InflammationNeointimal hyperplasia u-3 fatty acid Resolvin D1Protectin D1 isomer a b s t r a c t Background: Specialized proresolving mediators from u-3 polyunsaturated fatty acid may control resolution of inflammation. We evaluated the influence of two specialized proresolving mediators, resolvin D1 (RvD1) and protectin D1 isomer (PD1 iso) on neointimal hyperplasia after balloon injury.Materials and methods: Sprague Dawley male rats at 12-14 wk of age were injured as a model of balloon angioplasty. Then, 1 mg/rat of RvD1 or PD1 iso was administered intravenously via the tail vein immediately and 2 d after angioplasty. The proliferation of injured artery and the infiltration of leukocytes, monocytes, and macrophages at 3 d after injury were evaluated by immunostaining. The activity of the inflammatory transcription factor nuclear factor kappa-light-chain-enhancer of activated B cells (NFkB) in the injured artery at 3 d after injury was evaluated using an enzyme-linked immuno sorbent assay kit. The proliferation of the neointima was evaluated by calculating the ratio of the neointimal and medial areas using specimens at 14 d after injury.Results: RvD1 and PD1 iso attenuated proliferation of medial cells (P < 0.05) and infiltration of leukocytes (P < 0.05) and monocytes/macrophages (P < 0.01). Although both RvD1 and PD1 iso mitigated NFkB activity (P < 0.01), RvD1 attenuated this activity more strongly (P < 0.01). RvD1 decreased neointimal hyperplasia by 37.3% (P < 0.01), whereas PD1 iso decreased neointimal hyperplasia by 31.8% (P < 0.05) (RvD1 versus PD1 iso:Conclusions: RvD1 and PD1 iso reduced the activity of inflammatory transcription factor NFkB within the injured artery and attenuated inflammatory cell

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The main objective is to examine whether the severity of peripheral arterial disease (PAD) affects the expenses and hospital stay of the patients who undergo bypass surgery below the inguinal ligament for PAD. Eighty consecutive patients who underwent infrainguinal bypass surgery for PAD between January 2012 and December 2014 were included in the study. Patients were divided into groups according to their critical limb ischemia (CLI) symptoms and the Wound, Ischemia, and Foot Infection (WIfI) classification. As endpoints, we assessed the duration of postoperative hospital stay and expenses during hospitalization. CLI was a significant factor for longer hospital stay and increased medical expenses (p = 0.009 and p = 0.001). In the patients with CLI, significant factors for longer hospital stay and increased medical expenses were (1) history of distal bypass (p = 0.33 and p = 0.003, respectively) and stage 4 local lower limb status in WIfI classification (p = 0.0007 and p = 0.053). PAD severity was associated with prolonged postoperative hospital stay and increased medical expenses. The presence or absence of CLI and its severity according to the WIfI classification correlated with medical expenses and hospital stay duration between the milder and severe groups.

BackgroundReduction en masse of inguinal hernia is a rare condition following manual reduction of an unrecognized incarcerated inguinal hernia. The preoperative diagnosis and surgical treatment via an inguinal approach has been considered difficult.Case presentationA 59-year-old man with lower abdominal pain was presented to our hospital. He was diagnosed reduction en masse of an inguinal hernia based on his CT findings which showed the presence a pre-peritoneal hernia sac containing the small bowel. An emergency operation via an anterior approach was performed and we found a hernial sac containing an incarcerated small bowel at the cranial and internal sides of the internal inguinal ring. Opening of the hernial sac revealed necrosis of the incarcerated small bowel and bowel resection was performed. Kugel patch was inserted into the pre-peritoneal space and the patient made an uneventful recovery.ConclusionWhen it is accurately diagnosed, reduction en masse of an inguinal hernia can be treated with direct Kugel repair via an anterior approach.

Background and Objective: Evaluation of the vessel wall condition during vascular surgery is an essential and important for technical success. However, no optimal method has been recommended for the objective assessment of the condition, and evaluation and decision of the suture/anastomotic sites are governed by the surgeon’s experience during surgery. Fluorescence-based visualization is a promising method available for objective assessment; therefore, we aimed to use this technique to distinguish non-aneurysmal wall from an aneurysmal one. Various proteases are known to play a role in aneurysm formation. We synthesized over 250 kinds of aminopeptidase-activatable fluorescent probes. To optimize aneurysmal wall evaluation based on specific fluorescent activity, these probes were investigated. Methods and Results: Vessel wall specimens were clinically obtained during open surgery for the abdominal aortic aneurysm at the University of Tokyo Hospital. Initially, to screen these probes comprehensively, the vessel walls were homogenized and supernatants were obtained. After incubating each probe in the supernatant, the increment of fluorescence was measured (excitation at 485 nm and detection at 535 nm). Among the 250 probes investigated, 6 showed a difference in the fluorescent activity between aneurysmal and non-aneurysmal walls. Next, these 6 probes were applied to freshly resected vessel walls on the from luminal side in the form of a gel, and fluorescent images were obtained using the Maestro® imaging system (PerkinElmer, Waltham, MA). Two probes showed a > 2-fold stronger activity in aneurysmal walls than that observed in non-aneurysmal walls. Conclusion: These probes may be useful for the objective evaluation of the nature of vascular walls. We plan to use small fluorescent detectors for native aortic wall intraoperatively and investigate target proteases that react with these probes.