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Biomedical subjects

Y Suda

Publications and source records attributed to Y Suda.

At least 19 recordsLinked to original sources

Dissociative ionization of ethanol by 400 nm femtosecond laser pulses.

The dissociative ionization of ethanol in short-pulsed laser fields at approximately 400 nm is investigated. The yield ratio of the C-O bond breaking with respect to the C-C bond breaking increases sharply as the temporal width increases from 60 to 400 fs, and the yield ratio is two to three times as large as that at 800 nm in the entire pulse-width range of 60-580 fs. The enhancement of the C-O bond breaking of singly charged ethanol at 400 nm and the bond elongation prior to the Coulomb explosion of doubly charged ethanol occurring in the relatively weak light field intensity of 10(12)-10(13) W cm(2) is interpreted by the efficient light-induced coupling among the electronic states at the shorter wavelength of 400 nm. From the double pulse experiment, in which ethanol is irradiated with a pair of short pulses (<80 fs), the most efficient coupling occurs at Deltat=160 fs that is much earlier than Deltat=250 at 800 nm, where Deltat denotes the temporal separation of the two pulses, indicating that the nonadiabatic field-induced potential crossings of singly charged ethanol occurs much earlier at 400 nm than at 800 nm.

Journal Article↗

Infected Charcot spine.

STUDY DESIGN: Case report of an infected Charcot spine following spinal cord injury. OBJECTIVE: To describe this very rare pathological condition and the results of surgical treatment. SETTING: A department of orthopaedic surgery in Japan. METHODS: A 44-year-old man presented with a destructive lesion in the lumbo-sacral spine and a fistula in his back. Anterior bone graft, percutaneous external spinal fixation, and suction/irrigation of the wound were performed. After 4 months, posterior spinal instrumentation surgery was carried out. RESULTS: Primary closure of the fistula and complete bone fusion was achieved after the operation. CONCLUSION: Infection of a Charcot spine, although a rare clinical entity, should be considered as a diagnostic possibility in the spinal cord-injured patients. External spinal fixation is a useful method for the unstable spinal lesion with infection.

Adult↗

Conservative treatment of isolated posterior cruciate ligament injury in professional baseball players: a report of two cases.

Conservative treatment is currently recommended for most isolated posterior cruciate ligament (PCL) injuries in athletes. However, it is not known whether conservative treatment is applicable even in high performance athletes with isolated PCL injury. The results in two extremely high performance athletes, professional baseball players with isolated acute PCL injury treated conservatively are reported. A catcher and an out fielder, who were regular players, hurt their knees in baseball games. Magnetic resonance images of the knee detected complete PCL rupture. Following a carefully guided physical therapy program, a 3-week period of immobilization of the knee in full extension was achieved with a knee brace, while performing hard quadriceps muscle strengthening exercise, and then running exercise was started. Six to eight weeks after injury, they were able to return fully to their original sporting activity despite tibial posterior translation on posterior drawer test, and to sustain this activity over 2 years. Switching of weight-bearing to non-weight-bearing in a deep knee flexion is considered to contribute to subjective instability in athletes with PCL-deficiency. Probably because our cases, even though extremely high performance athletes were infrequently subjected to such a situation while playing baseball, they were able to return to their pre-injury level of athletic performance without severe subjective instability through conservative treatment.

Adult↗

[Natural Y-grafting using internal thoracic artery branches for off-pump coronary artery bypass].

The excellent long-term patency rates achieved utilizing the internal thoracic arteries (ITAs) have stimulated a variety of approaches to expand the use of these conduits in coronary revascularization. The ITA divides at the level of the fifth or sixth intercostal space into the superior epigastric and musculophrenic branches. If these terminal branches of the ITA are large and long enough for grafting, they can be used to construct a "Y" anastomosis to the coronary arteries. We experienced 2 patients who underwent multivessel off-pump coronary artery bypass (OPCAB) using these ITA branches. In both patients the bilateral ITAs and the right gastroepiploic artery were taken down using the skeletonization technique as in situ grafts. One patient had 5 grafts including the right ITA terminal branches which were used for the left anterior descending branch (LAD) and diagonal branch. Another patient had 6 grafts including the left ITA terminal branches which were used for the posterolateral branch (PL)1 and PL2. Postoperative angiography revealed widely patent grafts in both patients. We believe that one of the advantages of applying the off-pump technique when the ITA branches are used is that it might be easier to arrange the angle of constructing a natural "Y" configuration compared with conventional coronary artery bypass grafting (CABG). In conclusion, the terminal branches of the ITA, if of suitable size, should be considered for "Y" grafts to diseased coronary arteries when performing complete arterial revascularization with only in situ grafts.

Aged↗

[How much can off-pump coronary artery bypass grafting be performed for complete revascularization using only in situ arterial conduits?].

With the rapid advance of percutaneous catheter intervention, the direction taken by surgeons is not only to make coronary artery bypass grafting (CABG) less invasive but also to obtain better long-term results by using more arterial conduits. However, off-pump CABG (OPCAB) with only in situ arterial conduits such as the left and right internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA) is technically demanding for the surgeon. The purpose of this study was to demonstrate the feasibility and safety of this technique. From January 2002 to December 2002, 57 patients underwent isolated CABG without cardiopulmonary bypass, excluding minimally invasive direct coronary artery bypass (MIDCAB) cases. There were 44 men and 13 women with a mean age of 64.1 years. Most of the patients (95%) underwent postoperative angiography within 1 month after surgery. The mean number of anastomoses was 3.8 +/- 1.4 (range 2-8). One patient suffered from mediastinitis and another from stroke. All patients were discharged from the hospital. Fifty patients (88%) received only in situ grafts for complete revascularization. Forty-one patients received bilateral ITAs and 27 received bilateral ITAs and RGEA. The mean number of anastomoses using bilateral ITAs and RGEA was 4.5 +/- 1.2 (range 3-8). The patency rate was 98%. Complete arterial revascularization with only in situ arterial conduits was associated with minimal operative risk and a high early graft patency rate, even in the off-pump situation. These results indicate that complete revascularization can be achieved in OPCAB with the exclusive use of in situ arterial conduits in patients with diffuse coronary arterial disease.

Adult↗

[Multivessel off-pump coronary aortic bypass grafting with an impaired and severely dilated left ventricle using the Starfish heart positioner].

Off-pump coronary artery bypass grafting (OPCAB) is gaining acceptance and is now more widely used for coronary revascularization worldwide. Accessing the vessels, particularly on the lateral and inferior walls of the heart, can sometimes be challenging while the heart is beating, especially in hearts with an impaired and severely dilated left ventricle. The Starfish heart positioner was designed to achieve optimal exposure of the lateral and inferior walls of the heart with minimal hemodynamic compromise. This device was used in a patient with a severely impaired and dilated left ventricle to successfully position the heart for quadruple bypass grafting using all in situ arterial grafts, such as bilateral international thoracic arteries (ITAs) and the right gastroepiploic artery. The degree of hematoma caused by the pressure of the suction cup of this device was minimal. This case report suggests that the use of Starfish heart positioner will facilitate and expand the ability of surgeons to easily and consistently perform OPCAB.

Coronary Artery Bypass↗

Surgically treated aortic root aneurysm following aortic valve replacement.

A 65-year-old man with aortic regurgitation underwent aortic valve replacement with a St. Jude Medical prosthetic valve about 6 years ago. At that time, the aortic root was slightly dilated at about 40 mm in diameter and the ascending aorta was within the normal range. This year, the man was diagnosed with an aortic root aneurysm in regular follow-up echocardiography. Chest-enhanced computed tomography and chest aortography at our hospital demonstrated a pear-like aortic root aneurysm about 60 mm in diameter. Elective operation for the aortic root aneurysm was conducted September 29, 1999, based on the Bentall procedure. Composite graft replacement with coronary reconstruction was conducted using a 28-mm Hemashield prosthetic graft and a 23-mm St. Jude Medical prosthetic valve under cardiopulmonary bypass. An 8-mm Hemashield graft was interposed on the left main coronary artery and the right coronary artery was directly anastomosed using a Carrel patch method. The postoperative course was uneventful and post-operative examination demonstrated good surgical results. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. Surgical cases of aortic root aneurysm after aortic valve replacement are rare, but serious complications with the possibility of rupture or dissection warrant surgical intervention.

Aged↗

Coexistence of lung cancer and hamartoma.

We present a rare case of a synchronous primary lung cancer adjacent to a hamartoma. A 71-year-old woman was admitted with congestive heart failure due to acute myocardial infarction. A chest radiogram on admission showed pulmonary edema with a tumor shadow in the right upper lung field. Because histological diagnosis was not obtained preoperatively, a wedge resection of the lung was conducted using video-assisted thoracoscopic surgery. The histopathological examination confirmed the coexistence of an adenocarcinoma with a chondromatous hamartoma. Right upper lobectomy was performed followed by excision of the mediastinal lymph nodes. Although hamartoma is generally considered to be a benign neoplasm, there have been several reports of increased risk to lung cancer in patients with a chondromatous hamartoma. Therefore, we recommend that patients with a hamartoma should be submitted to a complete evaluation and to regular follow-up, considering the risk to associated synchronous malignancy.

Adenocarcinoma↗

Outcome of patients with non-Hodgkin's lymphoma of the stomach after gastrectomy: clinicopathologic study and reclassification according to the revised European-American lymphoma classification.

BACKGROUND: The best treatment for patients with non-Hodgkin's lymphoma (NHL) of the stomach is still uncertain. The revised European-American lymphoma (REAL) classification has helped to define new, potentially more appropriate classification schemes for gastric lymphomas. METHODS: Fifty-one resected gastric lymphomas were reclassified according to the REAL classification, and the efficacy of multimodal treatment was examined retrospectively. The principal treatment plan consisted of: (1) surgical resection of the stomach with lymph node dissection, followed by (2) systemic chemotherapy, mainly using the cyclophosphamide/doxorubicin/vincristine/prednisone (CHOP) regimen. RESULTS: According to the Ann Arbor classification, 27 patients had stage IE, 19 had stage IIE, and 5 had stage IV NHL. Using the REAL classification, we diagnosed diffuse large B-cell lymphoma (DLBL) in 23 patients, marginal zone B-cell (low-grade mucosa-associated lymphoid tissue [MALT]-type) lymphoma in 22, follicle center lymphoma in 4, mantle cell lymphoma in 1, and peripheral T-cell lymphoma in 1 patient. Nine of the 51 patients relapsed, and 8 patients with DLBL died of cancer. Survival rates at 5 years after surgery were 96.0% for stage IE, 83.3% for stage IIE, and 87.0% for all patients. Univariate analysis indicated that the tumor histology (according to the REAL classification), depth of invasion, degree of nodal involvement, Ann Arbor staging, and chemotherapy had an impact on patient outcome (P = 0.0018; P = 0.0002; P = 0.0308; P = 0.0016, and P = 0.0118, respectively). CONCLUSIONS: These data reveal that gastric NHL, especially of the low-grade MALT-type, often remains localized and has a good prognosis after surgery. The REAL classification was useful for classifying new categories of NHL, including the MALT-type, in the clinical setting, and for determining the optimal treatment modality for gastric NHL.

Female↗

Roles of the anterior cruciate ligament and the medial collateral ligament in preventing valgus instability.

Both the medial collateral ligament (MCL) and the anterior cruciate ligament (ACL) are reported to prevent valgus instability of the knee. In this study, the anatomical mechanisms by which these ligaments prevent valgus instability were experimentally investigated. The valgus rotation angle and the magnitude of the medial joint space opening were measured in six cadaveric knees, using biplanar photography before and after the MCL and/or the ACL were severed. A significant increase in the valgus rotation angle and a large medial joint space opening were observed when the MCL was severed. An increase in the valgus rotation angle was also observed when the ACL was severed, but only a small medial joint space opening was present. The increase in the valgus rotation angle after ACL severance was nearly parallel to the increase in the internal rotation of the tibia. Thus, we concluded that both ligaments function to prevent valgus instability, but that the anatomical reasons for their function are different. The MCL prevents valgus instability by stopping an opening in the medial joint space. The ACL, on the other hand, prevents the internal rotation of the tibia. When the ACL is severed, the internal rotation increases, and causes the valgus rotation angle to also increase, despite the presence of only a small medial joint space opening.

Adult↗

Partial median sternotomy as a minimal access for off-pump coronary artery bypass grafting: feasibility of the lower-end sternal splitting approach.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) can be performed in several ways using a minimally invasive approach (MIDCAB). Using the left anterior small thoracotomy (LAST) approach, only the LAD can be grafted. To expand the indications for MIDCAB from single-vessel disease to double-vessel disease, we have used a partial sternotomy without a transverse cut, namely, the lower-end sternal splitting (LESS) approach. Through this approach, the LAD and RCA can be revascularized by means of a single small incision without the risk of damaging the tissue around the intercostal space during harvesting of ITA when the sternum is transversely divided. The purpose of this study was to demonstrate the feasibility and safety of this technique. METHODS: Between November 1999 and November 2000, a total of 22 patients underwent MIDCAB through a lower midline skin incision from the fourth intercostal space to the xiphoid process with longitudinal division of the lower half sternum up to the 3rd rib, without either a T- or reversed L-shaped division of the sternum. Of the patients, 14 had LAD disease only, 5 had both LAD and RCA disease, 2 had RCA disease only, and 1 had left main trunk disease. Two of the operations were of redo coronary artery bypass grafting. The mean age was 69.5 +/- 6.1 years (range 58 to 77 years). RESULTS: The mean length of the skin incision was 8.5 +/- 1.4 cm (range 7 to 12 cm). No hospital death or morbidity was observed. All patients had arterial conduits: LIMA in 20 patients, RIMA in 3, RGEA in 4, and RA in 1. The mean number of grafts per patient was 1.3 +/- 0.6 (range 1 to 3). No blood transfusion was required perioperatively. The patency rate was 96%. All patients were in New York Heart Association class I and no wound complications or postoperative pain occurred during follow-up. CONCLUSIONS: Our experience demonstrates that the LESS approach for MIDCAB is technically feasible for revascularizing not only the LAD but also the RCA system, with the same small incision using IMA and GEA. It can be used with excellent cosmetic results and safety. Although our experience is limited, we conclude that this less invasive surgical technique can be used as an alternative approach for MIDCAB in patients with LAD or RCA disease.

Aged↗

Changes in ultra-low and very low frequency heart rate variability after coronary artery bypass grafting.

This study was performed to assess the effects of coronary artery bypass grafting (CABG) on the ultra-low (ULF) and very low (VLF) frequency components of heart rate variability (HRV). Forty-nine CABG patients (aged from 38 to 77 years) were examined by 24-h ambulatory electrocardiographic (AECG) monitoring, both preoperatively and 4 weeks after CABG. HRV spectral components were obtained by maximum entropy method analysis. Then the ULF, VLF, low frequency (LF), high frequency (HF) and total frequency (TF) components were compared before and after CABG. The average 24-h heart rate increased significantly after CABG (69+/-11.5 vs 82.9+/-10.9 beats per minute [bpm], P < 0.0001). The power of the ULF, VLF, and LF spectral components showed a decrease after surgery (2,859.9 vs 1,601.2 ms2, P<0.0001, 1,215.0 vs 572.3 ms2, P<0.0001, and 260.3 vs 125.9 ms2, P< 0.002, respectively), but the HF power did not show any significant change (98.7 vs 125.9 ms2, NS). Analysis of the normalized ratio of the ULF component (ULF/TF ratio) revealed a significant increase postoperatively (0.6496+/-0.0931 vs 0.7003+/-0.1338, P < 0.0001), but the VLF/TF and LF/TF ratios decreased after CABG (from 0.2671+/-0.0689 to 0.2040+/-0.0832, P< 0.0001 and from 0.0568+/-0.0290 to 0.0429+/-0.0232, P< 0.0088, respectively). In contrast, there was no significant alteration in the HF/TF ratio. These results suggest that recovery of cardiac autonomic activity is delayed after surgery. However, improvement of the ULF/TF ratio, one of the prognostic indicators for patients with cardiac disease, should be related to the relief of myocardial ischemia by CABG.

Aged↗

Structural elucidation of a capsular polysaccharide from a clinical isolate of Bacteroides vulgatus from a patient with Crohn's disease.

The structure of a capsular polysaccharide (CPS) from a clinical isolate of Bacteroides vulgatus was elucidated. B. vulgatus IMCJ 1204 was isolated from feces of a patient with Crohn's disease. CPS was prepared by phenol/water extraction of the bacterial cells followed by hydrophobic interaction chromatography and then gel filtration chromatography of the extract. The structure of CPS was determined by chemical analysis and NMR spectroscopy including DQF-COSY, TOCSY, ROESY, HSQC-TOCSY, HMQC and HMBC to be a polysaccharide composed of the following repeating unit: -->3)beta-D-Glcp(1-->6)[alpha-D-GalpNAc(1-->2)beta-D-Galp(1-->4)]beta-D-GlcpNAc(1-->3)alpha-D-Galp(1-->4)beta-D-Manp(1-->.

Bacterial Capsules↗

Changes in occlusal state of patients with mandibular prognathism after orthognathic surgery: a pilot study.

This study examined the occlusal state of patients with mandibular prognathism and compared it with that of adults with normal occlusion (controls). It also examined changes in occlusal state after orthognathic operations in these patients. The values of occlusal contact area and bite force in patients before operation were significantly lower than in controls, and occlusal pressure in patients was higher than in controls. The occlusal contact area and bite force of the patients 1 month after the operation had decreased to below preoperative values. These values 12 months after the operation had increased by 2.0 and 1.8 times in women and 1.4 and 1.4 times in men, respectively, compared with preoperative values. However, absolute values remained extremely low compared with those of controls. In contrast to the above, occlusal pressure reached its maximum value 1 month after the operation and at 12 months it was close to the value for controls.

Adult↗

Proper use of MR imaging in internal derangement of the knee (orthopedic surgeon's view).

MR imaging of the knee is a highly accurate examination in terms of the detection of meniscal tears and cruciate ligament ruptures among internal derangement of the knee. The overall accuracy in more than 2000 published cases reached nearly as high as 90% in meniscal tears, and 94% in anterior cruciate ligament (ACL) and 99% in posterior cruciate ligament (PCL) ruptures. Furthermore, the negative predictive value of the knee MR imaging, the number of true negative examination results divided by the numbers of true negative plus false-negative examination results, reaches almost 100% because of its very low false-negative rate. Therefore, from the orthopedic surgeon's point of view, even though the medical cost becomes a great concern, MR imaging has prime importance in the diagnosis of the internal derangement of the knee.

Anterior Cruciate Ligament Injuries↗

Heparin modulates integrin function in human platelets.

PURPOSE: Heparin binds to human platelets and can cause activation and aggregation, although the mechanisms are unknown. To determine how heparin alters platelet function, we identified platelet-binding sites for heparin and measured heparin's influence on the function of platelet integrin alpha(IIb)beta(3) (glycoprotein IIb/IIIa). METHODS: Photoaffinity cross-linking and affinity chromatography experiments were performed to identify platelet membrane proteins that bind heparin. Heparin's effect on fibrinogen binding to platelets was measured with a radioligand-binding assay. The translocation to the cytoskeleton of Rap2, a guanosine triphosphate-binding protein, was measured from platelets aggregating in response to heparin and other agonists. RESULTS: Cross-linking and affinity chromatographic experiments positively identified the integrin alpha(IIb)beta(3) as a heparin-binding site. Heparin aggregation was calcium dependent. Low concentrations of unfractionated porcine mucosal heparin (2-5 U/mL) significantly increased fibrinogen I 125 binding to activated platelets, whereas higher doses did not. Heparin-mediated platelet aggregation was completely blocked by GRGDS peptide (5 mmol/L), a competitive inhibitor of fibrinogen binding, and was blocked by EDTA (2 mmol/L), which dissociates the functional integrin complex. Aggregation was associated with Rap2 translocation to the cytoskeleton, a sign of outside-in signaling. CONCLUSIONS: Heparin binds to the alpha(IIb)beta(3) integrin in vitro and ex vivo, and heparin increases fibrinogen binding to the integrin. Heparin-mediated aggregation requires an intact integrin and ligand and leads to Rap2 translocation to the cytoskeleton-an outside-in signal of ligand engagement. Heparin may directly modulate platelet integrin function, most likely through direct binding and modulation of integrin function.

Binding Sites↗

A novel method to study contraction characteristics of a single cardiac myocyte using carbon fibers.

To facilitate cardiac muscle research, we developed a novel method by which the force and length of a single ventricular myocyte can be recorded with a pair of carbon graphite fibers attached firmly to both ends. One fiber was stiff, whereas the other fiber was compliant to allow the recording of force and shortening during twitch contractions. The image of the compliant carbon fiber was projected onto a pair of photodiodes, and their output was fed to a piezoelectric transducer after variable amplifications to alter the effective compliance of the carbon fiber. Thus contraction of the myocyte was induced under virtually isometric conditions as well as under auxotonic conditions. We obtained a bell-shaped relation between the compliance under an auxotonic load and the work output of the myocyte, which was directly related to myocyte performance in the heart. Because it is easy to attach myocytes to the experimental apparatus, the present method would allow us to study cardiac muscle mechanics at the cellular and molecular levels.

Animals↗

Emx2 directs the development of diencephalon in cooperation with Otx2.

The vertebrate brain is among the most complex biological structures of which the organization remains unclear. Increasing numbers of studies have accumulated on the molecular basis of midbrain/hindbrain development, yet relatively little is known about forebrain organization. Nested expression among Otx and Emx genes has implicated their roles in rostral brain regionalization, but single mutant phenotypes of these genes have not provided sufficient information. In order to genetically determine the interaction between Emx and Otx genes in forebrain development, we have examined Emx2(-/-)Otx2(+/-) double mutants and Emx2 knock-in mutants into the Otx2 locus (Otx2(+/Emx2)). Emx2(-/-)Otx2(+/-) double mutants did not develop diencephalic structures such as ventral thalamus, dorsal thalamus/epithalamus and anterior pretectum. The defects were attributed to the loss of the Emx2-positive region at the three- to four-somite stage, when its expression occurs in the laterocaudal forebrain primordia. Ventral structures such as the hypothalamus, mammillary region and tegmentum developed normally. Moreover, dorsally the posterior pretectum and posterior commissure were also present in the double mutants. In contrast, Otx2(+/Emx2) knock-in mutants displayed the majority of these diencephalic structures; however, the posterior pretectum and posterior commissure were specifically absent. Consequently, development of the dorsal and ventral thalamus and anterior pretectum requires cooperation between Emx2 and Otx2, whereas Emx2 expression is incompatible with development of the commissural region of the pretectum.

Animals↗