Treatment of coronary bifurcation lesions with bioresorbable vascular scaffolds

AIM

Aim of the study was to report on the feasibility and early safety and efficacy of Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) for coronary artery bifurcations (CABs) treatment at a single high-volume center.

METHODS

All patients treated with Absorb implantation at our institution from March 2013 to March 2014 were enrolled in the prospective, single-center, ongoing, all-comers registry, which has the main purpose of evaluating the safety and efficacy of Absorb implantation in unselected patients treated in daily practice. In-hospital and at follow-up clinical outcomes of 46 patients undergoing treatment with Absorb in 46 CAB lesions were reported in the present study.

RESULTS

Treated CAB lesions involved the left main in 13.0% of cases, the left anterior descending artery in 65.0%, the left circumflex in 19.6%, and the right coronary artery in 2.2%. Bifurcations were classified as true (47.8%) and non-true (52.2%) according to the Medina classification. The provisional and the two-BVS techniques were used in 78.3% and 21.7%, respectively. Two-BVS techniques included: mini-crush 13.0%; reverse culotte 2.2%; T-stenting 2.2%; and V-stenting 4.3%. No in-hospital adverse events occurred. At 6 months no adverse events occurred. Only one case of target lesion revascularization was observed at day 227. No stent thrombosis occurred during follow-up.

CONCLUSION

Our preliminary experience suggested that CABs treatment with Absorb is feasible and associated with promising immediate and short-term clinical outcomes. However, larger studies with long-term follow-up are needed to adequately address the safety and efficacy of BVS use in CABs.

NK1R- and NK2R-dependent neuropeptide signaling regulates Type-1 immunity through activation of dendritic cells (INC6P.336)

Neurotransmitters such as Substance P (SP) and Neurokinin A (NKA) are widely distributed in both central and peripheral nervous system. Recently, we demonstrated that IFN-γ remarkably induced neurokinin-2 receptor (NK2R) expression in human dendritic cells (DCs). These findings strongly suggested that neuropeptide-signaling might regulate function of human DCs DC-mediated immune responses. In this study, we examined the effect of neuropeptide signaling on DC function. Human DCs generated from peripheral blood mononuclear cells (PBMCs) were treated with various type I cytokines or toll-like receptor ligands. Both neurokinin-1 receptor (NK1R) and NK2R mRNA expressions in DCs were significantly enhanced by poly I:C stimulation. The upregulation of NK1R and NK2R mRNA expressions was blocked in the presence of STAT-1 inhibitor. Surface expression levels of HLA-DR and costimulatory molecules on DCs, augmented by poly I:C, were modulated by NK1R or NK2R inhibitor. In addition, we found that blockade of NK1R- and NK2R-mediated signaling significantly suppressed various cytokine productions by antigen-specific CD4+ T cells stimulated with DCs. These findings indicate that NK1R- and NK2R-dependent neuropeptide signaling regulate Type-1 immunity through the activation of DCs, suggesting that such neuro-immune cross-talk through NK1R and NK2R signaling might be involved in various diseases with chronic inflammation caused by excessive Type-1-dominant immunity.

Activation of IL-6/STAT3-signaling cascade induces suppression of antigen presentation by human dendritic cells (TUM4P.917)

Immunosuppression in tumor microenvironments is one of the critical issues for cancer immunotherapy. We have been demonstrated that IL-6, a pleiotropic cytokine that regulate the growth, differentiation and survival of a variety of cells, significantly inhibited maturation of murine dendritic cells (DCs) via STAT3 activation both in vitro and in vivo. In this study, we focused on IL-6/STAT3-signaling cascade in human dendritic cells (DCs), and investigated the effects of IL-6 on antigen-presenting ability of DCs. Surface HLA class I, HLA class II, and costimulatory molecules of human DCs were evaluated after the stimulation with IL-6 in vitro. As a result, HLA-DR and CD86 expressions were significantly reduced by IL-6 treatment of human DCs. The reduction was remarkably blocked in the presence of STAT3 inhibitor. In addition, IFN-γ production by T cells after TCR-stimulation was significantly suppressed in the presence of IL-6-treated DCs compared with control DCs. Moreover, we found that activation of antigen-specific CD4+ T cells by DCs was remarkably reduced by the IL-6-treatment. In this study, we demonstrated that IL-6/STAT3-signaling cascade was one of the regulating factors for antigen presentation of DCs. From these findings suggest that IL-6/STAT3 signaling cascade regulates immunosuppressive function of human DCs, which would be a promising target for improving the effects of cancer immunotherapy.

IL-17 regulates Toll-like receptor-mediated activation of dendritic cells (TUM4P.905)

We have proposed that IL-17 produced by γδ T cells promoted angiogenesis and subsequent tumor progression in tumor microenvironment. However, the precise effect of IL-17 on immune system was remained unclear. Since dendritic cells (DCs) play a crucial role in immune regulation, we investigated the impact of IL-17 on DC function. Bone marrow-derived DCs were treated with IL-17 for 16 h and then stimulated with various toll-like receptor (TLR) ligands. IL-17 treatment significantly reduced IL-12, TNF-α, or IL-6 production by the DCs in a dose dependent manner. Interestingly, we found that IL-12 production was most clearly decreased compared to the other cytokines. In addition, IL-17 markedly suppressed the upregulation of MHC class II, CD40, and CD86 expressions on DCs after the stimulation. To evaluate effects of IL-17 on T cell-stimulating activity, IL-17-treated DCs were co-cultured with OVA antigen-specific T cells in the presence of OVA peptides or OVA proteins. We confirmed that IFN-γ production and T cell proliferation were suppressed by the IL-17-treatment. To determine effects of IL-17 on in vivo DC function, we established a novel tumor-bearing model using IL-17-producing cancer cells. As a result, expression levels of MHC class II and costimulatoly molecules on DCs were reduced in this model. These findings clearly indicated that IL-17 would inhibit activation of DCs including cytokine production and T cell activation in tumor microenvironment.

Significant association of poor glycemic control with increased resistance in efferent arterioles--study of inulin and para-aminohippuric acid clearance in humans

AIMS

To examine whether glomerular hemodynamic parameters in humans are associated with glycemic control indices, by simultaneously measuring clearance of inulin (Cin) and para-aminohippuric acid (CPHA).

METHODS

Thirty-one subjects (age 55.4±14.7 years; 15 men and 16 women; 21 diabetics and 10 non-diabetics) were enrolled. Cin and CPAH were measured simultaneously. Afferent arteriolar resistance (Ra), efferent arteriolar resistance (Re), glomerular hydrostatic pressure (Pglo) and glomerular filtration fraction (FF) were calculated according to Gomez' formula.

RESULTS

FF correlated significantly and positively with fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and glycated albumin (GA) (r=0.396, p=0.0303; r=0.587, p=0.0007; r=0.525, p=0.0070, respectively). Pglo correlated significantly and positively with FPG, HbA1c and GA (r=0.572, p=0.0008; r=0.535, p=0.0019; r=0.540, p=0.0053, respectively). Although there was no significant correlation between Ra and glycemic control indices, Re correlated significantly and positively with HbA1c and GA (r=0.499, p=0.0043; r=0.592, p=0.0018, respectively). FF, Pglo and Re were associated significantly with HbA1c and GA after adjustment for age.

CONCLUSIONS

These results demonstrate, in humans, that poor glycemic control is associated with increased Re, but not Ra. It is suggested that increased Re causes increased Pglo, leading to increased FF. Thus, hemodynamic abnormalities with poor glycemic control may be related to glomerular hypertension in humans.

Diffusion-weighted imaging vs STIR turbo SE imaging: capability for quantitative differentiation of small-cell lung cancer from non-small-cell lung cancer

OBJECTIVE

To compare the capability of differentiation of small-cell lung cancer (SCLC) from non-SCLC (NSCLC) between diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR) turbo spin-echo imaging.

METHODS

The institutional review board of Kobe University Hospital, Kobe, Japan, approved this study, and written informed consent was obtained from each patient. 49 patients with NSCLC (30 males and 19 females; mean age, 66.8 years) and 7 patients with SCLC (5 males and 2 females; mean age, 68.6 years) enrolled and underwent DWI and STIR. To quantitatively differentiate SCLC from NSCLC, apparent diffusion coefficient (ADC) values on DWI and contrast ratios (CRs) between cancer and muscle on STIR were evaluated. ADC values and CRs were then compared between the two cell types by Mann-Whitney's U-tests, and the diagnostic performances were compared by McNemar's test.

RESULTS

There were significant differences of mean ADC values (p < 0.001) and mean CRs (p = 0.003). With adopted threshold values, the specificity (85.7%) and accuracy (85.7%) of DWI were higher than those of STIR (specificity, 63.3%; p = 0.001 and accuracy, 66.1%; p = 0.001). In addition, the accuracy of combination of both indexes (94.6%; p = 0.04) could significantly improve as compared with DWI alone.

CONCLUSION

DWI is more useful for the differentiation of SCLC from NSCLC than STIR, and their combination can significantly improve the accuracy in this setting.

ADVANCES IN KNOWLEDGE

Pulmonary MRI, including DWI and STIR, had a potential of the suggestion of the possibility as SCLC.

Seasonal differences in total antioxidant capacity intake from foods consumed by a Japanese population

BACKGROUND/OBJECTIVES

This cross-sectional study aimed to estimate total antioxidant capacity (TAC) intake from food and beverages in a Japanese population from 7-day seasonal dietary records.

SUBJECTS/METHODS

The 7-day weighed dietary records of 390 subjects over four seasons between 1996 and 1998 were used. The TAC values (μmol trolox equivalents (μmol TE)/g) of various foods and beverages were defined, as reported in previous studies for weighed dietary records, using several different methods. TAC values of foods were estimated in 242 food and beverage items: 86.5% of vegetables, 99.1% of fruits, 71.5% of potatoes, 96.7% of beans, and 100% of chocolates. Differences in TAC intake per day and intake (g) per day among seasons in each of the food and beverage group were compared using a general linear model for repeated measures. The TAC intake/day were calculated for each food and beverage item in the four seasons.

RESULTS

TAC intake/day (μmol TE/day) varied from 10 189 (summer) to 12 292 (winter). TAC intake/day from fruits (2696) and potatoes (395) was highest in autumn, from vegetables (2827) it was highest in summer and from beans (4151) and tea (2331) it was highest in winter.

CONCLUSIONS

The dietary habits of the studied Japanese population showed the highest antioxidant capacity in winter and the lowest in summer.

Expansion of donor-reactive host T cells in primary graft failure after allogeneic hematopoietic SCT following reduced-intensity conditioning

Graft rejection remains a major obstacle in allogeneic hematopoietic SCT following reduced-intensity conditioning (RIC-SCT), particularly after cord blood transplantation (CBT). In a murine MHC-mismatched model of RIC-SCT, primary graft rejection was associated with activation and expansion of donor-reactive host T cells in peripheral blood and BM early after SCT. Donor-derived dendritic cells are at least partly involved in host T-cell activation. We then evaluated if such an expansion of host T cells could be associated with graft rejection after RIC-CBT. Expansion of residual host lymphocytes was observed in 4/7 patients with graft rejection at 3 weeks after CBT, but in none of the 17 patients who achieved engraftment. These results suggest the crucial role of residual host T cells after RIC-SCT in graft rejection and expansion of host T cells could be a marker of graft rejection. Development of more efficient T cell-suppressive conditioning regimens may be necessary in the context of RIC-SCT.

A study on how a 6-month aerobic exercise program can modify coronary risk factors depending on their severity in middle-aged sedentary women

It is well known that physical exercise can reduce coronary risk factors. But how an aerobic exercise modifies coronary risk factors in relation to severity and physical fitness is still controversial.Fifty-four middle-aged women (mean age, 55 years) completed a 6-month on-site and home-based anaerobic threshold-level exercise program. The changes in coronary risk factor profiles were observed during the pre-intervention and intervention periods. Before the intervention (during control period), most coronary risk factors showed a rather unfavorable trend. After the program, their mean body weight decreased from 56.7 to 55.7 kg (p>0.05) and the proportion of body fat from 30.9 to 27.9% (p>0.05) without any reduction in lean body mass. Systolic blood pressure (SBP) decreased from 129.0 to 125.0 mm Hg (p>0.05) and diastolic blood pressure from 79.5 to 76.6 mm Hg (p>0.05). Fasting plasma glucose (FPG) declined from 109.6 to 103.4 mg/dl (p>0.05). Changes in SBP and FPG were most remarkable in their respective worst tertile. Serum lipids improved only modestly. Maximum oxygen uptake increased from 23.6 to 26.1 ml/kg/min (p>0.01). However, no significant correlations were found between changes in coronary risk factors and those in physical fitness. We conclude that the 6-month aerobic exercise program would modify women's coronary risk factors depending on their initial values, probably independently of the changes in physical fitness.

The health system in Nepal-An introduction

We present here a study on the health system in Nepal. Approximately two-thirds of the health problems in Nepal are infectious diseases. Epidemics occur frequently with a high rate of morbidity and mortality and there are occasional outbreaks of infectious diseases of unknown etiology. In addition, the rapid rate of HIV infection in the Indian sub-continent is likely to add a new dimension of opportunistic infections. Until now, the Health System introduced as the General Health Plan in 1956 has been expanded by focusing on primary health care, and a comprehensive network-like Health System has been developed; the most basic unit is a Sub-Health Post or Health Post in each Village Development Committee area. However, the expansion of the Health System has not been matched by an expansion in the domestive resources, workers and supplies, and the available resources are not efficiently distributed. In addition, insufficient resources available for preventive and promotive medicine and the occurrence of non-infectious diseases such as cancer and cardiovascular diseases has been increasing. The Government recently introduced a Health Policy encouraging the private sector to invest in the production of health workers and in providing quality health services. As a result, several private health institutions have been founded and are expected to contribute to the development of the human resources required by Nepal.

Effects of cytosine arabinoside on rat and rabbit embryos cultured in vitro

The technique of rabbit whole embryo culture for 48 or 24 hr from day 9, 10 or 11 of gestation has been improved for elucidation of species differences. The effects of 1-beta-d-arabinofuranosylcytosine (ara-C) and its metabolite 1-beta-d-arabinofuranosyluracil (ara-U) on cultured rat and rabbit embryos were examined. Slc:SD rats on day 10.5 of gestation were explanted and cultured in rat serum containing ara-C (5-10 mug/ml) for 48 hr. Rabbit embryos of the Japanese White strain on day 9 or day 10 of gestation were explanted and cultured in rabbit serum containing ara-C (0.03-1.0 or 3-30 mug/ml) or ara-U (1.0 or 30 mug/ml) for 48 or 24 hr. Cultured rat embryos exposed to ara-C showed abnormalities of the head (malformations of the telencephalon, mesencephalon and rhombencephalon), mandible and limb bud, and short tail. Growth parameters, such as crown-rump length, head length, protein content and somite number, were reduced with increasing concentrations of ara-C. In the rabbit, embryos cultured from day 9 of gestation for 48 hr showed abnormalities of the head (telencephalon, rhombencephalon), mandible and limb bud with ara-C at 0.1 mug/ml and higher concentrations. Concentration-dependent decreases in crown-rump length, head length and protein content were observed. The findings in embryos cultured from day 10 of gestation were similar to those in embryos cultured from day 9. Ara-U produced no detectable abnormalities in embryos cultured for 48 hr from day 9 of gestation, or for 24 hr from day 10. These results indicate that ara-C has teratogenicity in vitro that is similar in both rat and rabbit embryos.

Three-dimensional airway lumen volumetry: comparison with bronchial wall area and parenchymal densitometry in assessment of airway obstruction in pulmonary emphysema

OBJECTIVES

The purpose of this study was to compare three-dimensional airway lumen volumetry with bronchial wall area and parenchymal densitometry in the assessment of airway obstruction in pulmonary emphysema.

METHODS

56 patients, who were smokers, underwent CT examination and pulmonary function tests (PFTs). For quantitative assessments, the following parameters were computationally calculated: (1) percentage of voxels -950, -960 and -970 HU in the lung (%LAA(-950), %LAA(-960) and %LAA(-970), respectively); (2) percentage of partial bronchi luminal volumes per total luminal volumes (LV(main), main and distal bronchial volume/total luminal volume; LV(lobe), lobar and distal bronchial volume/total luminal volume); and (3) mean wall area percentages of segmental bronchi of the right apical and left apicoposterior segment (WA%(seg)) and of subsegmental bronchi (WA%(sub)) in the upper lobes. These parameters were correlated with PFTs and statistically compared between a chronic obstructive pulmonary disease (COPD) group [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<70] and a non-COPD group.

RESULTS

FEV1, maximum mid-expiratory flow rate and forced expiratory flow at 25% vital capacity had significant correlation with LV(main) (r>0.53, p<0.0001), LV(lobe) (r>0.52, p<0.0001), WA%(seg) (|r|>0.29, p<0.05) and WA%(sub) (|r|>0.31, p<0.05). FEV1/FVC had significant correlation with all parameters (0.27<|r|<0.52, p<0.05). LV(main) and LV(lobe) and WA%(seg) and WA%(sub) were significantly different between the two groups (LV(main) and LV(lobe); p<0.0001, WA%(seg) and WA%(sub); p<0.05).

CONCLUSIONS

Bronchial luminal volumetric assessment better reflected the airflow limitation parameters.

ADVANCES IN KNOWLEDGE

Bronchial luminal volumetric assessment can potentially be used to gauge airflow limitation in pulmonary emphysema.

Temporary auxiliary partial orthotopic liver transplantation using a small graft for familial amyloid polyneuropathy

Donor shortage is a major issue in liver transplantation. We have successfully performed temporary auxiliary partial orthotopic liver transplantation (APOLT) using a small volume graft procured from a living donor for recipients with familial amyloid polyneuropathy (FAP). The aim of this study was to evaluate this procedure by comparing it with standard living donor liver transplantation (LDLT). We compared 13 recipients undergoing this procedure with 23 recipients undergoing a standard LDLT for the treatment of FAP. The estimated donor graft volume and the graft volume/recipient's standard liver volume ratio were significantly smaller in the temporary APOLT group than in the standard LDLT group. Postoperative complications were comparable, although the hospital stay was longer in the temporary APOLT group. All the patients safely underwent a remnant native liver resection about 2 months after their first operation in the temporary APOLT group. No symptoms related to FAP developed before the remnant liver resection, and no significant differences in graft and patient survival were observed between the two groups. We successfully performed temporary APOLT using a small volume liver graft without postoperative liver failure for FAP. Temporary APOLT for FAP might be a useful alternative procedure for expanding the donor pool for LDLT.