Stent Graft Placement for Injured Visceral Artery.

Injury of the visceral artery is a potentially fatal complication of iatrogenic procedures, trauma, and tumors. A stent graft can achieve rapid exclusion of the injured arterial portion and minimize the risk of ischemic complications by preserving arterial flow to organs. Although various types of stent grafts are available worldwide, Viabahn has only been approved for visceral arterial injury in Japan. The reported technical and clinical success rates, including cases with injured pelvic or thoracic arterial branches, are 80%-100% and 66.7%-100%, respectively. Severe ischemic complications are rare; however, fatal ischemia occurs when the stent graft is immediately occluded. The necessity of antiplatelet therapy is controversial, and a target artery diameter ≤ 4 mm is a significantly higher risk factor of stent-graft occlusion.

Estimating visceral fat area by multifrequency bioelectrical impedance.

OBJECTIVE: We developed a new method of estimating visceral fat area (VFA) using multifrequency bioelectrical impedance (BI). RESEARCH DESIGN AND METHODS: We considered abdominal composition as a parallel circuit model composed of VFA and subcutaneous fat area and calculated the impedance of VFA (IP(VFA)) from this model. The methods were tested against measures of VFA by computed tomography (CT). Multiple regression analysis was performed on 103 participants to estimate VFA. We cross-validated the regression equation against CT-measured VFA in 30 additional participants. RESULTS: The regression equation was VFA = 3.57 x sagittal abdominal diameter + 311.97 x waist-to-height ratio + 0.71 x age + 23.93 x sex + 1.57 x IP(VFA) (250 kHz) - 174.35 (r = 0.904, P < 0.01). We observed a strong correlation by cross-validation (r = 0.905). CONCLUSIONS: Our method using BI is a simple and convenient method for accurately estimating VFA.

Parabacteroides gordonii sp. nov., isolated from human blood cultures.

Three bacterial strains that had been isolated from human blood cultures, MS-1(T), MS-2 and MS-3, were characterized for their phenotypic and biochemical features, cellular fatty acid profiles, menaquinone profiles and phylogenetic positions based on 16S rRNA gene sequence analysis. 16S rRNA gene sequence analysis showed that the isolates were members of the genus Parabacteroides. These isolates were most closely related to Parabacteroides goldsteinii JCM 13446(T), with 95.9 % 16S rRNA gene sequence similarity. The levels of sequence similarity among the three strains were 99.7-100 %. The isolates were obligately anaerobic, non-pigmented, non-spore-forming, non-motile, Gram-negative and rod-shaped. The strains grew on media containing 20 % bile. These strains could be differentiated from P. goldsteinii by their ability to ferment l-arabinose and inabilities to ferment cellobiose, l-rhamnose and trehalose or to hydrolyse aesculin. The major menaquinone of the isolates was MK-10. Based on these data, we propose a novel Parabacteroides species, Parabacteroides gordonii sp. nov. The type strain is MS-1(T) (=JCM 15724(T) =CCUG 57478(T)).

Developments in estimating visceral fat area from medical examination data.

AIM: The aim of this study is to develop a simple method for estimating visceral fat area (VFA) using medical examination data. METHODS: The study subjects were 100 males who had undergone medical examinations and computed tomography (CT) at the umbilicus level. Multiple regression analysis was conducted to estimate VFA. The Bland & Altman Method was used to examine the tendency for mean difference between VFA observed by CT and VFA estimated by medical examination data. We calculated cross-validation and sensitivity and specificity at VFA > or = 100 cm2. RESULTS: As a result of multiple regression analysis, the waist-height ratio (WHtR) and triglyceride (TG) were taken as independent variables (r=0.910). The Bland & Altman Method showed 0.00+/-63.88 cm2. The cross-validation regression equation was r=0.889. Sensitivity was 0.833 and specificity was 0.900. CONCLUSION: WHtR is a simple index used to diagnose the accumulation of VFA. It has been reported that TG, which increases with accumulating VFA, is a factor in hyperlipidemia; therefore, we consider the obtained independent variables to be appropriate. In addition, the regression equation showed high correlation and good results by cross-validation, the Bland & Altman Method, sensitivity, and specificity. We assert that VFA can be estimated using this method.

Development of a new method for estimating visceral fat area with multi-frequency bioelectrical impedance.

Excessive visceral fat area (VFA) is a major risk factor in such conditions as cardiovascular disease. In assessing VFA, computed tomography (CT) is adopted as the gold standard; however, this method is cost intensive and involves radiation exposure. In contrast, the bioelectrical impedance (BI) method for estimating body composition is simple and noninvasive and thus its potential application in VFA assessment is being studied. To overcome the difference in obtained impedance due to measurement conditions, we developed a more precise estimation method by selecting the optimum body posture, electrode arrangement, and frequency. The subjects were 73 healthy volunteers, 37 men and 36 women, who underwent CT scans to assess VFA and who were measured for anthropometry parameters, subcutaneous fat layer thickness, abdominal tissue area, and impedance. Impedance was measured by the tetrapolar impedance method using multi-frequency BI. Multiple regression analysis was conducted to estimate VFA. The results revealed a strong correlation between VFA observed by CT and VFA estimated by impedance (r = 0.920). The regression equation accurately classified VFA > or = 100 cm(2) in 13 out of 14 men and 1 of 1 woman. Moreover, it classified VFA > or = 100 cm(2) or < 100 cm(2) in 3 out of 4 men and 1 of 1 woman misclassified by waist circumference (W) which was adopted as a simple index to evaluate VFA. Therefore, using this simple and convenient method for estimating VFA, we obtained an accurate assessment of VFA using the BI method.

The validity of body mass index criteria in obese school-aged children.

Childhood obesity is a medical and social problem in Japan. The number of obese children has been increasing steadily since 1980 according to a survey on school health statistics. However, more simple and reliable criteria for assessment of obesity in children are required. The aim of this study was to establish gender- and age-specific body mass index (BMI) cutoff values for evaluation of obesity in school-aged children. A total of 100,587 elementary school, junior and senior high school students, aged 6 to 17 years, comprised the study population, in whom BMI was measured. The BMI cutoff values were calculated by using the receiver operating characteristic (ROC) analysis in the degree of obesity of 20% or greater as definition of obesity. The validity of the determined cutoff values of BMI was then compared with the Rohrer index, the International Obesity Task Force (IOTF) data and the percentile method. The sensitivity and specificity of the BMI cutoff values were over 93% in both boys and girls of all ages, thereby providing criteria that are highly diagnostic in all ages. The Rohrer Index and BMI 95th percentile values tended to underestimate obesity, while the IOTF criteria tended to overestimate it. In conclusion, the BMI cutoff values determined in the present study enable us to detect obese individuals with extremely high precision, and thus may represent an instrument with superior diagnostic capabilities to those of the existing instruments currently being used for assessment of pediatric obesity.

Effect of intramuscular fat difference on glucose and insulin reaction in oral glucose tolerance test.

We investigated the relationship between insulin reaction and glycemic control in a 75-g oral glucose tolerance test of lipid in the paraspinal muscles using computed tomography (CT). The subjects were 79 males aged from 30 to 60 years old whose body mass index (BMI) was 25 or more. Those who had already been diagnosed as having type-2 diabetes mellitus in a regular health check and whose fasting plasma glucose was 126 mg/dl or more were excluded. Abdominal CT scan at the umbilicus level was conducted, and the visceral fat area (VFA) and subcutaneous fat area (SFA) were obtained. As an index of the relative lipid content within muscle, the mean skeletal muscle attenuation (MA) was determined. The age-adjusted odds ratio caused by the MA size for each variable was calculated. Compared with those with smaller intramuscular fat volume, those with larger volume demonstrated 8.75 times higher BMI, 3.73 times higher VFA and 2.88 times higher HOMA-IR. A significant difference was observed between the groups with high and low lipid content in the muscle in the values of Age, BMI, VFA, Fasting immunoreactive insulin (IRI) and HOMA-IR. It was suggested that MA of the paraspinal muscles reflected fat content, and this regional body composition parameter was closely related to insulin secretion response and glycemic control.

Smoking as a risk factor for visceral fat accumulation in Japanese men.

Epidemiological and clinical studies on the lifestyle-related obesity have identified smoking, physical activity and alcohol intake as risk factors for obesity. However, no consensus has yet been reached on the effect of smoking on visceral adiposity. This study was designed to assess whether smoking is associated with the accumulation of visceral fat, glucose and lipid metabolism. The subjects were 450 males aged from 24 to 68 years old, who were examined at the health control center in the regular health check conducted by their company. A self-administered questionnaire was used to ascertain smoking status, daily physical activity and alcohol drinking. The number of Brinkman index as an index for smoking status was positively related to being visceral fat area (VFA). In smokers whose Brinkman index was higher, the percent of subjects with abnormal body mass index, VFA, triglyceride, high density lipoprotein-cholesterol, atherosclerotic index, plasma glucose, immunoreactive insulin, or homeostasis model assessment of insulin resistance (HOMA-IR) was higher than that in non-smokers. When evaluated in terms of age-adjusted odds ratios for incidence of a VFA of 100 cm(2) or greater, alcohol drinking was associated with the highest odds ratio. Smoking, physical inactivity and excessive alcohol drinking were associated with visceral adiposity, and smoking affected glucose and lipid metabolism. In conclusions, these findings suggest that smoking is a risk factor for visceral fat accumulation and deterioration of glucose and lipid metabolism.

New body mass index criteria of central obesity for male Japanese.

In recent years, intra-abdominal visceral fat leads to obesity-related complications. A simple indicator that reflects the mass of visceral fat is also needed to enable practical screening of patients. The present study was designed to establish new body mass index (BMI) criteria of central obesity for male Japanese. The subjects were 516 men aged from 19 to 80 years old who were examined at the physical examination center in the regular health check conducted by their company. Correlations between visceral fat area (VFA) or subcutaneous fat area (SFA) and BMI in the subjects were investigated. Receiver Operating Characteristics (ROC) curve was used to find out the optimal cut-off values of BMI to predict central obesity. We compared the percentile ranks corresponding to VFA of 100 cm2, BMI of 25 kg/m2 and new BMI criteria to check to see whether the present BMI criteria classify correctly Japanese men as central obesity. Further evidence for the effectiveness of BMI for VFA is needed. The correlation coefficient between VFA or SFA and BMI was 0.59 or 0.67, respectively. At the cut-off for BMI that maximized sensitivity and specificity for predicting central obesity was 24 kg/m2. Moreover, the percentile value corresponding to VFA of 100 cm2, BMI of 24 kg/m2, and BMI of 25 kg/m2 was the 53, 50 and 61 percentile, respectively. It is necessary to lower a cut-off point for central obesity from BMI of 25 kg/m2 to 24 kg/m2.

Association between postprandial remnant-like particle triglyceride (RLP-TG) levels and carotid intima-media thickness (IMT) in Japanese patients with type 2 diabetes: assessment by meal tolerance tests (MTT).

Our study evaluated the relationship between the pathologic changes associated with atherosclerosis, as primarily represented by postprandial remnant-like lipoproteins and carotid intima-media thickness (IMT), in type 2 diabetic patients. Meal tolerance tests (MTT) were performed in 68 patients with type 2 diabetes. The subjects were divided by pre-meal and 2-h postprandial triglyceride (TG) levels into the normotriglyceridemia (NTG) group; the postprandial hypertriglyceridemia (PHTG) group; and the fasting hypertriglyceridemia (FHTG) group. HOMA-R values were significantly higher in the FHTG group than in the NTG group, with the plasma pre-heparin LPL mass and serum adiponectin levels in the FHTG and PHTG groups significantly lower than in the NTG group. One- and two hour postprandial RLP-TG levels were significantly higher in the PHTG group than in the NTG group, while there was no significant difference in postprandial glucose levels between the two groups. The IMT values were significantly higher in both the FHTG and PHTG groups than in the NTG group. Logistics regression analysis of the 1- and 2-h RLP-TG values using IMT as an induced variable showed the odds ratio for high IMT values to be 5.17 (p < 0.05) for the 1-h RLP-TG values and 3.01 (p = 0.105) for the 2-h RLP-TG values. Our study results suggest that delayed TG metabolism leading to the retention of remnants in type 2 diabetic patients appears to be closely associated with atherosclerosis, and that postprandial hyperlipidemia is an independent risk factor for the early onset of atherosclerosis.