Prognostic significance of cerebral metabolic abnormalities in patients with congestive heart failure

BACKGROUND

Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain.

METHODS AND RESULTS

We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6+/-11.9 years; left ventricular ejection fraction, 22.2+/-6.2%). Proton magnetic resonance spectroscopy data were obtained from localized regions ( approximately 8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5+/-14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (>12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95% CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sensitivity and 67% specificity to predict mortality.

CONCLUSIONS

The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.

Study on the Expression of Insulin-like Growth Factor II (IGF- II) in Hepatocellular Carcinoma Cells and Developing Rat Embryos

PURPOSE

The insulin-like growth factor II (IGF-II) gene expresses a family of transcripts in embryonic/fetal tissue, and also highly was expressed during hepatocellular carcinogenesis. In this study, we showed that IGF-II mRNA and protein levels are detected in rat embryo, HepG2 human hepatoma cells and Chang liver cells.

MATERIALS AND METHODS

This study included sections of rat embryos 7~17 days post coitum (d.p.c), HepG2 cells and Chang liver cells. Using immunohistochemistry, Northern blotting and Western blotting, we observed the expression of IGF-II in the rat embryo, HepG2 cells and Chang liver cells.

RESULTS

We localized IGF-II gene products in sections of rat embryo 7~17 d.p.c by performing immunohistochemistry. The IGF-II was mainly expressed in the proximal endoderm and ectoplacental cone between 7 and 9 d.p.c. At 10 d.p.c. the expression was localized at the heart primodium as well as the proximal endoderm, and at 11 d.p.c. the IGF-II was expressed in the liver and heart. After 12 d.p.c. and 14 d.p.c., the expression was also detected in the brain, muscle and bone, and head mesenchyme, respectively. While the expression of IGF-II protein was not detected in the normal adult liver, intense staining was detected in the heart, liver and choroids plexus at 17 d.p.c.

CONCLUSION

These results suggest that IGF-II may act as an oncofetal protein during hepatocellular carcinogenesis and embryogenesis.

Intraarticular entrapment of the obturator nerve in acetabular fracture

SUMMARY

The authors report a case of acetabular fracture of both columns that was associated with a rare nerve injury, entrapment of the obturator nerve in the hip joint.

MRI findings in neuro-behçet's disease

AIM

To evaluate the pattern and site of involvement in neuro-Behçet's disease (NBD).

MATERIALS AND METHODS

Twenty-one patients with NBD were evaluated. Using 1.5T magnetic resonance imaging (MRI), T1-weighted axial and sagittal images, gadolinium enhanced axial and coronal images and T2-weighted axial images were obtained.

RESULTS

The brainstem, basal ganglia, cerebral white matter, internal capsule, thalamus and spinal cord were involved in eighteen, nine, nine, seven, six and two patients, respectively. In nine patients with cerebral white matter involvement, four had subcortical involvement and three had periventricular involvement, in addition to two patients with focal deep white matter lesions. Among the brainstem lesions, pons involvement was seen in fourteen patients, all had ventrally located lesions, and nine had tegmental involvement. Midbrain involvement was seen in fourteen patients; the cerebral peduncle was involved in 11 of these. Five patients had brainstem atrophy: two cases were demonstrated at initial MRI, the other three cases were seen on follow-up MRI. Pyramidal signs, the most common neurological signs, were demonstrated in fourteen patients. Follow-up MRI was obtained 10 days to 20 months after the initial MRI in eight cases; all showed changes in size, shape and site of involvement. After gadolinium enhancement, thirteen patients demonstrated mottled non-confluent enhancement in the brainstem (eight patients), posterior limb of the internal capsule (three patients), pachymeninges (two patients) and spinal cord (two patients).

CONCLUSION

NBD manifests a reversible course, but chronic NBD may result in brainstem atrophy. Characteristic involvement along the corticospinal tract is well correlated with neurological signs.

The feasibility and safety of fluoroscopy-guided percutaneous intramyocardial gene injection in porcine heart

BACKGROUND

Catheter-based transendocardial gene injection would be useful for the delivery of genes into the heart. We examined the feasibility and safety of percutaneous intramyocardial gene injections with fluoroscopic guidance alone.

METHODS

We performed the procedure through an 8F arterial sheath inserted into the left carotid artery. In protocol 1, a mixture of India ink and normal saline was injected through a needle injection catheter in six pigs. We monitored blood pressure and ECG continuously during the procedure. Echocardiography, left ventriculography, and coronary angiography were performed. All pigs were sacrificed 2 days later and hearts were harvested. In protocol 2, a mixture of India ink and plasmid encoding CAT gene was injected in the same manner in eight pigs. Myocardial tissue was obtained 7 days after the procedure to assess gene expression. In protocol 3, four pigs were intentionally needle-perforated in the ventricular wall and were observed for 7 days.

RESULTS

In protocol 1, there was no significant hemodynamic changes or serious arrhythmias during the procedure. Echocardiography and angiography revealed no evidence indicating pericardial effusion or wall motion abnormalities. Harvested hearts revealed one intramyocardial hematoma in a total of 36 injection sites. In protocol 2, the gene expression could be identified in 39 sites out of 48 injections after 7 days. In protocol 3, no animal showed signs indicating cardiac tamponade during the observation period.

CONCLUSIONS

Our data suggest that fluoroscopy-guided percutaneous intramyocardial gene injection is a feasible and safe procedure, with no indication of associated significant hemodynamic changes, arrhythmias, or mortality.

Short peptides with induced beta-turn inhibit the interaction between HIV-1 gp120 and CD4

To identify novel peptides that inhibit the interaction between human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein gp120 and CD4, we constructed a targeted phage-displayed peptide library in which phenylalanine and proline were fixed at the fourth and sixth positions, respectively, because Phe43 and the adjacent beta-turn of CD4 are critical for interaction with gp120. Two synthetic peptides were selected after three rounds of biopanning against gp120, and one of them, G1 peptide (ARQPSFDLQCGF), exhibited specific inhibition of the interaction between gp120 and CD4 with an IC(50) of about 50 microM. Structural analysis using NMR demonstrated that G1 peptide forms a compact cyclic structure similar to the CD4 region interacting with gp120. Two derivatives of G1 peptide, a linear hexameric peptide (G1-6) and a cyclic nonameric peptide (G1-c), were synthesized based on the structure of the G1 peptide. Interestingly, they showed higher inhibitory activities than did G1 peptide with IC(50)'s of 6 and 1 microM, respectively. Thus, this study might provide a new insight into the development of anti-HIV-1 inhibitors.

Contribution of the Na+-K+-2Cl- cotransporter NKCC1 to Cl- secretion in rat OMCD

In rat kidney the "secretory" isoform of the Na+-K+-2Cl- cotransporter (NKCC1) localizes to the basolateral membrane of the alpha-intercalated cell. The purpose of this study was to determine whether rat outer medullary collecting duct (OMCD) secretes Cl- and whether transepithelial Cl- transport occurs, in part, through Cl- uptake across the basolateral membrane mediated by NKCC1 in series with Cl- efflux across the apical membrane. OMCD tubules from rats treated with deoxycorticosterone pivalate were perfused in vitro in symmetrical HCO/CO2-buffered solutions. Cl- secretion was observed in this segment, accompanied by a lumen positive transepithelial potential. Bumetanide (100 microM), when added to the bath, reduced Cl- secretion by 78%, although the lumen positive transepithelial potential and fluid flux were unchanged. Bumetanide-sensitive Cl- secretion was dependent on extracellular Na+ and either K+ or NH, consistent with the ion dependency of NKCC1-mediated Cl- transport. In conclusion, OMCD tubules from deoxycorticosterone pivalate-treated rats secrete Cl- into the luminal fluid through NKCC1-mediated Cl- uptake across the basolateral membrane in series with Cl- efflux across the apical membrane. The physiological role of NKCC1-mediated Cl- uptake remains to be determined. However, the role of NKCC1 in the process of fluid secretion could not be demonstrated.

Three-dimensional spiral CT cholangiography with minimum intensity projection in patients with suspected obstructive biliary disease: comparison with percutaneous transhepatic cholangiography

BACKGROUND

To evaluate the diagnostic potential of spiral computed tomographic (CT) cholangiography with minimum intensity projection (minIP) in the diagnosis of patients with suspected biliary obstruction.

METHODS

Nine consecutive patients with obstructive biliary disease were enrolled in this study. Spiral CT data (3-mm slice thickness, pitch 1-2:1) obtained 65 s after the start of contrast medium injection (150 mL Ultravist 370, 3 mL/s) were reconstructed at 1-mm intervals. Three-dimensional (3D) CT cholangiography with minIP (3D CTC) was generated with a Siemens software package. The quality of 3D CTC in its ability to demonstrate the anatomic detail, the level of obstruction, and the presence or absence of isolated hepatic segments was evaluated using percutaneous transhepatic cholangiography as a gold standard.

RESULTS

In all patients, 3D CTC demonstrated dilated intrahepatic ducts up to tertiary branches. 3D CTC correctly diagnosed the level of biliary obstruction and demonstrated isolated segments in all patients. In determining the cause of biliary obstruction, one patient with hilar cholangiocarcinoma was misdiagnosed as having biliary invasion by hepatocellular carcinoma.

CONCLUSION

3D CTC with minIP can determine the level and cause of biliary obstruction. 3D CTC can be obtained from regular thin-section helical CT data and may be a strong competitor against diagnostic magnetic resonance cholangiography because of its superior resolution and information on adjacent soft tissues and the duct itself.

Six-month angiographic follow-up after intravascular ultrasound-guided stenting of infarct-related artery: comparison with non-infarct-related artery

BACKGROUND

Compared with balloon angioplasty, stenting has been established as an effective treatment modality to reduce restenosis in patients with acute myocardial infarction. However, the immediate results that predict favorable long-term outcomes in the acute infarct stenting are unknown. Therefore, we evaluated long-term outcomes of stenting for infarct-related artery (IRA) lesions by using intravascular ultrasound (IVUS) compared with that of stenting for non-IRA lesions.

METHODS

IVUS-guided coronary stenting was successfully performed in 510 native coronary lesions (105 IRA vs 405 non-IRA). A 6-month follow-up angiogram was performed in 419 (82.2%) lesions: 87 (82.9%) IRA lesions and 332 (82.0%) non-IRA lesions. Coronary stenting on the IRA lesions was successfully performed within 7 to 10 days after onset of infarction in 42 patients and within 12 hours in 45 patients. Results were evaluated by clinical, angiographic, and IVUS methods.

RESULTS

There were no significant differences in clinical and angiographic variables between the two groups. IVUS variables including reference vessel area and minimal stent area were also similar between the two groups. There was no significant difference in angiographic restenosis rate between the two groups in cases of minimal stent area > or = 7 mm(2): 12.8% (6 of 47) in IRA versus 19.1% (33 of 173) in non-IRA lesions (P = .315). However, the angiographic restenosis rate in cases of minimal stent area <7 mm(2) was 50% (20 of 40) in IRA lesions versus 31.5% (50 of 159) in non-IRA lesions (P = .028).

CONCLUSIONS

Angiographic restenosis is significantly higher in stenting for IRA lesions compared with that for non-IRA lesions in cases of minimal stent area < 7 mm(2).

Different clinical features of aortic intramural hematoma versus dissection involving the ascending aorta

OBJECTIVES

The goal of this study was to test the hypothesis that the absence of direct flow communication through intimal tear in aortic intramural hematoma (AIH) involving the ascending aorta has different clinical impact on clinical course compared with typical aortic dissection (AD).

BACKGROUND

Although emergent surgical repair has been applied for patients with proximal AIH as if it was typical AD, the natural history of proximal AIH is not known clearly yet.

METHODS

Direct comparison of the clinical data of 81 patients with proximal AD and 24 patients with AIH was performed retrospectively.

RESULTS

Patients with AIH were older (67 +/- 10 vs. 50 +/- 13, p = 0.001), and female gender was more predominant in AIH (19/24 vs. 29/81, p = 0.001). The development of mediastinal hemorrhage and pericardial and pleural effusion was more frequent in patients with AIH than it was in patients with AD. Although medical treatment was more frequently selected in the AIH group (75% vs. 15%, p = 0.001) due to old age and other associated medical diseases, the mortality rate with medical treatment was much lower in patients with AIH than it was in patients with AD (6% vs. 58%, p = 0.003). In follow-up imaging studies of 13 patients who survived AIH without surgical repair, seven patients showed complete resolution. Typical AD developed in three patients, and the other three patients showed focal AD only in the descending aorta. The two-year survival rate did not show significant difference (84% +/- 6% in AIH vs. 76% +/- 17% in AD, p = 0.47).

CONCLUSIONS

Absence of continuous flow communication can explain a more favorable clinical course of AIH than for AD, and medical treatment with frequent imaging follow-up and timed elective surgery in cases with complications can be a rational option for patients with proximal AIH.

Disodium cromoglycate inhibits production of immunoglobulin E

Disodium cromoglycate (DSCG) has been shown to inhibit the release of mediators from mast cells. In the present study, the effect of DSCG on active anaphylactic reaction was studied in mice. DSCG dose-dependently inhibited the active systemic anaphylactic reaction and serum immunoglobulin (Ig)E production induced by immunization with ovalbumin, Bordetella pertussis toxin and aluminum hydroxide gel. DSCG strongly inhibited IL-4-dependent IgE production by lipopolysaccharide-stimulated murine whole spleen cells. In the case of U266 human IgE-bearing B cells, DSCG also showed an inhibitory effect on the IgE production. These results suggest that DSCG has an anti-anaphylactic activity by inhibition of IgE production from B cells.

Comparison of hydro-US and spiral CT in the staging of gastric cancer

The purpose of this study was to compare the diagnostic accuracy of hydro-ultrasonography (US) and spiral computed tomography (CT) in the staging of gastric cancer. Forty-three patients with gastric cancers confirmed at surgery underwent hydro-US and spiral CT on the same day prospectively. Hydro-US and spiral CT were done after ingestion of water. US and CT images were independently analyzed. After surgery, pathological findings according to TNM classification were compared with US and CT findings. The detection rate for T1 tumors was 75% (12/16), and all T2-T4 tumors were detected (27/27). In the T class, good correlation with pathology occurred in 55.8% of cases for US and 58.1% for CT, and there was no difference in staging accuracy between US and CT (P=.7667). Overstaging occurred in 14% for US and CT. Understaging occurred in 30.2% for US and 27.9% for CT. In the N class, good correlation with pathology occurred in 60.5% for US and 55.8% for CT, and there was no difference in staging accuracy between US and CT (P=.0949). Overstaging occurred in 4.7% for US and 18.6% for CT, and understaging occurred in 34.9% and 25.6%, respectively. The diagnostic accuracy of hydro-US and spiral CT in the staging of gastric cancer was between 55.8% and 60.5%, and there was no significant difference in staging accuracy between hydro-US and spiral CT, except for a tendency to overstaging by CT and understaging by US in the N class (P<.05).

Neuroplasticity Induced by Tooth Pulp Stimulation in Trigeminal Subnucleus Oralis Involves NMDA Receptor Mechanisms

We have recently demonstrated that application of the mustard oil (MO), a small-fiber excitant and inflammatory irritant, to the rat maxillary molar tooth pulp induces significant increases in jaw muscle electromyographic (EMG) activity and neuroplastic changes in trigeminal (V) subnucleus caudalis. Since subnucleus oralis (Vo) as well as caudalis receives projections from molar pulp afferents and is also an integral brain stem relay of afferent input from orofacial structures, we tested whether MO application to the exposed pulp induces neuroplastic changes in oralis neurons and whether microinjection of MK-801, a noncompetitive NMDA antagonist, into the Vo influences the pulp/MO-induced neuroplastic changes in chloralose/urethan-anesthetized rats. Single neuronal activity was recorded in Vo, and neurons classified as low-threshold mechanoreceptive (LTM), wide dynamic range (WDR), nociceptive-specific (NS), deep (D), or skin/mucosa and deep (S + D). The spontaneous activity, mechanoreceptive field (RF) size, mechanical threshold, and response to suprathreshold mechanical stimuli applied to the neuronal RF were assessed prior to and throughout a 40- to 60-min period after MO application to the maxillary molar pulp. In animals pretreated with saline microinjection (0.3 μl) into the Vo, MO application to the pulp produced a significant increase in spontaneous activity, expansion of the pinch or deep RF, decrease in the mechanical threshold, and increase in response to suprathreshold mechanical stimuli of the nociceptive (WDR, NS, and S + D) neurons except for those nociceptive neurons having their RF only in the intraoral region. The pulpal application of MO did not produce any significant neuroplastic changes in LTM neurons. Furthermore, in animals pretreated with MK-801 microinjection (3 μg/0.3 μl) into the Vo, MO application to the pulp did not produce any significant changes in the RF and response properties of nociceptive neurons. In other animals pretreated with saline (0.3 μl) or MK-801 (3 μg/0.3 μl) microinjected into the Vo, mineral oil application to the pulp did not produce any significant changes in RF and response properties of nociceptive neurons. These findings indicate that the application of MO to the tooth pulp can induce significant neuroplastic changes in oralis nociceptive neurons and that central NMDA receptor mechanisms may be involved in these neuroplastic changes.

Short peptides with induced beta-turn inhibit the interaction between HIV-1 gp120 and CD4

To identify novel peptides that inhibit the interaction between human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein gp120 and CD4, we constructed a targeted phage-displayed peptide library in which phenylalanine and proline were fixed at the fourth and sixth positions, respectively, because Phe43 and the adjacent beta-turn of CD4 are critical for interaction with gp120. Two synthetic peptides were selected after three rounds of biopanning against gp120, and one of them, G1 peptide (ARQPSFDLQCGF), exhibited specific inhibition of the interaction between gp120 and CD4 with an IC(50) of about 50 microM. Structural analysis using NMR demonstrated that G1 peptide forms a compact cyclic structure similar to the CD4 region interacting with gp120. Two derivatives of G1 peptide, a linear hexameric peptide (G1-6) and a cyclic nonameric peptide (G1-c), were synthesized based on the structure of the G1 peptide. Interestingly, they showed higher inhibitory activities than did G1 peptide with IC(50)'s of 6 and 1 microM, respectively. Thus, this study might provide a new insight into the development of anti-HIV-1 inhibitors.

Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction

Spontaneous recanalization (SR) occurs after the onset of acute myocardial infarction (AMI), but its clinical significance in the reperfusion era remains uncertain. We evaluated the determinants and prognostic significance of SR in 196 consecutive patients with AMI who underwent primary angioplasty at our institution. The study population was divided into 2 groups according to the presence (group I, n = 44) or absence (group II, n = 152) of SR (Thrombolysis In Myocardial Infarction [TIMI] anterograde > or = 2 flow on the preintervention angiogram). The primary end point was the occurrence, within 6-weeks after AMI, of death, nonfatal reinfarction, and congestive heart failure. Baseline characteristics were similar between the 2 groups. Peak levels of creatine kinase were lower in group I than in group II (2,500 +/- 1,800 vs 4,000 +/- 2,900 U/L, respectively, p < 0.05). The rate of TIMI flow grade 3 after intervention was higher in group I than in group II (93.2% vs 79.6%, respectively, p < 0.05), and patients in group I had a faster corrected TIMI frame count than those in group II (22.7 +/- 12.4 vs 30.3 +/- 22.8, respectively, p < 0.05). Preinfarction angina (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.10 to 4.33, p < 0.05), heavy thrombi (OR 0.10, 95% CI 0.01 to 0.74, p < 0.05), and good angiographic collaterals (OR 0.12, 95% CI 0.02 to 0.89, p < 0.05) were independent predictors of SR. Death, reinfarction, and severe arrhythmia were not different between the 2 groups. However, heart failure occurred more frequently in group II than in group I (15.1% vs 2.3%, respectively, p < 0.05). The primary end point was also significantly lower in group I than in group II (4.5% vs 18.4%, respectively, p < 0.05). In conclusion, SR in AMI is associated with faster coronary flow, smaller infarct size, and a better clinical outcome after primary angioplasty.

Serum 8-hydroxy-guanine levels are increased in diabetic patients

OBJECTIVE

The production of reactive oxygen species is increased in diabetic patients, especially in those will poor glycemic control. We have investigated oxidative damage in type 2 diabetic patients using serum 8-hydroxyguanine (8-OHG) as a biomarker.

RESEARCH DESIGN AND METHODS

We studied 41 type 2 diabetic patients and compared them with 3 nondiabetic control subjects. Serum 8-OHG concentration was assayed using high-pressure liquid chromatography.

RESULTS

The type 2 diabetic patients had significantly higher concentrations of 8-OHG in their serum than the control subjects (5.03 +/- 0.69 vs. 0.96 +/- 0.15 pmol/ml P < 0.01). There was no association between the levels of 8-OHG and HbA1c. We also could not and any correlation between serum 8-OHG levels and age, duration of diabetes, serum lipids, or creatinine or albumin exeretion rate. Creatinine clearance showed marginal correlation with serum 8-OHG levels (P = 0.06). Among the diabetic patients, those with proliferative retinopathy had significantly higher 8-OHG levels than those with nonproliferative retinopathy or without retinopathy. Likewise, the serum 8-OHG levels in patients who had advanced nephropathy (azotemia) were higher than in patients with normoalbuminuria, microalbuminuria, or overt proteinuria.

CONCLUSIONS

Our findings show that measuring serum 8-OHG is a novel convenient method for evaluating oxidative DNA damage. Diabetic patients, especially those with advanced microvascular complications, had significantly higher serum 8-OHG levels; this suggests that such changes may contribute to the development of microvascular complications of diabetes.

Ability of peripapillary atrophy parameters to differentiate normal-tension glaucoma from glaucomalike disk

PURPOSE

To investigate the ability of peripapillary atrophy (PPA) parameters to differentiate normal-tension glaucoma (NTG) from glaucomalike disk (GLD).

METHODS

Thirty-three eyes of 33 patients with GLD that had no evidence of visual field defect and retinal nerve fiber layer defect and 33 eyes of 33 patients with NTG, matched with age and intraocular pressure, were enrolled. The participants were selected from the database of patients referred from a routine health checkup because of high cup-to-disk ratio (>0.5). Topographic measurements for the optic disk were performed using the Heidelberg Retina Tomograph (HRT). The extent of PPA (zone beta) was measured with Atrophy Zone Analysis software of HRT. Receiver operating characteristic (ROC) curves (GraphROC version 2.0) were used to compare the new formula including PPA parameters with that of the HRT discriminant analysis formula in differentiating NTG from GLD.

RESULTS

The area of zone beta, atrophy-to-disk area ratio, and angular and radial extent of zone beta were significantly larger in NTG (P < 0.01). Multiple logistic regression analysis showed that rim area and corrected radial extent of zone beta are variables that show significant difference between NTG and GLD (P < 0.05). The area under the ROC curve for the new formula including rim area and corrected radial extent of zone beta (0.8655) was significantly larger than that for the HRT discriminant analysis formula (0.7351) (P = 0.0128).

CONCLUSION

The PPA measurement obtained by HRT can be a useful additional tool to differentiate NTG from GLD after the first screening by disk photograph in a routine health checkup.

Sensitive determination of bisphenol A in environmental water by gas chromatography with nitrogen-phosphorus detection after cyanomethylation

A new technique is proposed for the determination of bisphenol A in environmental water. The sample preparation consists of a single-step extraction of bisphenol A from a water sample with methylene chloride and the cyanomethyl derivatization of bisphenol A. 2,2'-Biphenol is used as an internal standard. Bisphenol A and biphenol can be quantitatively converted to their corresponding cyanomethyl ethers, which are then measured by gas chromatography with nitrogen-phosphorus detection. Peak shape and quantification of bisphenol A are excellent, with linear calibration curves over a range of 0.1-100 ng/ml. The detection limit is 0.1 ng/ml in water samples. The average recovery and RSD at a concentration of 5 ng/ml are 89.3 and 4.5%, respectively. The procedure is applicable to the quantification of bisphenol A in tap water, raw water and stream water.

Hyperacute rejection in single lung transplantation--case report of successful management by means of plasmapheresis and antithymocyte globulin treatment

We describe the third case and first successful treatment of hyperacute rejection in a pulmonary allograft recipient and detail the immediate clinical findings. The patient underwent single right lung transplantation for severe emphysema and chronic obstructive pulmonary disease. Three hours after completion of the vascular anatomoses oxygen desaturation and increased airway pressure was noted in combination with graft edema, frothy, pink fluid draining from the bronchial orifice, hemodynamic instability, thrombocytopenia, and coagulopathy. The retrospective cross-match result was reported to be positive. The clinical diagnosis of hyperacute rejection was made. A donor-specific IgG HLA antibody to A2 was identified. The standard immune suppression regimen was immediately modified and a hyperacute rejection protocol applied including plasmapheresis and antithymocyte globulin treatment as well as cyclophosphamide to decrease antibody existence and production. A remarkable clinical recovery was observed after the fifth postoperative day and completion of plasmapheresis when a repeated retrospective cross-match showed significantly decreasing anti-donor reactivity.

Facet tropism: a comparison between far lateral and posterolateral lumbar disc herniations

STUDY DESIGN

An assessment of the difference in the degree of facet tropism and disc degeneration between far lateral and posterolateral lumbar disc herniations.

OBJECTIVE

To investigate the effect of the difference in the degree of the facet tropism and disc degeneration with respect to the development of far lateral lumbar disc herniation and posterolateral lumbar disc herniation, and to compare the effect between the two types of herniations.

SUMMARY OF BACKGROUND DATA

The effect of facet tropism on the development of posterolateral lumbar disc herniation has been investigated previously, but there has been no study on far lateral lumbar disc herniation.

METHODS

Thirty-eight lumbar disc herniations (far lateral, n = 19; posterolateral, n = 19) were included this study. The degree of facet tropism and disc degeneration was measured at the herniated disc level by using magnetic resonance imaging. The results were compared to show any differences between the two types of lumbar disc herniations.

RESULTS

There were significant differences in the degree of facet tropism (24.74 vs. 14.26, P = 0.004) and disc degeneration (23.92 vs. 15.08, P = 0.005) between the far lateral and posterolateral lumbar disc herniations. There was no significant correlation between the degree of facet tropism and the degree of disc degeneration in far lateral lumbar disc herniation (r = -0.369, P = 0.120).

CONCLUSION

This results suggest that the differences in the degree of facet tropism and disc degeneration might be considered a key factor in distinguishing the development of far lateral lumbar disc herniation from that of posterolateral lumbar disc herniation.

Automation of the synthesis of highly concentrated 188Re-MAG3 for intracoronary radiation therapy

We have developed an efficient method and an automated synthetic system for the preparation of highly concentrated 188Re-MAG3. Routine production of 188Re-MAG3 for use in intracoronary radiation therapy was performed by compressed air driven semi-automated shielded system. 188Re-MAG3 was prepared with a commercial kit and reducing agents, purified and concentrated by C18 Sep-Pak cartridges to desired radioactivity and volume. Using this automated system, reproducible radiolabeling yields of 80-85% were obtained.

Enhanced gene expression of renin-angiotensin system, TGF-beta1, endothelin-1 and nitric oxide synthase in right-ventricular hypertrophy

It has been suggested that various vasoactive substances and growth factors are involved in left-ventricular myocardial hypertrophy and failure. However, limited data are available on the role of humoral factors involved in right-ventricular (RV) hypertrophy. To examine implications of humoral factors involved in the development of RV hypertrophy, altered mRNA expressions of the renin-angiotensin system (RAS), transforming growth factor (TGF)- beta1, endothelin-1 and nitric oxide synthase (NOS) were investigated in monocrotaline (MCT)-induced pulmonary hypertensive rats. Male Sprague-Dawley rats were treated with MCT (60 mg x kg(-1), s.c.) to induce a selective RV hypertrophy. Three or 6 weeks later, the heart was removed to determine the tissue gene expressions in the right and left ventricles (LV) by reverse transcription-polymerase chain reaction due to the relatively low mRNA expression levels of the RAS components in the ventricle (n= 6 in each group). MCT-treated rats showed a selective RV hypertrophy at weeks 3 and 6 of MCT treatment (the ratios of RV/body weight were 1.5- and 2.2-fold higher than the controls, respectively). Levels of renin and angiotensinogen mRNAs in the hypertrophied RV were significantly increased at both weeks 3 and 6 of MCT treatment. The angiotensin-converting enzyme mRNA level also increased approximately 2-fold at week 3. In contrast, RAS component mRNAs in the LV were not significantly altered by MCT treatment, except for a 1.8-fold increase of angiotensinogen mRNA at week 3. The expression of Ang II receptors, either AT1A or AT1B, was not significantly altered by MCT treatment. Furthermore, MCT treatment significantly increased TGF- beta1 mRNA levels in the RV at weeks 3 and 6, while it did not significantly affect them in the LV. Endothelin-1 mRNA expression was significantly higher in the RV at week 3, but was normalized at week 6 of MCT treatment. The gene expression of the endothelial constitutive isoform of NOS was increased in the RV at weeks 3 and 6, but not in the LV. Elevated gene expression of local RAS, along with TGF- beta1 and endothelin-1 in the present study may contribute to the development of RV hypertrophy. On the contrary, an enhanced ecNOS expression may be a mechanism counteracting the hypertrophy.

Pre-transplant corticosteroid use and outcome in lung transplantation

BACKGROUND

The early experience of lung transplantation was plagued with airway anastomotic complications. The use of corticosteroids in the pre-transplant period has been implicated as a major contributing factor in bronchial dehiscence, and many patients have been denied transplantation on the basis of corticosteroid use. We conducted the current study to assess the risks associated with pre-transplant corticosteroid use.

METHODS

We analyzed records of 73 single- and bilateral-single lung transplant recipients who had chronic obstructive pulmonary disease or alpha(1)-antitrypsin deficiency as their underlying disease from 1986 to 1996. Twenty-six patients (steroid group) received daily corticosteroid therapy (prednisone, 1.5 to 40 mg/day) up to the time of transplantation, whereas 47 patients did not receive chronic corticosteroids and had no corticosteroid therapy within 3 months of transplantation (non-steroid group).

RESULTS

The demographic profiles of the 2 groups were comparable. We noted no statistical significances in length of hospital stay, duration of intensive care, and post-operative pulmonary function. The rates of cytomegalovirus infection, acute rejection, bronchiolitis obliterans syndrome, and survival were also similar. The non-steroid group seemed to have a higher rate of bronchial stenosis at 3 years (29% vs 6%, p = 0.03). Bronchial dehiscence did not occur in either study group.

CONCLUSIONS

Pre-transplant use of corticosteroids does not adversely affect outcome following lung transplantation.

Phosphatidylinositol 4-phosphate 5-kinase type I is regulated through phosphorylation response by extracellular stimuli

Phosphatidylinositol 4-phosphate 5-kinase (PIPK) catalyzes a final step in the synthesis of phosphatidylinositol 4,5-bisphosphate (PIP(2)), a lipid signaling molecule. Strict regulation of PIPK activity is thought to be essential in intact cells. Here we show that type I enzymes of PIPK (PIPKI) are phosphorylated by cyclic AMP-dependent protein kinase (PKA), and phosphorylation of PIPKI suppresses its activity. Serine 214 was found to be a major phosphorylation site of PIPK type Ialpha (PIPKIalpha) that is catalyzed by PKA. In contrast, lysophosphatidic acid-induced protein kinase C activation increased PIPKIalpha activity. Activation of PIPKIalpha was induced by dephosphorylation, which was catalyzed by an okadaic acid-sensitive phosphatase, protein phosphatase 1 (PP1). In vitro dephosphorylation of PIPKIalpha with PP1 increased PIPK activity, indicating that PP1 plays a role in lysophosphatidic acid-induced dephosphorylation of PIPKIalpha. These results strongly suggest that activity of PIPKIalpha in NIH 3T3 cells is regulated by the reversible balance between PKA-dependent phosphorylation and PP1-dependent dephosphorylation.