Background Perivascular adipose tissue ( PVAT ) is causally associated with vascular function and the pathogenesis of vascular disease in association with metabolically driven chronic inflammation called metaflammation. However, the difference in PVAT surrounding the coronary artery ( CA ‐ PVAT ) and that surrounding the internal thoracic artery (ITA‐PVAT), a vessel resistant to atherosclerosis, remains unclear. Herein, we investigated whether CA ‐ PVAT , ITA ‐ PVAT , and subcutaneous adipose tissue ( SCAT ) have distinct phenotypes. Methods and Results Fat pads were sampled from 44 patients (men/women, 36:8; age, 67±13 years) with CA disease who underwent elective CA bypass grafting. Adipocyte size in ITA ‐ PVAT and that in CA ‐ PVAT were significantly smaller than that in SCAT . A greater extent of fibrosis and increased gene expression levels of fibrosis‐related molecules were observed in CA ‐ PVAT than those in SCAT and those in ITA ‐ PVAT . CA ‐ PVAT exhibited more pronounced metaflammation, as indicated by a significantly larger extent of CD 68‐positive and CD 11c‐positive M1 macrophages, a lower ratio of CD 206‐positive M2 to CD 11c‐positive M1 macrophages, a lower gene expression level of adiponectin, and higher gene expression levels of inflammatory cytokines and inflammasome‐ and endoplasmic reticulum stress–related molecules, than did ITA ‐ PVAT and SCAT . Expression patterns of adipocyte developmental and pattern‐forming genes were totally different among SCAT , ITA ‐ PVAT, and CA ‐ PVAT . Conclusions The phenotype of ITA ‐ PVAT is closer to that of SCAT than that of CA ‐ PVAT , which may result from inherent differences in adipocytes. ITA ‐ PVAT appears to be protected from metaflammation and consecutive adipose tissue remodeling, which may contribute to the decreased atherosclerotic plaque burden in the ITA.

We report a case of cardiac myxoma of the aortic valve. To our knowledge, this represents only the seventh such case ever documented. A 61-year-old woman underwent an echocardiography to screen for hypertensive-diabetic cardiac complications, which showed a mass on her aortic valve. Although she had not experienced a fever, the mass closely resembled a vegetation, resulting in an initial diagnosis of infective endocarditis. We extirpated the mass and repaired the aortic valve with the patient under cardiopulmonary bypass. The postoperative course was uneventful. Histological examination confirmed that the mass was a myxoma.

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Aim. This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods. This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy. Results. Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,P=0.690) and recurrent bleeding (22.7% vs. 20.0%, P=0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68–12.0, P<0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23–7.53, P=0.016). Conclusions. In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage.

A 44-year-old man, unaffected by Marfan's syndrome, had previously undergone thoracoabdominal replacement for a chronic, type B dissecting aneurysm. Reconstruction of the visceral arteries was performed using an island technique. However, approximately 3 years after the operation, the reconstructed part of the aorta containing the visceral arteries became dilated and an aneurysm formed. We have succeeded both in repairing the aneurysms and "re-reconstructing" the visceral arteries using a branched graft. We conclude that the technique of separate revascularization is worth considering from the beginning, even if the patient does not present with Marfan's syndrome.