[Retrograde Stanford Type A Aortic Dissection of Marfan Syndrome Long After Thoracic Endovascular Aortic Repair:Report of a Case].

A 52-year-old woman with Marfan syndrome developed Stanford type B aortic dissection and was treated with thoracic endovascular aortic repair. However, 29 months later, she presented with retrograde Stanford type A aortic dissection. We successfully performed aortic arch replacement with the frozen elephant trunk technique and valve-sparing aortic root replacement. The advantages of the frozen elephant trunk technique are that the distal anastomosis can be created without stent-graft resection and the cardiac arrest time is shortened. Therefore, the frozen elephant trunk technique was considered valuable and safe in this potentially lethal situation.

Oleic acid to stearic acid ratio might be a potential marker for insulin resistance in non-obese Japanese.

Results from a recent study indicate that a higher level of oleic acid/stearic acid ratio was associated with metabolically unhealthy obesity. This was further validated in cross-sectional and interventional studies; however, this was not extensively studied in a non-obese population. We recruited 260 Japanese subjects with serum free fatty acid profiles undergoing anti-aging health examinations. The determinants for oleic acid/stearic acid ratio were investigated using multiple regression analyses. To compare different markers, the subjects were classified based on oleic acid/stearic acid ratio and the combination of oleic acid/stearic acid ratio and triglyceride levels. The oleic acid/stearic acid ratio exhibited a positive correlation with the logmatic transformed triglyceride/high-density lipoprotein cholesterol ratio and the fasting triglycerides-glucose index, both of which were used as markers for insulin resistance. Multiple regression analyses revealed that the triglyceride/high-density lipoprotein cholesterol ratio and fasting triglyceride-glucose index were positively associated with the oleic acid/stearic acid ratio. Most markers were the worst in the highest triglyceride group in both oleic acid/stearic acid groups. In addition, most markers were worse in high oleic acid/stearic acid ratio group than low group. In conclusion, oleic acid/stearic acid ratio might be a useful marker for insulin resistance in non-obese Japanese subjects.

Uric acid, ferritin and γ-glutamyltransferase can be informative in prediction of the oxidative stress.

The anti-oxidant system is affected not only by aging but also many lifestyle factors. We aimed to clarify the determinants of medical check-up items affecting the anti-oxidant system. We studied 959 Japanese individuals who underwent anti-aging health check-ups (mean age: 61.1 years) at Tokai University from 2006 to 2016. As parameters of oxidative stress, we measured serum total anti-oxidant status, 8-hydroxy-2'-deoxyguanosine, and isoprostane. Anti-aging health check-up data and lifestyle information were collected from participants in this study. Step-wise multiple regression analyses were conducted to identify determinants that influence serum total anti-oxidant status, 8-hydroxy-2'-deoxyguanosine, and isoprostane, respectively. Serum total anti-oxidant status was significantly correlated with uric acid, vitamin A, folate, and valine. 8-hydroxy-2'-deoxyguanosine was significantly correlated with age, ferritin, drinking habit, and vitamin Eα. Isoprostane was significantly correlated with vitamin Eα, γ-glutamyltransferase, ferritin, and smoking habit. The strong antioxidant powers of uric acid and vitamins were confirmed. It was suggested that branched-chain amino acids themselves such as valine or peptides containing them may possess antioxidant ability because of its strong correlation. Uric acid, ferritin, and γ-glutamyltransferase, which are common items measured in medical checkups, can be informative in predicting the oxidative stress situation in a general medical examination.

[Right Atrial Approach for the Surgical Repair of Delayed Ventricular Septal Rupture].

Ventricular septal rupture(VSR) after acute myocardial infarction(AMI) is a rare and serious complication that is associated with extremely high mortality. Delayed VSR is particularly uncommon and is difficult to diagnose and treat. A 68-year-old man presented with dyspnea on effort. Coronary angiography revealed subtotal occlusion of the right coronary artery(RCA) with collateral circulation to the chronically and totally occluded left anterior descending artery (LAD). Elective stenting of the RCA was successfully performed for a recent MI of the RCA, while percutaneous coronary intervention(PCI) in the LAD ended in failure. At 21 days after the 1st PCI, the patient developed acute heart failure with new pansystolic murmur. Cardiac catheterization showed a left to right ventricular shunting without new coronary artery lesions. Fortunately, the hemodynamic status was stable, and we could perform elective surgical repair by right atrial approach. Simultaneously, a left internal thoracic artery bypass to the LAD was performed. The postoperative course was uneventful. The patient is currently doing well at 5 years after the operation.

Antifungal peptidic compound from the deep-sea bacterium Aneurinibacillus sp. YR247.

Aneurinibacillus: sp. YR247 was newly isolated from the deep-sea sediment inside the Calyptogena community at a depth of 1171 m in Sagami Bay. The strain exhibited antifungal activity against the filamentous fungus Aspergillus brasiliensis NBRC9455. A crude extract prepared from the YR247 cells by ethanol extraction exhibited broad antimicrobial activities. The antifungal compound is stable at 4-70 °C and pH 2.0-12.0. After treatment with proteinase K, the antifungal activity was not detected, indicating that the antifungal compound of strain YR247 is a peptidic compound. Electrospray ionization mass spectrometry of the purified antifungal compound indicated that the peptidic compound has an average molecular weight of 1167.9. The molecular weight of the antifungal compound from strain YR247 is different from those of antimicrobial peptides produced by the related Aneurinibacillus and Bacillus bacteria. The antifungal peptidic compound from the deep-sea bacterium Aneurinibacillus sp. YR247 may be useful as a biocontrol agent.

Properties of an ionic liquid-tolerant Bacillus amyloliquefaciens CMW1 and its extracellular protease.

An ionic liquid-tolerant bacterium, Bacillus amyloliquefaciens CMW1, was isolated from a Japanese fermented soybean paste. Strain CMW1 grew in the presence of 10 % (v/v) 1-butyl-3-methylimidazolium chloride ([BMIM]Cl), a commonly used ionic liquid. Additionally, strain CMW1 grew adequately in the presence of the hydrophilic ionic liquids 10 % (v/v) 1-ethyl-3-methylimidazolium trifluoromethanesulfonate ([EMIM]CF3SO3) or 2.5 % (v/v) 1-butyl-3-methylimidazolium trifluoromethanesulfonate ([BMIM]CF3SO3). Strain CMW1 produced an extracellular protease (BapIL) in the culture medium. BapIL was stable in the presence of 80 % (v/v) ionic liquids, [EMIM]CF3SO3, [BMIM]Cl, [BMIM]CF3SO3, 1-butyl-3-methylimidazolium tetrafluoroborate, 1-butyl-3-methylimidazolium hexafluorophosphate, and 1-butyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide, and functioned in 10 % (v/v) these ionic liquids. BapIL was stable at pH 4.0-12.6 or in 4004 mM NaCl solution, and exhibited activity in the presence of 50 % (v/v) hydrophilic or hydrophobic organic solvents. BapIL was completely inhibited by 1 mM PMSF and partially by 5 mM EDTA. BapIL belongs to the true subtilisins according to analysis of the deduced amino acid sequence. We showed that BapIL from the ionic liquid-tolerant B. amyloliquefaciens CMW1 exhibited tolerance to ionic liquid and halo, alkaline, and organic solvents.

A high-molecular-weight, alkaline, and thermostable ß-1,4-xylanase of a subseafloor Microcella alkaliphila.

An endo ß-1,4-xylanase (XynE15) from a culture broth of a deep subseafloor microorganism, Microcella alkaliphila JAM-AC0309, was purified to homogeneity. The molecular mass of XynE15 was approximately 150 kDa as judged by SDS-PAGE. The optimal pH and temperature for hydrolysis of xylan were pH 8 and 65 °C. The enzyme was stable to incubation for 30 min at up to 75 °C, and the half-life at 50 °C was 48 h. XynE15 hydrolyzed arabinoxylan, oat spelt xylan, and birchwood xylan well, but not avicel, carboxymethylcellulose, or arabinan. Xylooligosaccharides were hydrolyzed to mainly xylobiose from higher than xylotetraose. The genome sequencing analysis of strain JAM-AC03039 revealed that XynE15 was composed of 1,319 amino acids with one catalytic domain and three carbohydrate-binding domains belonging to glycoside hydrolase (GH) family 10 and carbohydrate-binding module (CBM) family 4, respectively.

Comparative study of MAFLD as a predictor of metabolic disease treatment for NAFLD.

A novel concept of Metabolic Associated Fatty Liver Disease (MAFLD) was proposed, incorporating metabolic abnormalities such as obesity and diabetes, which are risk factors that affect the prognosis. Non-Alcoholic Fatty Liver Disease (NAFLD), entails fat accumulation in the liver without alcohol consumption and is often linked to obesity, insulin resistance, and metabolic syndrome. However, the broad nature of the disease concept has hindered prognosis accuracy. In this study, we assess the contribution of the impact of diagnostic criteria for MAFLD on metabolic disease progression compared to conventional diagnostic criteria for NAFLD. A total of 7159 patient who were presented to the health screening center in Tokai University Hospital both in 2015 and 2020 were included in the study. Fatty liver was diagnosed using abdominal ultrasonography. The diagnostic criteria for NAFLD were consistent with the global guidelines based on alcohol consumption. The diagnostic criteria for MAFLD were based on the International Consensus Panel. Medications (anti-hypertensive, diabetic, and dyslipidemia medications) were evaluated by self-administration in the submitted medical questionnaire. A total of 2500 (34.9%) participants were diagnosed with fatty liver (FL +), 1811 (72.4%) fit both NAFLD and MAFLD diagnostic criteria (overlap), 230 (9.2%) fit only the NAFLD diagnostic criteria (NAFLD group) and 404 (16.1%) fit the MAFLD diagnostic criteria (MAFLD group) at 2015. Over the next 5 years, medication rates increased in the NAFLD group for anti-hypertensive, + 17 (7.4%); diabetes, + 3 (1.3%); and dyslipidemia, + 32 (13.9%). In contrast, the only-MAFLD group showed a more significant increase with + 49 (12.1%), + 21 (5.2%), and + 49 (12.1%), for the respective medications, indicating a substantial rise in patients starting new medications. Our analysis of repeated health check-ups on participants revealed that the diagnostic criteria for MAFLD are more predictive of future treatment for metabolic disease than conventional diagnostic criteria for NAFLD.

Mitral valve repair with patch augmentation for atrial functional mitral regurgitation complicated with giant left atrium.

OBJECTIVE: We aimed to assess the results of posterior leaflet augmentation with an autologous pericardial patch in atrial functional mitral regurgitation. METHODS: Data of 16 patients with atrial functional mitral regurgitation who underwent posterior leaflet patch augmentation for mitral valve repair were retrospectively analyzed. This procedure was applied to a short posterior leaflet with a height of < 10 mm in P2. The median age was 72.5 [67.8-78.3] years. Preoperative New York Heart Association functional class was II in 7 (43.8%) and III or IV in 9 (56.2%) patients. Mitral regurgitation was moderate in 2 (12.5%) and severe in 14 (87.5%) patients. RESULTS: Operative mortality occurred in 1 (6.2%) patient due to cerebral infarction. One patient required valve replacement because of patch perforation early after operation. Mitral regurgitation was reduced to less than mild in 15 (93.8%) patients and less than trivial in 11 (68.8%) patients (P < 0.01) postoperatively. As for mid-term results, New York Heart Association functional class improved to I or II in 12 (75%) patients (P < 0.01). Two cases of thrombotic complication were observed. Remote recurrent regurgitation occurred in one case due to small patch size. The 3-year free rate of valve-related morbidity and regurgitation recurrence was 65.6% and 87.1%, respectively. The 5-year survival rate was 93.8%. CONCLUSIONS: Pericardial patch augmentation in atrial functional mitral regurgitation leads to good survival and mitral regurgitation recurrence-free rates. Steady anticoagulation and the use of larger patches would be necessary to reduce thrombotic complications and recurrent MR.

Ingestion of taxifolin-rich foods affects brain activity, mental fatigue, and the whole blood transcriptome in healthy young adults: a randomized, double-blind, placebo-controlled, crossover study.

The antioxidant properties of polyphenols, which are found in most plants, have been shown to be useful for maintaining health, including enhancing brain function and alleviating stress. We aimed to investigate the effect of a single intake of taxifolin-containing foods on cognitive task performance and whole blood gene expression in healthy young adults. This study was a randomized, placebo-controlled, double-blind, crossover trial in which healthy young adults were administered a single dose of either a placebo or food containing taxifolin. Cognitive tests (serial 3s, serial 7s, and rapid visual information processing) to examine brain activity and visual analog scale questionnaires to analyze mental fatigue were applied. The set of tests was repeated four times. The findings showed that taxifolin intake improved calculation abilities and reduced mental fatigue. An analysis of whole blood gene expression before and after the test revealed that the expression of foreign substance removal-related genes increased following the ingestion of taxifolin and that most differentially expressed genes were enriched in granulocytes. Taxifolin intake was shown to affect the brain activity of healthy young adults and demonstrated an antifatigue effect, thereby reducing subjective fatigue. A single intake of taxifolin may enhance the removal of foreign substances by strengthening the innate immune system and suppressing the occurrence of injury.

Correction: Ingestion of taxifolin-rich foods affects brain activity, mental fatigue, and the whole blood transcriptome in healthy young adults: a randomized, double-blind, placebo-controlled, crossover study.

Correction for 'Ingestion of taxifolin-rich foods affects brain activity, mental fatigue, and the whole blood transcriptome in healthy young adults: a randomized, double-blind, placebo-controlled, crossover study' by Fumika Shinozaki et al., Food Funct., 2023, https://doi.org/10.1039/d2fo03151e.

Prediction and Validation of Metabolic Dysfunction-Associated Fatty Liver Disease Using Insulin Resistance-Related Indices in the Japanese Population.

Background: Recently, metabolic dysfunction-associated fatty liver disease (MAFLD), which is based on evidence of hepatic steatosis and any of the following three conditions: overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation, has been proposed. It is uncertain how indices that predict insulin resistance (IR) are associated with MAFLD. Methods: Among subjects who had undergone health examinations at our hospital, 1,257 (787 men and 474 women) who underwent fatty liver evaluation, were included in this cross-sectional study. The discriminatory ability of each index for MAFLD was tested using a receiver operating characteristic curve analysis. The associations between the homeostasis model assessment-IR (HOMA-IR), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, triglyceride-glucose (TyG) index, and MAFLD were investigated using multiple logistic regression analysis. Results: The mean age and body mass index of MAFLD subjects were 58.1 years and 26.0 kg/m2 in men and 63.0 years and 26.1 kg/m2 in women, respectively. The cutoff values of HOMA-IR, TG/HDL-C ratio, and TyG index in men and women were 1.40 (area under the curve [AUC]: 0.81) and 1.90 (AUC: 0.88); 1.56 (AUC: 0.75) and 1.06 (AUC: 0.78); and 8.62 (AUC: 0.75) and 8.45 (AUC: 0.80), respectively. All indices were significantly higher in both men and women with MAFLD. In the multivariate models, the odds of MAFLD were higher among both men and women in the highest tertile than those in the lowest tertile. When subjects were divided by sex, presence of MAFLD, and alanine aminotransferase (ALT) values, all indices were significantly higher in both men and women with high ALT levels who were diagnosed with MAFLD. Conclusion: IR strongly correlated with MAFLD, particularly in subjects with high ALT levels.

Usefulness of Vitamin D Deficiency Questionnaire for Japanese (VDDQ-J) for Screening of Vitamin D Deficiency and Low Muscle Mass in Relatively Healthy Japanese Anti-Aging Health Checkup Examinees.

The Vitamin D Deficiency Questionnaire for Japanese (VDDQ-J) has been developed as an alternative indicator of the vitamin D nutritional status when serum 25(OH)D measurement is unavailable. In the present study, we compared the usefulness of the VDDQ-J with that of serum 25(OH)D concentration and examined the relationship among vitamin D, DXA-based body composition, and muscle strength in 163 anti-aging health check examinees. The median age, 25(OH)D concentration and VDDQ-J score were 62.0 y, 20.1 ng/mL and 22.0 points, respectively. In total, 47.9% of the subjects had serum 25(OH)D concentrations of <20 ng/mL. The VDDQ-J score was significantly negatively correlated with the serum 25(OH)D concentration, and the positive predictive value for vitamin D deficiency was 86.3%. The prevalence of sarcopenia was 6.1%. Low 25(OH)D levels and high VDDQ-J scores were significantly associated with low muscle mass in both univariate analysis and multiple linear regression analysis. The serum 25(OH)D level showed a significant negative correlation with body fat mass. The VDDQ-J score was selected as a significant determinant of low skeletal muscle mass index (<7.0 kg/m2 for men and <5.4 kg/m2 for women) by a multiple logistic regression analysis. In conclusion, the present study showed that a low vitamin D nutritional status as indicated by both low 25(OH)D levels, and high VDDQ-J scores was associated with low muscle mass and the VDDQ-J is considered useful not only for the detection of vitamin D deficiency but also in the screening of individuals with low muscle mass and a high risk of sarcopenia.

Estimated Elovl6 and delta-5 desaturase activities might represent potential markers for insulin resistance in Japanese adults.

Purpose: Results from a recent study indicated that lower stearic acid/palmitic acid (SA/PA) and arachidonic acid/dihomo-γ-linolenic acid (AA/DGLA) ratios were associated with metabolically unhealthy obesity. However, this has not been extensively studied in the Japanese population. Methods: We recruited 291 Japanese subjects with serum free fatty acid profiles undergoing health examinations. Whole serum desaturase activity was estimated as the product: precursor ratio -SA/PA ratio for elongation of long-chain fatty acid family member 6 (Elovl6) and AA/DGLA for delta-5 desaturase (D5D). The determinants of Elovl6 and D5D activity were investigated using multiple regression analyses. Results: The Elovl6 and D5D activities exhibited a negative correlation with the logmatic-transformed TG/HDL-C ratio and TyG index. Multiple regression analyses revealed that the TG/HDL-C ratio and TyG index were negatively associated with Elovl6 and D5D activities. Most atherogenic markers were worse in the low Elovl6 or D5D activity group than in the high Elovl6 or D5D activity group. When study subjects were further stratified by TG levels, most atherogenic markers were the worst in the highest TG group in either the lowest Elovl6 or lowest D5D activity groups. Conclusion: The estimated Elovl6 and D5D activities might be useful markers of insulin resistance in Japanese subjects.

Simple Height Reduction of the Posterior Leaflet in Robotic Mitral Annuloplasty.

Systolic anterior motion is occasionally encountered during mitral valve repair using neochordal reconstruction for mitral regurgitation owing to large posterior leaflet prolapse. In cases with a redundant posterior leaflet, the risk of systolic anterior motion increases if the redundant posterior leaflet is unresected to decrease the leaflet height. The posterior leaflet was fixed at the anterior annulus, cut near the posterior annulus, and resected into a spindle shape. The excised part of the posterior leaflet was subsequently closed with a continuous suture. Herein, we report our simple height reduction technique of the posterior leaflet, the "curtain technique," performed in robotic surgery.

A Novel Ring Knot Pusher With Closed Triangle Tip for Minimally Invasive Cardiac Surgery.

We created a novel ring-type knot pusher with a closed triangle tip, wherein the thread is never detached from the knot pusher head during the ligation process. This knot pusher has a small head and is suitable for complex fields, such as the subvalvular apparatus of the mitral valve, allowing the surgeons to observe the knot itself. Considering that the thread passes through the inner corner of the triangle during the tying-down process without swinging inside the triangle, this knot pusher allows for a stable and secure ligation.

Transitional Changes in Job Stress and Psychological Adjustment of Hospital Workers During the COVID-19 Pandemic in Japan.

OBJECTIVES: The aim of the present study was to longitudinally evaluate job stress and burnout before and after the third wave of in Japan and identify transitional changes in the mental health status of a cohort of employees at a coronavirus disease 2019 (COVID-19)-dedicated hospital. METHODS: The same surveys were conducted in October 2020 and March 2021. 151 subjects who responded to both surveys were included. The Maslach Burnout Inventory-General Survey was used to evaluate burnout. Multiple logistic regression analyses were performed to determine odds ratios for factors associated with burnout using a non-burnout group as a reference. RESULTS: In the cohort, 31.1% of employees showed dropout intention and 13.2% of employees were experiencing burnout in March 2021. Hospital workers were more motivated by a sense of contribution and accomplishment, which could balance increased exhaustion in March 2021. The following factors associated with burnout remained to be solved: self-quarantine, unfavorable patient prognosis, poor communication of information, lack of sleep in comparison to the pre-COVID-19 period, and desire for good communication of information. CONCLUSION: It is important to continuously evaluate the mental health status of employees and to provide targeted prevention and intervention in order to mitigate psychological distress and avoid burnout and resignation.

Early outcomes of the Frozenix J-graft with exclusion of the non-stent part at a single center.

Background: The frozen elephant trunk technique is useful in aortic arch repair; however, some adverse events are associated with the Frozenix J-graft. We designed a technique to prevent these adverse events and achieve easy anastomosis (Total Exclusion of the Non-Stent part of Frozenix using an Everting anastomosis [TENSE]), and we assessed the outcomes of this technique in the present study. Methods: From April 2017 to May 2021, 44 patients with aortic arch disease underwent TENSE, in which the proximal stump of the stent part of Frozenix was matched to the distal anastomosis end between the left common carotid and left subclavian arteries. Results: The median age of the patients (35 men, 9 women) was 76.5 years. The predicted mortality and morbidity rates were 10.0% and 40.2%, respectively, according to the JapanSCORE II. Two patients (4.5%) died of aneurysm rupture and interstitial pneumonia, respectively, during hospitalization. Four patients (9.1%) who developed postoperative cerebral infarction had a previous cerebral infarction (P=0.010). No patients developed spinal cord complications or Frozenix kinking. Follow-up computed tomography showed no endoleaks or aneurysmal dilatation, although one patient had possible distal stent graft-induced new entry. Conclusions: Our strategy provided good early outcomes without spinal cord complications or Frozenix kinking in patients with aortic arch disease. Continuous follow-up is needed to avoid missing distal changes.

A Case of Silent COVID-19 Pneumonia Found by an Optional Chest CT Scan During a Health Check.

We experienced a case of silent Coronavirus disease 2019 (COVID-19) pneumonia that was found by an optional chest computed tomography (CT) scan during a health check. A 62-year-old man with a present medical history of hypertension visited the health screening center at Tokai University Tokyo Hospital on August 7th, 2020. Prior to entry into the hospital, his body temperature was measured and his history was obtained (called 'COVID-19 triage'), but there were no remarkable findings. Subsequently, patchy ground glass opacities were observed with peripheral distribution in bilateral multiple lobes. Based on this finding COVID-19 pneumonia was highly suspected. Subsequently, a PCR test was positive for COVID-19. Even in health check settings, we should be aware of possible encounters with COVID-19 infections. The high risk of silent spread plays a significant role in the ongoing pandemic. Chest CT scans, which can efficiently identify silent COVID-19 pneumonia, should be performed earlier during health check examinations, at least before gastroendoscopy, which causes significant droplet dispersion. Health check examination providers should not cancel or postpone health checks; rather, it is necessary for them to provide health check examinees with a safe environment with minimal delay in access to recommended health care services.

Histology of the tricuspid valve annulus and right atrioventricular muscle distance.

OBJECTIVES: Histologically, the mitral valve annulus comprises a collection of collagen fibres. However, the existence of collagen fibres in the tricuspid valve annulus has not been elucidated. Our goal was to clarify the histology of the tricuspid annulus. METHODS: Fifty human hearts without heart disease that were autopsied at Osaka City University Hospital between January 2009 and December 2017 were examined. The tricuspid valve was sectioned at 12 sites around the annulus, and the atrioventricular junction distance was measured. RESULTS: None of the tricuspid valve annulus samples had a continuous aggregation of collagen fibres that could be called an annulus. The interventricular space between the right atria and ventricles was composed of adipose tissue only on the anterosuperior and inferior sides, and no adipose tissue was found on the septal side. Comparing the atrioventricular muscle distance of the anterosuperior and inferior sides, the distance at the inferior side was statistically significantly larger than that of the anterosuperior side in 47 cases (P < 0.0001). CONCLUSIONS: There was no continuous circumferential aggregation of collagen fibres in the right atrioventricular junction. The distance between the right atrial and ventricular myocardium was greater at the inferior side than that at the anterosuperior side, which might lead to more inferior annular dilation versus anterosuperior dilation. These anatomical features will be fundamental for future discussions of the suturing method used in prosthetic ring annuloplasty for tricuspid regurgitation.