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Elderly patients with multiple infarctions revealed a high prevalence of postoperative stroke after coronary artery bypass grafting (CABG). However, postoperative neurological complications and characteristics of silent brain infarction (SBI) have not been evaluated in elderly patients undergoing CABG. Four hundred forty-nine patients (≥60 years old) scheduled for CABG underwent cerebral magnetic resonance imaging (MRI) and MR angiography preoperatively to assess cerebral infarctions and carotid and intracranial artery stenosis. Atherosclerosis of the ascending aorta was assessed by epiaortic ultrasound during surgery. Patients were sorted by their history of cerebrovascular disease (CVD) and the presence of infarction by MRI: SBI (infarction without CVD), BI (symptomatic brain infarction; CVD and infarction), and controls (no findings of either CVD or infarction). SBI was found in 35.5% of the 449 patients and increased with age. The prevalence of pre-existing multiple infarctions was less frequent in SBI than in BI. The incidence of postoperative stroke and cognitive dysfunction was 1.3% and 4.9% in controls (n = 225), 5.7% and 15.2% in SBI (n = 158), and 9.1% and 18.2% in BI (n = 66). Patients with SBI were older and had more renal dysfunction and preoperative cognitive impairment. Stepwise logistic regression demonstrated that age, renal dysfunction, preoperative cognitive impairment, atherosclerosis of the ascending aorta, and intracranial arterial stenosis were associated significantly with SBI. Patients with SBI were ranked at moderate risk of neurological complications after CABG between control and BI. Increased age, renal dysfunction, and preoperative cognitive impairment appeared to be strongly associated with SBI.

ObjectiveThis study aimed to evaluate intravenous (IV)/intraperitoneal (IP) paclitaxel and IP carboplatin (TCipTip therapy) feasibility in epithelial ovarian (EOC), fallopian tube (FTC), or peritoneal carcinoma (PC) patients.MethodsFrom December 2007 to August 2010, 20 women with histologically confirmed stage IC to IV EOC, FTC, or PC received 6 TCipTip cycles after the primary cytoreductive surgery. Intravenous paclitaxel was administered at 135 mg/m2followed by IP carboplatin based on the area under the curve = 6 on day 1; IP paclitaxel at 60 mg/m2was administered on day 8. The toxicity grade was determined by CTCAE version 3.0. The institutional review board requested we reduce the IP paclitaxel dose in the first cycle to ensure safety.ResultsTwenty women, including 18 with EOC, 1 with stage IIC FTC, and 1 with stage IV primary PC, received TCipTip therapy. There were 12 serous, 5 endometrioid, 1 mucinous, 1 clear cell adenocarcinoma, and 1 mixed carcinoma (clear cell and endometrioid) cases. Eleven women achieved optimal status at primary surgery. Grade 3/4 hematologic toxicity incidence was 73% (neutrocytopenia), 9% (thrombocytopenia), and 24% (anemia). Grade 3/4 nonhematologic toxicities were observed in 5 patients (4 with grade 3 allergy and 1 with grade 3 ileus). Twelve patients (60%) completed more than 6 chemotherapy cycles. Reasons for interruption included paclitaxel allergy, grade 2 abdominal pain, carboplatin allergy during the seventh cycle, disease progression, pleural embolism, ileus, and address change.ConclusionsToxicities for TCipTip therapy were acceptable; this therapy is feasible for EOC, FTC, or PC patients. Further TCipTip therapy evaluation is warranted.

Objectives Currently, pegylated liposomal doxorubicin (PLD) is regarded as one of the standard treatment options in recurrent ovarian cancers (ROC). Bevacizumab has shown significant antitumor activity for ROC in single-agent or in combination with cytotoxic agents. We have conducted a preliminary study to investigate effects of combination of bevacizumab and PLD for heavily pretreated patients with ROC. Methods Thirty patients with ROC were treated with combination therapy with weekly bevacizumab and PLD, 2 mg/kg of continuous weekly bevacizumab and 10 mg/m2 of PLD (3 weeks on, 1 week off). The treatment was continued until development of disease progression, or unmanageable adverse effects. Response evaluation was based upon Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0, and Gynecologic Cancer Intergroup (GCIG) CA125 response criteria. Adverse effects were analyzed according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Results Overall response rate was 33%, and clinical benefit rate (CR + PD + SD) was 73%. Median progression-free survival was 6 months (range: 2–20 months), and a 6-months progression-free survival was 47%. Any hematological toxicities more than grade 3 were not observed. Two cases developed non-hematologic toxicities more than grade 2; a case with grade 3 hand-foot syndrome, another with grade 3 gastrointestinal perforation (GIP). The case with GIP was conservatively treated and recovered after 2 months, and there was no case with treatment-related death. Conclusion The present investigation suggested that combination therapy with bevacizumab and PLD was active and well tolerated for patients with ROC. We recommend the regimen be evaluated in further clinical studies.

Cognitive dysfunction is more frequent after cardiac surgery. However, the preoperative cognitive state is seldom assessed when the effects of cardiac surgery on cognition are investigated. Postoperative cognitive dysfunction may be associated with the preoperative cognitive state and the existence of cerebral ischemic lesions in patients who undergo cardiac surgery.Data were collected prospectively on 362 consecutive patients scheduled to undergo elective cardiac surgery. The brains of all patients were imaged by magnetic resonance imaging (MRI) to assess prior cerebral infarctions, carotid artery stenosis and intracranial arterial stenosis, and diffusion-weighted imaging (DWI) was used to assess acute cerebral ischemia. Patients were classified with impaired cognitive function prior to surgery if their score on the Hasegawa dementia rating scale was24. Postoperative cognitive dysfunction from baseline was determined using four neuropsychological tests.Prior to surgery 40 patients (11%) were assessed with impaired cognition. Relative to the other patients, these patients were older and less well educated, and they had significantly higher rates of peripheral vascular disease, white matter lesions, cerebral infarction on MRI, carotid artery stenosis and postoperative cognitive dysfunction. Of these 40 cognitively impaired patients, seven (18%) had cerebral ischemia, based on DWI images before surgery; in comparison, nine of the 322 patients (3%) without preoperative cognitive impairment were found to have abnormalities on the DWI images (P0.001). An analysis by stepwise logistic regression demonstrated that the significant risks for preoperative cognitive impairment were advanced age, lower attained level of education, peripheral artery disease, prior cerebral infarctions, and abnormalities on DWI images.These findings suggest that preoperative cognitive impairment associated with cerebral ischemic lesions and an increased risk of postoperative cognitive dysfunction existed in our patient cohort undergoing cardiac surgery.

Aim: To evaluate toxicity, response and progression-free survival of single nedaplatin chemotherapy in women with platinum/taxane-resistant/refractory epithelial ovarian, tubal and peritoneal cancer. Methods: Seventeen patients with platinum/taxane-resistant/refractory epithelial ovarian, fallopian tube or primary peritoneal cancer who were treated with a single nedaplatin regimen at 90 mg/m2 administration on day 1 of a 28-day cycle in our institution between 2005 and 2007 were retrospectively investigated. Results: Ten of 17 patients (59%) had measurable disease. Seven patients were evaluated according to cancer antigen (CA) 125 levels. The overall response was 24% (complete response, 2 patients; partial response, 2 patients). Two of these 4 patients had measurable disease. Stable disease and progressive disease was noted in 6 (35%) and 7 (41%) patients. Median progression-free survival was 8 months (range 3–11) in patients who responded to therapy and 4 months (range 2–6) in patients with stable disease. Mean platinum-free interval due to treatment without using platinum analogues after developing platinum-resistant/refractory disease was 11 months (range 8–12) in patients who responded to nedaplatin regimen and 3 months (range 1–11) in patients who did not (P

Cosmetic product application may be an etiologic risk factor for dry eye syndrome. This study aimed to investigate whether a cosmetic product material (CPM) could migrate onto the ocular surface and whether eyedrop instillation might exacerbate this migration.CPM was prepared by mixing equal volumes of hydroxyethyl cellulose gel (Scopisol; Senju Pharmaceutical Co. Ltd., Osaka, Japan) and a 10% fluorescein solution. Seventy-five female volunteers were randomly separated into three groups: the outer eyelash line group, in which CPM was applied on the upper and lower eyelids approximately 2 mm from the eyelash line; the eyelash line (EL) group, in which CPM was applied close to the eyelash line but without touching it; and the inner eyelash line group, in which CPM was applied on the eyelash line extending to the margin of the eyelids. The right eye was used for this study. At 5 and 30 minutes after CPM application, slit-lamp examination was carried out to detect fluorescence, an indication of CPM migration and contamination of the ocular surface. A strip of Schirmer test paper was used to collect tears, and the color of the paper was scored (contamination score: 0-5) to determine the relative quantity of CPM contamination on the ocular surface. In another set of experiments, 5 minutes after CPM application, one drop of balanced saline solution was instilled into the eye. Thirty seconds later, eyes were examined by slit-lamp microscopy and tears were collected to determine the migration percentage (eyes with CPM migration/total eyes) and contamination score.At 5 minutes after CPM application, the inner eyelash line group displayed a significantly higher migration percentage (96%) and average contamination score (3.35 ± 0.77) compared with the outer eyelash line (12%; 0.15 ± 0.34) and EL (20%; 0.35 ± 0.32) groups. At 30 minutes, both the migration percentage and the average contamination score increased remarkably in the EL group (60% and 2.71 ± 1.01). The migration percentage and average contamination score in the outer eyelash line group (P = 0.005 and P = 0.003, respectively) and EL group (P = 0.009 and P = 0.006, respectively) were significantly higher after eyedrop instillation compared with values before eyedrop instillation.CPM can migrate onto the ocular surface when applied close to the eyelid margin. This migration increases with time and can be exacerbated by eyedrop instillation.

Survival of the conceptus is dependent on continuous progesterone signaling in the maternal decidua but how this is achieved under conditions of oxidative stress that characterize early pregnancy is unknown. Using primary cultures, we show that modest levels of reactive oxygen species (ROS) increase sumoylation in human endometrial stromal cells (HESCs), leading to enhanced modification and transcriptional inhibition of the progesterone receptor (PR). The ability of ROS to induce a sustained hypersumoylation response, or interfere with PR activity, was lost upon differentiation of HESCs into decidual cells. Hypersumoylation in response to modest levels of ROS requires activation of the JNK pathway. Although ROS-dependent JNK signaling is disabled on decidualization, the cells continue to mount a transcriptional response, albeit distinct from that observed in undifferentiated HESCs. We further show that attenuated JNK signaling in decidual cells is a direct consequence of altered expression of key pathway modulators, including induction of MAP kinase phosphatase 1 (MKP1). Overexpression of MKP1 dampens JNK signaling, prevents hypersumoylation, and maintains PR activity in undifferentiated HESCs exposed to ROS. Thus, JNK silencing uncouples ROS signaling from the SUMO conjugation pathway and maintains progesterone responses and cellular homeostasis in decidual cells under oxidative stress conditions imposed by pregnancy.—Leitao, B., Jones, M. C., Fusi, L., Higham, J., Lee, Y. Takano, M., Goto, T., Christian, M., Lam, E. W.-F., Brosens, J. J. Silencing of the Jnk pathway maintains progesterone receptor activity in decidualizing human endometrial stromal cells exposed to oxidative stress signals.

The aim of this study is to investigate p16INK4a expression by immunocytochemistry for ascites in advanced ovarian cancer and explore the possibility to predict chemotherapeutic response and prognosis. The immunocytochemical study was performed on cytology of ascites obtained from 37 Stage III or Stage IV ovarian cancer patients with measurable disease before platinum/taxane-based first-line chemotherapy following primary cytoreductive surgery or as neoadjuvant chemotherapy. Twenty-one of 21 (100%) responders and 6 of 16 (44%) nonresponders showed p16INK4a immunopositivity (p < 0.001). Immunopositivity was frequently observed in serous adenocarciomas (17 of 18, 94%). Overall survival was significantly better in immunopositive cases compared with immunonegative cases (p = 0.0006). For subcellular localization, cytoplasm was diffusely positive in immunopositive cases (n = 27), 12 of which showed stronger nuclear immunostaining and demonstrated superior overall survival. In vitro expression of p16INK4a protein was also examined for both parent chemosensitive and acquired chemoresistant ovarian cancer cell lines. Chemosensitive KF28 parent cells showed stronger nuclear staining compared with chemoresistant KFr13Tx cells showing stronger cytoplasmic staining by immunocytochemistry, which were also confirmed by western blotting. Our data suggest that p16INK4a expression in cytology of ascites is a candidate marker in prediction of the primary response to chemotherapy and prognosis.

Background In current Gynecologic Oncology Group studies, serum creatinine level is adjusted to 0.6 mg/dL in patients with levels Patients and Methods Carboplatin clearance was estimated in 115 patients with serum creatinine Results The carboplatin clearance calculated by the Jelliffe formula was significantly larger than the other 2 formulae ( P Conclusion Despite adjusting the serum creatinine level, the Adjusted-Jelliffe formula overestimates the creatinine clearance when compared with the Cockcroft-Gault formula.

Background: To investigate the effects of UDP-glucuronosyltransferase 1A1 (UGT1A1) *28, *6 and *27 in patients with gynecologic cancer who received chemotherapy with irinotecan and cisplatin. Methods: Patients eligible for this study had cervical or ovarian cancer treated with chemotherapy; a course of the regimen consisted of 60 mg/m2 of irinotecan on days 1, 8 and 15, and 60 mg/m2 of cisplatin on day 1 every 4 weeks. UGT1A1 polymorphisms and toxicities were analyzed. Results: From March 2007 to December 2007, 30 Japanese patients were enrolled; 24 ovarian carcinoma patients and 6 cervical cancer patients. The following genotypes of UGT1A1 were found: wild type in 17 patients (57%), *28 in 4 patients (13%), *6 in 8 patients (27%), *28*6 in 1 case (3%) and no case of *27 (0%). Grade 3/4 neutropenia, thrombocytopenia and diarrhea were significantly more frequent in *6 patients compared with wild-type patients. Also, in *6 patients irinotecan administration on days 8 or 15 was significantly more often omitted due to toxicities. In patients with *28 or *28*6, side effects were similar to those in patients with *6. Conclusion: In addition to UGT1A1*28, UGT1A1*6 might also be a key candidate to determine the dose of combination chemotherapy with irinotecan and cisplatin.

Background Diffusion-weighted magnetic resonance imaging (DWI) has found ischemic lesions in the brain after cardiac surgery. However, preoperative cerebral injury has not been studied closely. In this study, we used DWI to assess the prevalence of abnormalities in patients scheduled for cardiac surgery. Methods We used conventional magnetic resonance imaging and DWI to study 247 consecutive patients scheduled for elective cardiac surgery. Clinical characteristics, neuropsychological test performance, and radiographic data were collected and compared with a group of patients who had normal findings on DWI. Results Eleven of the 247 patients (4.5%) had cerebral ischemic lesions on DWI before surgery. Compared with patients who had normal findings on DWI, patients who had abnormalities had significantly higher rates of history of cerebrovascular disease (64% versus 12%), cardiac catheterization within 14 days before DWI (91% versus 54%), preoperative cerebral infarctions (45% versus 5%), carotid artery stenosis (36% versus 5%), and preoperative cognitive impairment (55% versus 9%). Of the 11 patients with DWI abnormalities, 5 had delayed elective surgery and follow-up image studies; of these 5, 4 showed no relevant ischemic lesion on preoperative follow-up imaging. Among the other 6 patients, 1 had an infarction due to expansion of the same lesion that was detected on the preoperative DWI. There was no significant difference with regard to the incidence of postoperative stroke and cognitive dysfunction. Conclusions In all, 4.5% of cardiac surgery patients had existing cerebral ischemic lesions on DWI without obvious neurologic defects. Further studies are required to determine whether the lesions are associated with postoperative cognitive dysfunction or stroke.

The role of transcriptional factor FOXO1 in the mechanism of drug-resistance in ovarian cancer has not been elucidated. In ovarian cancer cell lines, FOXO1 expression and its correlation with paclitaxel treatment was investigated by cytotoxic assay and silencing experiment. Clinical ovarian cancer samples were also examined for FOXO1 expression by immunohistochemistry. FOXO1 expression was distinctively upregulated in paclitaxel-resistant cell line, and enhanced by exposure to paclitaxel. FOXO1 overexpression was frequently observed in tissue samples from chemoresistant patients compared to chemosensitive patients. FOXO1 silencing in paclitaxel-resistant cell line decreased its resistance. Modification of oxidative stress by co-treatment with pharmacologic modulators of reactive oxygen species attenuated cytotoxicity of paclitaxel. Downstream targets of FOXO1 involving oxidative stress were also attenuated in silencing experiment, suggesting its involvement in altered sensitivity to paclitaxel. These results indicate that FOXO1 links to cytotoxic stress induced by paclitaxel and contributes to the drug-resistance in ovarian cancers.

We previously reported that in rats, long-term Zn deficiency significantly reduced taste sensitivity and total carbonic anhydrase (CA) activity in the submandibular gland. We therefore investigated the effects of Zn deficiency on salivary secretion and the expressions of CA isozymes (II and VI) in the rat submandibular gland, since those isozymes are thought to be related to taste sensation and salivary secretion. Male Sprague‐Dawley rats, age 4 weeks, were divided into three groups (Zn-def, low-Zn and pair-fed, that were fed a diet containing 2·2, 4·1 or 33·7mgZn/kg, respectively, for 42 d). Northern blot analysis indicated that Zn deficiency reduced CA II mRNA expression in the submandibular gland without reducing CA VI mRNA expression. In Western blot analysis, Zn deficiency significantly reduced CA II (erythrocyte CA) protein expression in the submandibular gland without reducing CA VI protein expression. Salivary secretion was lower in the Zn-def group than in the pair-fed group. These results suggest that decreased CA isozyme II expression underlies the decreased CA activity previously reported in the submandibular gland in Zn-def rats, and this may reduce regular salivary secretion. Zinc deficiency: Carbonic anhydrase II and VI: Submandibular glands

Testosterone levels in men decrease with age; this decline has been linked to various diseases and can shorten life expectancy. Geranylgeraniol (GGOH) is an isoprenoid found in plants that plays an important role in several biological processes; however, its role in steroidogenesis is unknown. Here, we report that GGOH enhances the production of testosterone and its precursor progesterone in testis-derived I-10 tumor cells. GGOH induced protein kinase A (PKA) activity and increased cAMP levels and was found to regulate cAMP/PKA signaling by activating adenylate cyclase without altering phosphodiesterase activity. GGOH also stimulated mRNA and protein levels of steroidogenic acute regulatory protein, a downstream effector in the cAMP/PKA pathway. These results demonstrate that GGOH enhances steroidogenesis in testis-derived cells by modulating cAMP/PKA signaling. Our findings have potential applications for the development of therapeutics that increase testosterone levels in aging men.

Advanced age is associated with systemic atherosclerosis and is a risk factor for neurological dysfunction after coronary artery bypass grafting (CABG). However, few studies have investigated early neurological dysfunction after off-pump CABG in elderly patients.Data were collected prospectively on 218 patients (/=60 years) who underwent elective off-pump (n = 89) or on-pump CABG (n = 129). Four cognitive tests were performed preoperatively and 1 week postoperatively. Neuropsychological (NP) dysfunction was defined as a decrease in an individual's performance in more than two tests of at least 20% from baseline. We compared the incidence of NP dysfunction, stroke, graft patency grading, and systemic atherosclerosis between patients who underwent off-pump and on-pump CABG.Off-pump patients were more likely to have a history of cerebrovascular disease, peripheral vascular disease, smoking, multiple cerebral infarctions, and severe aortic atherosclerosis. None of the off-pump and three on-pump patients suffered intraoperative strokes (P = 0.27). The incidence of NP dysfunction was 11.2% in the off-pump group and 22.5% in the on-pump group, (P = 0.02). Multivariate analysis revealed that NP dysfunction was associated with cardiopulmonary bypass (CPB) and multiple cerebral infarctions. The off-pump group had fewer vessels grafted (2.4 vs 3.4; P0.01), and a higher rate of stenosis (50%) and occlusion of the grafted vessels (13.0% vs 7.4%; P = 0.01) than the on-pump group.Off-pump CABG reduced postoperative NP dysfunction in elderly patients with severe systemic atherosclerosis compared to on-pump CABG.

Using cDNA microarray analysis, we identified SGK1 (serum- and glucocorticoid-regulated kinase 1) as a gene aberrantly expressed in midsecretory endometrium of women with unexplained infertility. SGK1 is a serine/threonine kinase involved primarily in epithelial ion transport and cell survival responses. Real-time quantitative PCR analysis of a larger, independent sample set timed to coincide with the period of uterine receptivity confirmed increased expression of SGK1 transcripts in infertile women compared with fertile controls. We further demonstrate that SGK1 expression is regulated by progesterone in human endometrium in vivo as well as in explant cultures. During the midsecretory phase of the cycle, SGK1 mRNA and protein were predominantly but not exclusively expressed in the luminal epithelium, and expression in this cellular compartment was higher in infertile women. In the stromal compartment, SGK1 expression was largely confined to decidualizing cells adjacent to the luminal epithelium. In primary culture, SGK1 was induced and phosphorylated upon decidualization of endometrial stromal cells in response to 8-bromo-cAMP and progestin treatment. Moreover, overexpression of SGK1 in decidualizing cells enhanced phosphorylation and cytoplasmic translocation of the forkhead transcription factor FOXO1 and inhibited the expression of PRL, a major decidual marker gene. Conversely, knockdown of endogenous SGK1 by small interfering RNA increased nuclear FOXO1 levels and enhanced PRL expression. The observation that SGK1 targets FOXO1 in differentiating human endometrium, together with its distinct temporal and spatial expression pattern and increased expression in infertile patients, suggest a major role for this kinase in early pregnancy events.

Background: It has been reported that measurements of eosinophil-derived neurotoxin (EDN) may be useful for identifying eosinophil activities in allergic diseases including atopic dermatitis. Methods: EDN concentrations in the urine were measured by enzyme-linked immunosorbent assay, and the number of eosinophils in the peripheral blood was counted in 30 patients with atopic dermatitis. The severity of atopic dermatitis was graded on the criteria proposed by Rajka and Langeland. The disease activity was assessed by each patient on a visual analogue scale (VAS). Results: Urinary concentrations of EDN in patients with atopic dermatitis showed a significant positive correlation with disease severity. Urine EDN concentrations also correlated with VAS scores for itching, skin condition, overall skin symptoms and total VAS score, but not with the VAS score for skin dryness. Urinary EDN concentrations did not correlate with the number of eosinophils in the peripheral blood. Conclusions: The urinary EDN concentration in patients with atopic dermatitis is a useful clinical marker for monitoring disease activity.

高齢化社会の到来に加え, 手術手技や麻酔管理の向上により高齢者の手術は増加し, 術後脳障害も増加していると考えられる. 術後脳障害を予防するには脳梗塞の病型や病態を勘案して周術期管理計画を立案することが重要である. 脳血管障害の既往を有する患者の術後再発率は高く, 術前評価や厳重な循環管理, 発生機序に応じた治療が必要である. 脳梗塞の多くは血栓や塞栓による脳動脈の閉塞によって生じることや, 術後の凝固能亢進により血栓形成が加速されることから, 抗血栓療法や脳灌流圧の適正な維持が重要である. 周術期管理を行う麻酔科医には脳虚血の予知や脳蘇生などの重要な役割があり, 頭部, 頸部における動脈硬化の診断や全身管理のスキルが求められる.

Carbon nanohorn (CNH) doping in MgB 2 wire prepared by suspension spinning was studied to enhance flux pinning. The mixed powders of MgB 2 and CNH with nominal composition of (MgB 2 ) 0.95 C 0.05 were suspended in a mixed poly(vinyl alcohol) solution. The as-drawn filaments were hot-pressed under 20 MPa at 200 °C for 8 h. The samples were enveloped by an iron sheet with a pellet of mixed powder of Mg and B and vacuum-sealed in a fused quartz tube, and then sintered at the temperature ranging from 885 °C to 900 °C for 2–3 h. The superconductivity of the samples was studied by electrical resistivity and SQUID method. Serious deterioration of T c was not observed for the doped sample. The CNH doping resulted in enhancement of the transport J c values at 4.2 K in high fields ranging from 6 T to 10 T by sintering at 885 °C for 2 h. The superconductivity at 4.2 K was maintained by applying the field of 14 T for the doped sample sintered at 900 °C for 3 h.

We prepared filamentary 0.1 at% Zr-doped (Nd 0.33 Eu 0.38 Gd 0.28 )Ba 2 Cu 3 O x superconductors by solution spinning and partial melting in flowing 0.1% O 2 + Ar gas. The transport critical-current density ( J c ) was measured at 77 K in applied magnetic fields up to 14 T by rotating the sample along a direction perpendicular to the filament length. Anisotropic behavior of the field dependence of J c was detected by applying a field of more than 4 T. The J c values for the Zr-doped sample were higher than those for the undoped sample on the application of fields of up to 11 T. The J c values measured at the optimized angle for the doped sample were more than 10 5 A/cm 2 at 77 K by applying fields of up to 6 T. Transmission electron microscopy (TEM) of the sample was performed using an ultra high-voltage TEM to clarify the pinning centers. Intergrowth of 124 phase and stacking faults in the oriented 123 matrix were observed both for the doped and undoped samples. Zr doping resulted in the fluctuation of the structure with a short disorder range of 10–30 nm. A modulated structure and fine twin planes crossing each other were partly observed for the doped sample. The presence of such small-scale disorder could improve flux pinning in the middle field region.

The effect of nanoscale SiC addition on the field dependence of J/sub c/ for MgB/sub 2/ superconducting wire by suspension spinning was examined to enhance the flux pinning. The suspension spinning of commercially available MgB/sub 2/ and SiC powders was examined to fabricate a long superconducting MgB/sub 2/ wire by using the spinning medium of poly(vinyl alcohol) (PVA) or polyacrylonitrile (PAN). The as-drawn filaments were uniaxially pressed under 20 MPa at 200/spl deg/C for 8 h to remove volatile components and connect the MgB/sub 2/ grains. The filamentary samples were enveloped by an iron sheet with a pellet of mixed powder of Mg and B to prevent Mg loss, and vacuum-sealed in a fused quartz tube and sintered. The field dependence of J/sub c/ for the samples was examined at 4.2 K in magnetic fields up to 14 T. The J/sub c/ of the sample was strongly dependent on the spinning medium and sintering condition. Addition of 5 at% SiC in the sample spun by PVA medium attained the maximum J/sub c/ value more than 1000 A/cm/sup 2/ at 4.2 K by applying the field of 14 T.

In order to study the effect of matrix composition in the filamentary (Nd, Eu, Gd)Ba 2 Cu 3 O y ((Nd, Eu, Gd)123) superconductors on critical current density, we prepared three samples with various rare-earth ratios: (Nd 0.33 Eu 0.38 Gd 0.28 )123 (sample A), (Nd 0.33 Eu 0.33 Gd 0.33 )123 (sample B), (Nd 0.33 Eu 0.08 Gd 0.58 )123 (sample C). The filamentary precursor was prepared by a solution-spinning method and partially melted in flowing 0.1%O 2 + Ar and 1%O 2 + Ar. The samples had well aligned texture along the filamentary diameter as well as the length except sample C processed in flowing 1%O 2 + Ar. The T c value for the samples processed in flowing 0.1%O 2 + Ar is higher than that for 1%O 2 + Ar. The high J c value more than 10 4 A/cm 2 at 77 K and self-field is attained for samples A and B. The field dependence of J c for the samples was measured at 77 K up to 14 T by changing the angle along the filament diameter. The anisotropic behavior of the J c -B curve was detected. The J c values and irreversibility field for the samples processed in flowing 0.1%O 2 + Ar are higher than those for 1%O 2 + Ar. By optimizing the angle for the samples, the highest J c value of 3400 A/cm 2 at 14 T was attained for sample A.

We have prepared fine filamentary EuBa 2 Cu 3 O x superconductors by solution spinning and melt processing to fabricate the high- T c superconducting wire with high-critical current density ( J c ) at 77 K and high-magnetic fields. The filamentary precursor was partially melted in flowing 0.1% O 2 + Ar and then oxygenated. The samples in diameter of 55 μm had well aligned texture along the filament diameter as well as the length. The T c value of the sample was 90 K. The transport J c for the samples was measured at 77 K in applied magnetic fields up to 14 T by rotating the sample in a direction of the filament diameter. Anisotropic behaviour of the field dependence of J c along the filament diameter was detected. The sample rotated the optimized angle exhibited the highest J c value of 11,000 A/cm 2 at 77 K and 14 T. The transmission electron microscopic image for the filamentary EuBa 2 Cu 3 O x superconductors was observed by using ultra high-voltage transmission electron microscope to clarify the pinning center. Intergrowth of 124-phase and nano-scale particle in the orientated 123 matrix were observed. The presence of such small-scale disorders could improve flux pinning at high fields.

We prepared precursor filamentary Ho 1 Ba 2 Cu 3 O x superconductors by a solution spinning. The filamentary precursor was partially melted in flowing O 2 under various heating conditions. The J c value of the sample was strongly dependent on the flowing O 2 rate. A J c value of 10 4 A/cm 2 at 77 K and self-field was attained for the sample melted in flowing O 2 rate of 0.25 l/min. The J c was measured at 77 K in applied magnetic fields up to 14 T by rotating the sample along the direction perpendicular to the filament length. Anisotropic behavior of the field dependence of J c was detected. A J c value of 100 A/cm 2 at 77 K is maintained by applying the field of 14 T for the sample without rotating. By rotating the angle from the optimized angle to 90°, the J c value decreased drastically and disappeared by applying the field more than 9 T.

We have studied a fabrication of filamentary ternary RE123 superconductors by changing the RE element for pinning enhancement. In this paper, the J c of the filamentary (Eu, Gd, Ho)123 superconductors prepared by solution spinning and partial melting under various atmospheres was examined. As the oxygen partial pressure decreased, the optimum melting temperature decreased. The T c of the samples melted in flowing 0.1%O 2 + Ar and 1%O 2 + Ar was around 92 K and the T c for the samples melted in flowing 20%O 2 + Ar was low such as 83 K. The transport J c values for the samples were measured at 77 K in applied magnetic fields up to 14 T by rotating the sample in a direction of the filament diameter. Anisotropic behavior of the field dependence of J c along the filament diameter was detected. The highest J c value of 4100 A/cm 2 at 77 K and 14 T was detected for the sample melted in flowing 0.1%O 2 + Ar. By the rotating the angle for 90°, the superconductivity at 77 K was disappeared by applying the field more than 8 T.

This paper describes the preparation of filamentary potassium-doped C 60 superconductors prepared by the suspension spinning method. Commercial C 60 powder was suspended in mixed poly(vinyl alcohol) solution of dimethyl sulfoxide and hexamethylphosphoric triamide (sample A). The viscous suspension was extruded as a filament into a precipitating medium of methyl alcohol and coiled on a drum. The filamentary sample was also prepared by the suspension spinning by using polyacrylonitrile solution of N , N -dimethylformamide (sample B). The samples were pyrolyzed to remove volatile components. Doping of potassium for the samples was prepared as following: At first, powder samples of nominal composition K 6 C 60 was prepared by reaction of C 60 with excess potassium. The K 6 C 60 powder and filamentary sample with stoichiometric ratio of K 3 C 60 were placed in Pyrex glass tubes and vacuum-sealed and heated at 250 °C for 36 h. SQUID measurement shows the superconductivity of sample B with T c =18 K. On the other hand, the superconductivity more than 2 K was not detected for sample A.

The filamentary Sm123 precursor was prepared by a solution spinning method. The precursor was partially melted in flowing 0.1%O 2 + Ar and 1%O 2 + Ar. The transport J c value for the filamentary Sm123 superconductors was examined at 77 K in applied magnetic fields up to 10 T. The J c value higher than 10 4 A/cm 2 was maintained up to 4 T for the samples melted in flowing 1%O 2 + Ar. The J c value gradually decreased with increasing applied magnetic fields from 4 to 6 T and the superconductivity rapidly deteriorated by applying the fields above 8 T. On the contrary, the J c values drastically decreased for the samples melted in flowing 0.1%O 2 + Ar by applying the fields higher than 1 T, and the superconductivity at 77 K was disappeared around 4 T.

The transport J c at 77 K for filamentary (Gd,Dy,Ho)–Ba–Cu–O superconductors prepared by solution spinning and partial melting was measured in magnetic fields up to 10 T. The partial melting of the filamentary sample was examined in flowing 0.1% O 2 + Ar, 1% O 2 + Ar and 20% O 2 + Ar. The field dependence of J c for the sample partially melted in flowing 1% O 2 + Ar was superior to that for the other samples. The J c maintained around 10 4 A/cm 2 by applying the field up to 6 T and then decreased drastically.

Partial melting of filamentary (Nd 0.33 Eu 0.08 Gd 0.58 )Ba 2 Cu 3 O y superconductors in flowing 0.1% O 2 + Ar (sample A) and 1% O 2 + Ar (sample B) under various heating conditions was examined to obtain high transport J c . The T c values for sample A and sample B were 92.3 and 84.6 K, and maximum J c values at 77 K and self-fields were 19,000 and 350 A/cm 2 , respectively. Sample A had well-aligned texture along the filament diameter as well as filament length. The field dependence of J c for sample A was measured at 77 K and magnetic fields up to 10 T by changing the angle along the filament diameter. An angular dependence of the J c along the filament diameter was detected. By optimizing the angle, the sample showed J c value of 420 A/cm 2 at 77 K and 8 T.

The field dependence of transport J/sub c/ or MgB/sub 2/ superconducting wire by suspension spinning was examined at 4.2 K in magnetic field up to 10 T. The suspension spinning of commercially available MgB/sub 2/ powder was examined to fabricate a long superconducting MgB/sub 2/ wire. The as-drawn filaments were pressed and pyrolyzed to remove volatile components. The filamentary samples were then cold-pressed, enveloped by an iron sheet with a pellet of mixed powder of Mg and B or with Mg powder, and vacuum-sealed in a fused quartz tube and sintered. The J/sub c/ of the sample was strongly dependent on the starting materials and sintering condition. Although the transport J/sub c/ value was low such as 4500 A/cm/sup 2/ at 4.2 K and self-field, the J/sub c/ value of more than 200 A/cm/sup 2/ was maintained by applying the field of 10 T.

In order to reduce thermal inputs through many measuring copper leads, we intended to fabricate a measuring leads unit using very fine YBa 2 Cu 3 O 7 filaments. The long YBa 2 Cu 3 O 7 filaments were prepared by a textile fiber spinning method for the oxide precursor. The 60 filaments with a size of 100 μm in diameter and 60 mm in length were attached onto three fiber-reinforced polymers, and were covered with epoxy resin. Both ends of the YBa 2 Cu 3 O 7 filament were soldered with pin connectors through copper leads with 0.1 mm in diameter. The YBa 2 Cu 3 O 7 measuring leads unit of 60 terminals was cooled by a pulse tube cryocooler. The newly developed YBa 2 Cu 3 O 7 measuring leads unit demonstrates the extremely small heat loads of 1/10 in comparison with conventional copper measuring leads.

We studied partial melting in filamentary Eu–Ba–Cu–O superconductors prepared by a solution spinning method. The precursor filaments were oxygen-controlled- melt-growth processed under various oxygen atmospheres in order to obtain a high Jc value. The superconducting properties of the Eu123 filament were strongly dependent on the heating condition and the atmosphere. The filamentary samples partial-melted in flowing 0.1% O 2 + Ar and 1% O 2 + Ar exhibited well aligned texture along the filament diameter as well as the direction of filament length and a dense microstructure without pores. Samples prepared in flowing 0.1% O 2 + Ar and 1% O 2 + Ar showed the Tc value of around 90 K, in contrast to the Tc value of 78 K for sample prepared in flowing 20% O 2 + Ar . The sample partial-melted in flowing 0.1% O 2 + Ar represented high Jc value more than 104 A/cm2 at 77 K and self-field over a wide partial melting temperature range of 1020–1040 °C and the excellent reproducibility.

The suspension spinning of commercially available MgB 2 powder was examined to fabricate a long superconducting MgB 2 wire. The MgB 2 powder was suspended in a mixed poly(vinyl alcohol) solution of dimethylsulfoxide and hexamethylphosphoric triamide. The viscous suspension solution was extruded as a filament into a precipitating medium of methyl alcohol and coiled on a drum. The as-drawn filaments were pressed and pyrolyzed to remove volatile components. The filaments were then cold pressed, enveloped by an iron sheet with a pellet of mixed powder of Mg and B, and vacuum sealed in a fused quartz tube and sintered. The effect of the J c on the starting materials and sintering conditions of the filamentary MgB 2 superconductors was examined. The J c of the sample was strongly dependent on the staring materials. The optimum sintering condition was sample to sample. The maximum J c value of more than 10 4 A/cm 2 at 4.2 K and self-field was attained.

The precursor Y1Ba2Cu3Ox (Y123) filaments were prepared by solution spinning through aqueous poly(vinyl alcohol) solution containing mixed Y, Ba and Cu acetates. The as-drawn filaments were heated to remove volatile components and to generate a superconducting phase. The filamentary superconductors were passed through Ag paste and sintered. By controlling the heating condition, the composite with excellent connection between the filaments and metallic Ag matrix was obtained. The overall transport critical current density (Je) of more than 2000 A/cm2 at 77 K and 0 T was achieved for the composite with partially melted Y123 filaments. Although the Je value decreased by applying a low magnetic field less than 0.1 T, the superconductivity of the composite maintained at 10 T at 77 K.

Rice bran (RB) is a major by-product of rice polishing and a rich source of bioactive compounds. Here, we investigated the anti-colitis effect of diet supplementation with fermented rice bran (FRB) in a murine model of ulcerative colitis. FRB was prepared by dual fermentation of RB using fungi and lactic acid bacteria. Colitis was induced in C57Bl/6N male mice (n = 8/group) by dextran sodium sulfate (DSS). Body weight change, disease activity index (DAI), histopathology score, tissue myeloperoxidase (MPO) activity, cytokine and chemokine transcript levels, and the production of short-chain fatty acids (SCFAs) and mucin in the colonic tissue were monitored. Based on histopathology scores, DSS induced severe mucosal inflammation, with an increased loss of crypts, and inflammatory cell infiltration in the control and RB groups, but not in the FRB group. MPO activity, thiobarbituric acid-reactive substance levels, and pro-inflammatory cytokine transcript (Tnf-α, Il-1β, Il-6, and Il-17) levels were significantly higher in the control and RB groups than in the FRB group. Thus, dietary FRB attenuated intestinal inflammation owing to elevated SCFAs and tryptamine production, which might regulate tight junction barrier integrity and intestinal homeostasis. These results suggest that FRB could comprise an effective potential preventive agent for ulcerative colitis.

11056 Background: Uterine leiomyosarcomas (ULMs) tend to recur regardless of their stage, and there is no satisfactory report for relapsed ULMs. Temozolomide (T) is derivatives of dacarbazin and these agents have been used for treatment of ULMs. ULMs has a plenty of vessels compared to uterine myoma so that bevacizumab (B) was used in ULMs. In the present study, we evaluated the effect of TB in heavily pretreated relapsed ULMs. Methods: From 2009 to 2016, total 19 patients (pts) with heavily pretreated ULMs were enrolled. Patients were treated with T (80mg/body/day) and B (2mg/kg; days 1, 8 and 15, q4 weeks). Treatment was continued until disease progression and/or unmanageable toxicities. Response was evaluated with the response evaluation criteria in solid tumors (RECIST) v1.1, and adverse effect (AE) was assessed by common terminology criteria for adverse events (CTCAE) v4.0. Results: Seventeen of 19 pts were subjected to response evaluation. Median age of pts was 56.3 years (range: 31-69). Three pts (18%) had complete response (CR), 2 (12%) had partial response, and 7 (41%) had stable disease (SD). The response rate (RR: CR+PR) and clinical benefit rate (CBR: CR+PR+SD) were 29% and 71%. The median progression-free survival was 14.2 months (range: 0-89). Median administration cycle was 9.5 (range: 2-48). AE with grade 3 and more over were observed in 6 pts. There was one dead case from perforation, but toxicity was almost manageable. Conclusions: We experienced 3 cases of CR, and two of them had CR for more than two years. Intriguingly, TB could be substantially effective even in relapsed patients with heavily pretreated ULMs. These results warrant further prospective and randomized studies.

5550 Background: Eribulin is a candidate for paclitaxel-refractory breast cancers, and Bevacizumab (B) is known to enhance efficacy of anti-cancer agents in ovarian cancers. A phase II study to evaluate weekly administration of B with eribulin and oxaliplatin (EriOX) in patients with platinum-resistant and refractory ovarian carcinomas (PR-ROC) was performed. Methods: Eligible patients were as follows: (a) ECOG PS = 0~2 (b) histologically confirmed epithelial ovarian cancer (c) diagnosed as platinum-resistant ovarian cancer (d) written informed consent. Patients were treated with weekly-B-EriOX consisting of B (2mg/kg), eribulin (1mg/m2) and oxaliplatin (30mg/m2), three weeks on and on week off, q4weeks. The study was conducted using two-stage design of Simon (type I error = 0.05, power = 0.9, true response rate = 25%). Biomarker analyses including serum VEGF, BNP, p53, IL-6, and Her-2 were also conducted. Results: A total of 34 patients were enrolled in the present study: 13 cases in the first-stage, and additional 21 cases in the second-stage. There were 3 responders (≧2) in the first-stage, and the protocol was proceeded to the second-stage. Median age of the patient was 58.5 years (range: 35-76), and median number of previous regimen was 4 (range: 2-9). Overall, two patients (6%) had a complete response (CR), 8 patients (24%) had a partial remission (PR) and 16 patients (47%) had a stable disease (SD). The response rate and clinical benefit rate (CR+PR+SD) were 29% and 76%, respectively. Median progression-free survival was 4 months (range: 1-27+). Hematological adverse effects (AE) with grade 3/4 were observed in 4 patients (11%). Non-hematological AE greater than grade2 was observed in one case: hypo albuminemia and edema, which were manageable and tolerable. As there were 10 responders (≧6), the protocol was considered for additional investigation. The Patients with elevated serum mutated p53 / IL-6 showed lower response and worse prognoses. Conclusions: Weekly B and EriOX administration was considered for additional investigation for patients with PR-ROC. Serum mutated p53 protein and/or IL-6 could be biomarkers in PR-ROC patients treated with weekly B and EriOX.

PURPOSE To compare the efficacy of three types of ocular lubricants in protecting corneal epithelial cells in dry eye animal models. METHODS Ocular lubricants containing 0.1% or 0.3% sodium hyaluronate (SH), carboxymethylcellulose (CMC), or hydroxypropyl methylcellulose (HPMC) were tested. First, ocular lubricant containing 0.002% fluorescein was dropped onto the rabbit corneas. The fluorescein intensity as an index of retention was measured. Second, a rabbit dry eye model was made by holding the eye open with a speculum, and 50 μL of each ocular lubricant was dropped onto the cornea. After 3 hours, the corneas were stained with 1% methylene blue (MB), and the absorbance of MB was measured. Third, a rat dry eye model was treated with the ocular lubricants for 4 weeks, and the corneal fluorescein staining was scored. Eyes treated with physiological saline were used as controls. Finally, immunohistochemistry was used to analyze occludin, an epithelial barrier protein, in cultured human corneal epithelial cells pretreated with ocular lubricants and desiccated for 20 or 60 minutes. RESULTS Our results showed that 0.3% SH had a significantly longer retention time than the other lubricants (all P < 0.01). The absorbance of MB was significantly lower in the 0.3% SH group. The corneas of rats exposed to 0.3% SH had significantly lower fluorescein staining scores. A significantly higher number of occludin-positive cells were found after exposure to 0.3% SH than other lubricants. CONCLUSIONS Ocular lubricant containing 0.3% SH would be preferable to treat patients with dry eye syndrome.

The preparation of filamentary (Nd, Gd)-123 superconductors was examined by changing starting composition and heating condition of melt processing in flowing 1% O 2 +Ar. High J c value of more than 2.4×10 4 A/cm 2 at 77 K and zero field and the high reproducibility were obtained for the filamentary (Nd 0.5 Gd 0.5 )-123 sample. The field dependence of J c for the sample was measured and J c value of more than 1×10 2 A/cm 2 at 77 K and 8 T was detected to the sample.

The precursor filament of Gd123 superconductors was prepared by solution spinning through a homogeneous aqueous solution of the metallic acetates. The precursor sample was partially melted in flowing 1% O 2 +Ar under various heating conditions. The maximum J c value of 2.1×10 4 A/cm 2 at 77 K and zero field was attained for filamentary Gd 1.18 Ba 2.12 Cu 3.09 O y superconductors. The sample had well aligned texture. The field dependence of J c for the sample was investigated. An angle dependence of J c along the filament diameter was detected. The J c value above 1×10 3 A/cm 2 was obtained at 77 K and 10 T.

The filamentary (Nd 0.333 Eu 0.333 Gd 0.333 ) 1.18 Ba 2.12 Cu 3.09 O x superconductors were prepared by solution spinning method and partially melted in flowing 1% O 2 +Ar and then oxygenated by a two-step process. The filamentary sample had a dense and well-aligned texture along the diameter as well as the length. The J c of the sample was measured at 77 K in fields up to 10 T. Anisotropic behavior of the J c – B curve along the filament diameter was detected. High J c value of more than 3500 A/cm 2 at 77 K and 10 T was achieved by applying the field in a direction normal to the c -axis of the sample.

The filamentary RE-Ba-Cu-O (RE=Nd, Nd-Eu-Gd, and Nd-Sm-Eu-Gd) precursor was prepared by a solution spinning method, through a homogeneous aqueous solution containing mixed acetates of RE, Ba and Cu, poly(vinyl alcohol) and organic acids. The filamentary precursor was partially melted in flowing 0.1%O/sub 2/+Ar or 1%O/sub 2/+Ar and then oxygenated under various conditions. The transport critical current density (J/sub c/) of the samples was measured in magnetic fields up to 10 T at 77 K. The influence of field dependence of J/sub c/ on the initial different RE elements in the filamentary RE-Ba-Cu-O superconductors was examined. The field dependence of J/sub c/ was improved by mixing three or four different RE elements. The J/sub c/ value at 77 K and up to 6 T for the sample partially melted in flowing 0.1%O/sub 2/+Ar was higher than that for the sample melted in flowing 1%O/sub 2/+Ar. The highest J/sub c/ value of more than 1.76/spl times/10/sup 4/ A/cm/sup 2/ at 77 K and 9 T was detected for filamentary Nd-Sm-Eu-Gd-Ba-Cu-O superconductors partially melted in flowing 0.1%O/sub 2/+Ar.

Polymer coating for filamentary YBa2Cu3O x superconductors was examined. The precursor filaments were prepared by solution spinning through aqueous poly(vinyl alcohol) solution containing mixed acetates of Y, Ba and Cu. The as-drawn filaments were heated to remove volatile components and to generate a superconducting phase. The synthesis of polyamide acid for the polymer coating was made. The filamentary superconductors were coated with the polyamide acid and cured to convert to the polyimide. The surface of the sample was an insulator. The critical current (I c) value of the filamentary sample at 77 K was preserved by the polyimide coating. Moreover, the I c for the polyimide-coated sample was maintained after holding at room temperature for more than 6 months. After thermal cycling between 77 K and room temperature 10 times, the I c for the coated sample did not deteriorate, whereas the I c for the sample without polymer coating disappeared. Polymer coating using epoxy resin applied to the filamentary superconductors was also examined.

39歳,女性の尋常性天疱瘡の1例を報告した。初診時には,四肢,体幹,口腔内,外陰部に水疱,びらんが認められた。病理組織学的検討,蛍光抗体直接法,ELISA法による血中抗デスモグレイン(Dsg)1,3抗体価測定を行った。これらの検査の結果より,尋常性天疱瘡粘膜皮膚型と診断し,ステロイド内服を開始した。経過中,臨床症状の停滞がみられたため,免疫抑制剤も併用した。治療期間中,定期的に抗Dsg 1,3両方の抗体価を測定し,これらと臨床症状との関連性を評価してみた。抗Dsg 1抗体価は皮膚症状と相関し,一方抗Dsg 3抗体価は粘膜症状と相関していた。このことはいわゆるDsg compensation theoryを裏付けると思われた。そしてまた,抗Dsg抗体価を測定することによって,確定診断できるだけではなく,病勢の把握もできると考えられた。

We examined the rates of sudden death to ordinary deaths of the patients in two hospitals in Obihiro. A total of 130 sudden death cases (89 men and 41 women) out of 1, 088 ordinary deaths were listed (11.9%) during the period of two years from 1992 through 1993.We also looked into the cause of sudden death in 86 autopsied cases over a 15-year period from 1985 through 1999 from a pathological stand point. Cardiac diseases underlay 49 cases of sudden death. Myocardial infarction (42 cases), cardiomyopathy (2), sarcoidosis (1), amyloidosis (2) and valvular disease (2) were regarded as the causes of death in the 49 cases. Myocardial infarction occurred more frequently in men than in women (27: 15). Next to cardiac diseases came aortic diseases such as ruptured aortic aneurysm (7 cases) and dissecting aneurysm (6). Cardiac diseases (49 cases) and aortic diseases (13) combined to account for 62 of 86 (72.1%) autopsied cases. Among noncardiovascular diseases, respiratory diseases (18 cases) topped the list, followed by alimentary diseases (3) and cerebral bleeding (2). The major cause of respiratory diseases was pulmonary embolism (16). Pulmonary embolism more often occurred in women than in men (14: 2). There was one case of unidentifiable sudden death, namely Pokkuri disease. A decreased incidence of sudden death on Sunday should be noted. A circadian rhythm was evident. The incidence of sudden death started rising from 6: 00 and peaked at 15: 00. Sudden death occurred during rest (42 cases), during routine daily activity (14), during sleep (11), during bathing (1), during defecation (8), during surgery (2), during physical exercise (6) and during agricultural work (2).

UNLABELLED We performed intraoperative echocardiography with an epiaortic probe to assess the correlation between echocardiographic appearance and pathological findings of the aorta and to examine the effect of cross-clamping on the aortic wall in 276 patients who underwent coronary artery bypass grafting. The ascending aorta was divided into three segments as follows: lower (L), upper (U), and innominate. The anterior (ant) and posterior (post) intimal thicknesses of each of the three segments were measured. The echogenicity at each of the six locations was examined and was classified as isoechoic or nonisoechoic (hyperechoic, hypoechoic, or mixed type). Tissue punched from the ant L wall of the ascending aorta for vein anastomosis was examined for the presence of atheroma. At the ant L, the prevalence of atheroma was significantly higher in nonisoechoic walls than in isoechoic walls (P = 0.049). We divided patients into two groups according to echogenicity at the U segments. Group A (n = 213) consisted of patients whose echogenicities at both ant U and post U were isoechoic. Group B (n = 63) consisted of patients with nonisoechoic echogenicity at ant U and/or post U. The intimal thicknesses at all six locations in Group B patients were greater than those of Group A (P < 0.01). Deformities at the clamp site after cardiopulmonary bypass were observed significantly more often in Group B than in Group A (P < 0.01). Our data suggest that a nonisoechoic aortic wall indicates more advanced atheroma and a higher risk of deformities at the clamp site. Examination of the echogenicity of the ascending aorta may be one method to reduce perioperative neurological complications. IMPLICATIONS We performed epiaortic echocardiography during coronary artery bypass grafting and found that the presence of atheroma and deformities at the cross-clamping site were significantly more prevalent in nonisoechoic walls than isoechoic walls.

Background. Advanced age is associated with increased systemic atherosclerosis and is a consistent neurologic risk factor after coronary artery bypass grafting (CABG). Methods. We studied prospectively whether varying degrees of a total atherosclerotic score derived from the brain, carotid arteries, and ascending aorta predicted postoperative neuropsychologic (NP) dysfunction and stroke in 177 elderly patients (> 60 years) undergoing CABG. Results. Group L (low total atherosclerotic score) had rates of NP dysfunction of 25% and 4%, group I (intermediate) had rates of 33% and 22%, and group H (high) had rates of 79% and 43% on postoperative days 1 and 7, respectively (p < 0.001). The incidence of stroke was higher in group H (14.3%) than in groups I and L (7.8% and 0.9%; p 5 0.013). Stepwise logistic regression analysis demonstrated the significant predictors of NP dysfunction on postoperative day 7 to be total atherosclerotic score, peripheral vascular disease, and diabetes mellitus, and those of stroke to be total atherosclerotic score, peripheral vascular disease, and hyperlipidemia. Conclusions. Perioperative evaluation of craniocervical and aortic atherosclerosis is useful to identify a high-risk patient at postoperative NP dysfunction and stroke after CABG.