Impacts of liver macrophages, gut microbiota, and bile acid metabolism on the differences in iHFC diet-induced MASH progression between TSNO and TSOD mice.

BACKGROUND: Tsumura-Suzuki non-obese (TSNO) mice exhibit a severe form of metabolic dysfunction-associated steatohepatitis (MASH) with advanced liver fibrosis upon feeding a high-fat/cholesterol/cholate-based (iHFC) diet. Another ddY strain, Tsumura-Suzuki diabetes obese (TSOD) mice, are impaired in the progression of iHFC diet-induced MASH. AIM: To elucidate the underlying mechanisms contributing to the differences in MASH progression between TSNO and TSOD mice. METHODS: We analyzed differences in the immune system, gut microbiota, and bile acid metabolism in TSNO and TSOD mice fed with a normal diet (ND) or an iHFC diet. RESULTS: TSOD mice had more anti-inflammatory macrophages in the liver than TSNO mice under ND feeding, and were impaired in the iHFC diet-induced accumulation of fibrosis-associated macrophages and formation of histological hepatic crown-like structures in the liver. The gut microbiota of TSOD mice also exhibited a distinct community composition with lower diversity and higher abundance of Akkermansia muciniphila compared with that in TSNO mice. Finally, TSOD mice had lower levels of bile acids linked to intestinal barrier disruption under iHFC feeding. CONCLUSIONS: The dynamics of liver macrophage subsets, and the compositions of the gut microbiota and bile acids at steady state and post-onset of MASH, had major impacts on MASH development.

Relationship of dietary intake between children aged 12-59 months and their mothers in rural Kenya: a cross-sectional study in two seasons.

OBJECTIVE: The aim of the study was to investigate the quantitative association between the dietary intakes of children and their caregivers. METHOD: In this cross-sectional study, a non-consecutive 2-day 24-h dietary recall was conducted in two seasons. Participants comprised 142 pairs of 12-59-month-old children and their female caregivers from rural areas of Kenya. Energy and micronutrient adequacy, food group intakes and food allocation were assessed. Differences and correlations between caregiver and child diets were examined, and multiple regression analysis was used to investigate the relationship between the children's and caregivers' dietary intakes. RESULTS: The child's diet was significantly lower in energy and higher in micronutrient adequacy than was the caregiver's diet (p < 0.001). Specifically, the child's diet contained more fruits, dairy products, sugar and confectionaries per 4184 kj. Children were allocated relatively more dishes containing nutrient-rich foods than staple foods. The correlation coefficients between the dietary intake of caregivers and children were stronger among 24-59-month-old children. After controlling with covariates, caregiver energy intake was significantly associated with child energy intake (standardised beta [ß] = 0.512, p < 0.001), and caregiver micronutrient adequacy was associated with child micronutrient adequacy (ß = 0.679 and ß = 0.262 after energy adjustment, p < 0.001). CONCLUSIONS: The dietary intakes of caregivers and children were closely related. The children had a more nutrient-rich diet compared to that of their caregivers. Differences in food group intakes and food allocation may contribute to the higher nutrient adequacy of children. There is a need to improve the diet of caregivers, which would contribute to improving the diet of children.

Dynamics of Liver Macrophage Subsets in a Novel Mouse Model of Non-Alcoholic Steatohepatitis Using C57BL/6 Mice.

Macrophages are critical for the development of non-alcoholic steatohepatitis (NASH). Our previous findings in TSNO mouse livers showed that an iHFC (high-fat/cholesterol/cholate) diet induced liver fibrosis similar to human NASH and led to the accumulation of distinct subsets of macrophage: CD11c+/Ly6C- and CD11c-/Ly6C+ cells. CD11c+/Ly6C- cells were associated with the promotion of advanced liver fibrosis in NASH. On the other hand, CD11c-/Ly6C+ cells exhibited an anti-inflammatory effect and were involved in tissue remodeling processes. This study aimed to elucidate whether an iHFC diet with reduced cholic acid (iHFC#2 diet) induces NASH in C57BL/6 mice and examine the macrophage subsets accumulating in the liver. Histological and quantitative real-time PCR analyses revealed that the iHFC#2 diet promoted inflammation and fibrosis indicative of NASH in the livers of C57BL/6 mice. Cell numbers of Kupffer cells decreased and recruited macrophages were accumulated in the livers of iHFC#2 diet-fed C57BL/6 mice. Notably, the iHFC#2 diet resulted in the accumulation of three macrophage subsets in the livers of C57BL/6 mice: CD11c+/Ly6C-, CD11c-/Ly6C+, and CD11c+/Ly6C+ cells. However, CD11c+/Ly6C+ cells were not distinct populations in the iHFC-fed TSNO mice. Thus, differences in cholic acid content and mouse strain affect the macrophage subsets that accumulate in the liver.

Delaying the third dose of Japanese aluminum-free hepatitis A vaccine Aimmugen elicits effective immune responses against hepatitis A in adults.

Inactivated aluminum-adsorbed hepatitis A vaccines such as Havrix, Vaqta, and Avaxim are commonly used worldwide. These vaccines are typically administered in a two-dose series (at 0 and 6-12 months). However, a lyophilized inactivated aluminum-free hepatitis A vaccine, Aimmugen, which is approved in Japan, is typically administered in a three-dose series (at 0, 2-4, and 24 weeks). Hence, individuals visiting endemic hepatitis A areas receive the primary two doses of Aimmugen before traveling and the third booster dose much later. It is currently uncertain whether boosting with a delayed third dose of Aimmugen is effective, or whether a new vaccination schedule should instead be initiated. Therefore, we investigated the anti-hepatitis-A viral immune response of adult travelers who received the third dose of Aimmugen more than 24 weeks after the first dose. Participants were vaccinated with the third dose of Aimmugen more than 2 years after the first two doses. Antibody titers were measured at Day 0 (prevaccination) and at 28-42 days after the third dose of Aimmugen. Twenty-nine adult participants were enrolled in the study (14 men and 15 women; mean age ± standard deviation age, 36.2 ± 8.1 years). The interval between the first two doses and the third dose was 3-14 years. The seroprotection rate (i.e., the percentage of participants with anti-hepatitis A virus antibody titers ≥ 10 mIU/mL) was 96.6 % (28/29) at Day 0 and increased to 100 % (29/29) at Days 28-42. Geometric mean concentration increased from 105 to 4,013 mIU/mL. We demonstrated that delaying the third dose of Aimmugen still elicited effective immune responses after priming with two doses of the vaccine. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR): MIN000013624. Registered 03 April 2014. https://center6.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000015906.

The innate immune receptor RP105 promotes metabolic syndrome by altering gut microbiota composition and intestinal barrier function.

Radioprotective 105 (RP105) plays a key role in the development of high-fat diet (HFD)-induced metabolic disorders; however, the underlying mechanisms remain to be understood. Here, we aimed to uncover whether RP105 affects metabolic syndrome through the modification of gut microbiota. We confirmed that body weight gain and fat accumulation by HFD feeding were suppressed in Rp105-/- mice. Fecal microbiome transplantation from HFD-fed donor Rp105-/- mice into HFD-fed recipient wild-type mice significantly improved various abnormalities associated with metabolic syndrome, including body weight gain, insulin resistance, hepatic steatosis, macrophage infiltration and inflammation in the adipose tissue. In addition, HFD-induced intestinal barrier dysfunction was attenuated by fecal microbiome transplantation from HFD-fed donor Rp105-/- mice. A 16S rRNA sequence analysis indicated that RP105 modified gut microbiota composition and was involved in the maintenance of its diversity. Thus, RP105 promotes metabolic syndrome by altering gut microbiota composition and intestinal barrier function.

Association of breakfast skipping with habitual dietary intake and BMI in female rotating shift workers.

OBJECTIVE: Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers. DESIGN: Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants. SETTING: A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions. PARTICIPANTS: A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis. RESULTS: The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality. CONCLUSIONS: Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

Impact of Vancomycin Treatment and Gut Microbiota on Bile Acid Metabolism and the Development of Non-Alcoholic Steatohepatitis in Mice.

The potential roles of the gut microbiota in the pathogenesis of non-alcoholic fatty liver disease, including non-alcoholic steatohepatitis (NASH), have attracted increased interest. We have investigated the links between gut microbiota and NASH development in Tsumura-Suzuki non-obese mice fed a high-fat/cholesterol/cholate-based (iHFC) diet that exhibit advanced liver fibrosis using antibiotic treatments. The administration of vancomycin, which targets Gram-positive organisms, exacerbated the progression of liver damage, steatohepatitis, and fibrosis in iHFC-fed mice, but not in mice fed a normal diet. F4/80+-recruited macrophages were more abundant in the liver of vancomycin-treated iHFC-fed mice. The infiltration of CD11c+-recruited macrophages into the liver, forming hepatic crown-like structures, was enhanced by vancomycin treatment. The co-localization of this macrophage subset with collagen was greatly augmented in the liver of vancomycin-treated iHFC-fed mice. These changes were rarely seen with the administration of metronidazole, which targets anaerobic organisms, in iHFC-fed mice. Finally, the vancomycin treatment dramatically modulated the level and composition of bile acid in iHFC-fed mice. Thus, our data demonstrate that changes in inflammation and fibrosis in the liver by the iHFC diet can be modified by antibiotic-induced changes in gut microbiota and shed light on their roles in the pathogenesis of advanced liver fibrosis.

Roles of Macrophages in Advanced Liver Fibrosis, Identified Using a Newly Established Mouse Model of Diet-Induced Non-Alcoholic Steatohepatitis.

Macrophages play critical roles in the pathogenesis of non-alcoholic steatohepatitis (NASH). However, it is unclear which macrophage subsets are critically involved in the development of inflammation and fibrosis in NASH. In TSNO mice fed a high-fat/cholesterol/cholate-based diet, which exhibit advanced liver fibrosis that mimics human NASH, we found that Kupffer cells (KCs) were less abundant and recruited macrophages were more abundant, forming hepatic crown-like structures (hCLS) in the liver. The recruited macrophages comprised two subsets: CD11c+/Ly6C- and CD11c-/Ly6C+ cells. CD11c+ cells were present in a mesh-like pattern around the lipid droplets, constituting the hCLS. In addition, CD11c+ cells colocalized with collagen fibers, suggesting that this subset of recruited macrophages might promote advanced liver fibrosis. In contrast, Ly6C+ cells were present in doughnut-like inflammatory lesions, with a lipid droplet in the center. Finally, RNA sequence analysis indicates that CD11c+/Ly6C- cells promote liver fibrosis and hepatic stellate cell (HSC) activation, whereas CD11c-/Ly6C+ cells are a macrophage subset that play an anti-inflammatory role and promote tissue repair in NASH. Taken together, our data revealed changes in liver macrophage subsets during the development of NASH and shed light on the roles of the recruited macrophages in the pathogenesis of advanced fibrosis in NASH.

Mealtime Regularity Is Associated with Dietary Balance among Preschool Children in Japan-A Study of Lifestyle Changes during the COVID-19 Pandemic.

The novel coronavirus-19 (COVID-19) pandemic has considerably impacted children's lives. The aim of this study was to determine whether the pandemic affected mealtime regularity among preschool children and whether maintaining regular mealtimes or changes in mealtime regularity during the pandemic were related to dietary balance, including chronological relationships. This online cross-sectional survey involving individuals registered with a company that provides meals to children aged 2-6 years was conducted in February 2021. Using a 40-point scale, a healthy diet score (HDS) was developed to evaluate children's dietary balance. The participants were divided into four groups based on their responses, and multiple regression analyses were performed with the HDS as the dependent variable. Maintaining regular mealtimes was associated with practices such as waking and going to bed earlier, less snacking, and eating breakfast every day. Even after adjusting for basic attributes, lifestyle habits, household circumstances, and other factors, regular mealtimes were still positively correlated with the HDS. These findings indicate that maintaining regular mealtimes is associated with higher HDS scores and better lifestyle habits. Furthermore, as the changed HDS was higher in the group whose mealtimes became regular during the pandemic, adopting regular mealtimes may lead to a more balanced diet.

Energy Intake from Healthy Foods Is Associated with Motor Fitness in Addition to Physical Activity: A Cross-Sectional Study of First-Grade Schoolchildren in Japan.

Childhood motor fitness is important for the physical and mental health of children and the prevention of future lifestyle diseases. This study aimed to investigate how energy intake from healthy foods and physical activity are associated with motor fitness among first-grade children. First-grade children (aged 6-7 years) attending three public elementary schools in Tokyo, Japan (n = 884), participated in this cross-sectional study. Self-administered questionnaires were distributed, which focused on lifestyle habits and required completion of a 1-day dietary record of meals that children ate at home. School lunch consumption was also assessed. Motor fitness was assessed by the New Physical Fitness Test (NPFT). Multiple regression analysis was used to investigate the association of the amount of energy from healthy foods and physical activity with NPFT scores. NPFT scores were positively correlated with involvement in after school exercise classes, playing outside (in boys only), and total energy intake. Energy intake from healthy foods showed a positively associated with NPFT scores (boys, ß = 0.120, p = 0.011; girls, ß = 0.140, p = 0.004), while energy intake from unhealthy foods did not. Energy intake from healthy foods was associated with motor fitness in children in addition to physical activity.

High Adherence to the Food Pyramid's Recommendations Avoids the Risk of Insufficient Nutrient Intake among Farmers in Peri-Urban Kenya.

This study aimed to investigate whether the Kenyan Food Pyramid (FP) can evaluate excess or insufficient nutrient intake. Participants were farmers (56 men and 64 women, aged 18-60 years) in Wangige Village, Kiambu County-a peri-urban area of Kenya. Cross-sectional data were collected for demographic characteristics, physical measurements, and 2-day and 24-h dietary recalls. The average adherence level to the FP (hereafter, "FP score") was 25.0 out of 50.0, with a minimum and maximum of 14.1 and 41.5, respectively. Energy and protein % energy ratio were significantly higher (p for trend < 0.05) in the higher FP score group. A higher FP score was also associated with a higher energy-adjusted micronutrient intake, and it was more likely to meet nutrient requirements. However, the higher FP score group had a higher risk of excess sodium intake (p for trend < 0.001). The Kenyan FP could be a useful tool for avoiding the risk of insufficient nutrient intake, but not for avoiding high energy and sodium intake. It is necessary to include appropriate evaluations to limit energy, sugar, and salt. Food groups and recommendations of the FP should be optimised according to the dietary environment of the target population so as to promote their health.

Nutrient Profiles of Dishes Consumed by the Adequate and High-Salt Groups in the 2014-2018 National Health and Nutrition Survey, Japan.

Dish-based nutrient profile analyses are essential for setting goals to achieve a balanced diet. In 2014, the Japanese government proposed the "Healthy Meal" criteria, which requires a salt content of 3 g/650 kcal per meal. To examine the current intake status of a nationally representative sample, we conducted a series of secondary analyses of the 2014-2018 National Health and Nutrition Survey data. Participants (aged 18-74 years) were grouped as "high-salt" consumers if their salt intake was 3 g/650 kcal or higher and "adequate" consumers if they consumed less than 3 g/650 kcal. A total of 13,615 participants were identified as "adequate" consumers and 22,300 as "high-salt" consumers. The median salt intake in the "high-salt" group was 11.3 g/day, while that in the "adequate" group was 7.5 g/day. Almost all dishes consumed by the "adequate" group had significantly high energy and fat content but low salt content, compared with those consumed by the "high-salt" group. For example, the median energy, fat, and salt contents in the main dishes consumed by the "adequate" group were 173 kcal, 10.4 g, and 0.9 g/dish, respectively, while those in the main dishes consumed by the "high-salt" group were 159 kcal, 8.9 g, and 1.1 g/dish, respectively. Examples of balanced dishes that are low in both salt and fat content can be proposed to help improve the Japanese consumers' dietary behavior.

Increase in congenital syphilis cases and challenges in prevention in Japan, 2016-2017.

In Japan, the increase in congenital syphilis (CS) notifications has become a public health concern. We conducted a case series study to describe the characteristics of CS patients and their mothers. Of the 13 mothers who consented to participate, seven had regular prenatal care visits, including four who had tested negative at their first trimester syphilis screening. Only three mothers noted that their partners were tested, with all three partners being diagnosed with syphilis. Raising awareness for syphilis prevention during pregnancy, partner testing, and considering additional syphilis testing at the third trimester of pregnancy during times of increased syphilis prevalence is imperative.

Collateral artery bypass in the infrapopliteal segment.

A 74-year-old man with diabetes and end-stage renal failure on regular dialysis required revascularization for gangrene of multiple toes and a heel ulcer on the right foot with chronic limb-threatening ischemia. However, the anterior tibial artery, posterior tibial artery, and peroneal artery, which are the usual targets below the knee, showed obstruction or calcification and were considered inappropriate bypass targets. Instead, a collateral artery developed along the area of the posterior tibial artery, and bypass surgery was performed with this artery. This is a case report showing successful collateral artery bypass grafting in the distal infrapopliteal segment.

Breakfast before resistance exercise lessens urinary markers of muscle protein breakdown in young men: A crossover trial.

OBJECTIVES: Skipping breakfast prolongs the fasting state initiated after the last meal consumed the previous day and can have negative effects on muscle protein balance. The aim of this crossover trial was to examine the effects of skipping breakfast before a single bout of resistance exercise (RE) on muscle protein breakdown (MPB), as assessed using the urinary 3-methylhistidine/creatinine ratio (3-MH/Cr). METHODS: Thirteen healthy young men, who habitually consumed breakfast (21.8 ± 1.1 y of age), were assigned to eating breakfast (EB) and skipping breakfast (SB) conditions. Participants consumed meat-free diets throughout the 5-d experiment. On day 5, individuals in the EB group consumed breakfast (497 kcal) 2.5 h before RE (75% repetition maximum), whereas those in the SB group consumed the same meal after dinner. RESULTS: In the two-way analysis of variance, significant interactions were observed with blood insulin and free fatty acid levels, and the 3-MH/Cr ratio (P < 0.05). We confirmed a significantly greater decrease in the insulin level pre-RE (P < 0.001; d = 3.281), and increases in the free fatty acid level pre-RE (P < 0.001; d = 1.437) and post-RE (P = 0.013; d = 0.811) and the 3-MH/Cr ratio 6 (P < 0.001; d = 0.878) and 8 h (P < 0.001; d = 0.634) post-RE in the SB condition than in the EB condition. CONCLUSION: Eating breakfast before RE can be beneficial for MPB suppression. The importance of breakfast consumption in terms of positive muscle protein balance is emphasized on sports fields.

Surgical treatment of multiple coronary-to-pulmonary artery fistulas with severe coronary artery stenosis.

A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or a great vessel. CAF draining into the main pulmonary artery, called coronary-to-pulmonary artery fistula (CPAF), is one of the common variations of CAF. Although there is no definitive surgical indication of CPAF, it is treated concomitantly during other cardiac surgeries. Here, we present the case of a patient who underwent surgical closure of multiple CPAFs and coronary artery bypass grafting under cardiopulmonary bypass.

Surgical Management of Aortoenteric Erosion Due to Pulsatile Stress After Aneurysm Repair: A Case Report.

Secondary aortoenteric fistula or erosion (SAEFE), an abnormal connection between the aorta and gastrointestinal tract, is a rare but critical complication after abdominal aortic aneurysm repair. Most SAEFEs occur between the aorta or proximal graft anastomosis and the duodenum, and occurrence between the iliac graft and small intestine is rare. Standard SAEFE management involves graft removal and extra-anatomical bypass. However, this is extremely invasive and has a high mortality rate. We encountered a rare case of SAEFE with no sign of infection, which was successfully treated by ligating the iliac graft to reduce mechanical pulsatile stress and bleeding following the retroperitoneal approach.

Time-of-Day of Energy Intake Is Associated with Body Fat Percentage in Japanese Female University Rhythmic Gymnasts and Non-Athlete Students.

This study investigated whether body fat percentage (BF%) in Japanese female university rhythmic gymnasts (RG) and non-athletes (control) was associated with the time-of-day of energy intake. A total of 57 females (RG group, n=34; control group, n=23) completed 24-h dietary recall surveys on 3 non-consecutive days. BF% was measured using a bioelectrical impedance analyzer after overnight fasting. Energy intake was stratified by time-of-day: morning (3:00 to 11:00), midday (11:00 to 17:00), evening (17:00 to 21:00), and nighttime (21:00 to 3:00). There was no significant difference between the groups in total energy intake, body weight, or body mass index. The RG group had significantly higher energy expenditure, a larger negative energy balance and lower BF% than the control group. The energy intake ratios (ER%) in the evening and at nighttime in the RG group were significantly lower and higher than in the control group, respectively. Total energy intake and energy balance did not show any significant association with BF% in either group. Multivariate linear regression with substitution model indicated that a substitution of ER% in the morning for ER% at nighttime was negatively associated with BF% after adjusting for confounding factors (ß=-0.240; 95% confidence interval (CI): -0.455, -0.025) in the control group. In the RG group, a substitution of ER% in the evening for ER% at nighttime was negatively associated with BF% (ß=-0.117; 95%CI: -0.214, -0.019). These results suggest that the timing of energy intake throughout the day is associated with BF% in Japanese university RG and non-athlete female students.

Distal Bypass Grafting Using the Basilic-Cephalic Loop Vein for Chronic Limb-Threatening Ischemia under Peripheral Nerve Blockades in a Patient with Severely-Reduced Heart Function and End-Stage Renal Disease.

A 51-year-old man with severe comorbidities required redo revascularization due to left chronic limb-threatening ischemia caused by a previous vein graft occlusion. The saphenous veins were not available due to previous surgeries. Femoro-posterior tibial artery bypass surgery was successfully performed using the basilic-cephalic loop vein under peripheral nerve blockades. This anesthesia allowed a series of surgical revascularizations without general anesthesia, and the postoperative courses were uneventful. The patient survived for 4 years with ambulatory status. In conclusion, loop graft can be an alternative single vein material for distal bypass when no saphenous veins are available.

Laser speckle flowgraphy can also be used to show dynamic changes in the blood flow of the skin of the foot after surgical revascularization.

OBJECTIVES: Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. MATERIALS AND METHODS: A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs). RESULTS: The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure. CONCLUSIONS: Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.