[Valve-sparing Root Reimplantation for Stanford Type A Acute Aortic Dissection Combined with Aortic Root Dilation and Bicuspid Aortic Valve;Report of a Case]

A 45-year-old male developed Stanford type A acute aortic dissection combined with aortic root dilation and congenital bicuspid aortic valve (BAV). He had a Sieveres type 0 BAV, lateral subtype with right and left cusps. Valve-sparing root reimplantation was performed with decalcification of the cusps. Transthoracic echocardiography(TTE) at discharge revealed no aortic regurgitation, and peak velocity of BAV was 2.15 m/second, mean pressure gradient was 9.6 mmHg and aortic valve area was 2.15 cm2. TTE after 6 months revealed only slight elevation of the peak velocity to 2.78 m/second. To perform successful reimplantation in the case of BAV, anatomic orientation of the cusps should be approximately at 180° and the tissue of the cusps should either be normal or have only minor abnormalities. Valve-sparing root reimplantation for BAV needs a careful follow-up for progression of the aortic valve dysfunction.

Gut microbiome alterations in type 1 autoimmune pancreatitis after induction of remission by prednisolone

Although increasing evidence demonstrates the association between intestinal dysbiosis and pancreatic diseases such as chronic pancreatitis and pancreatic cancer, it remains largely unknown whether intestinal dysbiosis is involved in the immunopathogenesis of autoimmune pancreatitis (AIP). Recently, we found that intestinal dysbiosis mediates experimental AIP via the activation of plasmacytoid dendritic cells (pDCs), which can produce interferon (IFN)-α and interleukin (IL)-33. However, candidate intestinal bacteria, which promote the development of AIP, have not been identified. Fecal samples were obtained from type 1 AIP patients before and after prednisolone (PSL) treatment and subjected to 16S ribosomal RNA sequencing to evaluate the composition of intestinal bacteria. Induction of remission by PSL was associated with the complete disappearance of Klebsiella species from feces in two of the three analyzed patients with type 1 AIP. To assess the pathogenicity of Klebsiella species, mild experimental AIP was induced in MRL/MpJ mice by repeated injections of 10 μg of polyinosinic-polycytidylic acid [poly(I:C)], in combination with oral administration of heat-killed Klebsiella pneumoniae. The AIP pathology score was significantly higher in MRL/MpJ mice that received both oral administration of heat-killed K. pneumoniae and intraperitoneal injections of poly(I:C) than in those administered either agent alone. Pancreatic accumulation of pDCs capable of producing large amounts of IFN-α and IL-33 was also significantly higher in mice that received both treatments. These data suggest that intestinal colonization by K. pneumoniae may play an intensifying role in the development of type 1 AIP.

Effects of daily intake of Harudori-kombu: A randomized, double-blind, placebo-controlled, parallel-group study

Background: Kombu (Laminariaceae) is traditionally consumed in Japan. “Harudori-kombu” is young kombu harvested in spring. Harudori-kombu contains functional components, such as fucoxanthin—a carotenoid—which confer various biological effects.Methods: In this study, we investigated effects of the continuous intake of dried Harudori-kombu (2.0 g/day) for 6 weeks. We conducted a randomized, double-blind, placebo-controlled, parallel-group study including 70 healthy Japanese subjects with body mass index between 22 and 30 kg/m2 and low-density lipoprotein cholesterol levels between 120 and 160 mg/dL. Subjects were randomly assigned to either Harudori-kombu group or placebo group. Subjects ingested 9 capsules per day for 6 weeks. We conducted medical interviews, vital sign examinations, and blood sampling at weeks 0 (baseline), 2, and 6. Moreover, we assessed body composition at weeks 0 and 6.Results: Harudori-kombu intake did not improve the lipid profile but did reduce body fat. In addition, adiponectin levels were significantly improved.Conclusions: Harudori-kombu intake showed beneficial health effects, such as reduction in body fat and improvement of adiponectin levels, and was deemed safe at the dose administered in this study.