Transplantation of the cadaver heart harvested one hour after hypoxic cardiac arrest using the core-cooling technique in dogs.

A shortage of donor organs in clinical transplantation prompted us to study whether resuscitated dead hearts could be utilized for successful orthotopic heart transplantation. After 60 min of hypoxic cardiac arrest, one group of canine hearts was resuscitated (Res group, n = 6). The other group was harvested directly (Non-Res group, n = 6). In the Res group, cardiopulmonary bypass was utilized for resuscitation at 37 degrees C and the animals were then core-cooled to 15 degrees C. The hearts then were preserved in University of Wisconsin solution and orthotopically transplanted. Stable prostacyclin analogue (OP2507) and verapamil, a calcium antagonist, were added to the cardioplegia, and substrate-enriched warm blood cardioplegia and a hydroxy radical scavenger (EPC) were administered at the time of reperfusion of the transplanted heart. All animals in each group were successfully weaned from cardiopulmonary bypass with dopamine (5 micrograms/kg/min). Cardiac function without dopamine was better preserved in the Res group than the Non-Res group (Emax: 130.6 +/- 41.5% vs. 47.1 +/- 24.7%; mean +/- SD, as percent of postbrain death values, P &#60; 0.01 by unpaired t-test). Cadaver hearts 60 min after anoxic arrest can be successfully re-animated and orthotopically engrafted. In addition, the core-cooling technique is useful. We believe this study serves as the key step in the clinical application of dead hearts to successful cardiac transplantation.</p

Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection

ObjectiveWe have developed a novel bronchoscopic multiple marking technique to assist resection of hardly palpable lung tumors. Because 3-dimensional virtual images were used and multiple markings made on the lung surface to provide “geometric” information, we termed this technique “virtual assisted lung mapping” (VAL-MAP). The safety and efficacy of VAL-MAP were evaluated.MethodsVirtual bronchoscopy was used to select 2 to 4 appropriate bronchial branches for marking. Bronchoscopy was conducted with the patient under local anesthesia. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of indigo carmine was injected. This procedure was repeated to complete all the planned markings. Post–VAL-MAP computed tomography was used to visualize the localization of the multiple markings on 3-dimensional virtual images, which were used as references in the subsequent operation.ResultsOf the 95 marking attempts made for 37 tumors in 30 patients, 88 (92.6%) were identified and contributed to the surgery. No clinically evident complications were associated with the procedure. A total of 15 wedge resections and 18 segmentectomies were thoracoscopically conducted, with a successful resection rate of 100%. Multiple markings of the VAL-MAP were complementary, enabling us to achieve complete resection even when 1 of the markings failed. The markings were visible even on interlobar fissures, at the apex, and on the diaphragm, which conventional percutaneous marking can hardly reach.ConclusionsVAL-MAP was safely conducted with satisfactory outcomes in our early experience. Additional confirmation of its safety and efficacy is necessary

Virtual endobronchial ultrasound for transbronchial needle aspiration

ObjectiveEndobronchial ultrasound-guided transbronchial needle aspiration could be performed better with computer-based preparation.MethodsThree-dimensional virtual bronchoscopy was used to develop 2 modes of computer-based “virtual endobronchial ultrasound.” “Virtual endobronchial ultrasound standard” used conventional virtual bronchoscopy to determine the spot and angle for transbronchial needle aspiration, which was further evaluated by virtual bronchoscopy. “Virtual endobronchial ultrasound advanced” used multiple layers of 3-dimensional images of the target lesions and associated vascular structures in combination with virtual bronchoscopy. Target lesions and associated vascular structures (eg, pulmonary artery) were visualized through half-transparent bronchial walls.ResultsBoth methods required 5 to 15 minutes of preparation per case. Virtual endobronchial ultrasound standard required only basic computer software for virtual bronchoscopy, whereas virtual endobronchial ultrasound advanced required an advanced computer application. Virtual endobronchial ultrasound advanced allowed for a more intuitive recognition of the target. Both methods were useful in evaluating the feasibility of transbronchial needle aspiration, especially when the target was out of regular mediastinal lymph nodes, or in targeting a lesion located at a high upper angle (eg, 4L lymph node). Because the puncture spot was predetermined, bronchoscopists did not have to search for the target using ultrasound at the time of actual endobronchial ultrasound-guided transbronchial needle aspiration; rather, ultrasound was used only for confirmation of the target location and visualization of transbronchial needle aspiration.ConclusionsBoth computer-based preparation methods of virtual endobronchial ultrasound were useful in predetermining the puncture spot of transbronchial needle aspiration, suggesting their potential complementary role to the conventional technique of endobronchial ultrasound-guided transbronchial needle aspiration

Continuing mind for primary care medicine as total family care mailing list (TFC-ML) group

There were historically two great doctors for primary care (PC) medicine in Japan. They are Dr. Shigeaki Hinohara and Dr. Yoshikazu Tasaka. Tasaka was always active in medical treatment, organizational management, postgraduate education, and information dissemination using the Internet, and started Total Family Care Mailing List (TFC-ML) in 1998. TFC-ML included medical information with his comments every day for long. Even after his death in 2007, TFC-ML activity has been continued by many voluntary PC physicians. His TFC mind has been transmitted to future PC physicians. His inspiration may often come to TFC members for better total family care

W-derived BAC probes as a new tool for identification of the W chromosome and its aberrations in Bombyx mori

We isolated four W chromosome-derived bacterial artificial chromosome (W-BAC) clones from Bombyx mori BAC libraries by the polymerase chain reaction and used them as probes for fluorescence in situ hybridization (FISH) on chromosome preparations from B. mori females. All four W-BAC probes surprisingly highlighted the whole wild-type W sex chromosome and also identified the entire original W-chromosomal region in W chromosome-autosome translocation mutants. This is the first successful identification of a single chromosome by means of BAC-FISH in species with holokinetic chromosomes. Genomic in situ hybridization (GISH) by using female-derived genomic probes highlighted the W chromosome in a similar chromosome-painting manner. Besides the W, hybridization signals of W-BAC probes also occurred in telomeric and/or subtelomeric regions of the autosomes. These signals coincided well with those of female genomic probes except one additional GISH signal that was observed in a large heterochromatin block of one autosome pair. Our results support the opinion that the B. mori W chromosome accumulated transposable elements and other repetitive sequences that also occur, but scattered, elsewhere in the respective genome. Edited by: E.R. Schmid

ヒトウニョウビョウセイ ジンフゼン デ イジ トウセキチュウ ニ キュウセイ ハッショウ 1ガタ トウニョウビョウ オ ハッショウ シタ コウキ コウレイシャ ノ 1レイ

We herein presented a case of a ７５-year-old man who was referred to our hospital for hyperglycemia in a drowsy state following a convulsive seizure after receiving hemodialysis at another clinic. He had been receiving maintenance hemodialysis for non-diabetic renal failure from the age of ７３ years. He was diagnosed with diabetic ketosis because his blood glucose level was ７０７mg/dl, HbA１c ８．３％, glycoalbumin ４０．５％, serum osmolality ３２３mosm/kg, and ３-hydroxybutyric acid ５．８ mmol/l. Continuous intravenous insulin infusion therapy was immediately initiated and was changed to intensive insulin therapy on the ７th day after his admission. He did not have metabolic acidosis or serious dehydration associated with the acute metabolic derangement observed on arrival because fluid corrections for acid-base and electrolyte imbalances in the blood had been achieved by hemodialysis prior to his referral to our hospital. ΔCPR at six minutes in the glucagon loading test was hardly affected, indicating that his endogenous insulin secretory capacity was markedly reduced. The GAD antibody was negative. He had the haplotype of HLA DR４, which is considered to reflect disease susceptibility for type１diabetes in Japanese individuals. Acuteonset type １ diabetes mellitus was diagnosed based on the diagnostic criteria for acute-onset type１ diabetes mellitus （２０１２） by the Committee of the Japan Diabetes Society. At the time of his discharge, ８ units of insulin lispro were being administered prior to each meal in addition to ２ units of insulin glargine before sleeping. He was transferred to a local clinic on the ２３rd day after his admission. Although glycoalbumin had been measured every six months in the present case, it was not useful for detecting new onset diabetes. Therefore, blood glucose measurements before dialysis need to be regularly performed, even in dialysis patients with non-diabetic renal failure, in order to detect the new onset of diabetes at an early stage

Living-donor lobar lung transplantation for rapidly progressive interstitial pneumonia associated with clinically amyopathic dermatomyositis: report of a case.

Diffuse interstitial pneumonia (IP) associated with collagen disease is a rare indication for lung transplantation. The manifestations of collagen disease are variable and dermatomyositis (DM) is often considered a contraindication for lung transplantation because of active myositis and a high incidence of malignancy. Furthermore, clinically amyopathic dermatomyositis (C-ADM) is associated with rapidly progressive IP resulting in a poor prognosis. Bilateral living-donor lobar lung was transplanted in a 52-year-old female with rapidly progressive IP associated with C-ADM, and the postoperative course was uneventful. To our knowledge, this case represents the first living-donor lobar lung transplantation for a patient with rapidly progressive IP associated with C-ADM

Statistical analysis of cloud layers and solar irradiations for all seasons in Toyohashi city, Japan

Several solar irradiation forecasting methods are being developed toward economically efficient solar power generation. Among these, the method that utilizes all sky imagers to estimate the direction of cloud movement above certain observation points is able to forecast fluctuations in solar irradiation with localized temporal resolution (∼30 min) through observation of shadows cast by clouds. The one-layered cloud is usually assumed in forecasting the direction of cloud movement. However, in reality, multilayered clouds may move in different directions in the sky. While such multilayered clouds may have effect on forecast accuracy, the extent to which multilayered clouds affect the solar irradiation and the generated solar power has never been reported. Therefore, the purposes of this study are (1) to give the dataset to know the effect of multilayered clouds and (2) to decide whether the multilayered clouds have to be considered in forecasting of solar irradiation. We analyzed the number of cloud layers and their effect on the solar irradiation, the generated solar power, and the clearness index through statistical analysis for all seasons in Toyohashi city, Japan. The dataset used to analysis includes data with 4381 h. The analytical results show that multilayered clouds were observed for ∼40% of the daytime duration even in winter. In addition, the results show that multilayered clouds were observed even when the solar irradiation, the generated solar power, and the clearness index were high, which suggests that the effect of multilayered clouds must be considered. In addition, it will be shown that the maximum number of cloud layers to be considered is 3 from statistical analysis