Although immune function is a factor in cases of sepsis with high mortality, it cannot be measured at the bedside. We investigated blood cytokines and the capacity of nucleated blood cells (NBCs) to produce cytokines (IL-6, 8, 10) using clinical data from septic patients, and considered how this was related to the patient outcome. This study targeted thirty patients suffering from severe sepsis or septic shock. Peripheral whole blood was collected prior to treatment for sepsis, 6 hours after such treatment, and again at 24 hours post-initiation. Residual peripheral blood was placed into laboratory dishes and exogenous lipopolysaccharide (LPS) was added (10 ng/mL). The capacity of NBCs to produce cytokines was calculated using the ratio of each cytokine before (nonLPS) and after (s-LPS) in vitro LPS stimulation (s-LPS/non-LPS). The ratio of these cytokines exhibited significant negative correlations with a higher APACHE II scores. The APACHE II score was significantly associated with a poor outcome, but there was no correlation with outcome for any other clinical data. A higher APACHE II score could be used to indirectly estimate immunoparalysis in the clinical setting.

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Background: Pacing induced atrial fibrillation (AF) has been shown to induce significant increases in sympathetic and parasympathetic neurons in dogs, and the efficacy of cardiac autonomic denervation by ganglionated plexi (GP) has been shown to increase the freedom from recurrence of AF. We compared the GP response to high-frequency stimulation (HFS) in patients with and without AF. Methods: The responses to HFS (20 Hz, 25 mA, 10 ms) at 5 left atrial GP sites were evaluated in 24 patients with AF (paroxysmal: 11, persistent AF: 5) and 16 patients with left side accessory pathways . Results: Vagal responses (> 50% increase in RR interval) to HFS were more frequently observed in patients with AF (Table). Conclusions: AF increases left atrial cardiac autonomic nervous system activity, which may contribute to the adjunct role of GP ablation following pulmonary vein isolation

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Background: Similar clinical outcomes have been demonstrated following pulmonary vein (PV) isolation (I) by radiofrequency catheter and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (PAF). However, no comparison of the clinical outcome in patients with PAF and persistent AF (PerAF) by CBA has been reported to date. The purpose of this study was to compare the efficacy of PVI in patients with PAF and PerAF. Methods: CBA based PVI using a second-generation 28-mm balloon was performed in 58 patients with PAF and 32 with PerAF. Follow-up (FU) was based on outpatient clinic visits at 1, 3, 6, and 12 months, which included Holter electrocardiograms and ambulatory event electrocardiograms. Results: The freedom from atrial tachyarrhythmia recurrences following a single cryoballoon ablation in patients with PAF and PerAF did not differ significantly between the PAF and PerAF patients over a relatively shorter follow-up period, as estimated by the Kaplan-Meir method. Conclusion: CB-based PVI had similar efficacy for both PAF and PerAF.

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Background: It is well known that the prevalence of atrial fibrillation (AF) increases in chronic renal failure patients undergoing hemodialysis (HD), and that AF often occurs during HD, resulting in hemodynamic instability. It is often difficult to treat AF because of the limited use of anti-arrhythmic drugs. While pulmonary vein isolation (PVI) using an irrigation-tip catheter is a widely accepted therapy for AF, little is known about the effectiveness and complications of PVI in HD patients. Method and Results: We compared the outcomes and complications between 6 HD patients (age: 64.8 ± 5.4 years, 4 men, 2 non-paroxysmal AF patients) and age- and sex-matched non-HD 12 patients (age: 66.2 ± 5.2 years, 8 men, 4 non-paroxysmal AF patients) who underwent PVI for AF. In 4 (66%) of the 6 HD patients, vascular complications (2 femoral hematoma and 1 pseudo-aneurysm) and epistaxis requiring blood transfusion occurred after the PVI, but these did not occur in the non-HD patients (p = 0.0197). There were no major complications, such as congestive heart failure, cardiac tamponade or cerebral infarction after catheter ablation, in either group. During the follow-up period of 14.6 ± 9.0 months, AF recurred in 2 HD patients (33.3%), compared with 5 (41.7%) of the non-HD patients during a follow up of 15.0 ± 13.2 months (p = 0.3904). Conclusions: Our data demonstrated the comparative efficacy of PVI using irrigation catheters between chronic HD patients and non-HD patients. Minor procedure-related complications, such as vascular complications and bleeding, were more prevalent in HD patients compared with non-HD patients.

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Background: Modulation of the intrinsic cardiac autonomic nervous system (ICANS) can occur after radiofrequency (RF) pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the effects of cryoballoon (CB) ablation and hot-balloon (HB) based PVI on the ICANS have not been evaluated. We compared the acute periprocedural effects on the ICAVS, as well as changes in heart rate variability (HRV) between RF-, CB- and HB-based PVI. Methods: The vagal response to high-frequency stimulation (25 Hz, 20 mA, 10 ms) applied to 5 major left atrial (LA)-ganglionated plexi (GP) before and after assessment of PVI in 31 patients with CB-PVI, 16 patients with HB (SATAKE Hot-BalloonTM, Toray, Tokyo, Japan), and 18 patients with RF-PVI. Among 47 patients (21: CB-PVI, 16: HB-PVI, and 10: RF-PVI) with sinus rhythm on admission, HRV was assessed for 5 minutes 1 day before and 2 days after PVI using high-resolution ECG (HRES-1000, FUKUDA DENSHI, Tokyo, Japan). Results: In the RF, CB and HB groups, 72%, 73% and 78% of the LA GPs were ablated. (P = 0.5018: N.S.) The change in heart rate (ΔHR) after PVI was increased significantly in the CB (+13.2 ± 7.1/min; P < 0.001), and HB groups (15.0 ± 8.0/min; P < 0.0001), but the HR did not change significantly in the RF group (+6.5 ± 11.3/min; P = N.S.). Conclusion: RF-, CB and HB-based PVIs affected the LA GPs response to a similar extent, but subsequent changes in heart rate exhibited different patterns between catheter- and balloon-based ablation.

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Optical microscopes are indispensable for modern medical practice and biomedical research. Though the basic design of modern microscopes was developed over 100 years ago, their optical quality has not been examined by modern physicians. In this study, we compared the optical functions of antique German microscopes with those of modern microscopes, using various samples including HE stained frog tissues, Gram-stained peripheral blood cultures and test slides of permanent silica preparations. Of great interest, the objective lenses of old microscope showed good resolution and contrast that were almost comparable to modern ones. However, the narrow field of view and the lack of lighting units were major disadvantages of these antique microscopes. In conclusion, the optical qualities of the late 19^th and early 20^th century microscopes were sufficient to support the great discoveries by hunters of microorganisms and great pathologists.

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Teratoma is the most common germ cell tumor (GCT) of the ovary. Recently, much has been learned regarding the pathogenesis of GCT from a molecular biology perspective. Based on molecular biological findings, 12p gain, and isochromosome 12p (i(12p)), unlike testicular postpubertal teratoma, most ovarian teratomas are derived from benign germ cells in a parthenogenetic-like process. Furthermore, it is known that somatic-type malignant tumors, such as cancer and sarcoma, rarely arise from dermoid cysts. Herein, we present the case of a patient diagnosed with a malignant neuroepithelial component arising from a mature teratoma. Fluorescence in situ hybridization (FISH) revealed that i(12p) was detected in the malignant component but was absent from the teratomatous portion.

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A 37-year-old woman underwent laparoscopic surgery due to uterine fibroids and right ovarian endometriosis, after undergoing GnRH analogue therapy. After surgery, she was started on dienogest to reduce the likelihood of recurrence. One year later, she experienced spontaneous pneumothorax four times, and she underwent thoracoscopic surgery. Pathological examination revealed endometriosis of the right diaphragm and she was diagnosed as having thoracic endometriosis syndrome (TES). After dienogest treatment, she exhibited recurrence of catamenial pneumothorax (CP) and pelvic endometriosis. TES is defined as the presence of endometrial tissue in or around the lung, and consists of CP, haemothorax, haemoptysis, and pulmonary nodules. Treatment of TES has varied widely. A combination of surgical and hormonal therapy is recommended, and the maintenance of amenorrhea is important for the prevention of CP.

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