The impact of core curriculum revisions on Japanese medical schools: Navigating curriculum evolution.

Purpose: This study examines the impact of the 2010 and 2016 Model Core Curriculum (MCC) revisions on medical education across all 82 medical schools in Japan.

Methods: A cross-sectional survey was conducted in 2021, focusing on the response to the MCC revisions, curriculum changes, and factors influencing these changes. The survey included questions on approaches to implementing the MCC revisions, timing of curriculum updates, factors triggering these revisions, changes in student performance and career paths, and the introduction of new subjects.

Effect of constipation on readmission for heart failure in patients with acute heart failure.

Aims: Constipation is a common gastrointestinal disorder that is associated with a high cardiovascular event rate in the general population. Although constipation is common in patients with cardiovascular diseases, only a few studies have examined the relationship between constipation and the prognosis of patients with heart failure. This study aimed to evaluate the effects of constipation on the prognosis of patients with acute heart failure.

[Lactic Acidosis after Cardiac Surgery Treated by Continuous Renal Replacement Therapy in a Patient on Metformin;Report of a Case].

Lactic acidosis is a common condition observed in a patient after cardiac surgery. It is important to identify the pathogenesis of lactic acidosis since the delay of an appropriate treatment leads to high mortality. Metformin overdose has been known as a risk of lactic acidosis, and previous reports have demonstrated that continuous renal replacement therapy(CRRT) is effective.

[Perioperative Risk Management for Extensively Atheromatous Aortic Disease].

Extensive atheromatous disease of the thoracic aorta is a significant risk factor of lethal complications and remains an unsolved issue in patients undergoing cardiovascular surgery. The disease condition has been documented to be associated not only with high operative risk but also with relatively poor prognosis especially in patients with aortic replacement, due to the susceptibility to potential embolic events such as neurological deficits. To achieve favorable outcomes after surgical intervention, precise preoperative evaluation and meticulous surgical planning are important.

[Surgical Treatment of Giant Coronary Artery Aneurysm Presented as Acute Coronary Syndrome].

Coronary artery aneurysm is rare disease, usually asymptomatic and is often found by chance by echocardiography, computed tomography(CT) and coronary angiography. However, its rupture or thrombotic obstruction to the periphery of the coronary artery leads to cardiac tamponade, angina pectoris, or myocardial infarction. We describe 2 cases of giant coronary artery aneurysm presented as acute coronary syndrome.

[Coronary artery spasm induced by neuroleptic malignant syndrome during off-pump coronary artery bypass grafting; report of a case].

A 61-year-old woman with a left main lesion and coronary spastic angina was scheduled for off-pump coronary artery bypass grafting (OPCAB). She had been orally receiving selective serotonin reuptake inhibitor( SSRI) for the treatment of depression. OPCAB to left anterior discending artery( LAD) and left circumflex branch (LCX) was performed using the bilateral internal thoracic arteries assisted by intra-aortic balloon pumping.

[Traumatic type A dissection with acute pericarditis 6 weeks after blunt trauma; report of a case].

A 38-year-old man presented with typical symptom of acute pericarditis and chronic cardiac tamponade 6 weeks after blunt trauma. Follow-up computed tomography after 2 weeks revealed a localized dissection at the proximal part of the ascending aorta. This is a rare case of chronic Stanford type A aortic dissection after blunt trauma, a diagnosis of which was established later with consistent suspicion and repeated examination by computed tomography.

[Distal aortic repair after aortic arch replacement].

Background: It is crucial to expose the proximal aorta in distal aortic repair, i.e., replacement of the descending thoracic aorta (DTA) or the thoracoabdominal aorta (TAA), after aortic arch replacement.

The present state and problems of graduate-entry programs (GEP) in national medical schools in Japan.

It is not certain whether graduate-entry program (GEP) or non-graduate-entry program (non-GEP) in medical education is desirable to foster excellent medical physicians in Japan. In order to clarify the present state and problems of GEP, we visited 27 national medical schools which have introduced limited term college graduate-entry program and discussed with the deans, the education committee and administration affairs.GEP students are elder and usually study harder than regular non-GEP course students.

[Aortic root surgery in patients with previous aortic root or valve operations].

Objectives: To assess the operative indication, risk factors, procedures, and outcomes of aortic root surgery in patients with previous aortic root or valve surgery.

Patients And Methods: Between 1995 and 2007, aortic root surgery was performed in 137 patients. Thirty-five of those, who had previous root replacement, root remodeling or aortic valve surgery, were evaluated retrospectively.

Enhanced perigraft angiogenesis prevents prosthetic graft infection.

Background: Prosthetic vascular graft infection is an unsolved fatal complication after aortic surgery. We hypothesized that increased vascularity around a prosthetic graft may exert a preventive role against bacterial infection.

Methods: Eighty-three Fischer rats were divided into five groups according to the types of subcutaneously implanted prosthetic graft and granulocyte-colony stimulating factor (G-CSF) treatment.

Successful management of esophagoparaprosthetic fistula after aortic surgery.

Aortoesophageal fistula is a relatively rare but highly fatal condition, especially in the case of secondary aortoesophageal fistulas after previous thoracic aortic surgery in which the aortic prosthetic graft itself may be involved in the infection, resulting in an esophagoparaprosthetic fistula. In this report, we describe a complicated case of esophagoparaprosthetic fistula arising after descending thoracic aortic replacement and endovascular pseudoaneurysm repair that was successfully treated by surgical resection and in situ aortic graft replacement using a homograft completely covered with an omental flap, combined with subtotal esophagectomy and staged reconstruction of the alimentary tract. The patient has been doing well for 24 months without signs of recurrent infection.

Redo total aortic arch replacement using an extended homograft for graft infection.

A 65-year-old man developed graft infection 3 years after total aortic arch replacement for a chronic dissecting aneurysm. Redo total aortic arch replacement was performed using an extended homograft following 2 days of open drainage of the mediastinum. The patient has been free from a recurrent mediastinitis over the last 3 years.

Surgical treatment of a retrosternal pseudoaneurysm arising from the posterior aortic root.

We report a case of a 60-year-old male with a retrosternal pseudoaneurysm arising from the posterior aortic root. He had undergone replacement of the aortic root and ascending aorta for an acute aortic dissection. His postoperative course was complicated with composite graft infection.

A CMV-actin-globin hybrid promoter improves adeno-associated viral vector gene expression in the arterial wall in vivo.

Background: Adeno-associated virus (AAV) vectors are attractive tools for direct intralumenal arterial gene transfer in interventional cardiology or cardiovascular surgery, but clinical application has been constrained by poor gene expression in this setting.

Methods: To improve arterial wall gene expression, a hybrid promoter consisting of a cytomegalovirus (CMV) immediate-early enhancer, a chicken beta-actin transcription start site, and a rabbit beta-globin intron (CAG promoter) was substituted for the Rous sarcoma virus (RSV) promoter in an AAV type 2 vector with an alkaline phosphatase (AP) reporter gene.

Results: Intralumenal transduction of rabbit carotid arteries by an AAV2 vector containing a CAG promoter resulted in gene expression in a mean of > or = 80% of the lumenal area at 14 days following exposure, compared to < or = 25% gene-expressing area with the RSV promoter-based control vector.

Widespread and early myocardial gene expression by adeno-associated virus vector type 6 with a beta-actin hybrid promoter.

Gene therapy for acute cardiac events such as myocardial infarction requires early gene expression over an entire region of myocardium, which has not been possible using adeno-associated virus (AAV) vectors to date. Here we demonstrate marked improvement in the distribution and rapidity of gene expression in myocardium using the AAV pseudotype 6 (AAV6) vector, compared to the standard serotype 2 (AAV2) vector. An alkaline phosphatase (AP) reporter construct driven by the chicken beta-actin promoter was packaged in either AAV6 or AAV2 capsids and delivered to rat hearts in vivo by direct injection.

Anterior spinal artery syndrome after minimally invasive direct coronary artery bypass grafting under general combined epidural anesthesia.

A 65-year-old patient with ischemic heart disease and severe diabetes mellitus underwent minimally invasive direct coronary artery bypass grafting under general combined with epidural anesthesia. Paraplegia developed after surgery and the diagnosis of anterior spinal artery syndrome was made based on the patient's neurological condition and magnetic resonance imaging findings. Paraplegia following epidural anesthesia is a rare but recognized complication and this complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the minimally invasive cardiac surgery.

Successful weaning from inhaled nitric oxide using dipyridamole.

A 33-year-old woman with an atrial septal defect associated with severe pulmonary hypertension underwent suture closure of the defect after assessment of operability by lung biopsy. Postoperative course was complicated by suprasystemic refractory pulmonary hypertension, and she became dependent upon treatment with inhaled nitric oxide. After multiple attempts to withdraw nitric oxide, dipyridamole was administered and blunted the rebound pulmonary hypertension after subsequent nitric oxide withdrawal.

Aortic root replacement with a stentless bioprosthesis in a patient with giant cell arteritis.

A 66-year-old woman was diagnosed with severe aortic regurgitation. Blood studies constantly showed positive C-reactive protein. Aortic valve replacement using a mechanical valve was carried out.

Effects of air pollution on the prevalence and incidence of asthma in children.

The effects of air pollution on asthmatic symptoms were assessed in a prospective cohort study of 3,049 schoolchildren in 8 different communities in Japan. Respiratory symptoms in these children were evaluated by questionnaires every year from the 1st through the 6th grades. The prevalence of asthma among the 1st graders was strongly associated with a history of allergic or respiratory diseases, but it was not associated with concentrations of air pollution.

Traffic-related air pollution and respiratory symptoms in children living along trunk roads in Chiba Prefecture, Japan.

Automobile exhaust is considered to be a potential risk factor for respiratory diseases. To investigate the effects of traffic-related air pollution on respiratory symptoms among children who lived near trunk roads, we conducted a cohort study on 2,506 schoolchildren in eight different communities in Japan. Over that four-year period, the prevalence of asthma was higher among girls who lived less than 50 m from trunk roads (roadside areas) than among girls in the other areas studied.

Gene gun-based co-immunization of merozoite surface protein-1 cDNA with IL-12 expression plasmid confers protection against lethal Plasmodium yoelii in A/J mice.

The carboxyl-terminal region of the merozoite surface protein-1 (MSP1) is a leading candidate for a vaccine against malaria in the erythrocytic stage. In this study, we investigated the utility of interleukin-12 (IL-12) cDNA as an adjuvant for malaria DNA vaccine in a mouse challenge model. We found that co-immunization of expression plasmids encoding a C-terminal 15-kDa fragment of MSP1 (MSP1-15) with the IL-12 gene using a gene gun significantly increased the protective immunity against malaria as compared with MSP1-15 DNA immunization alone.