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The carbon supersaturated tool steel and high-speed steel punches were utilized to demonstrate that the titanium work materials were forged in high reduction of thickness and fine-blanked without adhesion of their fragments and deposition of their oxide debris particle. This galling free forging and fine blanking came from the in situ formation of the free carbon tribofilm only on the highly stressed interfaces between the punch/die and the titanium work. Under this in situ solid lubrication, the low frictional state was sustained to induce less bulging deformation of work during the forging process. The fine blanking of titanium plates advanced without adhesive wear and fractured regions on their sheared surface. The long life of tools was certified even in fine blanking of titanium and titanium alloy plates.

Carbon fiber reinforced engineering plastic (CFREP) small-sized parts were fabricated by PM (Powder Metallurgy)-oriented forging process. This manufacturing procedure consisted of the green compaction and sinter-forging steps. In the first step, the CFREP powders were consolidated to a green compact with high density. This preform was further sinter-forged into a final product by hot stamping with the use of the induction heating unit. Hardness distribution was measured to describe the consolidation behavior with increasing the compression load, and to optimize the sinter-forging conditions for solidifying the green compact to the sintered product. X-ray tomography was utilized for non-destructive diagnosis on the residual pores and defects. The eight-teeth gear model was fabricated to demonstrate that two step procedure wrought well to yield the dense and defect-free gear with sufficient strength and integrity.

In a first family (family#1), we identified 53 members of whom 17 present a syndromic cardiac disorder characterized by electrical disorders (sinus node dysfunction, atrial fibrillation...) and developmental defects (atrial septal defect, valvopathy, left ventricle non-compaction...) following an autosomal dominant model. Among the affected family members, 6 are implanted with a pacemaker and one experienced a sudden death at 43yo. Despite a strong linkage pointing to the 4q25 region, exome sequencing failed to identify causal variant. Interestingly, 6 additional non-related families presenting the same phenotype have been also identified. Our aims are to identity the causal mutation and the molecular mechanism underlying this complex cardiac syndrome. Genetic study has been performed using whole genome sequencing (WGS). Based on transgenic mouse strains, we assessed the impact of Family#1 mutation on the phenotype and on gene expression. Then, we generated human cardiomyocytes derived iPS cells (CM-iPS) isogenic models to evaluate the epigenome (CUT&RUN and ATAC-seq), transcriptome (RNA-seq) and topological associated domain (TAD) remodelling (Hi-C). By WGS we uncovered a deletion of 15kb in a gene desert area on 4q25, segregating in all affected relatives of Family#1. The 6 other families present overlapping deletions. Mouse model recapitulates the cardiac phenotype and exhibit a dysregulation of Pitx2 expression in cardiac specific compartments. Based on human CM-iPS models, epigenetic data highlight among the 15kb deletion a unique open region containing a CTCF binding site, crucial for delimiting TAD boundaries. Hi-C assay reveals the fusion of 2 TADs and highlights new interactions between PITX2 and atrial specific regulatory elements. We identified a deletion located within a gene desert area associated with a complex cardiac disorder. The CTCF binding site contained in the deletion seems key in the TAD border. The TAD remodelling leads to new (regulatory) interactions and expression dysregulation of PITX2. We describe a new molecular mechanism implying a yet unidentified non-coding regulatory element of PITX2 and responsible for a complex electrical and developmental cardiac syndrome. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Nantes UniversitéFrench national reserch agency (ANR)

Biomedical titanium parts and tools required for tailored fine micro-textures to have their surface anti-bacteria. Formation of micro-grooves into a titanium plate by micro-embossing was the first step toward mass-production of titanium parts and tools with anti-bacteria surfaces. Plasma 3D-printing was proposed to fabricate a micro-punch array to transcribe the micro-groove textures into titanium plate.

Resume Les cypres comprennent 160 especes dont les principaux representants sont Cupressus et Hesperocyparis autour du bassin mediterraneen, Juniperus aux Etats-Unis et Cryptomeria au Japon. Leur pollen, abondant en saison est tres allergenique et responsable de rhinoconjonctivite, asthme et toux chronique. Quatre groupes d’allergenes, agrees WHO/IUIS, sont decrits : le groupe 1, une pectate lyase, allergene majeur, marqueur specifique de l’allergie au cypres, le groupe 2, des polygalacturonases, le groupe 3, des proteines thaumatin-like et le groupe 4 correspondant a des proteines fixant le calcium. En 2010, un allergene cationique de petite taille, BP14, sensibilisant principalement les patients allergiques au pollen de cypres du sud-est de la France a ete decrit. L’allergene, de pertinence clinique, appartient a une famille de proteine non decrite comme allergene dans le pollen, les snakin/gibberellin regulated proteins (GRP), petites proteines cationiques possedant des proprietes antimicrobiennes. La gibberelline est une phytohormone qui controle differentes voies metaboliques, dont la reponse au stress biotique et abiotique. Des allergenes de la famille snakin/GRP ont ete caracterises dans la peche (Pru p 7), les agrumes (Cit s 7), l’abricot du Japon (Pru m 7) et la grenade (Pun g 7). BP14 croise avec Pru p 7 et Cit s 7, ce qui explique les syndromes cliniques associes decrits cypres/peche et cypres/agrumes. Une vingtaine d’autres allergenes est, par ailleurs, repertoriee dans la litterature. Les etudes d’allergologie moleculaire sur ce pollen permettent de comprendre les reactions croisees soutenues par les donnees cliniques et ainsi d’accroitre la precision du diagnostic et du traitement immunotherapeutique.

Aim To clarify the natural course of prediabetes and develop predictive models for conversion to diabetes. Methods A retrospective longitudinal study of 2105 adults with prediabetes was carried out with a mean observation period of 4.7years. Models were developed using multivariate logistic regression analysis and verified by 10-fold cross-validation. The relationship between [final BMI minus baseline BMI] (δBMI) and incident diabetes was analyzed post hoc by comparing the diabetes conversion rate for low ( 2 ) and high δBMI (≥ −0.31kg/m 2 ) subjects after matching the two groups for the covariates. Results Diabetes developed in 252 (2.5%/year), and positive family history, male sex, higher systolic blood pressure, plasma glucose (fasting and 1h- and 2h-values during 75g OGTT), hemoglobin A1c (HbA1c) and alanine aminotransferase were significant, independent predictors for the conversion. By using a risk score (RS) that took account of all these variables, incident diabetes was predicted with an area under the ROC curve (95% CI) of 0.80 (0.70–0.87) and a specificity of prediction of 61.8% at 80% sensitivity. On division of the participants into high- ( n =248), intermediate- ( n =336) and low-risk ( n =1521) populations, the conversion rates were 40.1%, 18.5% and 5.9%, respectively. The conversion rate was lower in subjects with low than high δBMI (9.2% vs 14.4%, p =0.003). Conclusions Prediabetes conversion to diabetes could be predicted with accuracy, and weight reduction during the observation was associated with lowered conversion rate.

Amorphous carbon (a-C:H/a-C) or Diamond-like carbon, have a very high potential diverse engineering application especially in protective coating which made it an ideal method to be manipulated in process parameters so to achieve the desired mechanical and functional properties; this correlates to the smoothness, atomic density, and the sp3 content. The nano-structure of this amorphous carbon is characterized by its disordered state of sp2 and sp3. The mechanical property would response to the sp2/sp3 matrix with the small hydrogen content which leads to the significant increases in hardness, tribological and also the wettability properties. This vague columnar structure of DLC is strictly modified to fine and self-organized structure, where high-density, graphitic inter-columnar structure is embedded into the low-density amorphous carbon phase as being confirmed through characterization, mechanical properties and response. This unique hybrid system in the a-C:H films would control the functionality of the final coating in customized way to suit multi-disciplinary engineering applications. This Nano-columnar a-C:H system. However, this hybrid system is still bound to the triangular diagram of sp2-sp3-H in the formation of a-C or a-C:H. This formed nano-columanar a-C:H films shows a unique nano-structure and its graphatized inter-columnar network with amorphous columns responsible the desired properties manipulation. In this paper, correlation between the degree of graphitization and wettability is established.

Background Multi-slice computed tomography (CT) is frequently used to evaluate the morphology, arrangement, and other characteristics of bone. Three-dimensional volume rendering (3D-VR) has made it possible to three-dimensionally visualise tendons and other structures by arbitrarily changing CT values. In deformities of the forefoot region in rheumatoid arthritis (RA), dislocation of the metatarsophalangeal (MTP) joints results in the formation of painful calluses that require surgery; however, the toes can sometimes be displaced inwards or outwards by this dislocation. MTP joint dislocation also causes the flexor tendons to dislocate from their original positions, although the relationship with toe displacement is unclear. Objectives We therefore used 3D-VR to examine the relationship between the flexor tendons and toe displacement in the dislocated toes of RA patients. Methods Thirty-one feet (10 right and 21 left) of 24 patients (5 men and 19 women) were examined. The Tsuboi classification was used to classify MTP joint dislocation into subluxation (Grade 2) or dislocation (Grade 3). CT images taken with no load applied to the feet were used for preoperative evaluation. The mean age of the patients at the time of imaging was 59.0 (36–76) years. A Fujifilm volume analyzer (SYNAPSE VINCENT) was used for 3D-VR reconstruction and CT values were adjusted to visualise the flexor tendons and examine their relationship with the heads of the metatarsal bones. When the flexor tendons were displaced inward or outward from the base of the metatarsal bone head, this was classified as flexor tendon dislocation. Toe displacement was identified when the proximal phalanx was displaced inward or outward from the extended line of the metatarsal axis. Results MTP joint dislocation was seen in 80 toes (63 cases of dislocation and 17 cases of subluxation). The flexor tendons were dislocated in 27 s toes (15 inward and 12 outward), 27 third toes (21 inward and 6 outward) and 16 fourth toes (15 inwards and 1 outward). Of the cases of MTP joint dislocation, toe displacement was seen in 12 s toes (1 inward and 11 outward), 12 third toes (12 outward) and 2 fourth toes (1 inward and 1 outward). The flexor tendons were dislocated towards the displaced toes in all cases. No flexor tendon dislocation was seen in any of the cases of subluxation. Conclusions RA is often accompanied by hallux valgus and toe displacement is affected by retraction of the first toe. The results of this study demonstrate that the toes are displaced inwards in some cases and can become dislocated independent of the influence of the first toe. All the toes were displaced towards the dislocated flexor tendons and MTP arthritis had resulted in loosening of the joint capsule and ligaments and dislocation of the flexor tendons, which was likely to cause displacement. Disclosure of Interest None declared

Clamshell incision is a standard approach for bilateral lung transplantation, providing a good operative field; however, once wide dehiscence occurs, its management is sometimes difficult because of intense immunosuppression and malnutrition of the recipient. A 22-year-old man with idiopathic pulmonary arterial hypertension underwent cadaveric bilateral lung transplantation through a clamshell incision using standard cardiopulmonary bypass. He developed wound dehiscence on postoperative day (POD) 20 that resulted in exposure of the bilateral fifth ribs and open pneumothorax. Considering the extreme malnutrition and emaciation of the recipient, we avoided initial closure of the dehiscence. After the debridement of necrotic tissue, negative pressure wound therapy was initiated on POD 25 and was continued for approximately 6 months with trafermin spray application. Eventually, the wound, including the fifth ribs, was completely covered with granulation tissue except for the wire tying the sternum. On POD 217, the patient underwent removal of the sternal wire followed by split-thickness skin grafting. His wound was successfully closed and he was discharged without activity limitation on POD 265.

The objective of this study is to fabricate porosity-controlled polyethylene terephthalate porous materials using a CO

Water vapor transmission rate (WVTR) measuring devices with a quadrupole mass spectrometer (QMS) have an advantage in measuring low WVTRs because measurements are taken under an extremely low background of water vapor by realizing ultrahigh vacuum conditions. Here, the reliability of the QMS measurements was improved by including a porous plug with known molecular conductance in the device to generate a reference molar flux for in situ QMS calibration. Then, standard gas barrier (SGB) films made from a clay-polyimide nanocomposite film were also developed and used to validate the measurement. The measurement results for the SGB films were on the extrapolated calibration curve obtained with the porous plug down to WVTR at the 10

Purpose The optimal glycemic target for elderly patients with diabetes has not been established. The purpose of this study was to elucidate relationship between HbA1c and mortality in elderly patients with diabetes. Subjects Three hundred consecutive elderly (≥65yrs) patients with type 2 diabetes mellitus admitted for control of hyperglycemia between 2002 and 2010 were registered. Upon mortality survey at the end of 2012, 201 (70%) of them were traceable (men/women 121/80, mean age 71yrs, duration of diabetes 11yrs and HbA1c 9.9%). The analysis took account of the following baseline information: gender, age, duration of diabetes, HbA1c, body mass index, systolic blood pressure, eGFR, urinary albumin excretion, serum lipid levels and use of insulin and oral hypoglycemic agents. The follow-up HbA1c was also recorded. Results The mean follow-up period was 5.7yrs and 45 of the patients have died. The mortality hazard as a function of the baseline HbA1c quartile was significantly V-shaped with the nadir in quartile 2 (HbA1c 8.5–9.4%) ( P =0.02), and this relationship remained significant after adjustment for the confounders such as estimated glomerular filtration rate and insulin use. The follow-up HbA1c was 7.7±1.6% and not significantly related to mortality. Discussion/Conclusion There was a V-shaped relationship between baseline HbA1c and all-cause mortality in elderly patients with insufficiently controlled glycemia. The nadir was in Q2 in which the HbA1c value was 8.5–9.4%. No significant relationship was found between the follow-up HbA1c and mortality. Further studies are needed to clarify the relationship between HbA1c and mortality in the elderly.

The aim of our study is to evaluate the clinical and radiologic outcomes in patients with terrible triad injury, who underwent surgical treatment with or without the medial collateral ligament (MCL) repair. Fourteen patients who underwent surgery with a minimum of 12- month follow-up (mean, 17 months) were reviewed. Based on the systematic treatment protocol, radial head fracture, lateral collateral ligament, and coracoid fracture were treated. Subsequently, torn MCL was repaired in 7 patients, whereas in the remaining 7 patients, the MCL was not treated. Range of motion, elbow function, and radiographs regarding the arthrosis and heterotopic ossification were assessed. At final follow-up, no significant differences were found in elbow motion or function between the groups with and without MCL repair; except the pronation and supination which had superior range in repair group. In contrast, radiologic findings such as the arthrosis were seen more frequently in patients without MCL repair than those with repair. Our results indicate the effect of MCL repair on elbow motion and function might be small, whereas osteoarthritic changes occurred more frequently in elbows without MCL repair.

BACKGROUND AND PURPOSE: Axial-loaded MR imaging, which simulates the spinal canal in a standing position, demonstrates reductions of the dural sac cross-sectional area in patients with lumbar spinal canal stenosis. However, there has been no useful conventional MR imaging finding for predicting a reduction in the dural sac cross-sectional area on axial-loaded MR imaging. Previous studies have shown that increased facet fluid is associated with the spinal instability detected during positional changes. The purpose of this study was to analyze the correlations between facet fluid and dynamic changes in the dural sac cross-sectional area on axial-loaded MR imaging. MATERIALS AND METHODS: In 93 patients with lumbar spinal canal stenosis, the dural sac cross-sectional area was measured by using axial images of conventional and axial-loaded MR imaging. Changes in the dural sac cross-sectional area induced by axial loading were calculated. The correlation between the facet fluid width measured on conventional MR imaging and the change in dural sac cross-sectional area was analyzed. The change in the dural sac cross-sectional area was compared between the intervertebral levels with and without the facet fluid width that was over the cutoff value determined in this study. RESULTS: The dural sac cross-sectional area was significantly smaller on axial-loaded MR imaging than on conventional MR imaging. The facet fluid width significantly correlated with the change in the dural sac cross-sectional area (r = 0.73, P < .001). The change in the dural sac cross-sectional area at the intervertebral level with the facet fluid width over the cutoff value was significantly greater than that at the other level. CONCLUSIONS: The increased facet fluid on conventional MR imaging is highly predictive of the dynamic reduction of dural sac cross-sectional area detected on axial-loaded MR imaging in the clinical assessment of lumbar spinal canal stenosis.

Few randomized trials have shown how the placement of a palmar locking plate affects outcomes. The purpose of this study was to compare clinical and radiological outcomes of fixation using locking plates with different concepts for placement relative to the watershed line in a prospective randomized trial. Sixty-four patients with a displaced distal radius fracture were divided into two groups according to the plates used for fixation: distal-type (AcuLocTM, Group A) and proximal-type (VariAxTM, Group V). Wrist function including the range of motion and grip strength was compared at 1, 2, 3 and 6 months postoperatively. Loss of reduction was assessed radiologically. Both groups demonstrated overall satisfactory function at 6 months with no significant difference found between the groups. Minimal loss of reduction was demonstrated in both groups. Internal fixation using the palmar locking plates with two different placements provided satisfactory outcomes at 6-month follow-up, but our results indicate that plates placed distal to the watershed line may delay recovery of wrist motion.

In Yokohama Water Works Bureau, the target value for aluminium control in purified water is set to 0.05 mg/L. In this study, we examined the effects of pH and water temperature on the water solubility of aluminium during purification processes, and obtained a solubility curve of aluminium in water based on these parameters. The result indicated that the water solubility of aluminium increases as water temperature or pH increases. In addition, it was calculated from this solubility curve of aluminium in water, that the level of residual aluminium in purified water can be controlled at approx. 0.04–0.05 mg/L by adjusting pH of coagulated water to approx. 7.1–7.4 depending on water temperature. Furthermore, as a result of pH control according to actual coagulated water temperatures based on this assumption, it was demonstrated that the target value for aluminium control in purified water, (0.05 mg/L) is achievable.

Different methods of lithology predictions from geophysical data have been developed in the last 15 years. The geophysical logs used for predicting lithology are the conventional logs: sonic, neutron-neutron, gamma (total natural-gamma) and density (backscattered gamma-gamma). The prompt gamma neutron activation analysis (PGNAA) is another established geophysical logging technique for in situ element analysis of rocks in boreholes. The work described in this paper was carried out to investigate the application of PGNAA to the lithology interpretation. The data interpretation was conducted using the automatic interpretation program LogTrans based on statistical analysis. Limited test suggests that PGNAA logging data can be used to predict the lithology. A success rate of 73% for lithology prediction was achieved from PGNAA logging data only. It can also be used in conjunction with the conventional geophysical logs to enhance the lithology prediction.

Aluminium (Al), despite its low melting point, has a high electric conductivity and thermal conductivity but poor heating efficiency, ranking as a hard-to-weld material. It is routinely necessary to weld aluminium sheets to sheets made of a dissimilar metal, such as steel sheets (Fe). In this case, it is advisable to use seam welding than spot welding in order to ensure good weld strength and joint tightness. However, seam welding of Al/Fe sheets is difficult and little reported in literature.

Endocrine-disrupting chemicals, EDCs are of increasing interest from the viewpoint of health effects and human exposure as well as abnormality in wildlife reproductive systems. A nationwide survey of these EDCs was conducted to collect information on their existence in source and drinking waters in Japan. The analyzed 68 chemicals were as follows; 9 ethyl phthalates and similar compounds, 16 phenols, 8 styrenes, 2 organic tin compounds, 2 hormones, 26 pesticides and 5 other chemicals listed in SPEED '98 announced by the Environment Agency. Diethylhexyl phthalate (DEHP) was most frequently detected in 88% of 45 raw watersand 88% of 42 treated waters. Di-n-butyl phthalate (DBP) was found both in 26% of raw waters and in 12% of treated waters, as well. The maximum concentration of DEHP in treated water was 0.00026 mg/l, and that of DBP was 0.00018 mg/l. Bisphenol A (32%) and phenol (21%) were also common in raw waters, though they were hardly found in treated waters after chlorination. Among pesticides, pentachlorophenol (PCP) was found in 4 raw waters, with the maximum concentration of 0.00004 mg/l, and one treated water.

(2003). Magnetic pressure seam welding method for aluminium sheets. Welding International: Vol. 17, No. 12, pp. 929-933.

Studies on the effects of helium or hydrogen gases on the mechanical properties and size stability of SiC fibers were examined using accelerator implantation techniques. Three types of Nicalon fibers (Nicalon-CG, Hi-Nicalon, and Hi-Nicalon type-S) were examined. Three levels of implanted gas concentrations from 50 to 5000 appm were conducted. Swelling of the fibers was observed after helium implantation. The amount of swelling depended on the helium concentration and the type of fiber. The swelling had vanished after the post-implantation annealing at 1000 °C. The slight decrease of tensile strength was observed after the He implantation. It remained after the post-implantation annealing up to 1400 °C. The significant effects of hydrogen implantation on the strength and swelling were not observed in this work.

Effects of various alternative disinfectants, e.g. chlorine dioxide, ozone, ultraviolet radiation and chloramine, either alone or in combination with other physical treatments like sand filtration and membrane filtration, on the inactivation and removal of nematoda were studied. Ozone and chloramines were found to be effective for nematoda inactivation. Filtration alone was unable to remove nematoda completely. But the combination of UV radiation and sand filtration turned out to be very effective in the removal of nematoda from drinking water. 90% inactivation of nematoda needed a UV dose of (D10-value) 135 mJ/cm2, while 99% inactivation required 232.5 (135 + 97.5) mJ/cm2. This study was a part of a five-year national research project “Advanced Aqua Clean Technology for 21st Century” (ACT21).

Trimethyltin (TMT) preferentially induces neuronal changes in the hippocampus and pyriform cortex. In the present study we investigated the time course of microglial and astroglial responses associated with neurodegeneration after the administration of TMT (i.p. 9 mg/kg or 12 mg/kg body weight) in the rat. At a dosage of 9 mg/kg TMT, neurodegeneration was clearly demonstrated in the CA1 and CA3 regions of the hippocampus as argyrophilic (dark) neurons by day 4 using the Gallyas-Braak (G-B) impregnation method that has been shown to be sensitive and specific for neurodegeneration. Early microglial response was immunohistochemically shown with anti-microglial response factor-1 (MRF-1) antibody in the CA3 by day 1, preceding neurodegeneration morphologically detected by the G-B method. Activation of astrocytes was revealed by immunohistochemical staining for glial fibrillary acidic protein (GFAP) by day 2. In parallel with the maximal neurodegeneration, large numbers of hypertrophied microglia and astrocytes were observed in the CA1 and CA3 by day 7. Numbers of degenerative neurons appeared to be closely associated with adjacent microglia by the double staining of G-B impregnation and MRF-1 immunohistochemistry. The number of reactive microglia considerably decreased to the resting state by day 14, while hypertrophied astrocytes were still prominent in the CA3 up to day 21. With the high dose of TMT, granule cells in the dentate gyrus and CA1 and CA3 pyramidal cells were significantly impregnated. After TMT treatment, accompaning neurodegeneration we observed early response of microglia and prolonged activation of astrocytes, suggesting an individual role of glial cells in maintenance and repair of damaged neurons following brain injury.

When isolated rat pancreatic islets are treated with 16.7 mM glucose, a time-dependent potentiation (TDP) of insulin release occurs that can be detected by subsequent treatment with 5() mM KCl. It has been thought that TDP by glucose is a Ca 2+ -dependent phenomenon and only occurs when exposure to glucose is carried out in the presence of Ca 2+ . In contrast to this we now demonstrate TDP under stringent Ca 2+ -free conditions (Ca 2+ -free buffer containing 1 mM EGTA). In fact, under these Ca 2+ -free conditions glucose caused an even stronger TDP than in the presence of Ca 2+ . TDP induced by glucose in the absence of extracellular Ca 2+ was unaffected by inhibitors of protein kinase C (PKC). However, cerulenin or tunicamycin, two inhibitors of protein acylation, eradicated TDP without affecting glucose metabolism. The TDP by glucose was not associated with an increase in the cytosolic free Ca 2+ concentration ([Ca 2+ ]i) during subsequent treatment with high K + . Exposure of islets to forskolin under Ca 2+ -free conditions did not cause TDP despite a large increase in the cellular cAMP levels. In conclusion, glucose alone induces TDP under stringent Ca 2+ -free conditions when [Ca 2+ ]i was significantly lowered. Protein acylation is implicated in the underlying mechanism of TDP.

Roux-en-Y gastric bypass is an option of treatment for morbidly obese patients with diabetes. However, the value of the operation in mildly obese patients is not established. We report the first prospective systematic endocrine and metabolic analysis in a mildly obese patient who underwent a Roux-en-Y gastric bypass. In a 49-year-old man with BMI 32.6 kg/m(2) having type 2 diabetes, intramucosal gastric cancer was treated by partial gastrectomy with Roux-en-Y gastric bypass. Pre-operatively, he received 53 U/day insulin and the HbA1c value was 63 mmol/mol: meal tolerance test showed diabetic hyperglycemia and low insulin sensitivity with attenuated insulin secretion and normal glucagon-like peptide 1(7-36) secretion. After the operation, hypoglycemic agent was stopped. Body weight reduced from 84.0 to 77.0 kg within 2 weeks and increased thereafter to 79.4 kg at 4 months later, when the degree of hyperglycemia was unchanged as indexed by a HbA1c value of 62 mmol/mol. Upon repeated meal tolerance test, no increase of glucagon-like peptide 1 and insulin secretion, but significantly improved hepatic and peripheral insulin sensitivity were found, compared to the preoperative meal tolerance test. Marked dissociation of endocrine and metabolic effects of Roux-en-Y gastric bypass, that is, absence of increased glucagon-like peptide 1/insulin secretion with improvement of insulin sensitivity, was found in a mildly obese patient with type 2 diabetes.

The clinicopathologic findings of reversible ampulla-like ventriculogram of the left ventricle were studied in 8 elderly women and one middle-aged man. Their coronary arteriograms were normal, even in the 7 patients who had ST elevation on electrocardiogram. Coronary spasm was positive in only 2 of the 7 patients who received provocation tests. Biopsy specimens revealed focal myocyte injury. Normal coronary arteriograms during ST elevation and the presence of pathologic myocardial lesions were not consistent with a concept of stunned myocardium. The presence of myocardial lesions suggested that focal and disseminated myocardial damage had occurred.

症例は39歳,男性.血便のため平成10年11月17日当科受診し,諸検査にて左側大腸炎型の潰瘍性大腸炎と診断した.入院治療を行いステロイド投与により寛解が得られたため平成11年3月24日に退院したが,4月初旬より右悸肋部痛が出現したため再入院し,上腹部スクリーニングにて急性胆嚢炎を指摘した.胆道造影では胆管系に異常所見はなく胆嚢内にも結石を指摘できなかった.保存的治療のあと当院外科にて5月17日に胆摘術を施行したが,摘出標本では胆嚢内に結石はなく胆嚢壁のびらん,出血,肥厚を伴う慢性胆嚢炎の所見であった.潰瘍性大腸炎には様々な合併症があり,胆道系疾患合併も稀ではない.しかし無石胆嚢炎合併の報告は極めて稀なので報告した.