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A clipping device may impinge on the coronary artery following left atrial appendage occlusion during cardiac surgery, causing rare cardiac ischaemia perioperatively. This report highlights a case of delayed severe coronary artery stenosis resulting in ventricular fibrillation 2 months after cardiac surgery with the implantation of a left atrial clipping device. Following a percutaneous coronary intervention, the patient underwent clip removal surgery. Postoperative three-dimensional heart model verification revealed that the base of the left atrial appendage was more dorsal than usual, thereby increasing the potential risk of the clip impinging on the coronary artery. We should remember that this rare complication can occur after left atrial clipping, either in the early postoperative period or later. Using a clipping device for left atrial appendage (LAA) occlusion is safe and effective for patients with atrial fibrillation during cardiac surgery [1].

Although thoracic endovascular aneurysm repair (TEVAR) has been getting popularity as a less-invasive procedure, the treatment of thoracic aortic aneurysm with atherosclerotic aortic disease is still challenging. In hybrid TEVAR through the median sternotomy approach, side-biting clamp of the ascending aorta is often necessary for making an access route; however, it could cause embolic complication and aortic dissection. This study aimed to present the results of our preliminary study on the clampless aortic punch system (APS). The swine aorta was used as experimental specimen (diameter 16–20 mm). A 10-mm collagen-impregnated knitted Dacron graft was anastomosed to the aorta, and the APS was inserted into it. After piercing the aorta with the inner fish hook of the APS, the aortic wall was scooped out by an outer round cutter. Three different-angled cutters (0°, 15°, and 30°) were tested three times. The diameter of the punched-out lesion ranged from 6 to 9 mm (median 8 mm). Macroscopically, no major vessel injuries were seen 15° series, whereas minor or major vessel injuries were seen 30° and 0° series, respectively. Histological findings of 15° series confirmed the sharp edge of the stump and abrupt interruption of the elastic fiber without destruction of the normal three-layer structure of the aortic wall. This study suggests that our clampless APS could reduce the risk of stroke and aortic injury in hybrid TEVAR, and an animal study confirming its utility is now under consideration.

Aims This study aimed to investigate the association between the time to achieve walkability after cardiac surgery and the risk of cardiovascular disease after hospital discharge. Methods We conducted a prospective cohort study involving 553 ambulatory patients aged 71.5 (range, 64.0–77.0) years who underwent cardiac surgery. All patients were divided into five groups based on the time to achieve walkability ≥100 m within 1, 2, 3, 4 or 5 days after cardiac surgery. We examined the risk of post‐cardiovascular disease outcomes, including readmission due to heart failure, ischaemic heart disease and other cardiovascular disease, according to the time to achieve walkability with reference to 5 days using the Fine and Gray regression model, considering competing risks. Results In the survival curve analysis, we examined the time to experience post‐cardiovascular disease incidence after hospital discharge. During a median of 3.3 years of follow‐up, 118 patients developed cardiovascular disease. We observed a positive association between the time to achieve walkability and cardiovascular disease risk, particularly heart failure. The multivariate hazard ratios (95% confidence intervals) for heart failure readmission were N/A (not assessed due to the sample size being too small) for 1 day, 0.31 (0.10–0.99) for 2 days, 0.60 (0.21–1.79) for 3 days and 0.76 (0.22–2.72) for 4 days (P for trend = 0.032). Conclusions The shorter walkability achievement time was associated with a lower risk of cardiovascular diseases, more specifically heart failure readmission, among patients who underwent cardiac surgery. The time required to achieve walkability is a useful predictor for cardiovascular diseases after hospital discharge.

Aims In patients with heart failure, over‐activation of the cardiac sympathetic nerve (CSN) function is associated with severity of heart failure and worse outcome. The effects of MitraClip therapy on the CSN activity in patients with mitral regurgitation (MR) remained unknown. In this study, we evaluated the impact of the MitraClip therapy on CSN activity assessed by 123I‐metaiodobezylguanidine (MIBG) scintigraphy. Methods and results We enrolled consecutive patients with moderate‐to‐severe (3+) or severe (4+) MR who were scheduled to undergo MitraClip procedure in this prospective observational study. MIBG scintigraphy was performed at baseline and 6 months after the MitraClip procedure to evaluate the heart–mediastinum ratio and washout rate (WR). Changes in these MIBG parameters were analysed. Of the 13 consecutive patients, 10 were successfully treated with MitraClip procedure and completed follow‐up assessment. With regard to the MIBG parameters, changes in the early and delayed heart–mediastinum ratio from baseline to 6 months were not significant (2.16 ± 0.42 to 2.06 ± 0.34, P = 0.38 and 1.87 ± 0.39 to 1.83 ± 0.39, P = 0.43, respectively), whereas WR was significantly decreased (38.6 ± 3.9% to 32.6 ± 3.94%, P = 0.002). Conclusions The CSN activity of the WR on MIBG imaging was improved 6 months after MitraClip therapy in patients with 3+ or 4+ MR.

Introduction/objectives Patients who experience hip fractures often undergo bipolar hip arthroplasty (BHA) or open reduction and internal fixation (ORIF); however, acute postoperative pain remains a significant concern, often delaying rehabilitation and impairing recovery. This study compared acute phase pain characteristics (intensity and trajectory, and duration of analgesic use) between BHA and ORIF. Previous studies have suggested that patients undergoing ORIF may experience higher pain levels than those undergoing BHA, although most assessments have been limited to single time points, which may not capture the full scope of postoperative pain. Materials and methods This prospective cohort study was conducted between February and August 2024. Pain intensity was evaluated on postoperative day (POD) 1, 3, 5, 7, and 14 using a numerical rating scale. Pain trajectories (slope and intercept) were calculated based on pain intensity assessed on POD 1, 3, 5, and 7. The duration of analgesia was assessed from the time of surgery until discontinuation. Multiple linear regression analysis was performed to examine the effect of surgical type (0, BHA; 1, ORIF) on pain-related outcomes, adjusting for confounders including age, sex, preoperative C-reactive protein level, and operative duration. Results Data from 48 patients who underwent BHA and 32 who underwent ORIF were analyzed. There were no significant differences in pain intensity between the groups on POD 1 and 3. However, pain was significantly greater in the ORIF group on POD 5 ( p  < 0.01), 7 ( p  < 0.01), and 14 ( p  < 0.01). Regression analysis revealed that surgery type significantly influenced pain intensity on POD 14 (β = 1.27, p  = 0.01) and pain trajectory slope (β = 0.52, p  = 0.03). The intercept and analgesic duration were not significantly different between the groups. Conclusions Acute phase postoperative pain characteristics differed between BHA and ORIF, highlighting the need for targeted pain management during recovery in patients undergoing ORIF.

A seismic experiment was carried out in east Shikoku, Japan, to detect deep reflections across the Median Tectonic Line (MTL), which juxtaposes low-P/T metamorphic rocks with high-P/T metamorphic rocks. Our experiment employed an unconventional technique: sparse shot spacing, a strong energy source (dynamite) and a dense array of seismometers. The above specifications produce only single fold coverage without common midpoint (CMP) stacking. Nevertheless, the reflection profile provides essential information on the deep structure of the MTL, of other major faults, and of the Moho in east Shikoku. On the MTL, this profile is the first to delineate the MTL from the surface to about 12 km depth. The following three factors were essential to the success of our experiment. First, the receiver interval was sufficiently small to provide horizontal resolution that was able to detect deep reflectors. Second, the simple crustal structure does not require CMP stacking to enhance data quality. Third, a thin weathering layer at the surface reduced the attenuation of seismic waves and minimized the generation of the surface waves that often obscure deep reflectors. In these conditions, the technique can be an effective means of probing the deep crust while substantially reducing survey costs.

In patients with heart failure, over-activation of the cardiac sympathetic nerve (CSN) function is associated with severity of heart failure and worse outcome. The effects of MitraClip therapy on the CSN activity in patients with mitral regurgitation (MR) remained unknown. In this study, we evaluated the impact of the MitraClip therapy on CSN activity assessed by I-metaiodobezylguanidine (MIBG) scintigraphy. We enrolled consecutive patients with moderate-to-severe (3+) or severe (4+) MR who were scheduled to undergo MitraClip procedure in this prospective observational study. MIBG scintigraphy was performed at baseline and 6 months after the MitraClip procedure to evaluate the heart-mediastinum ratio and washout rate (WR). Changes in these MIBG parameters were analysed. Of the 13 consecutive patients, 10 were successfully treated with MitraClip procedure and completed follow-up assessment. With regard to the MIBG parameters, changes in the early and delayed heart-mediastinum ratio from baseline to 6 months were not significant (2.16 ± 0.42 to 2.06 ± 0.34, P = 0.38 and 1.87 ± 0.39 to 1.83 ± 0.39, P = 0.43, respectively), whereas WR was significantly decreased (38.6 ± 3.9% to 32.6 ± 3.94%, P = 0.002). The CSN activity of the WR on MIBG imaging was improved 6 months after MitraClip therapy in patients with 3+ or 4+ MR.

We deployed 56 temporary seismic stations within approximately a month after the occurrence of the 2004 mid-Niigata prefecture earthquake. Using manually-picked arrival data obtained from the temporary and surrounding permanent seismic stations, 1056 aftershocks have been relocated. Based on the spatiotemporal variations in the relocated aftershocks, the cluster activities associated with the mainshock and some large aftershock events are identified. The aftershocks associated with the mainshock, the largest occurred on the two steep west-dipping planes at an angle of 60° and approximately 5 km away. In contrast, the aftershocks following the event on Oct. 27 are aligned on east-dipping plane at a low angle of 25°. It is further observed that the aftershock area extended in both northeastward and southwestward directions at a later stage. The triggered seismicity around the northeast edge was more significant than that around the southwest edge. This difference could be understood by the discrepancy in the shear stress level accumulated at the dynamic shear rupture due to the mainshock.

To improve current cancer immunotherapies, strategies to modulate various immunosuppressive cells including myeloid derived suppressor cells (MDSC) which were shown to be negative factors in immune‐checkpoint blockade therapy, need to be developed. In the present study, we evaluated the role of the local renin‐angiotensin system (RAS) in the tumor immune‐microenvironment using murine models bearing tumor cell lines in which RAS was not involved in their proliferation and angiogenetic ability. Giving angiotensin II receptor blockers (ARB) to C57BL/6 mice bearing murine colon cancer cell line MC38 resulted in significant enhancement of tumor antigen gp70 specific T cells. ARB administration did not change the numbers of CD11b+ myeloid cells in tumors, but significantly reduced their T‐cell inhibitory ability along with decreased production of various immunosuppressive factors including interleukin (IL)‐6, IL‐10, vascular endothelial growth factor (VEGF), and arginase by CD11b+ cells in tumors. ARB also decreased expression of immunosuppressive factors such as chemokine ligand 12 and nitric oxide synthase 2 in cancer‐associated fibroblasts (CAF). Last, combination of ARB and anti‐programmed death‐ligand 1 (PD‐L1) antibodies resulted in significant augmentation of anti‐tumor effects in a CD8+ T cell‐dependent way. These results showed that RAS is involved in the generation of an immunosuppressive tumor microenvironment caused by myeloid cells and fibroblasts, other than the previously shown proliferative and angiogenetic properties of cancer cells and macrophages, and that ARB can transform the immunosuppressive properties of MDSC and CAF and could be used in combination with PD‐1/PD‐L1 immune‐checkpoint blockade therapy. Local renin–angiotensin system is involved in generation of immunosuppressive tumor microenvironment caused by myeloid cells and fibroblasts. Angiotensin receptor blockers can transform the immunosuppressive properties of myeloid derived suppressor cells and cancer‐associated fibroblasts and could be used in combination with PD‐1/PD‐L1 immune checkpoint blockade therapy.

The effects of body mass index (BMI) on assisted reproductive technology (ART) outcomes such as ovarian dysfunction, poor ovum quality, and endometrial dysfunction have been studied; however, many aspects remain controversial. Therefore, we retrospectively investigated the relationship between BMI and ART outcomes. For 14,605 oocyte retrieval cycles at our hospital between January 2016 and December 2020, BMI was divided into five groups (< 18.5, 18.5–20.0, 20.0–22.5, 22.5–25.0, ≥ 25 kg/m 2 ) and measured before oocyte retrieval. The normal fertilization and high-grade blastocyst rates were compared. In addition, in the 7,122 frozen-thawed embryo transfers (FET) with highest-grade embryos, the clinical pregnancy, miscarriage, and live birth rates were investigated in the five BMI groups. Multiple regression analysis on normal fertilization and high-grade blastocyst rates revealed no statistically significant differences. Furthermore, after propensity score matching on FET, there was no significant difference in clinical pregnancy, miscarriage, and live birth rates in the BMI groups. BMI is a risk factor for complications during pregnancy; however, it does not affect ART outcomes. Therefore, we believe weight guidance should be provided to women with obesity at the start of infertility treatment, but treatment should not be delayed.