms, are concentrated in the surviving firms. Research limitations/implications Prior research has shown that firms change their disclosure properties due to endogenous choices motivated by incentive or exogenous shocks. The results of this study, however, suggest that firms that receive going-concern opinions are incentivized to be more forthcoming in disclosing their financial information. Originality/value To the authors’ knowledge, this study is the first to investigate how firms’ general disclosures change subsequent to receiving a going-concern opinion.

Funding Acknowledgements Type of funding sources: None. Introduction Arrhythmias are frequently encountered in adult congenital heart disease (ACHD) and respond poorly to pharmacological therapies. Catheter ablation is challenging due to anatomical variation and complexity of the arrhythmia substrate. High density multi electrode mapping (MEM) with automatic annotation of activation time may aid mapping of arrhythmia, decrease procedure time and improve the accuracy of targeting of ablation therapy. Purpose To compare the acute and long term outcomes and procedural characteristics of catheter ablation in ACHD patients with and without automatic annotation of activation with MEM. Methods Retrospective analysis of the acute and long term outcomes of ACHD patients in a single centre undergoing ablation procedures from 1 Jan 2014 to 18 August 2017 was undertaken. 2 groups were identified. Group 1 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system without the use of automatic signal annotation. Most patients in this group had sequential mapping performed with the ablation catheter (78%), the rest had multi-electrode mapping with the PentaRay 20 pole catheter. Group 2 included patients who had arrhythmia mapping performed with the CARTO 3D electroanatomic mapping system using the automated CONFIDENSE mapping algorithm. Results Group 1: n = 27, mean age 44.6 +/-3 years. Male 46.6%. Group 2: n = 38, mean age 44.0 +/- 1.9 years. Male 56.7%. All patients had CHD of at least moderate complexity. 25% of patients in group 1 and 45% in group 2 were repeat ablations. 45 arrhythmias were induced in group 1 of which 29 were targeted and 74 arrhythmias were induced in group 2 of which 46 were targeted. Acute success rates (after attempts at reinduction) were 96.3% in group 1 and 94.7% in group 2. Recurrences of arrhythmia occurred significantly less in patients in group 2 compared to group 1 (44.7% and 70.4% respectively, p Conclusions The use of multi-electrode mapping with an automatic annotation algorithm was associated with a significantly lower risk of recurrence during the follow up period of this study.

We have developed a novel technique for the measurement of the avalanche fluctuation of gaseous detectors using a UV laser. The technique is simple and requires a short data-taking time of about ten minutes. Furthermore, it is applicable for relatively low gas gains. Our experimental setup as well as the measurement principle, and the results obtained with a stack of Gas Electron Multipliers (GEMs) operated in several gas mixtures are presented., A supplemental material (Addendum to be published in Nucl. Instrum. Methods Phys. Res. A) was added at the end of the manuscript. 8 pages, including 7 figures

Nuclear instruments & methods in physics research / A Accelerators, spectrometers, detectors and associated equipment Section A 918, 41 - 53 (2019). doi:10.1016/j.nima.2018.11.060, We have developed a gating foil for the time projection chamber envisaged as a central tracker for the international linear collider experiment. It has a structure similar to the Gas Electron Multiplier (GEM) with a higher optical aperture ratio and functions as an ion gate without gas amplification. The transmission rate for electrons was measured in a counting mode for a wide range of the voltages applied across the foil using an $^{55}$Fe source and a laser in the absence of a magnetic field. The blocking power of the foil against positive ions wasestimated from the electron transmissions., Published by North-Holland Publ. Co., Amsterdam

Regulators around the world are concerned about the potentially harmful effects of high audit market concentration on audit pricing and quality. However, results in the overall literature have failed to reach consensus on this issue. We contribute to this debate by arguing that the audit market is segmented and that concentration in the Big 4 segment of the market leads to higher audit pricing. Accordingly, our analyses use international data and focus on concentration within the Big 4 group of firms across countries. We find that audit fees are increasing in our concentration measure for clients where the barriers to entry by competing auditors are higher, as proxied by client size, international operations, and IFRS use. Finally, we find evidence that audit quality is decreasing in Big 4 market concentration for these types of engagements. This indicates a wealth transfer from shareholders to audit firms when auditor concentration is high because these complex clients are charged more, but receive audits that are of lower quality.

Micro-Pattern Gaseous Detectors Conference 2019, MPGD2019, La Rochelle, France, 5 May 2019 - 10 May 2019; Journal of physics / Conference Series 1498(1), 012020 (2020). doi:10.1088/1742-6596/1498/1/012020, We have developed a gating foil for the time projection chamber envisaged as a central tracker for the international linear collider experiment. It has a structure similar to the Gas Electron Multiplier (GEM) with a higher optical aperture ratio and functions as an ion gate without gas amplification. The transmission rate for electrons was measured in a counting mode for a wide range of the voltages applied across the foil using an $^{55}$Fe source and a laser in the absence of a magnetic field. The upper limit of the transmission rate for positive ions was estimated to be 3.36 ± 0.05 (stat. only)) × 10$^{−4}$ from the measured electron transmission at a relatively low reverse bias voltage applied to the foil ($ΔV$ =−15.5 V). The blocking power of the gating foil was confirmed to be high enough to suppress the influence of ion backflow., Published by IOP Publ., Bristol

A cluster complex with the composition (Bu4N)4[Re6S8(OC6H4-p-NO2)6] having terminal phenoxide ligands is obtained by the reaction of (Bu4N)4[Re6S8Cl6] with silver p-nitrophenolate. The compound crystallizes in the orthorhombic space group Pccn with the following unit cell parameters: a = 19.507(2), b = 31.645(3), c = 19.237(2) Å, V = 19.237(2) Å3, Z = 4, dcalc = 1.774 g/cm3.

This study examines the association between acquisition profitability and firm disclosure. Using a large sample of acquisitions over the period 1998-2008, this study provides evidence of a positive association between the profitability of acquisitions and firm disclosure prior to the acquisition. Specifically, firms issuing voluntary management earnings forecast more frequently prior to the acquisition announcement are associated with more profitable acquisitions. These findings suggest that disclosure can serve as a monitoring function towards encouraging managers to make corporate investment decisions that increase shareholder value.

Nocturnal vocalization is frequent in Parkinson's disease patients with rapid eye movement (REM) sleep behaviour disorder (RBD). We investigated the frequency of nocturnal vocalization and other sleep problems in patients with pure autonomic failure (PAF) and compared the results with idiopathic Parkinson's disease (IPD) and dementia with Lewy bodies (DLB). We interviewed consecutive patient–caregiver pairs with PAF ( n = 13), IPD ( n = 200) and DLB ( n = 19), and ischaemic stroke patients (controls, n = 43). Nocturnal vocalization was similarly frequent in PAF, IPD and DLB. Other dream enactments and vivid dreams also were more frequent in PAF, IPD and DLB compared with controls. Excessive night-time awakenings and daytime sleepiness were frequent in IPD but rare in PAF and controls. Clinical manifestation of sleep disturbances, at least of RBD-like symptoms including nocturnal vocalization and other dream enactments, may occur in PAF, as in IPD and DLB.

Oxygen is an essential molecule for all cellular activities including growth. Either excessive or deficient oxygen supply to cells induces the various responses of the cells. In the field of pathophysiology, effects of blood flow restriction on various organs have been studied for the past ∼130 years. Subsequently, the roles of oxygen at subcellular level have been studied in vitro. Although a number of studies show that a low-intensity exercise (20∼50% of one repetition maximum) with a moderate tourniquet restriction of blood flow results in increases in muscular strength and size, the mechanisms for this muscular adaptation remain unclear. In particular, it is uncertain whether the low-intensity exercise with blood flow restriction using a tourniquet causes the hypoxia or hyperoxia in the muscle, and then what signals leading to muscular hypertrophy are activated inside and/ or outside the cells. Also, it is not well understood what side effects occur in addition to conferring the benefits of strength gains. The review summarizes recent studies on the muscular adaptations to oxygen environment and discusses the mechanisms that may be involved in the resistance exercise with restricted blood flow.

Le caryotype de la taupe de Siberie Talpa altaica (32 autosomes dont 13 paires de metacentriques et submetacentriques et 3 paires de subtelocentriques, selon les etudes precedentes) a ete etudie en detail. Le chromosome 1 est le plus grand element de ce caryotype: il porte un bloc heterochromatique riche en GC sur tout son bras court. Ce segment montre un heteromorphisme entre les bivalents. Chez certaines taupes nord-americaines et asiatiques, la structure caryotypique, qui comprend seulement un chromosome beaucoup plus grand, est comparable; ces chromosomes ont ete consideres comme homologues par les auteurs precedents. Nous concluons cependant que le chromosome 1 de T. altaica est derive du chromosome subtelocentrique 16 de la taupe espagnole T. occidentalis, qui a ete etudiee par banding et par duplication heterochromatique C. Nous pensons qu'il n'y a la qu'une ressemblance superficielle avec les especes nord-americaines et asiatiques de Talpidae. Cette observation nous incite a suggerer une homogeneite caryologique des especes europeennes et siberienne du genre Talpa.

Flow-through thin latissimus dorsi perforator flaps were used in six cases with complicated defects of the legs. This flap has a small amount of latissimus dorsi muscle with a considerable amount of fatty tissue removed to make a thin flap. In addition, the flap has several branches of the subscapular vessel, which are interposed to the recipient vessels of the legs. The advantages of this thin flap are: (1) flow-through vascular reconstruction can preserve the main vessels of the damaged legs; (2) the double arterial inflows and venous drainage systems of the flap ensure safe vascularization of the flap; (3) a flow-through venous drainage system from the distal extremities can also be established to prevent congestion of the affected legs; (4) this flap is versatile (it can be either thin or large); and (5) even in emergent ischemic legs, simultaneous elevation of the flap is possible with preparation of the legs. This flow-through flap is indicated for: (1) cases with a large skin defect and obstruction of the main vessels in the leg; (2) cases with a possibility of tumor recurrence in the legs; and (3) young women or girls with a large defect in the legs, rather than the rectus abdominis musculocutaneous flap.

This paper proposes a new method for model-based tracking of a human body in 3D motion from multiple views. The tracking is performed by estimating the pose increment of the body parts from multiple image sequences after establishing of fitting an articulated model to the human body at the initial frame. The pose increment can be obtained from solving a system of linear equations. This calculation does not depend on the number of view points. Experiments verify that the proposed method can avoid occlusion and visual degenerate from a particular view point, and track a human body in complicated motion.

An acute type rejection episode occurred in one of two patients treated with Interferon alpha (IFN alpha) for type C hepatitis (CHC). Histopathological examination of the graft kidney revealed focal cellular infiltration and chronic transplant glomerulopathy which showed acute or chronic type rejection. In spite of bolus administration of methyl-prednisolone, the elevation of serum creatinine level continued. After administration of anti-human lymphocyte globulin (AHLG), renal function improved, but urinary protein was still positive. Another patient had no episode of rejection during or after IFN alpha therapy.

Compact tension (CT) specimens of pressure vessel steel A533B have been subjected to linear distributions of temperature along the crack line. The temperature dependence of fracture toughness for the A533B steel creates a fracture toughness gradient in such a specimen. The specimens simulated an irradiated pressure vessel wall and a functionally gradient material. The CT specimens subjected to linear distributions of temperature were tested to evaluate the fracture toughness for crack initiation. In all tests, the temperature at the crack tip was kept at −10°C or −55°C. If the value of the temperature gradient ahead of the crack tip exceeded a critical value, the fracture toughness deviated from the toughness obtained under a uniform temperature of −10°C or −55°C.

A (K,Na)NbO 3 (KNN)-based multilayer piezoelectric ceramic with nickel inner electrodes was successfully fabricated by co-firing in a reducing atmosphere. We studied the compositional modification of KNN in order to increase reducing resistance in the sintering process, and obtained a good composition by using a solid solution with CaZrO 3 . A multilayer ceramic specimen had a ratio between the strain and induced electric field S/E of 360 pm/V, which is close to the highest value of KNN-type non-textured ceramics ever reported. Nickel is a suitable electrode material for multilayer structures with thinner ceramic layers, because of a high electro-migration resistance and low material cost. Thus, nickel inner electrode multilayer ceramics with KNN are good candidates as lead-free materials to replace PZT for several piezoelectric applications.

The high-power piezoelectric characteristics in h001i oriented ceramics of bismuth layer structured ferroelectrics (BLSF), SrBi(2)Nb(2)O(9) (SBN), (Bi,La)(4)Ti(3)O(12) (BLT), and CaBi(4)Ti(4)O(15) (CBT), were studied by a constant voltage driving method. These textured ceramics were fabricated by a templated grain growth (TGG) method, and their Lotgering factors were 95%, 97%, and 99%, respectively. The vibration velocities of the longitudinal mode (33-mode) increased proportionally to an applied electric field up to 2.5 m/s in these textured BLSF ceramics, although, the vibration velocity of the 33-mode was saturated at more than 1.0 m/s in the Pb(Mn,Nb)O(3)-PZT ceramics. The resonant frequencies were constant up to the vibration velocity of 2.5 m/s in the SBN and CBT textured ceramics; however, the resonant frequency decreased with increasing over the vibration velocity of 1.5 m/s in the BLT textured ceramics. The dissipation power density of the BLT was almost the same as that of the Pb(Mn,Nb)O(3)-PZT ceramics. However, the dissipation power densities of the SBN and CBT were lower than those of the BLT and Pb(Mn,Nb)O(3)-PZT ceramics. The textured SBN and CBT ceramics are good candidates for high-power piezoelectric applications.

The computational complexity of a two-dimensional filter is basically O(N times N) (N is the size of the filters), though in some filters in which coefficients can be separated as to x and y axes {separable), the complexity can be reduced to O(N) by decomposing a filter to two one-dimensional filters. The computation time of non-separable filters becomes very long for large N even with hardware systems. In this paper, we propose an approach for applying large non-separable filters on large images using an FPGA. Our current targets are circularly symmetric filters whose coefficients on same concentric circles are the same. In our approach, regular polygons inscribed in those circles are used to approximate them. With this approach, the computational complexity can be reduced to O(N). A circuit based on this approach was implemented on Xilinx XC2V6000. It can apply filters more than N = 127 in one clock cycle to each pixel in an given image, which makes it possible to achieve real-time processing of HD images.

A novel method of exciting shear Alfv\'en waves using electrodes inserted in a plasma was developed for basic study of Alfv\'en eigenmodes in a heliotron/torsatron plasma. The electrodes can induce excitation current along the confinement field line, and generate magnetic perturbations perpendicular to the confinement field. By sweeping the frequency of the current in a cold plasma, the toroidicity-induced Alfv\'en eigenmode was resonantly excited at the predicted frequency and radial location. Plasma response to the applied magnetic perturbations indicates a fairly large damping rate caused by continuum damping.

Whole-body positron emission tomography (PET) with l8F-fluorodeoxyglucose (FDG) is frequently used for tissue characterization, staging and therapy control images (Conti et al. 1996; Sven and Jorg 2001). We examined the potential application of l8F FDG-PET for cancer screening in a large number of asymptomatic individuals (Yasuda and Shohtsu 1997; Ide and Suzuki 1996). A wide variety of cancers have been detected at potentially curable stages in asymptomatic individuals. However, FDG-PET study has obvious limitations in the detection of urological cancers, cancers of low cell density, small cancers and hypometabolic or FDG-negative cancers. Thus conventional examinations are also needed for cancer screening in conjunction with FDG-PET and understanding the images obtained in such cases helps in preventing misinterpretation of PET images (Yasuda et al. 2000). In the following section we report on our 7-year experience with whole-body PET for cancer screening in asymptomatic individuals.

Ballistic missile defense deployment by Japan, while defensive in nature, has the potential to dramatically upset the balance of power and regional stability of East Asia. On 31 August 1998, North Korea tested a medium range Taepodong missile over Japan that landed in the Pacific Ocean to the northeast. The test had a sobering effect on the perceived collective security of the nation as it took the missile less than nine minutes to reach Japan. This incident, the September 11th terrorist attacks and regional balance of power shifts have all pushed Japan toward a more engaged, assertive and autonomous foreign policy. The deployment of a ballistic missile defense (BMD) system by Japan, while defensive in nature, is certain to create tensions and upset the perceived balance of power between Japan and regional competitors, North Korea and China.

PET is not yet fully utilized in surgical-decision making. Surgeons are not well acquainted with the basics of PET and the interpretations of images. Their knowledge may be limited to “malignant lesions being visualized as hot spots.” This simplistic view is not enough to convince surgeons of the value of PET. It is our responsibility as nuclear medicine physicians and radiologists engaged in PET oncology to inform surgeons of not only the advantages of PET, but also its limitations so that the capabilities of PET can be fully exploited in the surgical treatment of tumors, both malignant and benign.

Changes in myostatin content and localization in mouse skeletal muscles were investigated during aging, hindlimb suspension (HS) and reloading after HS. During aging, the content of myostatin among solubilized proteins in gastrocnemius and plantaris muscles (Gast/Plant) was initially low and increased until their wet weight/body weight ratio reached a peak. It remained unchanged with further aging, although gradual atrophy of the muscles was seen to occur. Also, the myostatin content did not change significantly during HS (up to 14 days) in both Gast/Plant and soleus muscles, though the muscles showed morphological signs of atrophy. However, reloading for 2 days after a 14-day HS caused significant decreases in the myostatin content in both of these muscles. Immunohistochemical observations showed the sarcoplasmic existence of myostatin, the amount of which appeared to decrease after reloading. The results suggest that myostatin plays a part in the processes of muscular growth and loading-induced hypertrophy, but is not involved in either aging-related or unloading-induced muscular atrophy.

Unprecedented charged particle momentum resolution is required for precision Higgs studies at the International Linear Collider (ILC), which in turn demands as many as 200 sampling points with a high spatial resolution of 100 microns or better if we are to adopt a TPC for the central tracker. We discuss a novel theoretical resolution formula for a GEM-readout TPC, which is applicable to inclined tracks as opposed to the previous formula which is valid only for normal incidence. The formula identifies key factors that determine the spatial resolution and helps optimize the readout pad geometry and High Voltage settings for a given gas mixture. The formula is compared to the latest beam test results for a LC TPC Large prototype.

The applicability of the right internal thoracic artery (RITA) for coronary artery bypass grafting is higher when used as a free graft than as a pedicled graft. However, the technical difficulty of directly connecting the proximal end of the free RITA to the much larger aorta leads to poor patency. To overcome this technical limitation, we have used a modification that places the proximal end of this artery onto the hood of an accompanying vein graft at the aortic anastomosis instead of directly onto the aorta. We performed isolated coronary artery bypass grafting on 43 patients using the free RITA as a second arterial graft following pedicled left internal thoracic artery grafting. The mean patient age was 60 years and 38 patients were male. There was no mortality and no incidence of morbidity related to free RITA use. Postoperative coronary angiography performed in all patients revealed that all proximal anastomoses were widely patent, making the patency rate of the free RITA 100%. With these encouraging results, the free RITA graft with the described modification is thought to be a more promising second arterial graft with greater versatility than the pedicled graft. The long-term evaluation of a large patient population will determine the significance of this modification.

We report a case with occlusion of multiple branches of the aorta and a pseudoaneurysm due to rupture of a severely calcified non-aneurysmal thoracoabdominal aorta in a patient with Takayasu's disease. The patient was successfully treated by endoluminal stent-grafting without mesenteric ischemia.

A 13-year-old girl, who had undergone a modified Blalock-Park operation using an equine pericardial patch for a type A aortic arch interruption at 10 days of age, and patch repair of a ventricular septal defect at 1 year, presented with recurrent stenosis of the aorta. She underwent balloon angioplasty which resulted in a pseudoaneurysm at the distal suture line of the patch. Endovascular stent-grafting was employed. Soon after placement, the stent-graft had migrated into the distal portion of the descending aorta. The distal aortic arch and proximal descending thoracic aorta were replaced with a prosthetic graft. The migrated stent-graft was removed. The operation was performed through an anterior approach under hypothermic circulatory arrest and selective cerebral perfusion. The postoperative course was uneventful. The migration was likely caused by the limited ability to bend the stent-graft to match the curvature of the arch, the stiffness of the scarred equine pericardial patch, and the shape of the aorta.

The purpose of this study was to examine comprehensively and quantitatively the effects of sustained occlusion of the circumflex branch of the left coronary artery on neuronal expression of Fos, the protein product of the proto-oncogene c-fos, in the rat brain. Occlusion coronary artery induced a fall in mean arterial pressure of about 10-30%, maintained for a period of 60 min. Baroreceptors were activated by occlusion coronary artery-induced hypotension. In control rats treated with without coronary ligation, few Fos-positive cells were observed. Following coronary artery occlusion, there was a significant increase in the number of Fos-positive cells in the several brain regions. These brain regions containing Fos-positive neurons in rats treated with coronary artery occlusion included nucleus tractus solitarius (NTS), area postrema (AP), caudal and rostral ventrolateral medulla (VLM), lateral parabrachial nucleus (PBN), supraoptic nucleus (SON), paraventricular nucleus (PVN) and central nucleus of the amygdala (CE). This finding partly differs from previous studies where Fos expression occurred by other reasons such as hypovolemia, hemorrhage, nitroprusside or hydralazine etc. These results generally fit within an emerging understanding of brain circuitry underlying cardiovascular regulation.

The placement of the suture line for interatrial patches in complete and incomplete atrioventricular canal defect repairs varies from surgeon to surgeon despite established anatomic knowledge of the atrioventricular conduction system. This study describes our technique for it and reviews early and long-term outcomes.Between 1980 and 1999, 64 infants and children underwent repair of either complete (n=39) or incomplete (n=25) atrioventricular canal defects. Thirty-four of the children (53.1%) had Down's syndrome. The suture line for the interatrial patch originated on either the artificial or native ventricular septal crest and continued leftward above the annulus of the left inferior leaflet of the atrioventricular valve at the posteroinferior corner. All stitches were placed in a horizontal mattress or U-shaped fashion.The operative survival rate was 94% (4 early deaths) and the overall survival rate was 85% (6 late deaths). Atrioventricular heart blocks occurred in none of the patients. Although left-sided atrioventricular function significantly improved with repair, two patients (3.1%) required reoperation for valve replacement because of residual or recurrent insufficiency.This suture technique for interatrial patches is straightforward and results in a low incidence of heart block and a low re-operation rate for left atrioventricular valve insufficiency.

In this study, we investigated perioperative and long-term prognosis and the risk of major complications after repair of ventricular septal defect in 48 patients with Down's syndrome who underwent ventricular septal defect repair between May 1980 to August 1999 were compared with those in 48 patients with normal chromosomes matched for age and time period. Pp/Ps were significantly lower after the operation in both groups; however perioperative and postoperative Pp/Ps of Down's syndrome group were significantly higher than that those of control group. The duration of intubation was significantly longer in the Down's syndrome group and the case-control study revealed that the risk of long intubation (or = 7 days) was significantly higher in the Down's syndrome group, but the incidence of PH crisis did not differ between the 2 groups. The main reasons of prolonged intubation period were respiratory complications such as pneumonia or atelectasis. In Down's syndrome group, a 5 months old boy died of heart failure on the 5th postoperative day. All other patients were survived through a mean follow-up period of 122.4 months (the follow-up rate was 95.8%). In conclusion, the perioperative and long-term prognosis after ventricular septal defect repair in patients with Down's syndrome were similar to those in patients with normal chromosome.

We describe a 12-year-old patient with asplenia syndrome and gut malrotation who, after an interim step before a modified Fontan operation, developed life-threatening mediastinitis. A flap of the omentum arising from the transverse colon, longitudinally located in the left of the abdomen, was created and transferred to the mediastinum after a division of the arterial arcade at its most caudal extent. Her postoperative course was uneventful, and 12 months later, the modified Fontan operation was successfully completed. Although visceral heterotaxy results in an omental deformation, it does not preclude the use of an omental flap.

Multiple systemic-to-pulmonary artery shunts often represent a deviation from the initial management strategy for cyanotic congenital heart disease. This study analysed the outcome in patients undergoing a second shunt.Between 1965 and 1998, 80 patients required a second shunt. Patient age ranged from 11 days to 11.2 years at the initial shunt, and 4 months to 25.6 years at the second shunt. The interval between shunts ranged from 11 days to 19.6 years.The patient survival rates at 1, 6, 12, 60 and 120 months following the second shunt were 95.0 +/- 2.4%, 92.5+/-3.0%, 87.4+/-3.7%. 82.4+/-4.5% and 74.8+/-5.8%, respectively. Although excess pulmonary flow was not encountered after the second shunt, mode and incidence of morbidity were otherwise similar to the first one. Between 9 months and 7.5 years after the second shunt, 24 patients underwent successful definitive repair. Multivariable analysis identified pulmonary atresia (p=0.027) and a short (1 year) interval between the two shunts (p=0.034) as the independent risk factors for long-term shunt failure. Single ventricle physiology (p=0.002) and a central approach for the second shunt (p=0.016) were independent risk factors for lack of application, or failure of intracardiac definitive repair.A significant limitation in longevity and quality of life is common in patients requiring a second shunt, especially those associated with pulmonary atresia, the single ventricle physiology heart, or ungraftably hypoplastic contralateral branch pulmonary artery to the first shunt. Since excess pulmonary blood flow leading to congenital heart failure and/or ventricular diastolic dysfunction is unlikely, all patients who preclude definitive repair due to decreased pulmonary blood flow even after the first shunt should be shunted again.

We report a case of an 89-year-old man presenting with unstable angina and left main trunk disease. Minimally invasive direct coronary artery bypass grafting supplemented by catheter intervention was successfully performed. In view of the increasing elderly population, angioplasty/bypass combination therapy may be an important alternative for elderly coronary artery disease patients.

This study was undertaken to assess optimum anticoagulation control after bileaflet mechanical valve replacement by using the international normalized ratio of prothrombin time (PT-INR). From January to December 1995, 261 patients (pts) underwent mechanical valve replacement in the aortic (n = 95), mitral (n = 126), aortomitral (n = 39) or isolated tricuspid (n = 1) valve position in 8 medical centers in Tokyo, Japan. The St. Jude Medical valves were implanted in 184 pts and the Carbomedics valves in 77. There were 17 valve-related events as follows: 11 thromboembolic events (3.62%/pt-yr) including 10 transient ischemic attacks. 5 non-fatal bleeding events (1.65%/pt-yr), 2 reoperations (0.66%/pt-yr). At 18 postoperative months, free rates from all deaths (actuarial survival) thromboembolism, reoperation and all valve-related events were 95.3%, 95.7%, 98.7% and 88.9%, respectively. Under anticoagulant therapy, thrombin-antithrombin III complex and D-dimmer remained in high levels at 1 month after operation, and both values decreased to the control level at 6 months. In patients with thromboembolic events, PT-INR tended to be less than 2.0. The patients with bleeding events showed some increase of PT-INP or received anti-platelet agents. The 5 to 95 percentile of PT-INR at 6 months was 1.2 to 3.0 in the patients without valve-related events. These results suggested that optimum range of PT-INR might be between 1.2 and 3.0 after bileaflet mechanical valve replacement in patients without high risk of thromboembolism and between 2.0 and 3.0 in patients with the high risk.

In this study, a new surgical technique for the surgical treatment of patent ductus arteriosus (PDA) is evaluated. The subaxillary extrapleural approach was performed on 836 patients with patent ductus arteriosus. And 20 of these patients were evaluated for postoperative outcomes compared with the routine technique. The results indicated that the new method is safe, less traumatic and has better cosmetic effects. It is concluded in this article that the subaxillary extrapleural approach for PDA is a good modification to the routine surgical technique, that is surgery through the posterolateral approach.

A forty-seven-year-old Japanese woman under treatment for systemic lupus erythematosus (SLE), complained of severe back pain. Chest X-ray and MRI showed an aneurysmal dilatation of the ascending aorta. Subsequently an aortic replacement was performed. Microscopically, the resected aorta showed Takayasu's aortitis with chronic dissection. Both aortitis and dissection are rare events in SLE patients. To our knowledge, this is the first report of Takayasu's aortitis with dissection in a patient with SLE.

Recently, minimally invasive cardiac surgery (MICS) has been developed and popularized as a less stressful and less invasive technique in the field of cardiac surgery. There are eight currently available MICS approaches for open heart surgery. The optimum approach should be selected for each patient based on the results of preoperative examination including chest X-ray, computed tomography, and angiography. Between December 1996, when we first introduced MICS for mitral repair, and the end of November 1998, we performed MICS in 67 patients [excluding cases of MIDCAB]. These included 11 patients who received the Port-Access (Heartport, Inc.) system. Although no patients died in hospital stay, one died of cerebrovascular bleeding eight months later. All patients were evaluated in the outpatient department as being NYHA class I. In view of future technological progress, we expect that MICS will gradually become more widespread in cardiac surgery.