Background: Changes in resting membrane potential due to extracellular potassium ([K+]_e) accumulation are thought to be responsible for TQ segment depression in ischemia. However, the nature of the [K+]_e-TQ relationship remains to be fully elucidated. Methods: We created a carotid-coronary shunt in 21 pigs, and recorded [K+]_e and TQ-segment potentials simultaneously during graded left anterior descending artery (LAD) flow reduction via 4-6 K⁺-sensitive electrodes placed in the LAD. Only data from K⁺ electrodes with calibration slopes of 55-65 mV/decade change in K⁺ were used. Results: While the correlation between the changes in potassium equilibrium potential (E_K) and the TQ shift was linear, the regression slopes initially increased and then decreased during graded flow reduction (S = -0.338, Q = 30 mL/minute, S = -3.253, Q = 10 mL/minute, S = -0.312, Q = 0 mL/minute), i.e., TQ depression at all E_K values became larger, then smaller as the flow was decreased in a stepwise manner. The inhomogeneity of changes in [K+]_e and TQ potential changes and their relationship also decreased initially then increased during graded flow reduction (R = -0.237, LAD flow = 30 mL/minute; R = -0.819, LAD flow = 15 mL/minute; R = -0.115, LAD flow = 0 mL/minute). Conclusions: Although [K+]_e and the TQ shift are related linearly, there is large variability in their relationship in the setting of graded coronary flow reduction. Therefore, local TQ-segment potentials cannot be used as indices of the severity of ischemic changes.

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Background: Sites of high dominant frequency (DF) and complex fractionated atrial electrograms (CFAEs) are used as ablation targets to eliminate atrial fibrillation (AF). These sites are identified using spectral and time domain analyses. The frequency spectrum of the signal is determined by its cycle length as well as the morphology and amplitude of the electrogram, and these factors can affect the DF analysis. We determined the DFs, mean AF cycle lengths (fractionation intervals [FIs]), and voltages from bipolar and unipolar electrograms-and compared the values derived from the 2 types of recordings. Methods: Five patients with paroxysmal AF and 5 patients with persistent AF were included in the study. Highdensity unipolar electrograms recorded through a band-pass filter of 1-400 Hz and bipolar electrograms recorded through a band-pass filter of 30-400 Hz were obtained with the use of a 20-pole circular mapping catheter positioned in the left atrium (LA), and DF, AF cycle length, and unipolar and bipolar voltages during sinus rhythm (SR) were analyzed with the use of NavX software. Results: While the unipolar FIs were longer than the bipolar FIs, the bipolar and unipolar DFs were similar. The SR voltages of the unipolar and bipolar electrograms at CFAE sites (FIs <120 msec) were higher than those at the non-CFAE sites, but did not differ between the high DF (>8 Hz) and other DF sites. Overlap between the CFAE sites and the high DF sites identified from both bipolar and unipolar electrograms was only 7.9%. Conclusion: FIs and DFs may represent different electrophysiologic substrates.

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脳挫傷の治療では，血管内微小血栓による二次性脳損傷をいかに抑制するかが重要である．Cilostazol は抗血小板剤として脳梗塞の予防に広く用いられている．この抗血小板作用は脳挫傷における血管内微小血栓形成を抑制する効果を期待できるが，その反面，出血の増悪を起こすことが危惧される．この研究の目的は脳挫傷におけるcilostazol の効果を明らかにすることである．Controlled cortical impact (CCI) device を用いてラット脳挫傷モデルを作成した．CCI 単独群，aspirin 群，cilostazol 群の3 群に分けて，急性期での血管透過性亢進と血管内微小血栓形成，そして慢性期での脳挫傷体積を比較した．Aspirin 群では急性期の出血が著明であった．Evans blue 漏出体積を計測し血管透過性の亢進を評価すると，cilostazol 群ではCCI 単独群およびaspirin 群と比較し有意な減少を認めた(p＜0.05)．さらに慢性期における脳挫傷体積は，CCI 単独群と比べ，aspirin 群での脳挫傷欠損体積が有意に大きく，cilostazol 群では有意に小さかった (p＜0.05)．Cilostazol は急性期の血管内微小血栓の形成を軽減させた．一方でprogressive hemorrhage は軽度に抑えることができることから，脳挫傷での血管内皮保護効果や血管内皮機能改善効果の関与が示唆された．脳挫傷に対するcilostazol による治療の可能性が期待される．

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Objectives: To improve the survival rate in patients with nasopharyngeal squamous cell carcinoma (NSCC). Material and Methods: A total of 56 patients with NSCC were enrolled in this study, in order to observe the long-term survival. The primary site was treated conservatively with neoadjuvant chemotherapy (NAC) and concurrent chemoradiation therapy (CCRT), using superselective intra-arterial infusion chemotherapy (SSIAC) with cisplatin, docetaxel, and 5-fluorouracil. Cervical lymph node metastasis was treated using neck dissection. Results: The 5- and 10-year overall survival rates were 67.9 and 60.5%, respectively. The 5- and 10-year survival rates improved particularly in patients with T3 cancer (96.5 and 96.5%, respectively), N1 cancer (100 and 100%, respectively), and poorly-differentiated cancer (88.2 and 79.2%, respectively). In contrast, the 5- and 10-year survival rates were worse in patients with T4 cancer (28.7 and 0%, respectively), N3 cancer (11.1 and 0%, respectively), and moderately-differentiated cancer (18.7 and 0%, respectively). There were significant differences in the overall survival rates between patients with stage III and IVA, stage III and IVB, and between IVA and IVB NSSC. Conclusion: We demonstrated that NAC and CCRT using SSIAC, with neck dissection to control cervical lymph node metastasis, were safe and effective in patients with NSCC. The introduction of maintenance therapy and intensity-modulated radiation therapy (IMRT), as well as molecular-targeted drugs and heavy-particle radiotherapy, should be considered.

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高齢者の中大脳動脈(middle cerebral artery: MCA) 領域脳梗塞では，脳萎縮の存在が生命・機能予後に影響すると報告されている．そこで，我々は計測するに簡便な二次元（梗塞面積）の評価方法を提唱すると同時に，病前の脳萎縮の程度を加味できる新評価法とすることで，それらが生命・機能予後の予見可能性を評価した．2009 年から2011 年までに当院に入院した60 歳以上のMCA 領域梗塞患者86 例を解析した．生命予後の点では脳萎縮を加味した測定法が有用であった．一方，機能転帰予測には脳萎縮を加味する利点はなかった．これは，脳萎縮が高度であれば急性期生命予後を改善する一方で，機能予後を悪化させる逆説的な結果となった．このことから，脳萎縮を同時に考慮し，評価に加えられるこの方法が，高齢者の広範囲MCA 梗塞に対する治療選択の一助になると考えられた．

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胸腺癌は稀な疾患であり，外科的切除の可否が大きく予後に影響する．分子標的薬治療において数種の分子標的薬関連蛋白は他臓器同様に胸腺癌においても効果が実証されている．しかし，Peroxisome Proliferator-Activated Receptor γ (PPARγ) は胸腺癌に対して未だ有効性が証明されていない．今回，胸腺癌群8 例，胸腺腫群(Type B3) 8 例の症例でPPARγ に対するモノクローナル抗体を使用し免疫組織化学染色を行い，発現率，発現陽性率，胸腺癌群における発現陽性群と陰性群間での生存率を算出し，これらの発現が (1) 診断因子，(2) 予後因子，(3) 治療選択因子となりうるかを検討した．結果：PPARγ は胸腺癌群で発現率，発現陽性率が有意に高率であり，胸腺癌における陽性群で生存率の有意な延長を認めた．PPARγ の高発現が診断因子，予後因子，治療選択因子となりうる可能性が示唆された．

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症例は60 歳代，男性．膿気胸で胸腔鏡下膿胸腔掻爬，肺部分切除術を施行したが，退院後2 ヶ月で手術時のドレーン抜去部から膿性排液がみられたため，膿気胸再発の診断で再入院となった．ドレナージで経過をみていたが，抗生剤治療による薬剤性腎障害を発症したため，開窓術を行った．開窓術後第2 病日に呼吸困難を訴え，肺の高度虚脱を認めた．胸腔内を陰圧に保つ必要があり，開胸創を密閉できるVAC 治療システムを使用することとし，携帯が可能なActiV.A.C.^® 型陰圧維持管理装置（KCI 社，以降Acti 型）を装着した．25 mmHg の陰圧で維持すると肺は良好に伸展，呼吸困難は改善した．また，当初は二期的に開窓部を閉鎖する手術を考えていたが，創部の狭小化と肺の伸展を認め，術後10 ヶ月の時点で創は完全に閉鎖し上皮化した．VAC 療法は簡便であり，Acti 型は携帯可能なことから外来通院も可能で呼吸器外科領域でも安全に使用できると考えられた．

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