[Congenital Left Internal Mammary Artery to Pulmonary Artery Fistula with Aneurysmal Change Diagnosed Incidentally:Report of a Case].

An internal mammary artery to pulmonary artery (IMA-PA) fistula is a very rare vascular abnormality. Patients with this disease are often asymptomatic, but they may develop symptoms such as heart failure and hemoptysis. A 60-year-old woman was incidentally diagnosed with left IMA-PA fistula by chest computed tomography (CT) during an examination for colon cancer. She was asymptomatic, but we determined that surgery was indicated because of the presence of an aneurysmal change. We performed complete surgical resection of the IMA-PA fistula and aneurysm under cardiopulmonary bypass. Her postoperative course was uneventful. Although a specific management strategy for IMA-PA fistula has not yet been established, surgical treatment should be performed to prevent rupture in cases with aneurysmal change.

[Successful Pulmonary Embolectomy using a Bronchoscope:Report of a Case].

Surgical pulmonary embolectomy is indicated for acute massive pulmonary thromboembolism complicated by floating thrombi in the right heart system. Postoperative residual thrombi are associated with persistent pulmonary hypertension and subsequent right heart failure, resulting in poor surgical outcome. A 67-year-old man was admitted to our institution owing to dyspnea on exertion. Transthoracic echocardiography revealed a floating right atrial mass and right ventricular overload. In addition, enhanced computed tomography (CT) showed a right atrial mass as well as bilateral massive pulmonary embolism. We performed an urgent pulmonary embolectomy using a bronchoscope as an adjunctive angioscope to completely remove the peripheral thrombi and to prevent serious complications, such as endobronchial hemorrhage due to pulmonary arterial injury. A clear, bloodless view of peripheral pulmonary arteries was obtained using short intermittent circulatory arrest technique. Postoperative course was uneventful, and he was discharged ambulatory 20 days after the surgery without any symptoms.

Elucidation of the whole carotenoid biosynthetic pathway of aphids at the gene level and arthropodal food chain involving aphids and the red dragonfly.

BACKGROUND: Aphids can be positioned as robust pest insects in farming and as ones of the model organisms for arthropods in molecular biology. Carotenoids are pigments that protect organisms from photooxidative damage caused by excessive light. Aphids were shown to possess genes of fungal origin for carotenoid biosynthesis, whereas a little knowledge was available about the functions of the genes and the biosynthetic pathway. Even carotenoid species contained in aphids were not enough understood. Main purpose of this study is to clarify these insufficient findings. RESULTS: The whole carotenoid biosynthetic pathway of the pea aphid (Acyrthosiphon pisum) was elucidated at the gene level, through comprehensive functional analysis of its carotenogenic genes, using Escherichia coli that synthesized carotenoid substrates, along with structural and quantitative analysis of carotenoids from various aphid species. Four genes were needed to synthesize all carotenoids accumulated in aphids from geranylgeranyl diphosphate. The tor gene mediated desaturation reaction from phytoene to 3,4-didehydrolycopene. It was revealed that a gene designated ApCrtYB3, which was considered to have functionally evolved in aphids, can convert lycopene into uncommon carotenoids with the γ-ring such as (6'S)-ß,γ-carotene and γ,γ-carotene. We further demonstrated that the atypical carotenoids work as ecological indicators for estimating the food chain from aphids to predatory arthropods, and showed that aphids contributed with significant levels to the food chain from insect herbivores to several predatory arthropods, i.e., the red dragonfly (Sympetrum frequens; adults), seven-spotted ladybird (Coccinella septempunctata), and two spiders, Oxyopes sertatus and Nephila clavata. Gut microflora of the dragonfly (mature adults) was also found to include endosymbiotic bacteria such as Serratia symbiotica specific to the black bean aphid (Aphis fabae). CONCLUSIONS: We revealed the whole carotenoid biosynthetic pathway of aphids, including functional identification of the corresponding genes. Subsequently, we showed that arthropodal food chain can be estimated using the uncommon carotenoids of aphids as ecological indicators. This result indicated that aphids made significant contributions to the food chain of several predatory arthropods including the red-dragonfly adults. Aphids are likely to be positioned as an important "phytochemicals" source for some predatory insects and arachnids, which are often active under bright sunlight.

Effects of systemic insecticides on the population dynamics of the dragonfly Sympetrum frequens in Japan: Statistical analyses using field census data from 2009 to 2016.

Since the mid-1990s, populations of the common Japanese dragonfly Sympetrum frequens in rice fields have declined severely. Application of systemic insecticides-especially fipronil-to nursery boxes of rice seedlings is suspected to be the main cause of the decline. However, until now there have been insufficient population data to test the causality. We conducted a dragonfly survey from 2009 to 2016 in four prefectures of Japan and compiled the data to enable the comparison of population growth rates along five main census routes over the years. We also estimated the use ratio of each insecticide applied to nursery boxes in rice fields (i.e., the area exposed to insecticide as a ratio of the total rice field area) by prefecture. We then statistically analyzed the effects of the insecticides on the dragonfly's population growth rates, taking into account the potential confounding factors based on current knowledge. There was a significant negative association between the annual increase in use ratio of the sum of systemic insecticides (e.g., fipronil, imidacloprid, and chlorantraniliprole) and the annual population growth rate of S. frequens. This association suggests that systemic insecticide use affected the decrease in population density of the dragonfly, although some agronomic factors need to be further examined as potential confounders.

[Pacemaker Dislocation into the Peritoneal Cavity].

A 16-day-old neonate with congenital complete atrioventricular block underwent epicardial pacemaker implantation under the rectus. Four months later, abodominal X-ray imaging revealed dislocation of the generator from the abdomen to the pelvis. The infant was diagnosed with intraperitoneal pacemaker dislocation. However, there were no abdominal manifestations or complications associated with the bowel, urinary tract, and vascular system. Surgical refixation was performed in a hybrid room. Fluoroscopy helped avoid bowel injury when removing the generator from the peritoneal cavity. The pacing lead, which was adherent and entangled with the omentum, was released under direct vision. The generator was placed in a new pocket created in the subcutaneous layer of the anterior fascia of the rectus.

Effects of short-term, sublethal fipronil and its metabolite on dragonfly feeding activity.

Dragonflies, Sympetrum spp., are indispensable to agriculture and are a central element of culture in Japan. However, S. frequens populations in rice paddy fields have declined in recent decades. Dragonfly larvae are predatory aquatic insects that feed on other organisms found in habitats with slow-moving or standing water. The increasing use of fipronil and neonicotinoid insecticides in agriculture is also increasing exposure to Sympetrum spp. in larval stages through paddy soil and water. The role of fipronil insecticides in the decline of dragonflies is of concern, and we here examine the sublethal effects of this insecticide on the feeding behaviors of two Sympetrum spp. Based on the quantity of prey items consumed and the time to capture prey items, feeding inhibition was determined to be a potential mechanism of the decline of Sympetrum spp. following 48-h exposure to fipronil and fipronil sulfone. Prey consumption by S. infuscatum was significantly reduced for fipronil sulfone at all concentrations (0.01-1000 µg/L). S. frequens exposed to 1, 10, 100 and 1000 µg/L fipronil sulfone had significantly longer prey capture times. Fipronil sulfone was 2.8, 9.7 and 10.5 times more toxic to S. infuscatum than fipronil in terms of acute toxicity, feeding inhibition and delayed toxicity, respectively. In addition, fipronil sulfone was 6.6, 2.9 and 9.1 times more toxic, respectively, to S. frequens than fipronil. Our findings suggest that sublethal effects on feeding inhibition lead to severe mortality at realistic paddy soil and water concentrations. Our results provide the first demonstration that short-term exposure to fipronil and fipronil sulfone can consequently cause significant harm to dragonfly larvae survival due to feeding inhibition. These findings have implications for current pesticide risk assessment and dragonfly protection.

[Traumatic Disruption of the Aortic Root and the Ascending Aorta with Multisystem Trauma;Report of a Case].

We report a case of traumatic disruption of the aortic root with multisystem trauma. A 45-year-old male was suffered from multiple injuries including subarachnoid hemorrhage, lung contusion, retroperitoneal hematoma and femoral bone fracture caused by a traffic accident. He had a history of 3 cardiac surgeries including repair of atrioventricular septal defect and mitral valve replacement using a mechanical valve. Contrast-enhanced computed tomography (CT) revealed leakage of the contrast medium from the aortic root and a filling defect on the right coronary artery. Because of hemorrhagic complications, emergency operation was avoided. He was operated 2 days after the trauma. Laceration of the left-coronary sinus and the non-coronary sinus was observed. Bentall operation was performed and the right coronary artery( RCA) was bypassed with a saphenous vein graft. He was treated with open fixation of the right femur 14 days after the operation and was discharged 58 days after the 1st operation.

Superior Mesenteric Artery-Pancreaticoduodenal Arcade Bypass Grafting for Repair of Inferior Pancreaticoduodenal Artery Aneurysm with Celiac Axis Occlusion.

We report a case of an aneurysm of the inferior pancreaticoduodenal artery (IPDA), with chronic occlusion of the celiac axis. Both surgical aneurysmectomy and endovascular coil embolization were anticipated to sacrifice IPDA, which could lead to severe acute ischemia in the celiac region. The treatment involved surgical ligation of the aneurysm after bypass grafting from the superior mesenteric artery to the anterior IPDA. A postoperative computed tomography revealed no enhancement of the aneurysm and sufficient collateral blood supply by the patent bypass graft.

[Cardiac angiosarcoma resected after definitive diagnosis by thoracoscope-assisted biopsy].

A 31-year-old woman presented with cardiac tamponade. Contrast-enhanced chest computed tomography(CT) revealed an inhomogeneously-enhanced soft tissue mass measuring 50×35×30 mm, which was in contact with the right atrial wall. The mass was definitely diagnosed as cardiac angiosarcoma by thoracoscope-assisted biopsy. The right atrial wall, including the tumor, was extensively resected, and then reconstructed with the equine pericardium. Postoperative radiation therapy was performed, but the patient developed malignant ascites with an intra-pericardial ectopic tumor recurrence. Additional radiation therapy was performed, but she died 177 days after the operation. Although thoracoscopeassisted biopsy is considered to be a useful diagnostic method for cardiac tumors on the surface of the heart, it carries the risk of spreading tumor cells. In the present case, the tumor should have been resected immediately after the prompt pathological diagnosis.

Rupture of Kommerell diverticulum after total arch replacement.

A 62-year-old man was brought to the emergency room of our hospital because of chest pain. Computed tomography revealed a right aortic arch and an aberrant left subclavian artery with Kommerell diverticulum and acute aortic dissection (Stanford type A). Total arch replacement was performed emergently through a median full sternotomy. A stomach feeding tube was placed postoperatively for the patient to receive nutrition, and esophageal bleeding was observed postoperatively. The patient died because of the bleeding. Autopsy findings showed a communication between the esophagus and Kommerell diverticulum. Rupture of Kommerell diverticulum and perforation of the esophagus were indicated.

Repair of ventricular septal perforation with asymmetrical conical patch exclusion.

We report a case of repair of the postinfarction ventricular septal perforation (VSP), using an equine pericardium tailored in an asymmetrical conical shape for exclusion (modified sack technique) and an additional direct patch closure of VSP. An asymmetrical conical patch is easily sutured to the normal septum away from the VSP edge by using the longer part of the cone border. The postoperative left ventriculogram 1.5 months after surgery revealed a minor leakage from the patch to the excluded left ventricle. However, no residual left to the right shunt was found in calculation from the oxygen saturation in blood samples. Echocardiography 1 year after surgery showed no residual patch leakage at all. We suggest that this modified sack technique is a simple and easy method by which to exclude the VSP.