Prognostic value of the liver fibrosis marker fibrosis-5 index in patients with severe isolated tricuspid regurgitation: comparison with fibrosis-4 index.

The fibrosis-4 index (FIB4), a liver fibrosis maker, has been shown to be associated with the prognosis in patients with severe isolated tricuspid regurgitation (TR). Recent study showed that the fibrosis-5 index (FIB5), which was calculated by albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, had better prognostic value than FIB4 in patients with heart failure. The aim of this study was to evaluate the usefulness of FIB5 index for predicting prognosis in patients with severe isolated TR and compare the prognostic value between the FIB4 and the FIB5 in those patients. This was a dual-center, retrospective study. 113 consecutive outpatients with severe isolated TR (mean age, 65.8 years; 47.8% male) were analyzed. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. During a median follow-up of 3.0 years, 41 MACEs occurred. Patients with MACEs had a lower the FIB5 than patients without MACEs. The multivariate Cox analysis revealed that the FIB5 < -4.30 was significantly associated with higher incidence of MACEs after adjusted by confounding factors. Receiver-operating characteristic curve analyses showed that prognostic values did not differ between the FIB5 and the FIB4 in whole patients and in patients aged ≥ 70 years; while, in patients aged < 70 years, the FIB5 had better prognostic value than the FIB4. The FIB5 may be a useful predictor of MACEs in patients with severe isolated TR.

The Usefulness of a Three-Microneedle Device for Indocyanine Green Fluorescence Lymphography.

Background: Indocyanine green (ICG) fluorescence lymphography is widely used to diagnose lymphedema. There is little consensus on the appropriate injection method for ICG fluorescence lymphangiography. We used a three-microneedle device (TMD) for skin injection of ICG solution and investigated its usefulness. Methods and Results: Thirty healthy volunteers were injected with ICG solution using a 27-gauge (27G) needle in one foot and a TMD in the other foot. Injection-related pain was evaluated using the Numerical Rating Scale (NRS) and Face Rating Scale (FRS). The skin depth of the injected ICG solution was evaluated by injecting the solution into the skin of amputated lower limbs using a 27G needle or TMD using ICG fluorescence microscopy. The median and interquartile range of the NRS scores was 3 (3-4) and 2 (2-4) in the 27G needle and TMD groups, respectively; that of the FRS scores was 2 (2-3) and 2 (1-2) in the 27G needle and TMD groups, respectively. Injection-related pain was significantly lower with the TMD than with the 27G needle. The lymphatic vessels were similarly visible using both needles. The depth of the ICG solution varied for each injection with a 27G needle (400-1200 µm) and was consistent at ∼300-700 µm below the skin surface using the TMD. Injection depth was significantly different between the 27G needle and the TMD. Conclusions: Injection-related pain decreased using the TMD, and ICG solution depth was consistent on fluorescence lymphography. A TMD may be useful for ICG fluorescence lymphography. Clinical Trials Registry (UMIN-CTR; ID: UMIN000033425).

Proton conductivity dependence on the surface polymer thickness of core-shell type nanoparticles in a proton exchange membrane.

The proton exchange membrane (PEM) is the main component that determines the performance of polymer electrolyte fuel cells. The construction of proton-conduction channels capable of fast proton conduction is an important topic in PEM research. In this study, we have developed poly(vinylphosphonic acid)-block-polystyrene (PVPA-b-PS)-coated core-shell type silica nanoparticles prepared by in situ polymerization and a core-shell type nanoparticle-filled PEM. In this system, two-dimensional (2D) proton-conduction channels have been constructed between PVPA and the surface of silica nanoparticles, and three-dimensional proton-conduction channels were constructed by connecting these 2D channels by filling with the core-shell type nanoparticles. The proton conductivities and activation energies of pelletized PVPA-coated core-shell type nanoparticles increased depending on the coated PVPA thickness. Additionally, pelletized PVPA-b-PS-coated silica nanoparticles showed a good proton conductivity of 1.3 × 10-2 S cm-1 at 80 °C and 95% RH. Also, the membrane state achieved 1.8 × 10-4 S cm-1 in a similar temperature and humidity environment. Although these proton conductivities were lower than those of PVPA, they have advantages such as low activation energy for proton conduction, suppression of swelling due to water absorption, and the ability to handle samples in powder form. Moreover, by using PS simultaneously, we succeeded in improving the stability of proton conductivity against changes in the temperature and humidity environment. Therefore, we have demonstrated a highly durable, tough but still enough high proton conductive material by polymer coating onto the surface of nanoparticles and also succeeded in constructing proton-conduction channels through the easy integration of core-shell type nanoparticles.

The Fibrosis-4 Index Predicts Cardiovascular Prognosis in Patients With Severe Isolated Tricuspid Regurgitation.

BACKGROUND: The fibrosis-4 (FIB-4) index is used to evaluate liver disease patients. It can also be used to evaluate the prognosis for heart disease patients; however, its ability to determine the prognosis of severe isolated tricuspid regurgitation (TR) patients is unclear. This study aimed to clarify the association between FIB-4 index scores and the cardiovascular prognosis for severe isolated TR patients.Methods and Results: This was a dual-center, retrospective study. From 2011 to 2019, 111 consecutive outpatients with severe isolated TR (mean age, 68.6 years; 53.2% male) were evaluated. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. The association between FIB-4 index scores and echocardiography was also evaluated. During a median follow up of 3.0 years, 24 patients were lost to follow up and 40 MACEs occurred. Baseline FIB-4 index scores for patients with MACEs were significantly higher than those for patients without MACEs. A multivariate analysis revealed that FIB-4 index scores are significantly associated with MACEs (hazard ratio, 1.89; 95% confidence interval, 1.01-3.54; P=0.046). A linear regression analysis indicated that FIB-4 index scores were correlated with echocardiographic parameters, including the left atrial volume index and left ventricular end-diastolic diameter. CONCLUSIONS: The FIB-4 index score may be a useful predictor of MACEs for patients with severe isolated TR.

Identification of a Male Sterile Candidate Gene in Lilium x formolongi and Transfer of the Gene to Easter Lily (L. longiflorum) via Hybridization.

Pollen-free varieties are advantageous in promoting cut-flower production. In this study, we identified a candidate mutation which is responsible for pollen sterility in a strain of Lilium × formolongi, which was originally identified as a naturally occurred male-sterile plant in a seedling population. The pollen sterility occurred due to the degradation of pollen mother cells (PMCs) before meiotic cell division. Genetic analysis suggested that the male-sterile phenotype is attributed to one recessive locus. Transcriptome comparison between anthers of sterile and fertile plants in a segregated population identified a transcript that was expressed only in pollen-fertile plants, which is homologous to TDF1 (DEFECTIVE in TAPETAL DEVELOPMENT and FUNCTION1) in Arabidopsis, a gene encoding a transcription factor AtMYB35 that is known as a key regulator of pollen development. Since tdf1 mutant shows male sterility, we assumed that the absence transcript of the TDF1-like gene, named as LflTDF1, is the reason for pollen sterility observed in the mutant. A 30 kbp-long nanopore sequence read containing LflTDF1 was obtained from a pollen-fertile accession. PCR analyses using primers designed from the sequence suggested that at least a 30kbp-long region containing LflTDF1 was deleted or replaced by unknown sequence in the pollen-sterile mutant. Since the cross between L. × formolongi and Easter lily (L. longiflorum) is compatible, we successfully introgressed the male-sterile allele, designated as lfltdf1, to Easter lily. To our knowledge, this is the first report of molecular identification of a pollen-sterile candidate gene in lily. The identification and marker development of LflTDF1 gene will assist pollen-free lily breeding of Easter lilies and other lilies.

Development of a novel task-based functional magnetic resonance imaging phantom based on a bubble-compression approach.

PURPOSE: Phantoms used in previous functional magnetic resonance imaging (fMRI) studies have drawbacks, such as a complicated circuit and equipment use, a single signal-change rate, and T2 * values that do not correspond to those of living human brains. We aimed to develop a phantom for use in task-based fMRI studies (gradient-echo echo-planar imaging; GRE-EPI) with bioequivalent T1 and T2 * values, using an innovative method to control the rate of signal change. METHODS: A gel phantom with T1 and T2 * values equivalent to that of the living brain gray matter was fixed in a 150 mm diameter container, with five holes, each of which could hold a 30-ml syringe. The gel phantom contained microscopic air bubbles; this made it possible to control the percent signal change by injector-induced water pressure changes. Using this phantom, we investigated the percent signal change, derived an equation that can approximately reproduce an arbitrary percent signal change, compared different gel phantom samples, investigated the change in relaxation time and bubble size during signal change, and assessed the change in values in each sample over time. RESULTS: The relaxation time of the gel phantom was similar to the literature values for gray matter. The percent signal change achieved was approximately 0%-13.51% and was dependent on the water pressure change. The derived equation was y = 0.000008x3 - 0.000771x2 + 0.034222x - 0.026054, with y being the percent signal change and x being the pressure in kPa; the reproducibility was high. No significant difference was detected among samples of gray matter gel phantoms (P > 0.05). The change in the rate of signal change with the change in water pressure was due to the change in T2 * value with the change in bubble size. With pressure increasing from 0 to 151.7 kPa, the T2 * value increased from 52 ms to 85 ms. The newly developed gel phantom was stable for 60 days, but its bubble size changed after 21 days. CONCLUSION: We developed a novel phantom for use in fMRI, which could reproduce minute signal changes similar to the blood-oxygen-level-dependent effect and with bioequivalent T1 and T2 * values, and used an innovative method to control the percent signal change by compressing the air contained in the phantom for validation of fMRI using GRE-EPI. This phantom reproduced the percent signal change due to changes in T2 * values, which is very similar to scanning a human body. This phantom is expected to be a powerful tool for advancing the study of task-based fMRI.

Novel Filler-Filled-Type Polymer Electrolyte Membrane for PEFC Employing Poly(vinylphosphonic acid)-b-polystyrene-Coated Cellulose Nanocrystals as a Filler.

Low-acidity polymer electrolyte membranes are essential to polymer electrolyte fuel cells (PEFCs) and water electrolysis systems, both of which are expected to be next-generation energy and hydrogen sources. We developed a new type of high-performance polymer electrolyte membrane (PEM) in which the core particles are precisely electrolyte polymer coated and filled into binder resin. Cellulose nanocrystals (CNCs), which have attracted attention as light, rigid, and sustainable materials, were selected as the core material for the filler. The CNC surface was coated with a new block copolymer containing a proton conductive polymer of poly(vinylphosphonic acid) (PVPA) and a hydrophobic polymer of polystyrene (PS) using RAFT polymerization with particles (PwP) we developed. The pelletized fillers and the filler-filled polycarbonate membranes achieved proton conductivities of over 10-2 S/cm with lower activation energies and much weaker acidity than the Nafion membrane.

Exploring the size of reference population for expected accuracy of genomic prediction using simulated and real data in Japanese Black cattle.

BACKGROUND: Size of reference population is a crucial factor affecting the accuracy of prediction of the genomic estimated breeding value (GEBV). There are few studies in beef cattle that have compared accuracies achieved using real data to that achieved with simulated data and deterministic predictions. Thus, extent to which traits of interest affect accuracy of genomic prediction in Japanese Black cattle remains obscure. This study aimed to explore the size of reference population for expected accuracy of genomic prediction for simulated and carcass traits in Japanese Black cattle using a large amount of samples. RESULTS: A simulation analysis showed that heritability and size of reference population substantially impacted the accuracy of GEBV, whereas the number of quantitative trait loci did not. The estimated numbers of independent chromosome segments (Me) and the related weighting factor (w) derived from simulation results and a maximum likelihood (ML) approach were 1900-3900 and 1, respectively. The expected accuracy for trait with heritability of 0.1-0.5 fitted well with empirical values when the reference population comprised > 5000 animals. The heritability for carcass traits was estimated to be 0.29-0.41 and the accuracy of GEBVs was relatively consistent with simulation results. When the reference population comprised 7000-11,000 animals, the accuracy of GEBV for carcass traits can range 0.73-0.79, which is comparable to estimated breeding value obtained in the progeny test. CONCLUSION: Our simulation analysis demonstrated that the expected accuracy of GEBV for a polygenic trait with low-to-moderate heritability could be practical in Japanese Black cattle population. For carcass traits, a total of 7000-11,000 animals can be a sufficient size of reference population for genomic prediction.

A study of evaluating specific tissue oxygen saturation values of gastrointestinal tumors by removing adherent substances in oxygen saturation imaging.

OBJECTIVES: Oxygen saturation (OS) imaging is a new method of endoscopic imaging that has clinical applications in oncology which can directly measure tissue oxygen saturation (Sto2) of the surface of gastrointestinal tract without any additional drugs or devices. This imaging technology is expected to contribute to research into cancer biology which leads to clinical benefit such as prediction to efficacy of chemotherapy or radiotherapy. However, adherent substances on tumors such as blood and white coating, pose a challenge for accurate measurements of the StO2 values in tumors. The aim of this study was to develop algorithms for discriminating between the tumors and their adherent substances, and to investigate whether it is possible to evaluate the tumor specific StO2 values excluding adherent substances during OS imaging. METHODS: We plotted areas of tumors and their adherent substances using white-light images of 50 upper digestive tumors: blood (68 plots); reddish tumor (83 plots); white coating (89 plots); and whitish tumor (79 plots). Scatter diagrams and discriminating algorithms using spectrum signal intensity values were constructed and verified using validation datasets. StO2 values were compared between the tumors and tumor adherent substances using OS images of gastrointestinal tumors. RESULTS: The discriminating algorithms and their accuracy rates (AR) were as follows: blood vs. reddish tumor: Y> - 4.90X+7.13 (AR: 95.9%) and white coating vs. whitish tumor: Y< -0.52X+0.17 (AR: 96.0%). The StO2 values (median, [range]) were as follows: blood, 79.3% [37.8%-100.0%]; reddish tumor, 74.5% [62.0%-86.9%]; white coating, 73.8% [42.1%-100.0%]; and whitish tumor, 65.7% [53.0%-76.3%]. CONCLUSIONS: OS imaging is strongly influenced by adherent substances for evaluating the specific StO2 value of tumors; therefore, it is important to eliminate the information of adherent substances for clinical application of OS imaging.

Potential role of transforming growth factor-beta 1/Smad signaling in secondary lymphedema after cancer surgery.

Secondary lymphedema often develops after cancer surgery, and over 250 million patients suffer from this complication. A major symptom of secondary lymphedema is swelling with fibrosis, which lowers the patient's quality of life, even if cancer does not recur. Nonetheless, the pathophysiology of secondary lymphedema remains unclear, with therapeutic approaches limited to physical or surgical therapy. There is no effective pharmacological therapy for secondary lymphedema. Notably, the lack of animal models that accurately mimic human secondary lymphedema has hindered pathophysiological investigations of the disease. Here, we developed a novel rat hindlimb model of secondary lymphedema and showed that our rat model mimics human secondary lymphedema from early to late stages in terms of cell proliferation, lymphatic fluid accumulation, and skin fibrosis. Using our animal model, we investigated the disease progression and found that transforming growth factor-beta 1 (TGFB1) was produced by macrophages in the acute phase and by fibroblasts in the chronic phase of the disease. TGFB1 promoted the transition of fibroblasts into myofibroblasts and accelerated collagen synthesis, resulting in fibrosis, which further indicates that myofibroblasts and TGFB1/Smad signaling play key roles in fibrotic diseases. Furthermore, the presence of myofibroblasts in skin samples from lymphedema patients after cancer surgery emphasizes the role of these cells in promoting fibrosis. Suppression of myofibroblast-dependent TGFB1 production may therefore represent an effective pharmacological treatment for inhibiting skin fibrosis in human secondary lymphedema after cancer surgery.

Favorable effect of catheter ablation on nocturnal hypertension in patients with paroxysmal atrial fibrillation.

OBJECTIVES: The current study was performed to determine whether pulmonary vein isolation (PVI) improves nocturnal hypertension in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND: Abnormal night-time blood pressure (BP) fluctuation is a risk factor for atrial fibrillation. Imbalance of autonomic nervous function is a risk factor common to both of these abnormalities. PVI can reportedly modify the autonomic nervous function balance in patients with atrial fibrillation. METHODS: The study population comprised 50 consecutive patients (mean age, 69.8 ±â€Š7.5 years; 35.0% male) with PAF scheduled for PVI. Both 24-h ambulatory BP monitoring and heart rate variability analysis were performed before and at 3 months after PVI. RESULTS: Patients were classified into two groups according to the presence of nocturnal BP dipping before PVI: the normal dipping group (n = 27) and the nondipping group (n = 23). The low-frequency spectrum power and the ratio of low-frequency spectrum power to high-frequency spectrum power (low-frequency spectrum/high-frequency spectrum) were higher in the nondipping than the normal dipping group (low-frequency spectrum: 219.9 ±â€Š210.2 vs. 92.7 ±â€Š50.5 ms, respectively, P = 0.03; low-frequency spectrum/high-frequency spectrum: 1.8 ±â€Š1.9 vs. 0.9 ±â€Š0.8, respectively, P = 0.05). In the nondipping group, the elevated night-time BP disappeared in eight (35%) patients at 3 months after PVI, which was associated with an increase in high-frequency spectrum power. These patients did not develop atrial fibrillation recurrence during follow-up (mean, 568 ±â€Š218 days). CONCLUSION: Among patients with PAF, the nondipping group showed greater sympathetic activity (higher low-frequency spectrum power and low-frequency spectrum/high-frequency spectrum) than the dipping group. Restoration of BP dipping after PVI is associated with increased parasympathetic activity (higher high-frequency spectrum power) and reduced recurrence of arrhythmic events.

Development of a Noninvasive Skin Evaluation Method for Lower Limb Lymphedema.

Background: The skin's condition is altered in lymphedema patients, and evaluating this change is important. Some noninvasive methods for evaluating skin condition have been reported, especially in upper limb lymphedema. However, evaluating the skin in lower limb lymphedema remains challenging and is often limited to palpation. We aimed to develop a noninvasive skin evaluation method for lower limb lymphedema patients. Methods and Results: Twenty-five lower limb lymphedema patients were included. Skin induration and elasticity were measured using Indentometer® IDM 400 and Cutometer® MPA580. The relationship between the properties of skin from the healthy forearm and thigh, those of the affected thigh, and age was analyzed. Predicted skin induration age (IA) and elasticity age (EA) were calculated from the forearm, whereas actual values were calculated from the thigh, and the differences (ΔIA and ΔEA) were assessed. Patients were classified according to the International Society of Lymphology clinical staging system, and the differences in ΔIA and ΔEA were analyzed among the three groups (healthy, stage I/IIa, and stage IIb/III). Skin biopsy was performed in five unilateral lower limb lymphedema patients, and the dermal elastic fiber area was determined using microscopy with Elastica van Gieson staining. ΔEA significantly increased with disease progression, but ΔIA did not change significantly. Microscopy revealed elastic fiber filamentous changes, with decreased elastic fiber areas in lymphedema-affected skin. Conclusion: To our knowledge, this is the first report to evaluate lower limb skin elasticity in lymphedema quantitatively and noninvasively. ΔEA is useful for evaluating skin condition progression in lymphedema patients.

Cerebrospinal fluid T1 value phantom reproduction at scan room temperature.

The T1 value of pure water, which is often used as a phantom to simulate cerebrospinal fluid, is significantly different from that of in-vivo cerebrospinal fluid. The purpose of this study was to develop a phantom with a T1 value equivalent to that of in-vivo cerebrospinal fluid under examination room temperature (23°C-25°C). In this study, 1.5 and 3.0 T magnetic resonance imaging scanners were used. We examined the signal intensity change in relation to pure water temperature, the T1 values of acetone-diluted solutions (0-100 v/v%, in 10 steps), and the correlation coefficients obtained from volunteers and the prepared phantoms. The T1 value was close to the value reported in the literature for cerebrospinal fluid when the acetone-diluted solution was 70 v/v% or higher at scan room temperature. The value at that time was 3532.81-4704.57 ms at 1.5 T and it ranged from 4052.41 to 5701.61 ms at 3.0 T. The highest correlation with the values obtained from the volunteers was r = 0.993 with pure acetone at 1.5 T and r = 0.991 with acetone 90 v/v% at 3.0 T. The relative error of the best phantom-volunteer match was 32.61 (%) ± 6.71 at 1.5 T and 46.67 (%) ± 4.31 at 3.0 T. The T1 value measured by the null point method did not detect a significant difference between in vivo CSF and acetone 100 v/v% at 1.5 T and acetone 90 v/v% at 3.0 T. The T1 value of cerebrospinal fluid in the living body at scan room temperature was reproduced with acetone. The optimum concentration of acetone for cerebrospinal-fluid reproduction was pure acetone at 1.5 T and 90 v/v% at 3.0 T.

Utility of a Finger-Mounted Tissue Oximeter with Near-Infrared Spectroscopy to Evaluate Limb Ischemia in Patients with Peripheral Arterial Disease.

Objective: To investigate whether a finger-mounted tissue oximeter is useful in evaluating limb blood flow in patients with peripheral arterial disease (PAD). Materials and Methods: Seventy-two patients with PAD were included, and the ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), and skin perfusion pressure (SPP) were measured. The regional tissue oxygenation saturation (rSO2) was measured using a finger-mounted tissue oximeter at the ankle, dorsal foot, and each dorsal and plantar toe. Correlations between rSO2 and ABI and between TcPO2 and SPP were analyzed. The patients were divided into three groups: Fontaine IIa (F-IIa), IIb (F-IIb), and III and IV (F-III/IV) groups. The difference in rSO2 between each group was analyzed. Results: Significant correlations were observed between rSO2 and TcPO2 and between rSO2 and SPP. TcPO2 and SPP in the F-III/IV group were significantly lower than those in the F-IIa group. rSO2 in the F-IIb and F-III/IV groups was significantly lower than that in the F-IIa group. Conclusion: The measurement of rSO2 using finger-mounted tissue oximetry is quick, simple, and painless. It can be used on any skin area and is useful to evaluate limb circulation in patients with PAD.

Characteristics of Symptomatic Pulmonary Thromboembolism among Postoperative and Hospitalized Patients.

Backgrounds: Pulmonary thromboembolism (PTE) is severe complication which may arise during all medical service. The purpose of this study is to evaluate inpatient symptomatic PTE. Materials and Methods: From 2005 to 2016, we experienced 75 symptomatic PTE patients among 600 venous thromboembolism patients. According to the place of occurrence, patients were divided to inpatient group and outpatient group. We further divided inpatient group to surgical group and non-surgical group. Results: Inpatients group, 38 had PTE (surgical: 23, non-surgical: 15). Outpatients group, 37 had PTE (with medical practice: 22, without medical practice: 15). Severity of PTE were follows; cardiac arrest 2, massive 13, sub-massive 18, non-massive 42. In surgical group, anticoagulation had been used in 3/23 (13.6%), intermittent pneumatic compression had been used in 16/23 (72.9%), compression stockings had been used in 20/23 (90.9%). In non-surgical group, no anticoagulation had not been used, intermittent pneumatic compression had been used in 2/15 (13.3%), compression stockings had been used in 2/15 (13.3%). Conclusion: As PTE prophylaxis, anticoagulation had been scarcely used in surgical group. Delayed anticoagulation may decrease symptomatic PTE in surgical patients. Despite adequate prophylaxis, PTE cannot be prevented completely. Medical staff and patients should recognize the risk of PTE together. (This is a translation of Jpn J Phlebol 2018; 29(1): 33-40.).

Axillo-Axillary Artery Bypass With Coil Embolization of the Innominate Artery for a Traumatic Innominate Artery Aneurysm: A Case Report.

BACKGROUND: Innominate artery aneurysm (IAA) is a rare cervical artery aneurysm. Although atherosclerosis is its most common cause, IAAs due to cervical injury are often reported. Operative indications for IAAs include rupture or symptomatic aneurysm, saccular aneurysm, aneurysm with a diameter of 3 cm or greater, and aneurysmal change of the origin of the innominate artery. Although the ligature of the innominate artery or open surgical repair is well described, the usefulness of endovascular repair has also recently been reported. Herein, we report a case of traumatic IAA with infection in the cervical region after tracheostomy. CASE PRESENTATION: A 40-year-old man with cholecystolithiasis planned to undergo laparoscopic cholecystectomy at another hospital. Urgent tracheostomy was performed because of laryngeal edema at the induction of general anesthesia. Enhanced computed tomography angiography 1 week after the tracheostomy revealed a saccular IAA. The patient was deemed to be at high risk for aneurysm rupture and was referred to our hospital. Preoperative Matas test, Allcock test, and innominate arterial stump pressure measurement were performed to assess the cerebral blood flow and ischemic tolerance of the brain. These examinations showed the patency of the circle of Willis. An axillo-axillary artery bypass with coil embolization of the innominate artery was performed to avoid postoperative vascular graft infection. No postoperative complications such as infection or cerebral infarction occurred. Magnetic resonance imaging angiography performed 6 months after surgical treatment showed that the aneurysm had disappeared, and patency of the bypass graft was present. There were no postoperative complications, such as neurological deficits or graft infection, at more than 5 years after surgery. CONCLUSIONS: We report a successfully treated case of IAA after tracheostomy. Axillo-axillary artery bypass with coil embolization of the innominate artery is an effective treatment of IAA with cervical infection.

Successful Hybrid Treatment of Stent-Graft Migration Caused by Type B Aortic Dissection after Endovascular Aortic Aneurysm Repair: A Case Report.

Herein, we report a rare case of type B aortic dissection that occurred after endovascular aortic aneurysm repair (EVAR). A 66-year-old man underwent successful EVAR for an abdominal aortic aneurysm (AAA). Computed tomography (CT) 2 years after EVAR showed a type B aortic dissection with stent-graft migration and AAA expansion. Juxtarenal aortic expansion precluded simple stent-graft placement. He underwent hepato-spleno-renal bypass followed by stent-graft placement just below the superior mesenteric artery. Postoperative CT showed no endoleaks. This case reconfirms the importance of regular follow-up after EVAR and illustrates the usefulness of a hybrid approach.

Surgical Treatment of Abdominal Aortic Aneurysm with Congenital Solitary Pelvic Kidney and Superior Mesenteric Artery Stenosis.

We report the rare case of a 54-year-old man with uncontrolled renovascular hypertension, who was found to have an abdominal aortic aneurysm with congenital solitary pelvic kidney and superior mesenteric artery stenosis. A single renal artery branched from aneurysmal aortic bifurcation, and both the renal artery and the superior mesenteric artery (SMA) had severe stenosis at their origins. The aneurysm was repaired with a bifurcated Dacron graft, to which the renal artery was anastomosed. SMA bypass was created between the graft's left limb and the SMA using another Dacron graft. The operation was successful, with improvement in renal functions and control of hypertension.

Endovascular Treatment of a Ruptured Innominate Artery Aneurysm in Behcet Disease.

In Behcet disease (BD), vascular complication such as false aneurysm formation is common after surgical treatment in the arterial lesion, and the optimal treatment method remains controversial. Concerning the innominate artery aneurysm, lack of experience due to its rarity in vasculo BD makes decision making even more difficult. We report a ruptured innominate artery aneurysm in a 70-year-old man with BD, which was successfully treated by innominate artery stent grafting through the right common carotid artery, axillo-axillary artery bypass grafting, and right subclavian artery coil embolization. The patient is doing well without any vascular complications at eighth postoperative month.