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Highlights • We performed a hybrid TEVAR for concomitant anastomotic pseudoaneurysm and CoA. • TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive. • TEVAR can be an alternative option for young patients who have to resume work early after surgery., Introduction Anastomotic pseudoaneurysm is one of the most common but catastrophic complications in coarctation of the aorta (CoA); this is equally true even if the initial surgery is not directly related to the coarctation. Redo open heart surgery is usually required for the pseudoaneurysm; however, redo surgery remains challenging with high morbidity and mortality rates. Presentation of case A 38-year-old woman with CoA, who had undergone left subclavian artery (LSCA) to descending aorta bypass 21 years prior, was referred to us for the treatment of distal anastomotic pseudoaneurysm. Zone 2 thoracic endovascular aortic repair (TEVAR) with LSCA debranching was performed to exclude the distal anastomotic pseudoaneurysm and expand the CoA using a stent graft. The patient completely recovered and resumed work without delay. Discussion In patients who require surgical treatment for both pseudoaneurysm and CoA, hybrid TEVAR can be an alternative surgical option instead of conventional open repair. Conclusion TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive, especially for young patients who have to resume work early after surgery.

A 94-year-old man who underwent transcatheter aortic valve (TAV) replacement 6 years ago was admitted because of exertional dyspnea. Transthoracic echocardiography revealed severe aortic regurgitation owing to TAV dysfunction. The patient was considered to have a high risk of occlusion of the sinus of Valsalva during TAV-in-TAV. Therefore, we performed TAV-in-TAV concomitant with coronary artery bypass grafting (CABG). The postoperative course was uneventful, and computed tomography 9 months later revealed patency of both the grafts. Concomitant CABG could be considered as one of the options in patients with a high risk of coronary occlusion during TAV-in-TAV.

Purpose Transient receptor potential vanilloid 1 (TRPV1) not only is activated by multiple stimuli but also is involved with histamine-induced itch. The effects of TRPV1 on morphine-induced itch are unknown. We examined the effects of intrathecal administration of TRPV1 antagonist on morphine-induced itch, body temperature, and antinociception for mice. Methods Each C57/BL6j mouse was intrathecally administered with one of the following solutions: morphine, SB366791 (as the TRPV1 antagonist), morphine + SB366791, saline, or vehicle. For each mouse, each instance of observed scratching behavior was counted, the body temperature was measured, and the nociceptive threshold was determined using the tail-immersion test. Results SB366791 dose-dependently reduced the scratching behavior induced by the administration of morphine. SB366791 and the morphine + SB366791 groups did not manifest an increase in body temperature. Antinociceptive effects were observed to occur dose-dependently for morphine but not for SB366791. Compared with morphine alone, the administration of morphine + SB366791 did not reduce significant antinociceptive effects. Conclusion We propose that an intrathecal TRPV1 antagonist, SB366791, reduced morphine-induced itch without causing hyperthermia and did not suppress morphine-induced antinociception for mice.

Background Intrapulmonary penetration of the thoracic aorta is a rare, life-threatening complication of a chronic dissecting aortic aneurysm. It causes massive hemoptysis requiring prompt intervention to prevent fatal airway bleeding. A surgical approach that enables diverse surgical maneuvers and intraoperative organ protection is crucial. Case presentation A 62-year-old man, who underwent graft replacement of the ascending aorta for an acute type A aortic dissection 20 months before, developed massive hemoptysis and cardiac arrest. The hemoptysis was secondary to an aortopulmonary fistula from a rapidly expanding dissecting aortic aneurysm. However, a successful return of spontaneous circulation was achieved with cardiopulmonary resuscitation, including establishment of veno-arterial extracorporeal membrane oxygenation. The patient successfully underwent a total arch and descending thoracic aortic replacement. This was achieved by a median sternotomy combined with a left thoracotomy using a straight incision with a rib-cross (SIRC) approach. The patient was uneventfully discharged and remained well for the following 2 years. Conclusions When performing a surgical graft replacement for an aortopulmonary fistula with a thoracic aortic aneurysm, the surgical approach chosen is critical. A surgical procedure using a median sternotomy combined with a left thoracotomy and a SIRC approach can be an effective therapeutic option.

Introduction and importance: For treatment of prosthetic valve endocarditis (PVE), redo-aortic valve replacement (AVR) is usually required. However, the recurrence of PVE continues to be a serious problem that needs a solution. Case presentation An 83-year-old woman who had undergone AVR for aortic infective endocarditis 12 years ago was diagnosed with PVE complicated with acute cerebral infarction. Urgent redo-AVR was performed. After complete removal of the prosthesis, Perceval S valve was implanted successfully. There were no postoperative neurological deteriorations, and the echocardiogram showed no recurrence of PVE. Clinical discussion Theoretically, the fewer prostheses left in the heart, the lower the risk of PVE recurrence. Conclusion In patients with PVE, redo-AVR using the Perceval valve may be a suitable option since Perceval reduces the prosthesis in the heart compared with conventional redo-AVR., Highlights • We performed a redo-aortic valve replacement (AVR) using the Perceval valve. • The patient had prosthetic valve endocarditis (PVE) and acute cerebral infarction. • Postoperative thrombocytopenia did not lead to any cerebral complications in this case. • Perceval reduces the prosthesis in the heart compared with conventional redo-AVR. • Redo-AVR using Perceval will be beneficial in controlling recurrence of PVE.

In patients who require minimally invasive mitral valve repair (MICS-mitral), it is difficult to determine the appropriate length of artificial chordae, position, and number of artificial chordae. The Memo 3D Rechord, a complete prosthetic ring associated with a temporary chordal guide system comprised of yellow loops that function as a reference guide for automatically determining the height of neo-chordae. We sought to evaluate our tips for use of this system.Five patients (1 male, mean 68 years old) who underwent MICS-mitral using artificial chordae with the Memo 3D Rechord were evaluated. Prior to surgery, we assessed the prolapse position using 3-dimensional( 3D) echocardiography to decide the number and positions of the artificial chordae. Polytetrafluoroethylene (PTFE) sutures were passed through the papillary muscles and the free margin of the prolapsed leaflet, then appropriate positioning of the PTFE chordae was performed using a saline test. The PTFE chordae were passed through the loops and the free margin of the prolapsed leaflet was brought to the posterior annulus. Then, the PTFE sutures were tied and the temporary loop system removed.All patients had posterior leaflet prolapse. The number of the artificial chordae was 2 in 3 patients, and 1 in 2. The base of the artificial chordae was attached to the anterior papillary muscle in 3patients and posterior in 4. Additional indentation closure was required in 1 patient. All mitral valve repairs were performed successfully. Postoperative echocardiography mitral regurgitation( MR) grade was trivial in 5.Using our technique, it was possible to decide the appropriate length and position of the artificial chordae and MICS-mitral for leaflet prolapse with the Memo 3D Rechord is a simple and reproducible method.

Purpose Transient receptor potential vanilloid 1 (TRPV1) not only is activated by multiple stimuli but also is involved with histamine-induced itch. The effects of TRPV1 on morphine-induced itch are unknown. We examined the effects of intrathecal administration of TRPV1 antagonist on morphine-induced itch, body temperature, and antinociception for mice. Methods Each C57/BL6j mouse was intrathecally administered with one of the following solutions: morphine, SB366791 (as the TRPV1 antagonist), morphine + SB366791, saline, or vehicle. For each mouse, each instance of observed scratching behavior was counted, the body temperature was measured, and the nociceptive threshold was determined using the tail-immersion test. Results SB366791 dose-dependently reduced the scratching behavior induced by the administration of morphine. SB366791 and the morphine + SB366791 groups did not manifest an increase in body temperature. Antinociceptive effects were observed to occur dose-dependently for morphine but not for SB366791. Compared with morphine alone, the administration of morphine + SB366791 did not reduce significant antinociceptive effects. Conclusion We propose that an intrathecal TRPV1 antagonist, SB366791, reduced morphine-induced itch without causing hyperthermia and did not suppress morphine-induced antinociception for mice.

Background Vertebral artery dissection (VAD) sometimes has no specific symptoms and is difficult to differentiate from other forms of headache. Case presentation A woman in her thirties had a severe, throbbing left-sided headache. A migraine without aura was suspected and zolmitriptan was administered, which alleviated the symptoms. The woman was consequently deemed to have a migraine without aura. Despite the lack of abnormal neurological findings and showed no abnormalities on cranial computed tomography, her symptoms were not typical for migraines and showed little improvement with therapy. She therefore underwent a cranial magnetic resonance imaging (MRI) examination, which revealed VAD, for which she was transferred to the department of neurosurgery for conservative treatment. Conclusion The possibility of vertebral artery dissection should be considered in the differential diagnosis of severe secondary headaches, and prompt diagnosis and treatment based on detailed MRI and magnetic resonance angiography examinations should be performed.

Formation process of carbon nanocaps, which are formed at the beginning of carbon nanotube (CNT) growth by surface decomposition of SiC, was investigated by scanning tunneling microscopy (STM) and in situ near-edge X-ray absorption fine structure (NEXAFS) spectroscopy. As Si atoms were desorbed, carbon nanoparticles 1–2 nm in diameter were accumulated on SiC(000-1) surfaces. At around 1200 °C, these were coalesced and crystallized to carbon nanocaps. In addition, just before the crystallization, majority of C–C bonds were directed nearly parallel to the surface. Based on these experimental results, we proposed a model for carbon nanocap formation, which plays an important role to determine the CNTs.

直腸癌の患者において，癌性心膜炎による心タンポナーデを来した症例を経験したので報告する．症例は54歳の男性で，2006年6月，進行直腸癌，大動脈周囲および縦隔リンパ腺腫大を認め，化学療法を選択した．同年7月，直腸狭窄が強くなり直腸切断術を施行した．化学療法継続中の2007年7月，著明な顔面浮腫および労作時呼吸困難を自覚．大量の心嚢水貯留を認め，心タンポナーデと診断した．剣状突起下経皮的心嚢ドレナージを行った．同年10月，大量の心嚢水の再貯留あり，再度心嚢ドレナージを行った．Adriamycin30 mg，OK-432 10KEを心嚢内に注入した．その後，4か月経過した現在，心嚢水貯留の再発なく日常生活に復帰している．癌性心膜炎に対し，チューブドレナージ法と心嚢内へのadriamycin，OK-432注入療法を行い優れた効果を得た．進行直腸癌においては，全身化学療法により効果的な延命が期待できるゆえ，積極的に局所コントロールを行う意義がある．

Regarding mass image-forming lesions, the 2005 Guidelines for Ultrasonic Diagnosis of Breast Diseases, published by the Japan Society of Ultrasonics in Medicine (JSUM), includes the evaluation of tumor compressibility, which is visually assessed by the degree of deformation caused by applying external pressure to the tumor. However, this is only a subjective estimation under real-time observation; consequently, quantitative evaluation of tumor deformation and the percentage change in internal echo intensity was attempted based on changes in the depth-width ratio and in the internal echo intensity on hand-held probe compression. We evaluated the usefulness of these measurements in the differential diagnosis of benign and malignant tumors. The subjects were 139 patients (89 benign and 50 malignant cases) who underwent breast ultrasonography with a 10-MHz (from 4-to 10-MHz) linear probe. The deformation index (D.I.) of the tumor was defined as: [1 − (depth-width ratio with 3.0 ± 0.6-kg-weighted compression)/(depth-width ratio without compression)] × 100 (%). The rate of change in internal echo intensity was defined as the echo intensity with compression divided by the echo intensity without compression × 100 (%). There was a significant difference in the D.I. between benign lesions (35.5% ± 14.7%) and malignant lesions (15.4% ± 6.2%) (P < 0.001). The cut-off ratio in differentiating benign from malignant lesions was approximately 25%. The rate of change in echo intensity of benign lesions (149.7% ± 34.3%) was significantly higher than that of malignant lesions (122.9% ± 19.9%) (P < 0.001). Using an electronic linear probe, quantitative indexes including the D.I. and the rate of change in internal echo intensity could be obtained with the help of a weight meter, and could prove effective for the differential diagnosis of breast mass-image forming lesions.

胃癌術後直腸転移および虫垂転移をきたした症例を経験したので報告する．症例は57歳，男性．平成15年8月，胃癌に対し幽門側胃切除を施行した．病理組織学的検査所見はpor，se，n2(+)，ly1，v0，stageIIIA，根治度Bであった．平成18年6月，歯状線直上の直腸前壁に粘膜下を浸潤する形態の隆起性病変を認めた．病理組織学的には，胃癌と同等な低分化型腺癌が粘膜下層を中心に増殖しており，胃癌の直腸転移と診断した．免疫染色組織像においても胃および直腸の組織像で同様の所見を得た．その後，化学療法継続するも徐々に直腸狭窄をきたしたため，平成19年1月，人工肛門を造設した．同年4月，内ヘルニアによる絞扼性イレウスのため緊急手術を施行．その際虫垂切除し，虫垂口より便汁を減圧した．切除虫垂は胃癌，直腸と同様の組織像を呈し胃癌虫垂転移と診断された．その後，化学療法を継続するも，胃癌術後より52カ月目（直腸転移診断より17カ月，虫垂転移診断より8カ月）に癌死した．直腸および虫垂への転移形式はリンパ行性であると示唆された．

A 67-year-old woman with a diabetic renal failure was scheduled for a living kidney transplantation. Heparin was first used during hemodialysis 5 days before operation. Thrombocytopenia was found immediately after induction of general anesthesia, and the diagnosis of HIT was wade based on clinical symptom and 4 T's scoring. The surgery was continued because of the progress of donor surgery. Argatoroban was administered based on APTT measurement as an anticoagulation therapy during and after the operation. Although deep vein thrombosis was found 13 days after the operation, the transplanted kidney was established successfully. It is necessary to take a great caution in HIT development after heparin use.

症例は25歳女性。視野狭窄と右方への眼球偏位を伴う単純部分発作、およびこれに引き続いて意識消失し右方への向反をおこす複雑部分発作が月単位から週単位で出現している。脳波では発作間欠時·発作時ともに側方性·局在性を明らかにすることはできなかった。MRIでは左後頭葉に器質性変病を認めた。99mTc-ECDを用いた発作時SPECT検査では、左後頭葉内側および外側皮質に集積の亢進を認めた。FDG-PETでは左後頭葉内側および外側皮質に低代謝領域を認めた。上記の検査結果から本症例の発作が左後頭葉に起始するものと考えられた。FDG-PETは発作時SPECTに比べて患者の負担が小さく、施行も容易であるため、後頭葉てんかんの診断においてFDG-PETは有用であると考えられた。

The effects of lunchtime bright light exposure in patients of a geriatric hospital were investigated. Ten inpatients (six women and four men; mean age +/- SD: 81.2 +/- 8.8 years) with sleep disturbances were studied for 9 weeks. Nurses performed daily ratings for sleep-wakefulness disturbances. Approximately 8000 lx bright light exposure was performed for 3 weeks in the light therapy room. Before and after exposure, ocular function was evaluated. Clinical ratings of sleep-wakefulness improved in eight patients. The score of difficulty in falling asleep and drowsiness in the morning declined during the light exposure. The score of drowsiness in the afternoon decreased during the post-light exposure. Post-exposure ocular disturbances were not found.

To investigate the effects of evening bright light on the autonomic nervous system, heart rate variability (HRV) during sleep was analyzed in dim light (DL) and bright light (BL) conditions. We recorded polysomnography in nine healthy young women aged 20–21 years. Time series of % delta power was calculated in the 0.49–2.20 Hz band. Heart rate variability was analyzed from a 10-min segment of slow wave sleep. The low- to high-frequency ratio and the low-frequency component decreased significantly in the BL conditions compared with the DL conditions. However, the power of the high-frequency component did not change in the two conditions. These results indicate that evening BL affects the autonomic nervous system during slow wave sleep.

Inpatients with sleep disturbances in a geriatric hospital received 1 h of exposure to approximately 8000 lx bright light per day for 3 weeks. Polysomnogram was recorded for four female patients. Two (aged 68 and 87 years) were non-demented patients with weak cataracts and the other two (aged 92 and 93 years) were demented patients with severe cataracts. Electroencephalogram results showed that light exposure decreased the proportion of Stage W, while increased the proportion of Stage 2, and these effects continued for at least 3 weeks after the cessation of light exposure. These results suggest that exposure to bright light is effective in improving the disturbed sleep of patients.

Sleep structure was measured in five healthy elderly men in their homes. The subjects were exposed to bright light (6000 lx) for 30 min in the morning or instructed to sit in front of a desktop lighting device without light. Relative to the control conditions, bright light exposure significantly decreased time in bed and the number of awakenings. Rapid eye movement sleep was significantly fragmented by stage 1 sleep in the control condition compared with the bright light condition. These findings indicate that a short duration of morning bright light changes sleep structure and is effective in maintaining sleep.

We examined REM sleep periodicity in typical narcoleptics and patients who had shown signs of a narcoleptic tetrad without HLA-DRB1*1501/DQB1*0602 or DR2 antigens, using spectral analysis based on the maximum entropy method. The REM sleep period of typical narcoleptics showed two peaks, one at 70–90 min and one at 110–130 min at night, and a single peak at around 70–90 min during the daytime. The nocturnal REM sleep period of typical narcoleptics may be composed of several different periods, one of which corresponds to that of their daytime REM sleep.

Subjective sleep feeling and polysomnography were measured in 10 elderly women to investigate the effects of 8000 lux morning bright light (BL) exposure. The profile of sleep feeling in the BL condition was better than in the control condition. The proportion of awakening time in the first one-third of night sleep decreased, and the amount of awakening time in the last one-third increased in BL condition. Daytime napping reduced in BL condition. These findings suggested the effectiveness of exposure to bright light on the improvement of sleep quality and daytime vigilance of healthy elderly women.

To investigate the effects of 8000 lux morning bright light in the elderly, home-based motor activity on sleep was monitored for 5 days in 10 healthy women (mean age: 59.7 years old, range: 50-69 years old). The activity level and movement index on night 4 were significantly lower in bright light conditions, compared with the controlled condition. The activity level during the day was not significantly different between the two conditions. These results indicate that 8000 lux morning bright light improves sleep quality in healthy elderly women.

Sleep EEG of eight healthy males and eight females aged 54–72 years were recorded at their homes. The electroencephalograms were visually scored and analyzed by spectral analysis using the FFT method. There were no significant differences in sleep parameters except for a higher percentage of stage 3 + 4 in females. The spectral power of the delta band EEG was classified into two frequencies: 0.5–2 Hz and 2–4 Hz. The total amount of the delta band spectral power through the night was significantly larger in females. Periodic fluctuation of delta band power was observed in females along with non-rapid eye movement–rapid eye movement cycles.

In order to investigate the gender difference of sleep and activity in middle-aged and aged individuals, home-based sleep was self-evaluated for sleep quality and activity for 5 nights in 20 healthy adults (50-76 years old; 11 women, nine men). There was no significant gender difference for subjective sleep quality. However, the activity level and movement index at night were significantly higher in men than in women, and the activity level during the day was significantly lower in men than in women. The objective sleep quality of men was significantly worse than that of women, however, subjective sleep quality does not differ.

Using an actigraph, the activity patterns in 13 demented patients with delirium were examined. We analyzed the data of the eight patients, wearing the actigraphs for more than 10 days. They were classified into four types: type A, nocturnal delirium type; type B, wandering type; type C, hypobulia type; and type D, lying down type. The day to day activity variation was most prominent in type A and seemingly the least in type B. The dominant period of activity rhythm was nearly 24 h in all cases. Additional 12-h period was observed in type C. Actigraphs might become useful in making therapeutic decisions regarding demented patients with delirium.

Seven aged subjects aged 61-78 years were exposed to 6000 lx bright light for 30 min during morning hours at their homes for 1 week. Visual analog scale was recorded before bedtime and after rising to assess subjective feelings. Ophthalmological examinations were made before and after light exposure, to exclude pre-existing ocular disorders and to detect ocular damage. Furthermore, ocular fatigue was self-evaluated immediately before and after exposure. Visual analog scale results indicated that alertness reduced significantly before bedtime. Ophthalmological abnormalities were not found after exposure. These findings suggest that short duration morning bright light exposure reduces night-time vigilance.

Carbon nanotube (CNT)/n-type SiC heterojunctions were formed by surface decomposition of 6H-SiC(0001), where each CNT directly bonded to SiC crystal at the interface without any interlayer. Through heating temperature and heating time, the CNT length could be controlled up to 4 µm. For the sample with CNTs of 180 and 230 nm in thickness, distinct rectifying behavior was observed in the current–voltage measurements, with the forward direction observed at positively biased CNTs. When the CNT length was 1500 nm, the leakage current was increased. From cross-sectional transmission electron microscopy (TEM) observations, we conclude that the increase of the leakage current was due to the deterioration of crystalline quality of CNTs near the interface between CNTs and SiC, which was caused by the obstruction of the desorption of Si atoms by the lengthening of CNTs.

Energy band alignment at the interface between carbon nanotubes (CNTs) and n-type 6H-SiC formed by the surface decomposition of SiC was investigated using high-resolution photoelectron spectroscopy (PES). Valence band spectra of the CNT films showed a Fermi edge, indicating metallic character. PES results revealed that a Schottky barrier was formed at the interface and the barrier height was 1.38 eV. Current-voltage measurements of the interface showed rectifying behavior, which was consistent with the PES results.

In order to investigate the effects of 5000 lx evening bright light on autonomic nervous function, a spectral analysis was used to assess heart rate variability in consecutive 5-min epochs just after 60 min of bright light therapy was given to 12 young women (range: 20–21 years of age). The study revealed that a low frequency band (LF) increased in bright light conditions (BL) in comparison with controlled conditions (CL). High frequency band (HF), LF : HF ratio and the coefficient of variance (CV R-R) were not significantly different between the two conditions. These results indicate that 5000 lx evening bright light may affect sympathetic nervous system activity in healthy women.

Diagnosing narcolepsy is not always simple. Some patients secondarily show narcoleptic tetrad through irregular sleep patterns or psychotic diseases. The power densities of daytime electroencephalograms in genuine narcolepsy and secondary narcolepsy were analysed and compared. Electroencephalogram power densities for a 6.5-h period after waking in genuine narcoleptic patients were lower than those of secondary narcoleptic patients in the 11.0-12.5 Hz bands. Arousal levels may be lower in genuine narcoleptic patients than in secondary narcoleptic patients. Spectral analysis may be useful in clarifying differences between the two groups.

The study was designed to investigate gender differences in the sleep-wake patterns of healthy middle-aged individuals in their home environment. Polysomnography showed that daytime napping was more common in men than in women. Men had lower sleep efficiency index and experienced more stage 1 sleep. Males had significantly less stages 3 + 4 sleep, less stage REM sleep, and more transitions to wake from REM sleep. Men could not maintain stage REM as well as women. This study indicates that the gender differences in the sleep-wake patterns have appeared in a group of middle-aged individuals.