[Transthoracic digital color Doppler assessment of the left anterior descending coronary artery and intramyocardial blood flow]

Noninvasive assessment of the distal left anterior descending coronary artery and intramyocardial blood flow were attempted in 50 consecutive patients (28 males and 22 females, mean age [+/-SD] 58 +/- 12 years) using a 7.5 MHz transducer (Doppler frequency: 5 MHz) and a SSA-380A ultrasound digital system with special optimal settings for the color Doppler examination. Modified apical acoustic windows were used to visualize the blood flow in the distal left anterior descending coronary artery and the intramyocardial artery. By selecting a sample volume (2 mm wide) on the color trace of these blood flows, Doppler spectral tracing of the distal left anterior descending coronary artery and intramyocardial blood flows could be recorded using pulsed-wave Doppler system. Blood flow in the distal left anterior descending coronary artery was detected in 43 (86%, Vmax = 22 +/- 8.7 cm/sec, Vmean = 16 +/- 5.1 cm/sec) of 50 patients, and intramyocardial blood flow in 40 (80%, Vmax = 26 +/- 11.0 cm/sec, Vmean = 19 +/- 8.5 cm/sec) of 50 patients. Distal left anterior descending coronary artery and the intramyocardial blood flows can be imaged by transthoracic digital color Doppler echocardiography in the clinical setting.

Intravascular ultrasound analysis of reduction in progression of coronary narrowing by treatment with pravastatin

Serial intravascular ultrasound studies were performed to evaluate the effect of pravastatin on coronary atherosclerotic plaque. Administration of pravastatin reduced serum lipid levels and progression of coronary artery atherosclerotic plaque.

[Evaluation of left ventricular ejection fraction using an automated contour tracking method: comparison with equilibrium radionuclide angiography]

A recently developed contour tracking method provides automated edge detection of left ventricular endocardium without a region of interest. The accuracy of this automated contour tracking (ACT) method in the evaluation of left ventricular ejection fraction was assessed in 20 patients (16 males and 4 females, mean age 58 years) using both the ACT method and equilibrium radionuclide angiography. Ejection fractions measured by the ACT method correlated well with those measured by equilibrium radionuclide angiography (y = 0.8x + 11.9, r = 0.91, SEE = 4.0%, p < 0.01). The ACT method provides an accurate estimate of left ventricular ejection fraction.

Effects of balloon pulmonary valvuloplasty on atrial shunting--a patient with pulmonary valve stenosis and a large secundum atrial septal defect

Percutaneous balloon valvuloplasty has been established as an effective treatment for pulmonary valve stenosis (PS) in children and adults. However, there are few reports of the use of this technique in patients with other cardiac anomalies. We report the performance of balloon pulmonary valvuloplasty in a 72-year-old woman with a large atrial septal defect (ASD). This patient had a PS with a right ventricular pressure of 108/18 mmHg and a pulmonary arterial pressure of 42/21 mmHg, corresponding to a 66 mmHg pressure gradient. The ASD measured 32 x 27 mm. Balloon pulmonary valvuloplasty reduced the pressure gradient to 5 mmHg immediately after the procedure and to 2 mmHg 40 days after the procedure. The left-to-right shunt ratio was reduced from 17% before to 12% immediately after and to 36% 40 days after the procedure. In contrast, the right-to-left shunt ratio showed a transient increase from 16% before to 28% immediately after the procedure before decreasing to 11% 40 days after the procedure. The arterial blood oxygen tension was 53 Torr before, 46 Torr immediately after and 55 Torr 40 days after the procedure. The grade of heart failure decreased from New York Heart Association class IV before to class II in the chronic stage. These findings indicated that balloon pulmonary valvuloplasty in a patient with ASD transiently increased the right-to-left shunting associated with a decrease in oxygen tension, but that the change in the chronic stage was slight. In our patient with ASD valvuloplasty was useful in relieving the symptoms associated with elevated right ventricular pressure but could not reduce the hypoxemia caused by right-to-left shunting. In conclusion, valvuloplasty in patients with ASD should be considered as a preoperative treatment with the aim of reducing the risk of surgery and to treat symptoms in patients who refuse to undergo surgery.

Prediction of outcome of electrical cardioversion by left atrial appendage flow velocities in atrial fibrillation

We evaluated the usefulness of left atrial appendage (LAA) flow velocity during atrial fibrillation as an objective measure for prediction of the outcome of electrical cardioversion. Left atrial appendage peak velocities were measured by transesophageal echocardiography before cardioversion in 56 patients. Left atrial thrombus was demonstrated in 6 (11%) of these patients. Cardioversion was then performed in the 50 patients who did not have a thrombus and in 1 patient whose left atrial thrombus disappeared after anticoagulant therapy (n = 51). Thirty-eight patients converted to sinus rhythm which remained stable until discharge (initial success group). Of these, long-term (> 6 months) maintenance of sinus rhythm was achieved in 31 patients (82%). Five patients with almost no detectable appendage contractions during atrial fibrillation were classified in the initial failure group. The peak LAA flow velocity was significantly higher in patients with the initial success group compared with the patients in the initial failure group (25.6 +/- 12.0 vs 15.3 +/- 10.7 cm/s, respectively; p < 0.01). Left atrial appendage flow velocity during atrial fibrillation may be useful for identifying candidates for electrical cardioversion.

Further study on association of 5SrRNA-L5 protein complex and methionyl-tRNA to methionyl-tRNA synthetase in the macromolecular aminoacyl-tRNA synthetase complex

To obtain direct evidence for the attachment of 5SrRNA-ribosomal L5 protein particles (5SRNP) and methionine-tRNA (tRNA(met)) to methionyl-tRNA synthetase (MetRS) in the macromolecular aminoacyl-tRNA synthetase (ARS) complex of rat liver, a MetRS-5SRNP-tRNA(met) complex was dissociated from the macromolecular ARS complex fraction by n-octyl-beta-D-glucoside (Method I) or by omega-aminooctyl agarose (Method II) chromatography. The dissociated MetRS complex fraction was purified by gel filtration followed by tRNA-Sepharose chromatography using partially purified tRNA(met) in Method I, and by hydrophobic interaction chromatography in Method II. In both methods, final Superdex200 chromatography showed that MetRS activity was present in the region corresponding to the molecular weight of the MetRS-5SRNP-tRNA(met) complex (M(r) 200,000). One main protein band corresponding to the molecular weight of MetRS was observed on SDS-PAGE of the final product, which was concentrated by lyophilizing after dialysis against water. Using serum albumin as an inhibitor of adhesion of L5 to the microconcentrators which was used to concentrate the final product, a distinct L5 band was detected on SDS-PAGE, the intensity of which was comparable to that of the MetRS band. Northern blot analysis of RNA prepared from the tRNA-Sepharose fraction showed the presence of 5SrRNA. Dot blot analysis using an antibody against ribosomal protein L5 showed that L5 was present in the Superdex200 fractions prepared by both methods. The MetRS specific activities in MetRS complex fractions incubated without tRNA increased during the purification procedures, indicating that endogeneous tRNA(met) exists stably in the MetRS complex. 5SRNP and 5SrRNA markedly enhanced the MetRS activity in the MetRS complex, indicating that 5SRNP(A) plays a role as a positive effector of MetRS.

Ethanol sclerosis can be a safe and useful treatment for pericardial cyst

We report the case of a 41-year-old man with a pericardial cyst treated by percutaneous aspiration and ethanol injection. He was referred to our hospital because of electrocardiographic abnormality. On admission, chest x-ray revealed a large pericardial cyst in the right cardiophrenic angle. The cyst was examined by echocardiography, computed tomography, and cytological analysis of aspiration fluid from the cyst. Ethanol sclerosis was applied for treatment of the cyst, which had continued to increase in size. There was no recurrence of the cyst 6 months after the treatment. Percutaneous ethanol sclerosis can be the first choice of treatment for pericardial cyst.

[A population survey on bone mineral density in a fishing village in Wakayama Prefecture (Part 2); The analysis of the risk factors affecting the bone mineral density]

The purpose of this study was to detect factors affecting lumbar bone mineral density (BMD) of general inhabitants in a rural community. A cohort consisting of 2261 inhabitants aged 40-79 years was set up based on the resident registration in Taiji town, Wakayama Prefecture in 1992. Fifty men and 50 women in each of four age strata (40-49, 50-59, 60-69, 70-79), totaling 400 inhabitants, were selected randomly. After completion of a questionnaire by an interviewer, items about physical characteristics such as height, body weight, wrist length and grip power were measured. Examination of BMD of the lumbar spine and proximal femur by dual energy X-ray absorptiometry was performed. Correlation coefficients between BMDs and values of physical characteristics were determined. Lumbar BMD was examined to determine whether the following factors were positive or negative: past history, alcohol consumption, smoking habit, dietary habit, exercise, and in addition, pregnancy times and menstrual status for women. Among the values of physical characteristics, body weight was the most closely correlated with lumbar BMD. The items that showed significantly high values as factors affecting lumbar BMD were a past history of diabetes mellitus (men and women in their 70s), and exercise (men in their 50s and women in their 40s). Regarding pregnancy times and menstruation, BMD in women with a history of childbirth was significantly higher than that in those without the history among the women in their 70s. Although the BMD in the women with lactation was significantly lower than that in those without it among the women in their 40s, there was no difference in BMD between the women with and without the history who were 50 years old or over. The effect of menstrual status was investigated according to years after menopause in the women in their 50s. BMD was significantly lower in the women with ar least six years after menopause than in those within five years.

Effects of heart rate on coronary circulation and external mechanical efficiency in elderly hypertensive patients with left ventricular hypertrophy

BACKGROUND AND HYPOTHESIS

Mechanisms of heart failure in elderly hypertensive patients with hypertrophy have not been studied sufficiently. We hypothesized that impaired increment of coronary blood flow in response to increases in heart rate could be responsible for the occurrence or aggravation of heart failure.

METHODS

To test this hypothesis, we measured coronary hemodynamics and lactate balance during basal conditions and atrial pacing in 21 elderly patients aged > or = 65 years (mean 74 +/- 6 years) without coronary arterial disease: 7 normotensive control patients (Group 1), 7 hypertensive hypertrophic patients without a history of congestive heart failure (Group 2), and 7 patients with such history (Group 3). Coronary sinus blood flow (CSBF) was measured in coronary sinus using a thermodilution catheter.

RESULTS

During basal conditions, heart rate did not differ among the three groups (67 +/- 3 in Group 1, 65 +/- 11 in Group 2, and 63 +/- 6 beats/ in Group 3). CSBF was significantly higher in the two hypertrophic groups than in the control group, but CSBF normalized by left ventricular mass was significantly lower in both hypertrophic groups. External mechanical efficiency (EME) obtained as left ventricular work divided by myocardial oxygen consumption did not differ among groups during basal conditions (36 +/- 9% in Group 1, 35 +/- 8% in Group 2, and 29 +/- 9% in Group 3, NS). During atrial pacing to increase heart rate by 25 +/- 5% (lower) and 54 +/- 6% (higher), the increases in CSBF were markedly limited in both hypertrophic groups, and the response in Group 3 was more depressed than that in Group 2. EME did not change in the control group or in Group 2, but did decrease to 21 +/- 5% in Group 3 during the higher pacing rate (p < 0.01 vs. basal conditions). In this group, the relationship between EME and heart rate showed a significant negative correlation (r = -0.56, p = 0.02). Lactate balance in coronary sinus blood showed a tendency to production in Group 3 during the higher pacing rate, suggesting myocardial ischemia.

CONCLUSION

These findings suggest that in hypertensive hypertrophic patients with a history of heart failure, the coronary circulation system is vulnerable to increasing heart rate. In medical treatment of elderly hypertensive patients, control of heart rate in addition to blood pressure control should be considered to minimize the occurrence or aggravation of heart failure.

Increased serotonin release across the coronary bed during a nonischemic interval in patients with vasospastic angina

BACKGROUND

Platelet activation and coagulation abnormality have been observed during coronary spasm. It is crucial whether platelet activation occurs even during a nonischemic period.

HYPOTHESIS

This study was designed to determine whether platelets might be activated across the coronary bed during a nonischemic interval in patients with vasospastic angina.

METHODS

Plasma levels of serotonin, 6-keto-prostaglandin F1 alpha, and catecholamines in the aorta and the coronary sinus were simultaneously measured in 16 patients with vasospastic angina and 13 control patients with nonischemic heart disease.

RESULTS

None of these patients showed myocardial ischemia during sampling. The difference in transcardiac plasma levels of serotonin in patients with vasospastic angina was significantly higher than that in controls (1.48 +/- 1.08 ng/ml vs. 0.07 +/- 0.12 ng/ml, respectively, p < 0.001). Coronary sinus plasma norepinephrine levels in these two groups were almost the same (204.8 +/- 110.8 pg/ml vs. 190.4 +/- 131.6 pg/ml, respectively). The ratio of 6-keto-prostaglandin F1 alpha in the coronary sinus and the aorta was not different between the two groups (1.17 +/- 0.96 in patients with vasospastic angina vs. 1.15 +/- 0.68 in controls).

CONCLUSIONS

These data suggest that platelet activation across the coronary bed should be ascribed to endothelial dysfunction. Lack of compensatory enhancement of prostacyclin production might be concerned with dysfunction of coronary endothelial cells in these patients.

[A cohort study on the relationship between lifestyles and total mortality]

To clarify the relationship between lifestyles and total mortality, a 6-year cohort study was conducted for three communities in Wakayama Prefecture. During 1988-1990, information on lifestyles were obtained from a self-administered questionnaire utilizing 125 items. The survey protocol included a concentrated effort to train all observers for standardization and quality control. For the baseline survey, a total of 4,238 residents (1,947 men and 2,291 women) aged 40 to 79 years old were recruited from resident registration lists. Of these, 3,048 participants (1,308 men and 1,740 women) formed the cohort (response rate: 72%). Death certificates and change of residence registrations were analyzed annually utilizing local public health center and town records. Relative risk (RR) for each lifestyle component against total mortality was calculated applying Mantel-Haenszel methods to adjust for age, past history, walking, smoking (male) and BMI (female). During 6 years, 171 deaths (106 men and 65 women) and 63 resident changes (20 men and 43 women) were observed. Statistical significant RRs were observed for walking (RR: 1.7; p < 0.01) in men, walking (RR: 1.9; p < 0.01) in women, BMI (RR: 2.1; p < 0.001) in women, when calculated with all deaths during 6 years. As of smoking for men, RR was 1,4 (not significant), but by considering the possibility of effects of a latent period, and excluding deaths occurring in 1989 and 1990, RR became 2.1 (p < 0.01). These results suggest that non-smoking, walking daily and maintaining a moderate BMI may lower total mortality in this population.

[A population survey on bone mineral density in a fishing village in Wakayama prefecture. (Part 1) Distribution of bone mineral density by sex and age based on a representative sample of the community]

To establish reference values for bone mineral density (BMD), a population survey was carried out in a fishing community in Wakayama Prefecture. The BMD measurements of the lumbar spine (L2-L4) and proximal femur (femoral neck, trochanter and Ward's triangle area) were performed by sex and age, using dual-energy X-ray absorptiometry. Four hundred subjects, aged 40 to 79 years, were recruited randomly to give 50 persons in each of eight age-sex strata from a list of 2,261 residents (1,028 men and 1,233 women) living in a fishing village. The validity of sampling methods was assessed using a questionnaire about lifestyle factors, which was used for all residents aged from 40 to 79 years in the baseline survey. There were no significant differences between the subjects for BMD measurements and all the residents of the community in the frequencies of past history of diseases, healthy habits, food intakes, and rates of smoking, alcohol drinking, coffee and green tea consumption. These findings suggested that the present study population could be considered representative of samples obtained from the entire population in the fishing community. The results of BMD measurements in these subjects, who were selected at random, showed that except for a slightly high BMD of the lumbar spine in men in their 60's, the mean BMD of the lumbar spine and the three proximal segments of the femur decreased with increasing age in both sexes.

The critical role of intercellular adhesion molecule-1 in Masugi nephritis in rats

Intercellular adhesion molecule-1 (ICAM-1, CD54), an adhesion molecule of the immunoglobulin superfamily, is an endothelial cell surface ligand for such leukocyte integrins as lymphocyte-function-associated molecule 1 (LFA-1, CD11a/CD18), Mac-1 (CD11b/CD18) and CD43. These molecules mediate adhesive interactions between leukocytes and endothelial cells and are critically involved in infiltration of leukocytes into inflammatory lesions. We examined the expression of ICAM-1 in renal tissues of Masugi nephritis rats and directly examined the role of ICAM-1 by administration of neutralizing monoclonal antibodies (MAbs) to rat ICAM-1, LFA-1 alpha-subunit (LFA-1 alpha), beta-subunit (LFA-1 beta) and Mac-1 alpha-subunit (Mac-1 alpha). Within 3 h after injection of nephrotoxic serum, increased expression of ICAM-1 was detected in the glomeruli by in situ hybridization and an immunofluorescence study. Proteinuria was significantly suppressed by the MAbs against ICAM-1, Mac-1 alpha and LFA-1 beta. Neutrophil infiltration into the glomeruli was significantly prevented by injection of the MAbs against ICAM-1, LFA-1 alpha and LFA-1 beta. These results indicate that both ICAM-1/LFA-1 and ICAM-1/Mac-1 pathways are involved in neutrophil infiltration into the glomeruli. On the other hand, monocytic infiltration was prevented by the MAbs against ICAM-1, LFA-1 alpha and LFA-1 beta but not by anti-Mac-1 alpha MAb. Due to these results, ICAM-1 is considered to be a critical molecule involved in the pathogenesis of the leukocyte infiltration into the glomeruli in the heterologous phase of Masugi nephritis. Anti-ICAM-1 antibody may be beneficial in the treatment of leukocyte-mediated glomerular diseases.

[A population based study on factors related to bone mineral density in Wakayama Prefecture]

For evaluation of the community health program, 1543 inhabitants aged 40-79 years were recruited as cohort members in Miyama Village, Wakayama Prefecture. In this cohort, bone mineral density (BMD) of 400 subjects, 50 males and 50 females each randomly selected from each of four age strata, was measured at the lumbar spine and femur neck by dual energy X-ray absorptiometry. Information on exposure to possible risk factors was obtained from a self-administered questionnaire. The results were as follows; BMD at the lumbar spine and femur neck in women aged 70-79 who maintained an exercise habit (> or = one hour/week) was significantly higher than women with no exercise habit. The BMD at the femur neck in men aged 60-79 with alcohol drinking habit was significantly higher than those with no drinking habit. Significant correlation was not seen between milk intake or smoking and the BMD. BMD at the femur neck in women aged 60-69 with multiple child births (> or = 4) were significantly higher than those with fewer child births. The BMD in women aged 50-59 with earlier onset of menarche was higher than those with late menarche. Significant reduction in BMD of postmenopausal women was observed compared to premenopausal women analyzed after matching for age. The result of analysis of quantification method of the first type showed that age and menopause had a marked effect on BMD. Concerning lifestyles as other factors, a positive correlation was observed between BMD and drinking for men and exercise for women. These factors appear to be useful indicators of risk for osteoporosis.

Morphological observation by intravascular ultrasound in superior vena cava syndrome after pacemaker implantation

We report a case of superior vena cava (SVC) syndrome that was assessed by intravascular ultrasound (IVUS). A highly echogenic eccentric lesion was demonstrated by IVUS. The use of IVUS also confirmed in vivo that SVC syndrome following pacemaker insertion occurs as a result of intimal thickening of the venous wall.

Effects of ACE inhibition and beta-blockade on collagen remodelling in the heart of Bio 14.6 hamsters

1. The effects of angiotensin converting enzyme (ACE) inhibition and beta-blockade on collagen in the heart and on plasma catecholamines and tissue angiotensin (Ang) I and II were examined in Bio 14.6 Syrian hamsters. Male hamsters (76-79 days old) were given low-dose enalapril (3 mg/kg per day), high-dose enalapril (30 mg/kg per day), atenolol (50 mg/kg per day) or vehicle for 65 days. Age and sex matched healthy F1b hamsters were used as controls. Collagen concentration was determined by measuring hydroxyproline content and the relative proportion of type I, III, and V collagens was obtained by non-interrupted sodium dodecyl polyacrylamide gel electrophoresis (SDS-PAGE). Per cent collagen area (PCA) was measured by pixel counting in myocardial tissue by a personal computer. 2. Although heartweight (HW) and bodyweight (BW) in F1b controls were significantly higher compared with drug-treated groups and vehicles, the HW/BW ratio in cardiomyopathic Bio 14.6 hamsters tended to be high compared with F1b controls and was decreased by each drug treatment. 3. Collagen concentration, total collagen content and PCA in the heart of Bio 14.6 hamsters were significantly higher than F1b controls. Collagen concentration and total collagen content were significantly decreased in all drug-treated groups compared with vehicles. 4. The proportion of type I collagen tended to decrease while that of type III collagen tended to increase in all drug-treated groups compared with vehicles. Type V collagen in vehicle-treated group was significantly higher than in F1b controls, while it tended to decrease in all drug-treated groups compared with vehicles. 5. Plasma concentrations of catecholamines (adrenaline and noradrenaline) were decreased significantly by atenolol and high-dose enalapril, but not by low-dose enalapril. Tissue AngI remained unaltered in any of the drug-treated hamsters. Tissue AngII was decreased by the high-dose enalapril and beta-blockade, and tended to be decreased by low-dose enalapril treatment. 6. These results reveal that enalapril and atenolol produced similar beneficial effects on collagen remodelling in Bio 14.6 hamsters by decreasing the total amount of collagen, and also by changing collagen phenotypes through the inhibition of the renin-angiotensin system. Both drugs also improved myocardial morphological integrity.

Intravenous dopexamine in the treatment of acute congestive heart failure: results of a multicenter, double-blind, placebo-controlled withdrawal study

Acute hemodynamic effects of intravenous infusion of dopexamine were evaluated by a placebo-controlled withdrawal study in patients with acute congestive heart failure. Twenty patients were enrolled at 10 centers in Japan. All patients had a pulmonary capillary or diastolic pressure of 15 mmHg or greater and a cardiac index of 2.5 l/min/m2 or less. Phase I: Intravenous dopexamine was introduced in a single-blind, uncontrolled fashion at the rate of 0.5 micrograms/kg/min and was titrated up to achieve a 30% or more increase in the cardiac index. Two patients withdrew from the study due to sinus tachycardia and ventricular ectopy or exacerbation of heart failure. Phase II: The remaining 18 responders who were free of limiting side effects were randomized in double-blind fashion to continue dopexamine or to switch to placebo for an additional 60 minutes. At the end of phase II, the hemodynamic improvement obtained in phase I of the study disappeared completely after substitution of placebo but was maintained in dopexamine-treated patients. Our findings suggest that dopexamine, when given in appropriate doses to selected patients, shows balanced vasodilator action suitable for the treatment of acute congestive heart failure.

Left atrial thrombus formation immediately after cardioversion of atrial fibrillation despite adequate anticoagulant therapy

We observed a patient who exhibited de novo left atrial thrombus formation after cardioversion, despite administration of adequate anticoagulant therapy. Preexisting atrial thrombus was excluded by transesophageal echocardiography. Preexisting severe left atrial mechanical dysfunction may be considered as a risk factor for de novo thrombus formation after cardioversion, as well as the poor outcome of cardioversion.

Detection of right ventricular infarction by gadolinium DTPA-enhanced magnetic resonance imaging

We investigated the usefulness of gadolinium-enhanced magnetic resonance (Gd-MR) imaging for diagnosis of right ventricular (RV) infarction in 14 patients with acute inferior infarction. Myocardial perfusion images with thallium 201 and technetium 99m pyrophosphate (dual single-photon emission computed tomography: dual SPECT) and haemodynamic data were obtained on admission. Patients were classified into three groups based on dual SPECT and Gd-MR findings: no accumulation in the right ventricle (negative, Type 1), posterior RV infarction (Type 2) and anterior and posterior RV infarction (Type 3). No patients exhibited the haemodynamic criteria for RV infarction (a mean right atrial pressure above 10 mmHg and a ratio of mean right atrial pressure to pulmonary artery wedge pressure above 0.8). Dual SPECT identified RV infarction in eight patients (three Type 2 and five Type 3, 57% of the total). Gd-MR imaging also identified eight patients (57%) as positive (five Type 2 and three Type 3). Our results showed that Gd-MR imaging was not only useful for diagnosis of RV infarction, but also equal to dual SPECT in sensitivity and specificity, and superior to it as regards acquisition time and assessing the spatial anatomy of heart. In conclusion, Gd-MR imaging is superior to dual SPECT for detection of RV infarction.

Effects of intracoronary infusion of an inotropic agent, E-1020 (loprinone hydrochloride), on cardiac function: evaluation of left ventricular contractile performance using the end-systolic pressure-volume relationship

The phosphodiesterase (PDE) III inhibitor, E-1020 (loprinone hydrochloride), has positive inotropic and vasodilating effects. This study evaluated the positive inotropic effect of intracoronary E-1020 in eight patients with coronary artery disease and hypertensive heart disease. A direct intracoronary infusion of the PDE III inhibitor minimizes its vasodilating effect. After baseline hemodynamic measurements and coronary arteriography, a micromanometer-tipped 8F conductance catheter was introduced into the left ventricle to determine the hemodynamic effects of E-1020. Saline and vehicle were infused into the left main coronary artery at a rate of 2 ml/min. The dose of intracoronary E-1020 increased from 2.5 to 5.0 and 7.5 micrograms/min. The inotropic effect of E-1020 was defined as the change in the slope of the end-systolic pressure-volume relationship (Emax), which was independent of afterload and preload. Emax significantly increased at infusion rates of 7.5 micrograms/min from control. Peak +dP/dt increased at an infusion rate of 5.0 micrograms/min or higher, while left-ventricular end-diastolic pressure (LVEDP) decreased significantly at a rate of 5.0 and 7.5 micrograms/min. Intracoronary infusion of E-1020 at a rate of 2.5 micrograms/min produced a plasma concentration of 20 ng/ml, which was identical to the minimum effective plasma concentration seen in previous study by intra venous infusion. However, at a plasma concentration of 20 ng/ml, E-1020 has more vasodilating effects than inotropic effects. Clinically, E-1020 appears to have a positive inotropic effect that depends on the extent of myocardial perfusion.

Purification and characterization of phospholipase D (PLD) from rice (Oryza sativa L.) and cloning of cDNA for PLD from rice and maize (Zea mays L.)

Phospholipase D (PLD) was purified to high homogeneity from rice bran (Oryza sativa L.). Two peaks of PLD activity were resolved by Mono Q anion-exchange chromatography. The molecular mass of PLD in both peaks was 82 kDa on SDS-PAGE and 78 kDa in gel filtration. Antibodies raised against the protein in one of the peaks precipitated the enzyme activities in both peaks. Enzymatic characteristics of PLD in the two peaks were identical except for a difference of 0.1 in the isoelectric points. Sequence analysis covering more than 10% of the amino acids of the proteins and peptide mapping did not detect any difference in the primary structure of the proteins. A cDNA for PLD was isolated from rice and it encoded a protein of 812 residues. The N-terminal sequences of purified PLDs matched the deduced amino acid sequence starting from residue 47. A Northern blot showed this gene was expressed in leaves, roots, developing seeds and cultured cells, and a Southern blot detected a single band of rice genomic DNA hybridizing to the cDNA. A cDNA for PLD was also isolated from maize. The similarity of the deduced amino acid sequences of PLD was 90% between rice and maize, 73% between the cereals and castor bean.

Distribution of extracellular matrix receptors in various forms of glomerulonephritis

Integrins are heterodimeric transmembrane receptor glycoproteins consisting of alpha and beta subunits that mediate adhesion and interactions between cells and extracellular matrix. Such interactions may be perturbed in various pathologic states, resulting in the altered phenotypic expressions of the integrins in affected tissues. To ascertain the alterations in integrins in various renal diseases, their distribution was investigated in different forms of glomerulonephritis by indirect immunofluorescence and immunoelectron microscopy using specific antibodies directed against beta 1 integrins and integrin alpha v beta 3 (vitronectin receptor). In addition, the distribution of certain extracellular matrix components (ie, fibronectin, vitronectin, and type IV collagen) was examined. Integrin beta 1 and alpha v beta 3 were highly expressed in proliferating mesangial cells in immunoglobulin A nephropathy, membranoproliferative glomerulonephritis type I and diffuse proliferative lupus nephritis. Their putative ligands (ie, fibronectin, vitronectin, and type IV collagen) also were increased in the expanded mesangial regions. In immunoglobulin A nephropathy, integrin beta 1 and alpha v beta 3 were seen by immunoelectron microscopy to be localized to the mesangial cell membranes in close proximity to the immune complex deposits; however, fibronectin and vitronectin immunoreactivities were observed in the mesangial immune complex deposits. Similarly, vitronectin also was detected in the immune complex deposits of other forms of proliferative nephritis, ie, membranoproliferative glomerulonephritis type I and diffuse proliferative lupus nephritis. In diffuse proliferative lupus nephritis, the cellular crescents displayed immunoreactivity toward integrin alpha v beta 3 and vitronectin. In nonimmune complex glomerular disease associated with nephrotic syndrome (ie, minimal change nephrotic syndrome), integrin alpha 3 beta 1, which normally has a linear capillary distribution, was decreased.(ABSTRACT TRUNCATED AT 250 WORDS)