Lower extremity artery thromboembolism during removal of Impella after repair for ventricular septal rupture: A case report.

Although the anticoagulant complications of Impella are well known, the timing of heparin administration when using Impella immediately after open heart surgery has not been established. We report a case of a 59-year-old man with Impella-assisted repair of a ventricular septal perforation after acute myocardial infarction who developed thromboembolism of the lower extremity arteries after removal of Impella.

Walking trail access, exercise behavior, and going out-of-home among older adults: Examining longitudinal associations and mediators.

AIM: Although the presence of a walking trail within a neighborhood would be an important environmental determinant of health behaviors, such as exercise and going out-of-home, their longitudinal associations and mediators are still unconfirmed. This study examined the longitudinal associations of walking trail access with exercise behavior and going out-of-home and mediating roles of awareness and use of walking trails on their associations among older adults. METHODS: A four-wave questionnaire-based longitudinal survey was conducted among Japanese older adults (Wave 1: baseline; Wave 2: after one year; Wave 3: after three years; and Wave 4: after five years). Each survey measured weekly exercise time and frequency of going out-of-home. Wave 4 survey also measured awareness and use of walking trails. This study calculated distance to nearest walking trail using geographic information systems. This study analyzed the data from all waves (n = 834) for longitudinal associations and the data from Wave 4 (n = 567) for mediated associations. RESULTS: Latent growth modeling showed insignificant longitudinal associations of walking trail access with weekly exercise time and frequency of going out-of-home. The path analyses showed that a shorter distance to the walking trail was indirectly and significantly associated with longer weekly exercise time (standardized indirect effect=-0.03, p<.001) and a higher weekly frequency of going out-of-home (standardized indirect effect=-0.03, p<.001), mediated by awareness and use of walking trails. CONCLUSIONS: These findings indicate that the influence of walking trail access on exercise behavior and going out-of-home would be attenuated by awareness and use of walking trails among older adults.

Exploring potential correlations between HLA class II and the risk of microvascular complications in Japanese patients with type 1 diabetes.

Managing complications in Type 1 diabetes (T1D) remains challenging. HLA genes, particularly DR and DQ, are linked to T1D susceptibility. We studied 48 Japanese T1D inpatients and revealed associations between DRB1*04:05-DQB1*04:01 and DRB1*09:01-DQB1*03:03 haplotypes and complications, offering a new perspective for future research.

Characteristics of Human Leukocyte Antigen Class II Genes in Japanese Patients with Type 1 Diabetes and Autoimmune Thyroid Disease.

Genetic factors, particularly human leukocyte antigen (HLA) class II genes, are known to significantly influence the onset of type 1 diabetes (T1D). Additionally, patients with T1D often develop autoimmune thyroid diseases (AITD). Despite this association, comprehensive research on individuals with both AITD and T1D in Japan, especially regarding the influence of specific HLA alleles, remains insufficient. In this retrospective study, we analyzed 44 inpatients diagnosed with T1D. These patients were predominantly female, with an average onset age of 35 years, poor blood sugar control, and approximately 43.2% had concurrent AITD. We observed significant associations of HLA-DRB1*04:05, HLA-DRB1*09:01 and HLA-DRB1*15:02 alleles with T1D regardless of AITD presence, which had been previously established for T1D in Japanese. In this context, comparing Japanese patients with AITD alone, we noted AITD comorbidity with T1D results in alterations in the frequencies of HLA-DRB1*09:01, HLA-DRB1*04:03, and HLA-DRB1*15:02. Furthermore, HLA-DRB1*04:05, HLA-DRB1*09:01, HLA-DRB1*13:02, and HLA-DRB1*15:01 alleles may be alleles whose susceptibility varies for both conditions. These findings underscore the importance of understanding the relationship between T1D, AITD, and HLA genetics, which may inform personalized treatment strategies and facilitate the development of targeted therapies. Future research endeavors should aim to elucidate underlying mechanisms and validate these findings in larger cohorts.

[Right Atrial Myxoma After Catheter Ablation:Report of a Case].

An 81-year-old man underwent total arch replacement for thoracic aortic aneurysm 8 years ago and catheter ablation for paroxysmal atrial fibrillation 1 year ago. Transthoracic echocardiography revealed a mass in the right atrium, and the patient was admitted for close examination and treatment. Transesophageal echocardiography revealed a 23×17 mm large well-defined mass above the cavotricuspid isthmus. Two venous drainage cannulas were inserted directly to the superior vena cava and to the inferior vena cava via the right femoral vein, in order to avoid the direct contact with the right atrium prior to institution of cardiopulmonary bypass. The right atrial tumor was found attached to the cavotricuspid isthmus, and was resected together with the right atrial wall. Pathological examination showed myxomatous tissue. Postoperative course was uneventful. He was discharged 23 days after the operation.

[Surgical Treatment for Ruptured Thoracoabdominal Aneurysm Following Descending Aortic Replacement with Double Barrel Anastomosis].

A 75-year-old woman was diagnosed with type B acute aortic dissection 14 years ago and 3-channeled aortic dissection 7 years ago. She received total arch replacement 6 years ago and descending aortic replacement with double barrel anastomosis technique for distal anastomosis 5 years ago. Computed tomography( CT) revealed giant thyroid tumor and thoracoabdominal aortic aneurysm( 58 mm in diameter). She suffered from back pain during her follow-up period. CT revealed ruptured thoracoabdominal aortic aneurysm. First, the false lumen of descending aorta was closed by thoracic endovascular aortic repair, and then thoracoabdominal aortic replacement was performed uneventfully.

Physical Activity Components that Determine Daily Life Satisfaction Among Older Adults: An Intensive Longitudinal Diary Study.

BACKGROUND: Although previous studies have shown that engaging in physical activity can elevate daily life satisfaction, few studies have identified the specific aspects that can result in this. This study examined whether enjoying moderate-to-vigorous intensity exercises with others for a longer time, but not any aspects of non-exercise physical activity, was associated with higher daily life satisfaction among older adults. METHOD: We conducted an intensive longitudinal diary survey of 182 individuals for 1 week and obtained valid data for 853 person-days. The time spent engaging in light and moderate-to-vigorous physical activity at 8:00-11:59, 12:00-15:59, and 16:00-19:59 h was measured using an accelerometer. Duration, intensity, timing, social context, and enjoyment of the exercises were assessed based on diary entries. Stratified by non-exercise and exercise days, we conducted multilevel models. RESULTS: On non-exercise days, longer duration of light physical activity from 12:00 to 15:59 at the within-person level was associated with higher daily life satisfaction. On exercise days, longer duration of moderate-to-vigorous physical activity from 12:00 to 15:59 at the within-person level, longer exercise duration at the within-person level, exercising with moderate-to-vigorous intensity, and enjoyment of exercise at both the within- and between-person levels were associated with higher daily life satisfaction. CONCLUSION: These findings indicate that enjoying moderate-to-vigorous intensity exercise for a longer duration than usual and engaging in non-exercise physical activity in the afternoon are important for elevating older adults' daily life satisfaction.

Hot Water Eliminates the Bitter Taste of Oral Semaglutide: A Report of Four Cases.

Semaglutide is a well-designed drug with a special coating that allows for oral administration to patients with type 2 diabetes mellitus. However, patients taking oral semaglutide complain of its bitter taste. We therefore considered suggesting that patients take oral semaglutide with hot water. When the hot water temperature was increased to above 46.0°C but below 52.0°C, no bitter taste was perceived, with the daily mean interstitial glucose level remaining at the target range. Taking oral semaglutide with hot water helps reduce its bitter taste.

Between- and Within-Couple Concordance for Health Behaviors Among Japanese Older Married Couples: Examining the Moderating Role of Working Time.

BACKGROUND: Although previous studies report spousal concordance for health behaviors at between-couple levels, concordance at within-couple levels remains unconfirmed. To clarify the behavioral mechanisms of spousal concordance for health behaviors among older couples at both levels, it is necessary to examine the moderators (effect modifiers) of spousal concordance. This study examined (1) whether spousal concordance for dietary variety, exercise behavior, and TV viewing behavior was observed at both the between-couple and the within-couple levels and (2) whether this spousal concordance was moderated by working time among older Japanese couples. METHOD: This study analyzed data obtained from a questionnaire-based, three-wave longitudinal survey (baseline, 1-year follow-up, 3-year follow-up) among 210 Japanese older couples. Each spouse's dietary variety, exercise time, TV viewing time, the couple's working time, and demographic factors were investigated by multi-level analyses. RESULTS: One spouse's dietary variety and TV viewing time, but not exercise time, were significantly associated with the other spouse's corresponding behaviors at both levels. The regressions of the wife's TV viewing time on the husband's TV viewing time were moderated by working time at the within-couple level; the regressive effects of wife's TV viewing time on husband's TV viewing time were more relevant as working time was lower. CONCLUSION: This study found that spousal concordance for dietary variety and TV viewing was observed at within-couple and between-couple levels among older Japanese couples. In addition, shorter working time partly moderates the wife's influence on the husband's TV viewing among older couples at the within-couple level.

Total Pancreatectomy in a Patient Treated with a Sensor-augmented Pump Showing No Evidence of Hyperglycemia or Ketoacidosis without Any Insulin Administration.

Total pancreatectomy results in complete loss of insulin and glucagon. Sensor-augmented pumps (SAPs) allow fine-tuning of the basal insulin rate, which helps avoid both hypo- and hyperglycemic events. We herein report a case of total pancreatectomy treated with a SAP with no evidence of ketoacidosis without any insulin administration during a certain period of time. Furthermore, we observed a sudden drop in blood glucose levels without insulin, which may have been due to glucose effectiveness. Our case is valuable in arguing the concept of glucose effectiveness in the absence of insulin and glucagon.

Imeglimin Improved Plasma Glucose Levels in Patients With Latent Autoimmune Diabetes of Adults: Report of 2 Cases.

Imeglimin has not been well studied as an oral agent for the treatment of latent autoimmune diabetes of adults (LADA). We treated 2 cases of LADA with imeglimin. The case 1 patient was originally diagnosed with type 2 diabetes (T2D) at age 50 years and was treated with sulfonylurea, biguanide, canagliflozin, imeglimin, and dulaglutide. Before imeglimin, his glycated hemoglobin A1c (HbA1c) change was 94.0 mmol/mol (8.6%) in November 2022, but it dropped to 71.0 mmol/mol (6.5%) in May 2023 after imeglimin was added. The case 2 patient was originally diagnosed with T2D when she was aged 48 years. She was treated with vildagliptin, biguanide, luseogliflozin, and imeglimin. Her HbA1c before imeglimin was 92.9 mmol/mol (8.5%) in January 2023, which decreased to 75.4 mmol/mol (6.9%) in July 2023 after imeglimin was added. Although imeglimin has not been approved for treating type 1 diabetes and LADA, adding imeglimin to the current medication was effective in improving and controlling the patients' plasma glucose.

Leisure-time management and subjective well-being among older adults: A three-wave longitudinal survey.

AIM: As older adults have longer leisure time and the types and influences of leisure activities they participate in are diverse, appropriate management of their leisure time would be important to optimize their subjective well-being. Although greater use of time management in educational and occupational settings is associated with better job performance, academic achievement, and the well-being of workers and students, few studies have investigated time management in leisure settings. This study aimed to examine the longitudinal association between leisure-time management and subjective well-being among older adults. METHODS: Data on 879 individuals in Nada Ward, Kobe, Japan were obtained from a three-wave questionnaire-based longitudinal survey (Wave 1: December 2017 to January 2018; Wave 2: after one year; Wave 3: after three years). In each survey, leisure-time management (newly developed in this study) and subjective well-being (simplified Japanese version of the World Health Organization Five Well-Being Index) were measured. This study used a cross-lagged model to analyze the longitudinal association between leisure-time management and subjective well-being after considering their inverse association. RESULTS: The cross-lagged model indicated that that the standardized path coefficients from leisure-time management in Wave 1 to subjective well-being in Wave 2 (0.13, p<0.001) and from leisure-time management in Wave 2 to subjective well-being in Wave 3 (0.06, p=0.042) were positive and significant. CONCLUSIONS: This study found that leisure-time management is a determinant of subjective well-being among older adults. This finding indicates that the management of leisure time elevates one's subjective well-being among them.

[Surgical Treatment of the Perforation of the Right Ventricle and Diaphragm by a Permanent Pacing Lead:Report of a Case].

An 97-year-old woman was diagnosed with complete atrioventricular block and underwent pacemaker implantation( PMI). Three days after the PMI, computed tomography revealed cardiac perforation and migration of the lead to the abdominal cavity. Surgical procedure through median sternotomy was performed, and the penetrated lead was removed. The holes of the right ventricle and diaphragm were repaired. Abdominal organ was not injured. She was discharged 14 days after the surgical procedure.

[Delayed Type â ¢b Endoleak After Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm: Report of a Case].

An 85-year-old woman underwent aortic arch replacement and thoracic endovascular aortic repair (TEVAR) 5 years ago. She suffered from chest and back pain. Computed tomography (CT) demonstrated enlargement of the aortic aneurysm by a type Ⅲb endoleak. TEVAR was performed to close a type Ⅲb endoleak with a relining technique uneventfully. Intraoperative completion aortography and postoperative CT confirmed the disappearance of a type Ⅲb endoleak. She was discharged 27 days after the treatment.

[Acute Type A Aortic Dissection Complicated by Cerebral Malperfusion and Leg Ischemia:Report of a Case].

An 82-year-old woman suddenly developed chest pain and apoplexy. Computed tomography (CT) showed acute type A aortic dissection, the true lumen in the brachicephalic artery was severely compressed by the faulse lumen. Pulsation in the either leg was not detected during induction of anesthesia. We evaluated the cerebral blood flow and lower extremity blood flow using near infrared spectroscopy (NIRS) during the operation, tissue oxygenation index (TOI) was continuously monitored during the operation. Cardiopulmonary bypass( CPB) was established by puncturing the true lumen in the ascending aorta and bicaval venous drainage. TOI was returned to normal range by CPB. Although the central repair (ascending aorta replacement) was performed, leg ischemia persisted. We performed ascending aorta-bifemoral bypass. After the operation, leg ischemia disappeared and CT revealed patency of the bypass graft. Postoperative course was uneventful without deterioration of neurological function. She was discharged 49 days after the operation.

[Compartment Syndrome After Stanford Type A Acute Aortic Dissection Surgery:Report of a Case].

A 53-year-old man presented to the emergency department with chest and back pain. Contrast-enhanced computed tomography( CT) revealed a Stanford type A acute aortic dissection with a pseudo-lumen occlusion. On the same day, the patient underwent emergent aortic arch replacement with frozen elephant trunk. When introducing cardiopulmonary bypass, arterial cannula was inserted into the right femoral artery. The day after surgery, swelling of the right lower leg appeared with CK and intramuscular compartment pressure elevation. Thus, the patient was diagnosed with compartment syndrome and decompressive fasciotomy was performed. Although there was no preoperative blood flow disturbance in the lower extremities on preoperative CT, lower limbs ischemia happened. Necrotic muscles in his right leg required debridement, but amputation was not needed. The patient was discharged unaided utilising orthotics on the day 120. In muscular, young male patients, care should be taken in the method of blood delivery.

Role of Fyn and the interleukin-6-STAT-3-autophagy axis in sarcopenia.

Sarcopenia is the progressive loss of muscle mass wherein Fyn regulates STAT3 to decrease autophagy. To elucidate the role of inflammation in Fyn-STAT3-dependent autophagy and sarcopenia, here we aimed to investigate the underlying mechanisms using two mouse models of primary and secondary sarcopenia: (1) tail suspension and (2) sciatic denervation. In wild-type mice, the expression of Fyn and IL-6 increased significantly. The expression and phosphorylation levels of STAT3 were also significantly augmented, while autophagic activity was abolished. To investigate Fyn-dependency, we used tail suspension with Fyn-null mice. In tail-suspended wild-type mice, IL-6 expression was increased; however, it was abolished in Fyn-null mice, which maintained autophagy and the expression and ablation of STAT3 phosphorylation. In conclusion, Fyn was found to be associated with the IL-6-STAT3-autophagy axis in sarcopenia. This finding permits a better understanding of sarcopenia-associated metabolic diseases and the possible development of therapeutic interventions.

Assessment of factors associated with improved glycemic control after switching from intermittently scanned to real-time continuous glucose monitoring in Japanese patients with type 1 diabetes.

The advantages of real-time continuous glucose monitoring (rtCGM) over intermittently scanned CGM (isCGM) reportedly include lower glycated hemoglobin (HbA1c) levels as well as reduced glycemic variability. However, there have been few studies of the effect of switching from isCGM to rtCGM on glycemic control, as well as the specific factors underlying any observed improvements. To that end, all patients with type 1 diabetes mellitus who used the DEXCOM rtCGM device (Terumo Corporation, Tokyo, Japan) at our institution were reviewed, and 16 individuals with type 1 diabetes who switched from isCGM to rtCGM were investigated. The patients' HbA1c decreased in 75% of the cases (p = 0.02). On the other hand, GMI increased in 75% of the cases (p = 0.01). Intriguingly, the percentage of time below range and coefficient of variation were significantly improved with rtCGM compared to isCGM (2.9% vs. 7.6%, p = 0.016 and 35% vs. 40%, p = 0.0019, respectively). We also found that the discrepancy between HbA1c and GMI among users of isCGM was a key indicator that improved when switching to rtCGM. If discrepancies are observed between HbA1c and GMI when using isCGM, switching to rtCGM should be considered for improving glycemic control.

Does Future Time Perspective Moderate Associations of Instrumental and Affective Attitude With Exercise Behavior? A Three-Wave Longitudinal Survey Among Japanese Older Adults.

OBJECTIVES: To develop effective promotion strategies for exercise behavior in older adults, it is essential to identify the psychological determinants. Previous studies investigated affective and instrumental attitudes as determinants. However, from the conceptual assumptions of socioemotional selectivity theory, affective attitudes might be more influential on the exercise behavior of older adults with an expansive future time perspective, whereas instrumental attitudes would be more influential on those with limited perspectives. This study examined whether the associations of affective and instrumental attitudes with behavioral intention and exercise behavior differed according to future time perspective among older Japanese adults. METHODS: Data were obtained from a 3-wave longitudinal questionnaire survey of 886 individuals (Wave 1: December 2017-January 2018; Wave 2, 1-year follow-up; Wave 3, 3-year follow-up). Using the data on exercise behavior, affective and instrumental attitudes, and behavioral intention at each wave, and the data of future time perspective and demographic factors at Wave 1, this study performed multiple regression analyses and a multigroup cross-lagged model. RESULTS: Affective attitude was a significant predictor of behavioral intention regardless of future time perspective. Although instrumental attitude significantly predicted behavioral intention among those with a lower future time perspective, it did not predict behavioral intention among those with middle-to-higher future time perspective. Regardless of future time perspective, affective attitude, but not instrumental attitude, significantly predicted exercise behavior. DISCUSSION: Unlike the socioemotional selectivity theory, this study found that affective attitude was more influential on exercise behavior than instrumental attitude regardless of future time perspective among them.

Effect of dipeptidyl peptidase-4 inhibitors on glycated hemoglobin levels relies on dietary sodium intake.

AIMS: Sodium load increases endogenous glucagon-like peptide-1 (GLP-1) levels in humans. Therefore, patients with an increased amount of dietary sodium intake are supposed to have higher endogenous GLP-1 levels compared to those with less dietary sodium intake. Therefore, it can be hypothesized that patients with type 2 diabetes mellitus (T2DM) with more dietary sodium intake show better dipeptidyl peptidase-4 inhibitor (DPP-4i) effect on glycemic control because of the expected higher GLP-1 level. Thus, we performed a single-center cohort study to explore this idea. METHODS: Medical records of patients with T2DM prescribed DPP-4i in the last 11 years were investigated. Dietary sodium intake was measured before the DPP-4i prescription with Tanaka's formula using casual spot urine samples. The effect of DPP-4i on glycemic control was estimated by the subtraction of glycated hemoglobin (HbA1c) before DPP-4i initiation from HbA1c 1 year after DPP-4i administration. We analyzed 50 patients. RESULTS: DPP-4i improved HbA1c by -0.41% ± 0.66%. The effect of DPP-4i on glycemic control was significantly negatively correlated with the dietary sodium intake (r = -0.400). Thus, the more dietary sodium intake, the better the glycemic control by DPP-4i. CONCLUSIONS: Thus, patients can expect better plasma glucose control by DPP-4is if patients are taking increased dietary sodium intake.