Although glucose becomes an important preferential substrate for cardiac metabolism in ischemic heart diseases, insulin resistance (IR), a prominent feature in diabetes, impairs myocardial glucose utilization, leading to an energy deficiency state in ischemic myocardium. Recent large-scale clinical trials have shown that SGLT2-inhibitors reduce cardiovascular events in diabetic patients. However, the functional significance of cardiac SGLTs compared with those of other glucose transporters (insulin-dependent GLUT4 is the major isoform) remain incompletely understood. We found that GLUT4 expression was reduced in high-fat-diet (HFD)-induced obese mice hearts both at baseline and in response to ischemia-reperfusion, whereas in contrast, SGLT1 expression was maintained constant during ischemia-reperfusion regardless of diet conditions. SGLT2 was not detected in the hearts of any mice. After ischemia-reperfusion, cardiac function was impaired in HFD, associated with reduction in myocardial glucose uptake, probably due to blunted GLUT4 response. Although non-selective SGLT-inhibitor, phlorizin, impaired cardiac functional recovery in normal-diet mice, further impaired functional recovery with dramatically increased infarct size and reduction in glucose uptake were observed in HFD. A series of our recent studies suggested that cardiac SGLT1 (but not SGLT2) plays a compensatory protective role via enhanced glucose utilization, particularly under IR condition, in which stress-induced GLUT4 upregulation is compromised.

Within 1377 patients with varicose vein surgery, 9 patients had ascending thrombophlebitis in our hospital. All patients underwent anticoagulation therapy before surgery, and the mean days until the operation was 28.8 days. Endovenous thermal ablation was performed for patients who had lost thrombus after anticoagulation, and stripping surgery was selected for patients had remained thrombus. Although there is no fixed treatment policy, our perioperative results are satisfactory and our treatment policy is considered to be appropriate.

Residual dissecting aneurysm of the thoracoabdominal aorta after replacement of the proximal descending aorta is difficult to treat and an open repair is considered to be very high risk. Here we report a patient underwent two staged endovascular treatment for such pathology. The early result seemed to be successful, however, further careful observation is mandatory.

We report a case of a 45-year-old man, who was transported as an emergency case to our institution because of type B dissection with paraplegia and acute renal failure. Computed tomography (CT) showed severe stenosis of the true lumen by pressure of thrombus of false lumen, and laboratory data demonstrated renal ischemia. We performed TEVAR succesfully, but severe stenosis of the true lumen remained narrow. So, we added Peripheral self-expanding stent in narrow true lumen. After the operation, patient improved urine output and laboratory data. And narrow true lumen was gradually expanded.