Effects of wrapping tightness on acute cardiac function in dynamic cardiomyoplasty

BACKGROUND

It has not been clarified how tightly the heart should be wrapped for maximal augmentation of cardiac function in cardiomyoplasty.

METHODS

Hearts in acute failure induced by propranolol were wrapped with the left latissimus dorsi muscle, loosely (loose CMP), moderately (moderate CMP), and tightly (tight CMP) in each of 5 pigs. To measure the pressure between the latissimus dorsi muscle and the left ventricle (LV), a Millar pressure catheter with a latex balloon was placed on the anterior wall of the LV. Left ventricular wall tension was calculated according to Laplace's law, using the difference between the LV pressure and the balloon pressure.

RESULTS

In the loose CMP, moderate CMP, and tight CMP groups, the mean balloon pressures during unassisted beats were 8.2, 10.4, and 13.2 mm Hg, respectively. During unassisted beats, the mean LV wall tension values were 38,683, 29,938 (p < 0.05 versus loose CMP), and 26,652 (p < 0.05 versus loose CMP) dynes/cm, respectively, the peak LV pressures were 76.8, 73.8, and 65 (p < 0.05 versus loose CMP) mm Hg, respectively, and the stroke volumes were 12.8, 9.2, and 8.5 (p < 0.05 versus loose CMP) mL, respectively. During assisted beats, the mean LV wall tension values were 20,059, 11,290, and 7,893 (p < 0.05 versus loose CMP) dynes/cm, respectively, the peak LV pressures were 94.1, 98.1, and 92.0 mm Hg, respectively, and the stroke volumes were 13.8, 11.6, and 9.4 (p < 0.05 versus loose CMP) mL, respectively.

CONCLUSIONS

During unassisted beats, tight CMP (13 mm Hg) had the advantage of diminishing LV wall tension, but the disadvantage of diminishing LV pressure and stroke volume, compared with loose CMP (8 mm Hg). Moderate CMP (10 mm Hg), however, had the advantage of diminishing LV wall tension without a decrease in LV pressure and stroke volume.

[Neuropsychological analysis in 2 cases of infarction in the left precentral gyrus--with special reference to apraxia of speech and agraphia]

It remains controversial whether agraphia can coexist in a case with apraxia of speech, and whether an apraxia of speech can be classified into a category of aphasia. We examined the presence of agraphia in 2 right-handed patients of apraxia of speech. Case 1 of mild agraphia showed an infarcted lesion in the left precentral gyrus extending to the neighboring white matter, which involving the arcuate fasciculus on MRI. Positron emission tomography (PET) indicated decrease of cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) in the infarcted lesion, but no decrease of CBF and CMRO2 in the Broca's area. In this case, agraphia was more conspicuous in "kanji" than in "kana" and severity of the agraphia was not correlated to that of speech disturbance on naming test. Case 2 without agraphia showed a small infarcted lesion in the left precentral gyrus, which did not extend to the deep white matter on MRI. Agraphia can coexist with apraxia of speech in a case with the lesion in the left precentral gyrus, in which the cortical lesion is relatively widespread or extends to the deep white matter. However, lack of etiological connection between the agraphia and the apraxia of speech was suggested. We could not confirm the location in the left precentral gyrus which is responsible for the agraphia.

Direct recognition of rat MHC antigens on rat antigen-presenting cells by mouse CD4+ and CD8+ T cells and establishment of T cell clones exhibiting a direct recognition pathway

Alloantigens are recognized by T cells either through a direct pathway, which involves recognition of alloantigens expressed on allogeneic antigen-presenting cells (APC), or through an indirect pathway, which involves recognition of processed alloantigens presented by self APC. We investigated whether rat xenoantigens are also recognized by direct (xenogeneic APC-restricted) and/or indirect (self APC-restricted) pathways. C57BL/6 (B6) mouse anti-F344 or WKAH rat mixed lymphocyte reactions (MLRs) were partially inhibited by addition of either anti-mouse CD4 or CD8 monoclonal antibody (mAb) and almost completely blocked in the presence of both mAbs. These xenogeneic MLRs were almost completely inhibited by simultaneous depletion of both self and xeno APCs and only partially suppressed by the elimination of either type of APC, indicating that freshly prepared splenic mouse T cells can recognize rat xenoantigens through both direct and indirect pathways. Anti-F334 T cell lines were generated from B6 anti-F344 MLR cultures, and four CD4+ and four CD8+ T cell clones were isolated from these parental lines. The parental lines and those derived T cell clones were tested for their ability to proliferate depending on the presence of F344 APC. Proliferation of CD8 clones by stimulation with F344 APC was inhibited by the addition of anti-rat class I MHC mAb but not of anti-class II MHC mAbs. Conversely, proliferation of CD4 clones was reduced by addition of anti-class II MHC mAbs. Thus, these results indicate that xeno (rat)-reactive mouse T cells recognize xenoantigens via both indirect (self APC-restricted) and direct (xeno APC-restricted) pathways and that both CD4 and CD8 subsets of T cells participate in a direct pathway of xenoantigen recognition.

The involvement of the histone fold motifs in the mutual interaction between human TAF(II)80 and TAF(II)22

The TATA box-binding factor TFIID mediates transcriptional regulation through interactions with various regulatory factors and putative participation in reconfiguration of nucleosomes, utilizing its components, which include TATA box-binding protein (TBP) and TBP-associated factors (TAFs). Our and other previous studies have elucidated that there exist histone-similar TAFs. Studies on TAFs similar to histone H3 and H4 have revealed their biochemical and structural similarities to the corresponding histones. However, the existence of histone-like interactions involving the other TAFs is still ambiguous. Here we report the analyses with a two-hybrid system of the mutually interacting regions between hTAF(II)80 and hTAF(II)22, which resemble histone H4 and H2B, respectively. The results demonstrate the indispensability of the histone fold motifs of these two TAFs for mutual interaction. Together with earlier biochemical or structural studies, the present results suggest the presence of a histone octamer-like partial TAF complex and its involvement in transcription from chromatin templates.

Collagenase gene (colA) is located in the 3'-flanking region of the perfringolysin O (pfoA) locus in Clostridium perfringens

The 3'-flanking region of the beta-galactosidase gene (pbg), which is located downstream of the perfringolysin O gene (pfoA), and the 5'-flanking region of the collagenase gene (colA) of Clostridium perfringens strains NCTC8237 and 13, respectively, were analyzed. Southern analysis revealed that the colA gene is located 6.5 kb downstream of the pbg gene in the chromosome of C. perfringens. Sequence analysis showed that between the pbg and colA genes were the arcABDC and ahrC genes, whose putative products were quite similar to enzymes of the arginine deiminase pathway of Pseudomonas aeruginosa and the arginine repressor/activator of Bacillus subtilis, respectively. It is concluded that the genomic structure of the pfoA-colA region consists of pfoR-pfoA-ORF54-pbg-arcABDC-ahrC-colA.

Outcome of surgical resection for chest wall recurrence in breast cancer patients

BACKGROUND

Although recurrent breast cancer is a systemic disease, there might be several exceptions where local treatment has a favorable outcome.

METHODS

From 1989 to 1996, 15 patients underwent full thickness chest wall resection, supported by peri- and postoperative systemic treatments for patients with isolated chest wall recurrences, including soft tissue local recurrence and parasternal lymph node metastasis.

RESULTS

The 5-year survival rate after surgical removal was 47%. Patients with > 5-year disease-free intervals (DFI) after mastectomy showed a long survival after chest wall resection. Local failures appeared in four cases whose surgical margins were positive. No serious complication except one pyothorax occurred after surgery.

CONCLUSIONS

It is suggested that surgical treatment with a full thickness chest wall resection might have a favorable prognosis for selected patients with solitary lesion and long DFI.

Evaluation of myocardial viability during simple cold storage with the use of electrical properties in broad frequencies

BACKGROUND

The purpose of this study ws to determine whether myocardial viability during simple cold storage can be monitored from alteration of electrical properties of the preserved heart.

METHODS

Twelve anesthetized dogs underwent rapid cardiac extirpation and were preserved in simple cold storage ( 4 degree C). They were divided into two groups according to preservation solutions. Groups S and U were preserved in saline and University of Wisconsin Solutions, respectively. The loss-tangent (Tan delta) in dielectric spectroscopy was analyzed on serial measurements of electrical properties of the preserved heart with an electrical impedance meter. Myocardial specimens were taken for myocardial adenosine triphosphate measurement with high-performance liquid chromatography and myocardial water content. We investigated the correlations among myocardial adenosine triphosphate, myocardial water content, and Tan delta.

RESULTS

The maximum value of Tan delta corresponds to a frequency fT which ranged from 5 to 10 kHz in both groups and maximum Tan delta gradually decreased during preservation in both groups. Myocardial adenosine triphosphate in group U was significantly higher than that in group S. The ratio of measured adenosine triphosphate and maximum Tan delta to the preischemic values during preservation were expressed as percentage of adenosine triphosphate and percentage of maximum Tan delta. There was close correlation between myocardial percentage of adenosine triphosphate and percentage of maximum Tan delta during preservation in both groups. Myocardial water content in group S increased during preservation but did not increase in group U. There was no correlation between myocardial water content and percentage of maximum Tan delta during preservation. Tan delta function were used to characterize the electrical properties of biologic tissue and were clearly associated with ischemic histologic damage of tissues.

CONCLUSIONS

Therefore measurement of electrical properties in broad frequencies of the preserved heart may be feasible as a monitor of graft viability in a minimally invasive method.

Distinctive microcirculation of the brain during cerebral perfusion by observation with a CCD microscope

Establishment of safer cerebral protection remains an important issue in reducing cerebral complications during aortic arch repair. Various cerebral perfusion techniques have been used. Recently, the usefulness of retrograde cerebral perfusion (RCP) combined with hypothermia was reported. The authors evaluated the cerebral microcirculation during RCP by direct observation with a charge-coupled device (CCD) microscope. In six craniotomied, anesthetized swine, cardiopulmonary bypass was established by arterial perfusion through the femoral artery and venous drainage from the right atrium. The authors observed cerebral arteriolae and venulae on the brain surface. Each swine was cooled to a brain temperature of 20 degrees C. Perfusion was stopped, RCP was initiated with oxygenated blood through the superior vena cava, and cerebral perfusion pressure (CPP) was gradually increased. During antegrade cerebral perfusion (ACP), homogeneous vascular flow was observed in all models. During RCP, retrograde vascular flow was generated in four of the six models, but homogeneous retrograde vascular flow was achieved in arteriolae and venulae in only two models at a CPP of greater than 20 mmHg. It is suggested that homogeneous and effective retrograde perfusion may not be achieved at a CPP of less than 20 mmHg, and that RCP causes uneven microcirculation of the brain with a disadvantageous effect on cerebral protection when compared with ACP.

[An autopsy case of late-onset chorea]

Senile chorea has been an ill-defined clinical entity because of the difficulty of differentiating it from Huntington's disease (HD) of late-onset type. The gene specific for HD has recently been found to contain an abnormal (CAG)n trinucleotide repeat which allows it to be differentiated from the other conditions. Our case of late-onset chorea was differentiated from HD by PCR. An 80-year-old man had experienced gradually increasing chorea of his tongue, arms and legs for 4 years, but had not exhibited character changes, mental symptoms or dementia. He died of pneumonia at 84 years. The pathological findings in this case were different from those of HD. The brain weighted 1220 g, and did not show striatal atrophy or neuronal loss. The most remarkable findings were numerous foamy spheroids scattered in the caudate and putamen and proliferation of fibrous astrocytes within the thin myelinated fiber bundles and in the neuropil. Similar findings were reported by Freidman et al. (1990). Although it is debatable whether this finding was responsible for the development of the chorea, this case should contribute to our understanding of senile chorea as a clinicopathological entity.

Evidence of direct recognition subset in xeno-reactive helper T cells

There are two functional subsets of alloreactive helper T cells: one recognizes the alloantigens on self-antigen-presenting cells (APCs), and the other recognizes the alloantigens on allo-APCs. In this study, we analyzed which specific Th cells have a possible effect on concordant-xenograft rejection responses and how Th cells recognize xeno-antigens. In the proliferative response stimulated with spleen cells obtained from rats (r-SPC), mouse T cells (m-Tc) were not inhibited by GK1.5 (CD4) or 2.43 (CD8) antibodies. In a xeno-mixed lymphocyte reaction, m-Tc that included APC (APC(+)) proliferated when stimulated with r-SPC APC(+) or APC(-). In contrast, B6 T cell APC(-) proliferated only when stimulated with r-APC(+)SPC but not when stimulated with APC(-). The m-Tc lines responded to F344 SPC APC(+) but not to SPC APC(-); however, the m-Tc line did not respond to SPC from another rat strain. We hypothesize that both CD4+ Th and CD8+ Th are included in the concordant xeno-reactive Th; there are both xeno-APC-restricted Th and self-APC-restricted Th; and xeno-APC-restricted Th recognizes xeno-major histocompatibility complexes.

Isolation and characterization of a cDNA encoding a novel human transcription factor TFIID subunit containing similarities with histones H2B and H3

Using the yeast two-hybrid system, we isolated a human cDNA that encodes a protein (hp22) interacting with TATA box-binding factor TFIID subunit p80 containing similarity with histone H4. Sequence analysis showed that the open reading frame (ORF) specifies a 161-amino-acid (aa) polypeptide homologous to Drosophila melanogaster TFIID subunit p22 (dp22). Comparison of the aa sequence of human TFIID subunit p22 (hp22) with that of dp22 revealed that p22 is composed of two distinct regions; the less conserved N-terminal (20% identity) and the highly conserved C-terminal (65% identity) regions. Additionally, the C-terminal region was found to contain similarities with histones H2B and H3. Northern blot analysis showed mRNA corresponding to hp22 to be expressed in all tissues examined.

Ferricyanide reductase activity in cataractous human lens

We assayed ferricyanide reductase activity (one of NADH-dependent diaphorase activities) in the soluble and insoluble fractions of cataractous human lenses. Activity of this reductase in both the soluble and insoluble fractions tended to decrease in order of cortex > nucleus periphery > nucleus center, and it was suggested that a decrease of the reductase activity is closely correlated with lens protein aggregation, and to some extent associated with the development of nuclear sclerosis (coloration) and cortical cataract. Furthermore, insoluble fraction had very high specific activity per mg insoluble protein in cortex, and the activity decreased sharply with an increase in the level of insoluble protein. The reductase activity in the insoluble fraction may be also related to the metabolic activity of plasma membranes.

A clinical profile of corticobasal degeneration presenting as primary progressive aphasia

We report a patient with primary progressive aphasia who first presented with amnesic aphasia that developed over the course of 3 years into nonfluent aphasia with buccofacial apraxia, followed in the next year by cognitive impairment and parkinsonism. Pathological findings were typical for corticobasal degeneration except for the distribution of cortical atrophy. This case suggests that corticobasal degeneration should be included in the differential diagnosis of primary progressive aphasia, especially in association with parkinsonism.

Ascorbate free radical reductases and diaphorases in soluble fractions of the human lens

Major and minor ascorbate free radical (AFR) reductases, with diaphorase activity, and three other diaphorases were separated from the human lens soluble fraction by DEAE-cellulose ion-exchange column chromatography. They were characterized for adsorptivity to ion-exchange and 5'AMP-Sepharose 4B affinity columns, kinetic properties, and substrate specificity. The latter diaphorases were closely correlated with NADH-cytochrome beta 5 reductase. The major and minor AFR reductases were regarded as a major diaphorase group different from two ubiquitous diaphorases, i.e., NADH-cytochrome beta 5 reductase and DT-diaphorase. A major AFR reductase was partially purified approximately 50 fold over the lens soluble fraction by ion-exchange, affinity, and gel filtration (Sephacryl S-200 HR) column chromatography. From the partially purified enzyme, 2 bands, one sharp and one diffuse, were obtained by native polyacrylamide gel electrophoresis. Two proteins, of 20 and 24 kDa, were identified in the active enzyme bands by SDS-polyacrylamide gel electrophoresis. This suggests that the 20 and/or 24 kDa proteins may be components of the major AFR reductase.

[Coronary artery bypass grafting in cases with the atherosclerotic ascending aorta]

Among 172 cases of coronary artery bypass grafting, 9 cases (5%) revealed severely atherosclerotic ascending aorta. In 3 of the 9 cases, total aortic cross-clamping in the distal anastomoses of saphenous vein graft (SVG) and partial aortic clamp in the proximal anastomoses of SVG were performed. In 1 case with this technique, cerebral infarction was occurred. In 4 cases, total aortic cross-clamping in the distal and proximal anastomoses of SVG was performed. In 2 of these cases with this technique, cerebral infarctions were occurred. Hypothermic circulatory arrest was performed in 2 of the rest. In one case that was predicted to have atherosclerosis of ascending aorta prior to operation, the left internal thoracic artery was anastomosed to the left anterior descending, and SVG to the right coronary artery with hypothermia and ventricular fibrillation. And during the proximal anastomoses of SVG, hypothermic circulatory arrest without aortic clamping was initiated. In another case, atherosclerosis of ascending aorta was noted after aortic cross-clamping. Then the aorta was declamped, hypothermic circulatory arrest was established, the aorta was opened, the diseased segment was resected, and proximal anastomoses of SVG was performed to Dacron patch which was implanted for aortic wall. There were no cerebral infarction in last two patients.

Dielectric spectrogram for instantaneous evaluation of ischemic injury of the liver

Electrical properties of tissues sensitively reflect structural and physiologic changes. The authors examined the use of a dielectric spectrogram for instantaneous evaluation of ischemic injury of the liver. Wistar rats, which had enough collateral circulation for portal bypass with subcutaneous transposition of the spleen, were used. Four ischemic periods (15, 30, 60, and 120 min) were examined and followed by reflow. Permittivity and conductivity were measured at 39 frequency points in the 20 Hz-1 MHz range using an LCR meter system. They were then expressed in a loss tangent (LT) plot to clear their behavior. The maximum LT value (max-LT) and the minimum LT value (min-LT) of the normal liver were 3.98 +/- 0.28 and 2.98 +/- 0.22, and appeared in 15-20 kHz and 150-300 kHz, respectively. During the first 30 min after ischemia, max-LT decreased to 3.25 +/- 0.14 (p < 0.005) and its range shifted to 0.3-0.6 kHz, and min-LT decreased to 1.35 +/- 0.06 (p < 0.001) without shifting of range. Max-LT then decreased gradually and min-LT began to increase. After reflow, max-LT increased and higher max-LT was observed in the longer ischemic cases. Max-LT at 1 hr after reflow correlated negatively with recovery rate of bile flow at that time (y = -0.238x + 1.84, r2 = 0.82). Additionally, the difference between max-LT and min-LT at just before reflow (dif-LT) showed a significant correlation coefficient with recovery rate of bile flow at 1 hr after reflow (y = 2.22x -3.32, r2 = 0.92).

[Coronary artery bypass surgery in patients aged 75 years or older]

16 patients 75 years of age or older underwent coronary artery bypass grafting. The overall hospital mortality rate was 12.5% (2/16), 0% for elective procedures, 33.3% for urgent and emergent cases. 4 of 6 patients underwent emergency CABG after failed percutaneous transluminal coronary angioplasty. Major complications were altered mental status, low cardiac output syndrome (LOS), pulmonary dysfunction and renal dysfunction. One patient who died had LOS. Another patient who died occurred multiple organ failure after pulmonary dysfunction from self-extubation. There was no correlation the incidence of postoperative confusion and preoperative cerebral CT findings. CABG can be performed safely in patients 75 years or older, if the preoperative conditions are stable.

[Hemorrhagic cerebral infarction at the old age in a case with familial antithrombin III (ATIII) deficiency]

An old woman had stroke at age 67. Cerebral CT scan disclosed the low-density lesion with high-density area in the left temporal lobe, but no empty delta sign in the superior sagittal sinus. Thereafter, she had sometimes panic attacks. At the age of 70, she was admitted because of loss of consciousness probably caused by the same attack. On admission, Brain CT scan showed no fresh lesions. During the stay in the hospital, she had an episode of deep vein thrombosis of her left leg. The patient was found to have not only reduced biochemical activity but also low immunological level of AT III. Her nephew had also the low plasma AT III antigen concentration. Transesophageal echocardiography showed no abnormality, but atherosclerotic change at the aortic arch. We speculated that hemorrhagic cerebral infarction in the territory of the branch of middle cerebral artery could be induced by the arterial thrombus which was related to the hypercoagulable state associated with familial AT III deficiency, although the possibility of cardiogenic embolic infarction or of cerebral vein thrombosis could not be ruled out. Familial AT III deficiency is one of the causes of cerebral infarction even in the elderly.

Crystal structural analysis of tobacco necrosis virus at 5 Å resolution

X-ray diffraction intensities for tobacco necrosis virus crystals were collected at 5 A resolution using a Weissenberg camera with a large cassette of radius 430 mm. The synchrotron radiation source at the Photon Factory was used. The crystal structure of the virus was obtained by 91 cycles of the non-crystallographic symmetry averaging. Secondary structures such as alpha-helices and beta-structures were clearly identified in the electron-density map at 5 A resolution. This virus resembles southern bean mosaic virus both in orientation of coat protein subunits and in their folding. Ordered and disordered parts of each subunit of tobacco necrosis virus are shorter and longer than the corresponding parts of the southern bean mosaic virus by 12 and 27 residues, respectively.

[Adult-onset dementia with abundant neurofibrillary tangles resembling progressive supranuclear palsy]

We described an autopsy case of 79-year-old woman with clinically unclassified senile dementia. The patient developed forgetfulness at the age of 73, and later, persecution mania, apathy and episodic stupor, but no extrapyramidal symptoms. Neuropathological examination revealed severe neuronal loss and gliosis of substantia nigra, moderate neuronal loss and marked grumose degeneration of dentate nucleus, and mild astrocytosis of subthalamic nucleus. Abundant neurofibrillary tangles (NFT) were observed in subthalamic nucleus, globus pallidus, substantia nigra, locus ceruleus, tegmentum of brain stem, pontine nucleus, inferior olive, and dentate nucleus. Gallyas silver impregnation method showed a wide distribution of argyrophilic grains and threads in cerebrum, brain stem and cerebellum. Although absence of clinical and neuropathological hallmarks excluded the diagnosis of progressive supranuclear palsy (PSP), the distribution of NFT and argyrophilic grains in this patient resembled PSP.