Outcomes of Patients with Pulmonary Atresia with Intact Ventricular Septum Reaching Adulthood

Background: There is limited information on outcomes of adult patients with pulmonary atresia with intact ventricular septum (PA-IVS) due to the low incidence of disease and the large variation of surgical histories. Methods: Among 58 patients with repaired PA-IVS, a total of 32 patients aged ≥16 years and who were followed at our institution between January 2003 and December 2018 were reviewed. Surgical history, clinical outcomes, and laboratory, echocardiographic and electrocardiographic data were obtained by chart review. Results: Follow-up was from the age of 16 years and the median age at the latest follow-up was 23.7 years. Twenty-four patients had undergone biventricular repair (BVR), 3 had undergone one-and-a half ventricular repair (1.5VR), and 5 had undergone univentricular repair. Over a median follow-up period of 7.7 years (interquartile range: 4.1–11.0 years), 1 BVR patient died suddenly and 7 patients had heart failure. Arrhythmias were present in 5 patients. Ten patients underwent surgical re-interventions, including 4 BVR take-downs with conversion to 1.5VR and 3 Fontan conversions. Overall survival, heart failure-free, arrhythmia-free, and surgical re-intervention-free rates at 5 years and 10 years from the age of 16 years were 96.2% (95% confidence interval [CI], 77.2–99.4) and 96.2% (95% CI, 77.2– 99.4), 81.4% (95% CI, 62.1–92.1) and 74.6% (95%CI, 52.3–88.7), 88.7% (95% CI, 70.1–96.3) and 75.9% (95% CI, 51.7–90.2), and 80.7% (95% CI, 60.8–91.8) and 70.8% (95% CI, 49.7–85.7), respectively. Conclusion: Adults with PA-IVS have preserved long-term survival regardless of the early operative strategy, while they are at risk for heart failure, arrhythmia, and surgical re-intervention. Thus, detailed and continued follow-up is mandatory for all PA-IVS patients from childhood to adulthood

Debranching thoracic endovascular aortic repair for distal aortic arch aneurysm in elderly patients aged over 75 years old

Background: We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. Methods: Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. Results: Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. Conclusion: Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities

A new prognostic index for overall survival in malignant pleural mesothelioma: the rPHS (regimen, PS, histology or stage) index.

First published online: April 2, 2015[Objective] Existing prognostic indices for malignant pleural mesothelioma do not incorporate the recent advances in oncology care. The purpose of this study was to provide a prognostic index for overall survival in malignant pleural mesothelioma patients treated with chemotherapy with pemetrexed or best supportive care in the recent clinical setting. [Methods] A retrospective cohort study was performed in two hospitals in Japan (2007–13). The primary outcome was overall survival. The Cox proportional hazards model was used for multivariable analyses to identify prognostic factors. A final model was chosen based on both clinical and statistical significance. [Results] A total of 283 patients (chemotherapy: n = 228, best supportive care: n = 55) were enrolled in the study. On multivariate analysis, regimen including platinum plus pemetrexed, a performance status >0, non-epithelial histological type and Stage IV disease predicted poor overall survival in chemotherapy patients. As hazard ratios of individual risk factors were approximately similar, a prognostic index for overall survival was constructed by counting the risk factors. Median overall survival in chemotherapy patients decreased by each one-point increase in this count: 1030 days for zero; 658 days for one; 373 days for two; 327 days for three; 125 days for four. Internal validation using the bootstrapping technique showed robustness of the model (c-index, 0.677; 95% confidence interval, 0.624–0.729). Further, the discrimination was consistent in best supportive care patients (c-index, 0.799; 95% confidence interval, 0.725–0.874). [Conclusions] This novel index can provide clinicians and malignant pleural mesothelioma patients with a better framework for discussing prognosis at the time of diagnosis

Smooth muscle cell sheet transplantation preserve cardiac function and minimize cardiac remodeling in a rat myocardial infarction model

Background: We examined whether a vascular smooth muscle cell (SMC) sheet is effective in the treatment of a rat myocardial infarction (MI) model. Methods: We examined the effect of SMC sheet on the cardiac function and cardiac remodeling in a rat MI model in comparison with their effect of dermal fibroblast (DFB) sheet in vivo. Furthermore, we estimated the apoptosis and secretion of angiogenic factor of SMC under hypoxic condition in comparison with DFB. Seven days after MI, monolayer cell sheets were transplanted on the infarcted area (SMC transplantation group, SMC-Tx; DFB transplantation group, DFB-Tx; no cell sheet transplantation group, Untreated; neither MI nor cell sheet transplantation group, Sham). We evaluated cardiac function by echocardiogram, degree of cardiac remodeling by histological examination, and secretion of angiogenic growth factor by enzyme immunoassay. Results: Twenty-eight days after transplantation, SMC-Tx showed the following characteristics compared with the other groups: 1) significantly greater fractional area shortening (SMC-Tx, 32.3 ± 2.1 %; DFB-Tx, 23.3 ± 2.1 %; untreated, 25.1 ± 2.6 %), 2) suppressed left ventricular dilation, smaller scar expansion, and preserved wall thickness of the area at risk and the posterior wall, 3) decreased fibrosis, preserved myocardium in the scar area, and greater number of arterioles in border-zone, 4) tight attachment of SMC sheets on the scarred myocardium, and less apoptotic cell death. In in vitro experiments, SMCs secreted higher amounts of basic fibroblast growth factor (SMC, 157.7 ± 6.4 pg/ml; DFB, 3.1 ± 1.0 pg/ml), and showed less apoptotic cell death under hypoxia. Conclusions: Our results illustrate that transplantation of SMC sheets inhibited the progression of cardiac remodeling and improve cardiac function. These beneficial effects may be due to superior SMC survival

Successful Surgical Remodeling of a Giant Venous Aneurysm Formed in an Autogenous Arteriovenous Fistula : A Case Report

One complication of an autogenous arteriovenous fistula (AVF) for hemodialysis is the formation of a venous aneurysm. The treatment of a massive aneurysmal AVF generally involves ligation or resection with the use of prosthetic interposition. We present the case of a 46-year-old man in whom an AVF aneurysm was successfully treated by placating the excess free wall of the aneurysm with sutures. This method is a simple and effective intervention for managing aneurysm-associated complications. In addition, this approach helps to maintain the benefits of autogenous access while conserving future dialysis sites

Six Weeks of Hip Joint Training Using a Novel Multihip Joint Board Improves Sprint Performance in Competitive Collegiate Male Sprinters

In a previous study, we identified the possibility that hip joint training using a multihip joint board (MHJB) may increase the cross-sectional area (CSA) of the psoas major (PM) muscle and improve sprint performance. However, the preliminary study reported descriptive findings because of a limited sample size. Therefore, we aimed to investigate and statistically infer the effects of the MHJB training protocol with a larger sample of male collegiate sprinters. The sprinters were randomly assigned to either the MHJB group (n = 7) or the control group (n = 7). The MHJB protocol consisted of 7 separate exercises targeting the development of the hip musculature, all using the MHJB device. The MHJB group undertook the MHJB protocol 3 times per week for 6 weeks, after their normal daily workout, whereas the control group completed their normal daily workout without the MHJB protocol. Sprint performance was recorded from official 100-m competitions before, and after, the 6-week training period. At the end of the training period, significantly greater improvement in PM CSA and 100-m sprint was noted in the MHJB group compared with the control group. These findings confirm the efficacy of MHJB training for increasing PM CSA and improve sprint performance in competitive male sprinters

MEG time-frequency analyses for pre- and post-surgical evaluation of patients with epileptic rhythmic fast activity

Purpose: To evaluate the effectiveness of surgery for epilepsy, we analyzed rhythmic fast activity by magnetoencephalography (MEG) before and after surgery using time-frequency analysis. To assess reliability, the results obtained by pre-surgical MEG and intraoperative electrocorticography were compared. Methods: Four children with symptomatic localization-related epilepsy caused by circumscribed cortical lesion were examined in the present study using 204 channel helmet-shaped MEG with a sampling rate of 600 Hz. One patient had dysembryoplastic neuroepithelial tumor (DNT) and three patients had focal cortical dysplasia (FCD). Aberrant areas were superimposed, to reconstruct 3-D MRI images, and illustrated as moving images. Results: In three patients, short-time Fourier transform (STFT) analyses of MEG showed rhythmic activities just above the lesion with FCD and in the vicinity of DNT. In one patient with FCD in the medial temporal lobe, rhythmic activity appeared in the ipsilateral frontal lobe and temporal lateral aspect. These findings correlate well with the results obtained by intraoperative electrocorticography. After the surgery, three patients were relieved of their seizures, and the area of rhythmic MEG activity disappeared or become smaller. One patient had residual rhythmic MEG activity, and she suffered from seizure relapse. Conclusion: Time-frequency analyses using STFT successfully depicted MEG rhythmic fast activity, and would provide valuable information for pre- and post-surgical evaluations to define surgical strategies for patients with epilepsy

Finite element analyses of female-thread forming process and loosening proof of self-tapping screw

Tapping screw fabricates the female thread due to plastic deformation during screw rotation. Since the tapping screw skips the preliminary fabrication of female thread, it is widely used for the tightening in the fields of such as electric parts and car parts. However, there is a few theoretical studies for its self-tapping process and loosening proof. In this paper, we have investigated the mechanism of tapping torque and shape of female thread using three-dimensional finite element analysis. In addition to the plastic flow caused by the friction force due to the rotation of male thread, the plastic flow at the top of male thread separated by the up and down directions occurs. That contact at thread top mostly contributes the torque of self-tapping. Also, plastic flow along the lower surface of frank thread separated by the outside and inside radial directions creates the characteristic shape of female thread. The analysis results well reproduce the tapping torque and the shape of female thread. We also investigate the loosening proofs due to shear loading both for tapping screw and normal screw using there-dimensional finite element analysis. The shape of female screw obtained by self-tapping analysis is incorporated into the analysis model. It is found that the loosening proof of the tapping screw is superior to that of normal screw since contact at the top of thread in the lower part of tapping bolt inhibits the thread slip