Accurate estimation of modulation amplitude in Brillouin optical correlation-domain reflectometry based on Rayleigh noise spectrum.

In Brillouin optical correlation-domain reflectometry (BOCDR), spatial resolution relies on the modulation amplitude of the light. We propose a Rayleigh-based method that utilizes the spectral width of Rayleigh-induced noise to measure this amplitude without altering the setup or requiring an optical spectrum analyzer. With high frequency resolution and ease of implementation, our approach enhances the convenience and accuracy of spatial resolution evaluation in BOCDR.

A case of ECPELLA-supported treatment for post-infarction cardiac rupture.

The efficacy and risk of a combination of veno-arterial extracorporeal membrane oxygenation and Impella (Abiomed, Inc., Danvers, MA, USA), an approach known as ECPELLA, for post-infarction cardiac rupture is unclear. We describe the case of a 72-year-old man who presented with acute myocardial infarction. The patient was managed with ECPELLA because of hemodynamic compromise. One week later, there was a sudden increase in venous oxygen saturation. Transthoracic echocardiography revealed ventricular septal rupture, and free wall rupture. Intraventricular thrombus was also observed despite standard anticoagulation therapy. Even with double cardiac rupture, ECPELLA could facilitate left ventricular unloading and sustain hemodynamics. However, because of the risk of device failure due to thrombus aspiration into the Impella, the patient underwent repair surgery. Postoperatively, the patient was temporarily weaned off ECPELLA, and his hemodynamics deteriorated again, and he finally died. Learning objectives: ECPELLA can effectively stabilize the hemodynamics in cases of post-infarction cardiac rupture. However, there are still challenges to address, such as determining optimal ventricular reloading and ECPELLA management for intraventricular thrombus prevention. When using ECPELLA to delay surgery for post-infarction cardiac rupture, it is crucial to strike a balance between hemodynamic stabilization and avoiding potential serious complications.

A Novel Technique of No-Touch Endoscopic Saphenous Vein Harvesting.

No-touch saphenous vein harvesting is considered an ideal procedure for harvesting good-quality veins, whereas endoscopic vein harvesting (EVH) is considered ideal for decreasing wound complications. The no-touch EVH (NT-EVH) technique, which was developed in 2018, is one of the best vein-harvesting procedures. We have improved this method in several aspects since our initial experience. Herein, we present the details of this technique.

Virtual Reality Simulation for Minimally Invasive Coronary Artery Bypass Grafting With Aortic No-Touch Total Arterial Grafting Technique.

OBJECTIVE: Virtual reality can be applied preoperatively by surgeons to gain precise insights into a patient's anatomy for planning minimally invasive coronary artery bypass grafting (CABG) with in situ arterial grafts. This study aimed to examine virtual reality simulation for minimally invasive CABG with in situ arterial grafts. METHODS: Preoperative stereolithographic files in 35 in situ arterial grafts were converted using 320-slice computed tomography and workstation. The accurate length and direction of each graft were confirmed through virtual reality glasses. The simulation of graft designs was performed by using an immersive virtual reality platform. RESULTS: The mean harvested lengths of in situ left internal thoracic artery (n = 17), right internal thoracic artery (n = 12), and gastroepiploic artery (n = 6) grafts predicted by virtual reality simulation were 21.4 ± 3.4 cm, 21.2 ± 3.6 cm, and 22.8 ± 4.8 cm. The required lengths of these grafts predicted by virtual reality simulation were 15.8 ± 2.3 cm, 16.4 ± 2.1 cm, and 14.5 ± 4.4 cm. Minimally invasive CABG using virtual reality simulation was completed in 17 patients, of whom 16 patients underwent aortic no-touch total arterial CABG. The surgical strategy was adjusted in 11.8% of the cases due to the 3-dimensional virtual reality-based anatomy evaluation. The early mortality and morbidity were 0%, and the patency of the graft was 100%. The median time to return to full physical activity was 7.1 days. CONCLUSIONS: This study demonstrated the successful development and clinical application of the first dedicated virtual reality platform for planning aortic no-touch total arterial minimally invasive CABG. Virtual reality simulation can allow the accurate preoperative understanding of anatomy and appropriate planning of the graft design with acceptable postoperative outcomes.

Minimally invasive coronary artery bypass grafting with ultrasonically skeletonized internal thoracic artery.

Objective: This study aimed to examine the feasibility and safety of minimally invasive cardiac surgery coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery in the authors' initial experience. Methods: From February 2012 to May 2021, 247 consecutive patients who underwent minimally invasive coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery were reviewed retrospectively. Internal thoracic arteries were harvested in a full skeletonized fashion using an ultrasonic scalpel via left minithoracotomy. Bilateral internal thoracic arteries were used in 108 patients, and the internal thoracic arteries as in situ grafts were used in 393 anastomoses. Total arterial revascularization was performed in 126 patients, and 142 patients underwent aortic nontouch minimally invasive coronary artery bypass grafting. Results: The patients' mean (range) age was 65.9 ± 11.5 (30-90) years. The mean (range) number of anastomoses performed was 2.6 ± 1.1 (1-6). Forty-six patients (18.6%) had 4 grafts, 94 patients (38.1%) had 3 grafts, and 60 patients (24.3%) had 2 grafts. Minimally invasive coronary artery bypass grafting was completed without conversion to sternotomy in all patients. Cardiopulmonary bypass was performed in 3 patients (1.2%), reinterventions due to bleeding were performed in 7 patients (2.8%), and chest wound infections were observed in 5 patients (2.0%). There was 1 (0.4%) mortality. Conclusions: Minimally invasive coronary artery bypass grafting using an ultrasonically skeletonized internal thoracic artery is feasible and has shown good perioperative outcomes. This approach has the potential for further optimization with revascularization strategies.

Visualization of Anterior Chamber Angle Structures With Scattering- and Polarization-Sensitive Anterior Segment Optical Coherence Tomography.

Purpose: The purpose of this study was to compare three optical coherence tomography (OCT) modalities in the observation of anterior chamber angle structures; trabecular meshwork (TM), Schlemm's canal (SC), and band of extracanalicular limbal lamina (BELL). Methods: Three OCT modalities were used: (1) 2 × 2 Jones-matrix scattering OCT (S-OCT) representing conventional intensity OCT, (2) polarization-diverse S-OCT that was calculated as summation of all elements of the Jones-matrix to eliminate the influence of artifacts caused by sample birefringence, and (3) polarization-sensitive OCT (PS-OCT) to assess depth-resolved phase retardation. Results: In a total of 97 eyes of 55 subjects, nasal and temporal angles were scanned. The detection rate of TM and BELL was significantly different among modalities; highest with PS-OCT (95.1% and 99.2%), followed by 2 × 2 Jones-matrix S-OCT (71.1% and 88.7%) and polarization-diverse S-OCT (33.2% and 25.0%), indicating the influence of artifacts on 2 × 2 Jones-matrix S-OCT measurements. SC was visible with 2 × 2 Jones-matrix S-OCT, polarization-diverse S-OCT, and PS-OCT in 14.2%, 14.9%, and 0.3% of images, respectively. The intergrader agreement as evaluated with the prevalence-adjusted bias-adjusted κ value was higher with PS-OCT than with other S-OCTs. Conclusions: Visibility of anterior chamber angle structures was assessed with three OCT modalities. For TM and BELL that are rich in collagen fibers, PS-OCT provides significantly better visibility than S-OCT without the influence of artifacts arising from polarization or birefringence. Visualization of SC was more difficult with any OCT modalities. Translational Relevance: PS-OCT is a useful tool to investigate the anterior chamber angle structures which are difficult to observe with conventional OCT.

[Usage of New Device to Prevent Sternum Separation after Median Sternotomy in 140 Cases].

While minimally invasive cardiac surgery (MICS) has become increasingly popular recently even in the field of cardiovascular surgery, the conventional full median sternotomy is still the main approach to the mediastinum, especially for cases which cannot be applied for MICS or in the facilities where MICS is not performed. It has been known that sternal instability is one of the leading causes of sternal infection after median sternotomy. Therefore, we have sought for an additional product to secure strong sternal stability. Since August in 2018, we used a new type of corrugated plate( Super Fixsorb Wave) which is placed inside the sternum in addition to regular sternal wires for 140 patients who had full median sternotomy. Up to now, we have no complications regarding sternotomy including mediastinitis. We believe that additional use of Super Fixsorb Wave enables firm sternal stability and prevents mediastinitis following full median sternotomy.

Fermented product of rice with Lactobacillus kefiranofaciens induces anti-aging effects and heat stress tolerance in nematodes via DAF-16.

Rice kefiran is superior in functionality, has high concentration of mucilaginous polysaccharide, and low lipid content, compared to conventional kefiran. However, reports on its physiological functionality, especially studies on life expectancy and aging, in model organisms are rare. In this study, nematodes were used as model organisms that were fed rice kefiran, along with Escherichia coli OP50, as a result of which, the lifespan of nematodes was extended and age-related retardation of mobility was suppressed. It also increased the heat stress resistance in nematodes. Experiments using daf-16 deletion mutant revealed that rice kefiran functions via DAF-16. Thus, this study revealed the longevity, anti-aging and heat stress tolerance effects of rice kefiran in nematodes.

Minimally Invasive coronary surgery compared to STernotomy coronary artery bypass grafting: The MIST trial.

RATIONALE: Minimally invasive cardiac surgery has emerged as a safe alternative to standard cardiac surgery. Minimally invasive coronary surgery (MICS CABG) was developed to allow adequate exposure and complete revascularization in CABG from a small thoracotomy incision without cardiopulmonary bypass. Multiple studies have reported significant shorter length of hospital stay and earlier postoperative physical recovery for MICS CABG patients when compared to sternotomy CABG patients. However, there have been no convincing clinical trials that demonstrate improvement in post-operative quality of life for patients who undergo MICS CABG. STUDY DESIGN: The Minimally Invasive Coronary Surgery compared to Sternotomy Coronary Artery Bypass Grafting (MIST) trial is a multi-centered, prospective randomized controlled trial that compares the quality of life and recovery in the early post-operative period between patients undergoing MICS CABG versus patients undergoing sternotomy CABG. Patients will be randomized either to the MICS CABG group or the sternotomy CABG group, and the target enrollment is 88 patients per group. The primary outcome is quality of life assessment performed by SF-36 questionnaire at 1 month. CONCLUSION: The MIST trial is the first prospective study that compares the quality of life between MICS CABG and sternotomy CABG patients. The results of this trial may enhance the procedural desirability of MICS CABG by patients and provide an incentive for surgeons and institutions to increase the availability of MICS CABG in suitable patients.

Sterilized bifidobacteria suppressed fat accumulation and blood glucose level.

Probiotics such as Lactobacillus and Bifidobacterium improve the balance of intestinal microflora and have various physiological functions beneficial to human health. It is not always known whether the ingested microbial cells are viable- or killed. However, even sterilized bacterial cells are functional. Bacterial cell functions are strain-specific and their modes of action are still poorly understood. The aim of this study was to elucidate the roles of sterilized bifidobacteria in obesity and lipid metabolism. To this end, mice were orally ingested sterilized bacteria. Male C57BL/6J mice aged 7 wks were raised on a high-fat diet and received oral sterilized bifidobacteria for 4 wks. Although the amount of food they ingested did not change in response to bifidobacteria administration, both weight gain and epididymal body fat mass were significantly reduced. In addition, the elevated blood glucose, triglyceride, and total cholesterol levels observed in the mice on the high-fat diet all decreased in response to bifidobacteria treatment. Hepatic triglyceride levels also decreased. Furthermore, oral glucose tolerance and insulin resistance tests indicated that sterilized bifidobacteria improved glucose tolerance and diminished insulin resistance. Sterilized bifidobacteria also decreased blood lipopolysaccharides and altered intestinal flora. The present study indicates that in mice on a high-fat diet, sterilized bifidobacteria suppressed fat accumulation, improved insulin resistance, and lowered blood glucose levels.

Less-invasive coronary artery bypass grafting international landscape and progress.

PURPOSE OF REVIEW: Less-invasive coronary artery bypass grafting (CABG) has evolved in multiple forms. Specifically noteworthy are recent technical refinement and reports of mid-term outcomes from well designed trials and observational studies in off-pump CABG, minimally invasive coronary artery bypass grafting (MICS CABG) and hybrid coronary revascularization (HCR). This review summarizes the historical evolution and recent development in less-invasive coronary artery bypass grafting. RECENT FINDINGS: A recent network meta-analysis of CABG with various degree of aortic manipulation demonstrated that no-touch technique may result in a significant reduction of postoperative stroke risk. A 5-year follow-up data of CORONARY study demonstrated that there was no significant difference in the rate of mortality, repeat revascularization, or primary composite outcome. The first multicenter observational study of HCR and PCI cohorts demonstrated that there was no significant difference in major adverse cardiac and cerebrovascular events at 12 months, with diverging event-free survival favoring HCR toward the end of the study period. SUMMARY: Less-invasive CABG continues to evolve in multiple forms. MICS CABG with the use of bilateral internal thoracic arteries preserves the sternum while allowing for a robust revascularization. HCR augments each form of less-invasive CABG, and is expected to play a larger role in the near future.

Minimally invasive coronary artery bypass grafting: a systematic review.

To minimize surgical morbidity in coronary artery bypass grafting, minimally invasive cardiac surgery has gained popularity. Minimally invasive coronary artery bypass grafting offers unique advantages compared to conventional off-pump coronary artery bypass or minimally invasive direct coronary artery bypass in that it enables the surgeon to harvest and graft bilateral internal thoracic arteries via a small thoracotomy while being conducted completely off-pump. This review focuses on current evidence behind off-pump coronary artery bypass, multi-arterial revascularization, patient populations that would most benefit from bilateral internal thoracic artery minimally invasive coronary artery bypass grafting, the surgical technique, and early outcomes. By overcoming the perceived inability to utilize bilateral internal thoracic arteries in minimally invasive coronary artery bypass grafting, the new technique further expands the armamentarium of surgeons and cardiologists. Hybrid coronary revascularization with bilateral internal thoracic artery minimally invasive coronary artery bypass grafting further augments the appeal of the next generation of minimally invasive cardiac surgery.

Assistive Techniques for Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting.

We introduce assistive techniques for proximal anastomosis in off-pump minimally invasive coronary artery bypass grafting (MICS CABG) to overcome difficult access to the ascending aorta in MICS CABG. An 8-cm left thoracotomy is made in the fifth intercostal space. ThoraTrak retractor (Medtronic Inc, Minneapolis, MN USA) is used to open the thoracotomy and is pulled to the cephalad and rightward direction toward to the ascending aorta. The pericardium is opened from the ascending aorta to the left ventricular apex and to the inferior vena cava. Two retraction sutures on the pericardial edge are used to laterally displace the heart. After dissecting between the ascending aorta and main pulmonary artery, the Octopus tissue stabilizer (Medtronic Inc, Minneapolis, MN USA), of which the suction tip is bent 60 degrees, is used to retract the pulmonary artery caudally. A flexible side-biting clamp (Vitalitec Inc.) is placed on the ascending aorta, and proximal anastomoses are handsewn on the ascending aorta. A total of 31 proximal anastomoses were completed with this technique between November 2013 and June 2015. All proximal anastomosis was completed without any difficulty. In MICS CABG, the technical challenges in proximal anastomosis due to difficult access to the aorta can be overcome safely by using this technique.

Perioperative outcomes of off-pump minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries under direct vision†.

OBJECTIVES: We previously introduced techniques to harvest and use the right internal thoracic artery in minimally invasive coronary artery bypass grafting (CABG) via a single left thoracotomy for revascularization with bilateral internal thoracic arteries (BITA). We report our short-term outcomes of patients who underwent minimally invasive CABG using BITA and a single internal thoracic artery (SITA). METHODS: Consecutive patients who underwent minimally invasive CABG using BITA or SITA at a Japanese medical center between February 2012 and December 2015 were reviewed retrospectively. Preoperative, intraoperative and 30-day postoperative outcomes were analysed. Perioperative data for the SITA cohort is presented to provide a context in which the outcomes of the BITA cohort can be evaluated. RESULTS: A total of 25 and 37 patients underwent BITA and SITA revascularization, respectively. The mean duration of the operation was longer in the BITA group than in the SITA group (265 ± 104 vs 336 ± 73 min). There were no deaths in the BITA group and one death in the SITA group. There were no strokes in either cohort, and new haemodialysis was required in one patient in each group. All BITA grafts were harvested without major complications and were all patent on computed tomography angiograms 1 week following the operations. CONCLUSIONS: BITA can be safely harvested in a reproducible manner under direct vision via a small left thoracotomy. The potential advantages of minimally invasive CABG using BITA, although yet to be established, include a long-term survival benefit conferred by BITA grafts and elimination of the risk of sternal wound infection, in addition to the established advantages of minimally invasive coronary artery surgery. This approach has the potential for further optimization with hybrid revascularization strategies.

[Minimally Invasive Coronary Artery Bypass Grafting Using Bilateral In Situ Internal Thoracic Arteries].

A 73-year-old male with diabetes mellitius was referred to our hospital for coronary artery bypass grafting (CABG). Preoperative coronary angiography revealed three-vessel coronary disease. Minimally invasive coronary artery grafting (MICS CABG) via left thoracotomy was selected to decrease surgical site infection due to severe diabetes. In situ bilateral internal thoracic arteries (BITA) were harvested using a long type Harmonic scalpel. In situ right internal thorac artery( RITA)-left anterior descending artery (LAD), in situ left internal thorac artery( LITA)-high lateral branch (HL), and aorta-saphenous vein graft (SVG)-#4 posterior descending artery were performed. BITA, the ascending aorta for proximal anastomosis, and all coronary targets were directly accessed with off-pump technique. There were no major postoperative complications. Postoperative 3D-computed tomography angiography (CTA) revealed all grafts were patent. We believe that use of BITA in MICS CABG is feasible, and can provide satisfactory quality. Further research however, will be needed.

[Minimally Invasive Coronary Artery Bypass Grafting Using Proximal Anastomoses Device;Report of a Case].

A 68-years-old male with diabetes mellitius (HbA1c 6.5%) was referred for coronary artery bypass grafting(CABG). Preoperative coronary angiography (CAG) signed 3-vessels coronary disease[#2 75 %,#4 posterior descending (PD) 75%,#6 90%,#14 90%]. Minimally invasive coronary artery grafting (MICS CABG) was selected because of faster postoperative recovery than off-pump CABG via a 10 cm left 5th thoracotomy approach. In situ bilateral internal thoracic artery(BITA) and saphenous vein (SVG) was harvested by special manner using long type Harmonic. Bypass graft design was in situ right internal thoracic artery-LAD, in situ left internal thoracic artery-left circumtlex#14, and aorta-SVG-#4PD-#4atrio-ventricular. BITA, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed with off-pump technique. Heartstring III Proximal Seal System was used to anastomose SVG to the ascending aorta. There were no major postoperative complications. Postoperative CAG revealed all grafts patent and postoperative hospital stay was 14 days. This case was the 1st usage of Heartstring III Proximal Seal System in our clinic. We believe that the usage of Heartstring III Proximal Seal System in MICS CABG is realistically possible, and providing good quality;however, further research will be needed.

[Surgical Results of Minimally Invasive Coronary Artery Bypass Grafting].

INTRODUCTION: We report our clinical results of off-pump minimally invasive coronary artery bypass grafting( MICS CABG) under direct vision as our initial experience. SURGERY: An 8-10 cm incision was made in the left 4-5th intercostal space (ICS). Bilateral internal thoracic artery (BITA) were harvested under direct vision with the use of 32 cm Harmonic scalpel through the surgical port. And the right lung is displaced by a tissue stabilizer via subxiphoid incision. Subsequently, proximal anastomosis was made onto the ascending aorta with a tissue stabilizer to displace the pulmonary artery. After preparing for all grafts, distal anastomosis were done using tissue stabilizer with direct retraction technique. RESULTS: Between February 2014 and June 2015, 50 cases of MICS CABG were done in our hospital. A total of 19 cases were done using BITA. The average number of distal anastomoses was 2.6±1.2. The average operative time was 301.4±96.9 min. There was no mortality and no conversion to sternotomy, however there was an on-pump conversion. CONCLUSIONS: Off pump multi-vessel MICS CABG and harvesting BITA via left small thoracotomy under direct vision are feasible. Using BITA may provide advantages of long term benefits as a standard CABG and a hybrid coronary revascularization in MICS CABG.

Off-pump minimally invasive coronary artery bypass grafting using the bilateral internal thoracic arteries and the right gastroepiproic artery.

We report our initial experience of an off-pump total arterial minimally invasive coronary arterial bypass grafting (MICS CABG) with the use of bilateral internal thoracic arteries (BITA) and the right gastroepiproic artery. A 47-year old male with renal dysfunction secondary to diabetes mellitus was admitted for heart failure due to severe triple-vessel disease. Off-pump MICS CABG with total arterial grafts was elected because the patient refused to undergo median sternotomy due to the strong desire to regain the baseline function promptly. Total arterial grafts were selected to maximize the potential long-term outcome. There were no postoperative complications except temporary dialysis. Postoperative coronary computed tomography revealed the patency of all grafts. Our experience suggests that BITA can be safely harvested under direct vision in MICS CABG. Total arterial graft revascularization with BITA via minimally invasive approach may offer the benefits of MICS CABG while providing the undetermined but potentially superior conduit longevity of arterial grafts.

Minimally Invasive Coronary Artery Bypass Grating Using Bilateral In Situ Internal Thoracic Arteries.

When performing minimally invasive coronary artery bypass grafting (MICS CABG), it is difficult to access the right internal thoracic artery (ITA) under direct vision. We successfully performed off-pump MICS CABG using the bilateral in situ ITAs through a 8-cm left thoracotomy under direct vision for a 76-year-old man. His postoperative course was uneventful and all the grafts were patent. This novel, minimally invasive approach safely preserves the sternum and delivers the benefits of bilateral in situ ITA grafting, providing an alternative to conventional CABG and off-pump CABG.