Secretory Ig a in Saliva and Academic Stress

Several reports have proposed that the concentration of secretory immunoglobulin A (S-IgA) in saliva is an indicator of psychological stress. With this in mind, we decided to examine it in 10 second year medical student volunteers at Kawasaki Medical School course between May 4 and July 13, 2000 and discussed the relationship between S-IgA and the stress from academic examinations. Saliva was collected three times (on rising, at forenoon, and at bedtime) every Thursday. During this period, sporadic academic examinations were held twice and term-end examinations occurred during the last two weeks. Results showed the concentration of S-IgA significantly higher at the on rising time-point than at the other two time-points. There was also a tendency for the S-IgA level in saliva to be higher on the day before academic examinations and during them and lower on the days between these examinations. In addition, daily variations in the S-IgA concentration sometimes seemed to be disturbed by other academic stress. Therefore, it may be possible to use this measurement to monitor psychological stress in students and workers.

Tricuspid valve repair for severe tricuspid regurgitation due to pacemaker leads

Background

Tricuspid valve regurgitation due to pacemaker leads is a well-known complication. Although some reports have suggested that pacemaker leads should be surgically explanted, strongly adhered leads cannot always be removed. The aim of this study was to describe our tricuspid valve repair techniques with pacemaker leads left in situ.

Methods

Our retrospective study investigated 6 consecutive patients who required tricuspid valve surgery for severe regurgitation induced by pacemaker leads.

Results

From the operative findings, we identified 3 patterns of tricuspid valve and pacemaker lead involvement. In 3 patients, the leads were caught in the chordae, in 2 patients, tricuspid regurgitation was caused by lead impingement on the septal leaflet, and in 3 patients, tricuspid valve leaflets had been perforated by the pacemaker leads. During surgery, all leads were left in situ after being separated from the leaflet or valvular apparatus. In addition, suture annuloplasty was performed for annular dilatation in all cases. In one patient, the lead was reaffixed to the annulus after the posterior leaflet was cut back towards the annulus, and the leaflet was then closed. There was one hospital death due to sepsis. The degree of tricuspid regurgitation was trivial in all surviving patients at discharge. During a mean follow-up of 21 months, one patient died from pneumonia 20 months after tricuspid valve repair.

Conclusion

In patients undergoing tricuspid valve surgery due to severe tricuspid regurgitation caused by pacemaker leads, the leads can be left in situ after proper repair with annuloplasty.

Surgical repair of tricuspid regurgitation due to annular detachment caused by chest trauma

Traumatic tricuspid valve regurgitation (TR) is a fairly rare complication of blunt chest trauma, and is usually caused by chordal and/or papillary muscle rupture. A 45-year-old woman, with a history of blunt chest trauma 16 years previously, was referred for surgery due to severe TR. During surgery, we found a large perforation on the right atrial wall located just anteriorly to the anterior leaflet, which was caused by annular detachment, in addition to anterior leaflet prolapse due to rupture of anterior chordae. The tricuspid valve was successfully repaired by direct closure of the perforation and chordal replacement with suture annuloplasty. Herein, we report a successful surgical repair of TR with annular detachment with right atrial dissection caused by blunt chest trauma. <Learning objective: Traumatic tricuspid valve regurgitation is rare, but one may encounter it from time to time. In this report, we describe the first case report of tricuspid annular detachment with fistula between the right atrium and the right ventricle caused by right atrial dissection, in which successful surgical repair was performed.>.

[Redo Aortic and Mitral Valve Replacement by Manouguian's Procedure for Active Prosthetic Valve Infection]

The damage to the intervalvular fibrous trigone (IVFT) by infective endocarditis makes combined aortic and mitral valve replacement difficult. We performed Manouguian's double valve replacement for such a case and obtained a good result. A 81-year-old male underwent emergency operation due to active prosthetic valve endocarditis. He had a history of receiving combined aortic and mitral valve replacement because of active infective endocarditis at the age of 74 and redo aortic valve replacement 3 years after that. The infectious lesion extended from the mitral annulus to the IVFT and the aortic annulus, and it caused the prosthetic valve detachment from the aortic annulus. Manouguian's double valve replacement was required for radical resection and reconstruction of the IVFT. No recurrent infection or paravalvular leakage was observed during 49months follow up period. Manouguian's procedure is useful for complete resection of the infected IVFT and makes combined aortic and mitral valve replacement safer.

Nonquenched Isoscalar Spin-M1 Excitations in sd-Shell Nuclei

Differential cross sections of isoscalar and isovector spin-M1 (0(+)→1(+)) transitions are measured using high-energy-resolution proton inelastic scattering at E(p)=295  MeV on (24)Mg, (28)Si, (32)S, and (36)Ar at 0°-14°. The squared spin-M1 nuclear transition matrix elements are deduced from the measured differential cross sections by applying empirically determined unit cross sections based on the assumption of isospin symmetry. The ratios of the squared nuclear matrix elements accumulated up to E(x)=16  MeV compared to a shell-model prediction are 1.01(9) for isoscalar and 0.61(6) for isovector spin-M1 transitions, respectively. Thus, no quenching is observed for isoscalar spin-M1 transitions, while the matrix elements for isovector spin-M1 transitions are quenched by an amount comparable with the analogous Gamow-Teller transitions on those target nuclei.

Aortic valve replacement in patients with protruding coronary artery stents

We present two cases of aortic valve replacement (AVR) in patients with protruding coronary artery stents from the coronary ostia. In the first case, an 87-year-old female was referred for AVR due to severe aortic stenosis (AS). During the operation, we found stents protruding from the left and the right coronary ostia into the aortic root. We performed AVR with a mechanical valve and coronary artery bypass grafting with the saphenous vein to the left anterior descending artery. In the second case, a 77-year-old female was referred for AVR due to severe AS with a history of healed infective endocarditis. During surgery on the second patient, we found a stent protruding 7 mm from the left coronary ostium into the aortic root. The edge of the stent was trimmed, and AVR with a mechanical valve was performed. In both patients, we decided to use a mechanical prosthesis instead of a bioprosthesis because of the risk of leaflet injury. Herein, we discuss some issues regarding patients with AS requiring AVR with prior history of coronary stenting in the coronary ostia. <Learning objective: To explore the problem of coronary stents protruding into the ostia in cases of percutaneous coronary intervention of left main or right proximal lesions, which can compromise subsequent aortic valve procedures including surgical aortic valve replacement or even transcatheter aortic valve replacement thereafter.>.

[Surgical treatment for infective prosthetic mitral valve endocarditis with cardiogenic shock; report of a case]

We report a surgical case of active infective prosthetic mitral valve endocarditis with cardiogenic shock. The causative organism was methicillin-resistant coagulase negative Staphylococci (MRCNS) During medical treatment, the prosthetic valve was abruptly detouched partially from the mitral annulus, and the patient developed rapid hemodynamic deterioration. We performed emergency re-do mitral valve replacement. The postoperative course was uneventful. Rapid establishment of femoro-femoral bypass was very effective for the emergency re-do valve surgery.

Current role of hybrid CT/angiography system compared with C-arm cone beam CT for interventional oncology

Hybrid CT/angiography (angiography) system and C-arm cone beam CT provide cross-sectional imaging as an adjunct to angiography. Current interventional oncological procedures can be conducted precisely using these two technologies. In this article, several cases using a hybrid CT/angiography system are shown first, and then the advantages and disadvantages of the hybrid CT/angiography and C-arm cone beam CT are discussed with literature reviews.

[Total arch replacement for ruptured Stanford type B aortic dissection with thrombosed pseudolumen presenting hemodynamic deterioration]

We report 2 cases of ruptured type B aortic dissection with thrombosed pseudolumen presenting hemodynamic deterioration which is a life-threatening condition. In such cases, surgical treatment often resulted in high mortality rates. We underwent total arch replacement via median sternotomy. In both cases, postoperative courses were uneventful. This approach ensured us wider operative field to establish cardiopulmonary bypass quickly, and to perform distal anastomosis without much difficulty.

Modified gastric pull-up reconstructions following pharyngolaryngectomy with total esophagectomy

Reconstruction following pharyngolaryngectomy with total esophagectomy is a challenging surgery to perform. Between April 2008 and August 2012, three types of modified gastric pull-up reconstruction procedures, including a gastric tube creation combined with a free jejunal transfer (n = 7), elongated gastric tube creation with vascular anastomoses (n = 2) and pedunculated gastric tube creation with Roux-en-Y anastomosis (n = 5), were performed after pharyngolaryngectomy with total esophagectomy. To clarify feasibility of these reconstructive methods, we retrospectively analyzed the short-term outcomes. There were no graft failures. Salivary fistulae were observed in two cases after high pharyngoenteral anastomoses due to oropharyngeal extension of hypopharyngeal cancers. Overall morbidity rate was 21.4%, and no deaths occurred. Although the operation time was shortest for pedunculated gastric tube reconstructions, morbidity rates were similar among all methods. All three types of modified gastric pull-up reconstruction procedures can be performed safely. We can choose one of these methods according to the tumor status and the patient condition, understanding advantages and disadvantages of each procedure.

[Valve replacement for tricuspid infective endocarditis presenting paradoxical cerebral embolism]

Tricuspid valve infective endocarditis( IE) accounts for 5 to 10% of all IE. We encountered a 50-year old man who suffered from tricuspid valve IE presenting paradoxical multiple cerebral embolism with intracranial hemorrhage. On 6th day from his admission, we performed valve replacement for intractable tricuspid infective endocarditis regardless of acute phase of intracranial hemorrhage. The patient had an uneventful postoperative course with no neurological symptoms.

Energy dependence of the transverse momentum distributions of charged particles in pp collisions measured by ALICE

Differential cross sections of charged particles in inelastic pp collisions as a function of p_T have been measured at [Formula: see text] at the LHC. The p_T spectra are compared to NLO-pQCD calculations. Though the differential cross section for an individual [Formula: see text] cannot be described by NLO-pQCD, the relative increase of cross section with [Formula: see text] is in agreement with NLO-pQCD. Based on these measurements and observations, procedures are discussed to construct pp reference spectra at [Formula: see text] up to p_T=50 GeV/c as required for the calculation of the nuclear modification factor in nucleus-nucleus and proton-nucleus collisions.

Directed flow of charged particles at midrapidity relative to the spectator plane in Pb-Pb collisions at √(s(NN))=2.76 TeV

The directed flow of charged particles at midrapidity is measured in Pb-Pb collisions at √(s(NN))=2.76 TeV relative to the collision symmetry plane defined by the spectator nucleons. A negative slope of the rapidity-odd directed flow component with approximately 3 times smaller magnitude than found at the highest RHIC energy is observed. This suggests a smaller longitudinal tilt of the initial system and disfavors the strong fireball rotation predicted for the LHC energies. The rapidity-even directed flow component is measured for the first time with spectators and found to be independent of pseudorapidity with a sign change at transverse momenta p(T) between 1.2 and 1.7  GeV/c. Combined with the observation of a vanishing rapidity-even p(T) shift along the spectator deflection this is strong evidence for dipolelike initial density fluctuations in the overlap zone of the nuclei. Similar trends in the rapidity-even directed flow and the estimate from two-particle correlations at midrapidity, which is larger by about a factor of 40, indicate a weak correlation between fluctuating participant and spectator symmetry planes. These observations open new possibilities for investigation of the initial conditions in heavy-ion collisions with spectator nucleons.