Glycemic control and survival of diabetic hemodialysis patients--importance of lower hemoglobin A1C levels

AIMS

The significance of hemoglobin A1C (HbA1C) on the survival of diabetic hemodialysis patients still remains controversial. We investigated the impact of HbA1C on the survival.

METHODS

A total of 122 diabetic patients on maintenance hemodialysis (age, 59.9+/-11.9 years [mean+/-SD]; hemodialysis duration: 53+/-38 months) were surveyed (survey period: 46+/-19 months).

RESULTS

The cumulative survival of the poor glycemic control group (mean HbA1C of 3-month period > or =6.3%, n=62) was significantly lower than that of the good group (HbA1C<6.3%, n=60), as determined by Kaplan-Meier estimation (P=0.0084, log-rank test). Kaplan-Meier analysis also demonstrated that both cardiovascular and non-cardiovascular mortalities were higher in the poor group than in the good group (P=0.0545 and P=0.0453, respectively). In a multivariate Cox proportional hazard model, the mean HbA1C was a significant predictor of survival (OR 1.260 per 1.0%, 95% CI 1.020-0.579, P=0.0325).

CONCLUSIONS

Poor glycemic control is an independent predictor of poor prognosis in diabetic hemodialysis patients. HbA1C is a clinically useful parameter for identifying the risk for mortality, both for cardiovascular and non-cardiovascular mortality, and that careful management of glycemic control by use of HbA1C is important.

Influence of pitavastatin on glucose tolerance in patients with type 2 diabetes mellitus

AIM

We previously reported that glycemic control deteriorated in patients receiving atorvastatin, which is useful for the treatment of hypercholesterolemia in patients with type 2 diabetes. Pitavastatin has a strong lipid-lowering effect, comparable to that of atorvastatin, but it is unknown whether pitavastatin has an adverse influence on glycemic control. The aim of this study was to examine. The effects of three different statins (pravastatin, atorvastatin, and pitavastatin) on blood glucose and HbA(1C) levels in diabetic patients.

METHODS

We retrospectively compared glycemic control between groups receiving atorvastatin (10 mg/day, group A, n=99), pravastatin (10 mg/day, group Pr, n=85), and pitavastatin (2 mg/day, group Pi, n=95) from the start of treatment until 3 months later. Patients were excluded if the dosage of their antidiabetic drugs was changed, if their drug therapy was altered within 3 months before starting statin therapy, or if events occurred that could affect glycemic control such as hospitalization.

RESULTS

The subjects available for analysis were 74 patients from group A, 71 patients from group Pr, and 74 patients from group Pi. Arbitrary blood glucose levels increased from 147+/-51 mg/dL (mean+/-SD) to 176+/-69 mg/dL in group A, but only changed minimally from 136+/-31 to 134+/-32 mg/dL in group Pr and from 155+/-53 to 154+/-51 mg/dL in group Pi. HbA(1C) increased from 7.0+/-1.1% to 7.4+/-1.2% in group A, while it was 6.9+/-0.9% versus 6.9+/-1.0% in group Pr, and 7.3+/-1.0% versus 7.2+/-1.0% in group Pi. There was no correlation between Delta LDL-C and Delta HbA(1C) (the change from baseline to 3 months) in any of the groups.

CONCLUSION

The glycemic parameters only increased significantly in group A, suggesting that pitava-statin and pravastatin did not have an adverse influence on glycemic control in type 2 diabetic patients.

Cyclooxygenase-2 induction by lysophosphatidylcholine in cultured rat vascular smooth muscle cells: involvement of the p38MAPK pathway

Lysophosphatidylcholine (lysoPC) stimulates the release of prostaglandins (PGs) in various cells and tissues. Cyclooxygenase (COX)-2 has recently emerged as a key regulator of PG synthesis. We investigated whether lysoPC regulates COX-2 expression in cultured rat vascular smooth muscle cells (VSMCs). LysoPC strongly increased the expression of COX-2 mRNA in a time- and dose-dependent manner. COX-2 protein expression also was increased by lysoPC. The p38 mitogen-activated protein kinase (MAPK) inhibitor SB203580 significantly suppressed lysoPC-induced COX-2 mRNA and protein expression, but not a p42/44MAPK kinase (MEK-1) inhibitor, PD98059. LysoPC did not increased the transcription of the COX-2 gene, as assayed with a COX-2 promoter/luciferase chimeric plasmid and suppressed the decay of COX-2 mRNA. SB203580 markedly enhanced the decay of COX-2 mRNA induced by lysoPC, implying that p38MAPK activated by lysoPC helps to regulate COX-2 by stabilizing its mRNA. The COX-2 specific inhibitor NS-398 attenuated lysoPC-stimulated DNA and protein synthesis as well as PGE(2) production by VSMCs. These results suggest that in rat VSMCs lysoPC regulates COX-2 expression and PG production and also modulates cell proliferation through p38MAPK-mediated signaling pathways.

Design and analysis of a nonequilibrium cross-coupled network with a detectable similarity measure

In this paper, a nonequilibrium network which works as a dynamical associative memory is designed. The design is based on a new similarity measure between any stored pattern and a state of the network. Although conventional similarity measures, such as Hamming distance, direction cosine, and so on, are not detectable in a cross-coupled network, the similarity measure proposed in this paper is. The new similarity measure is employed in our design. The network should include the following properties in its output pattern sequence, so that the dynamics of cross-coupled network may be designed: 1) Stored patterns are frequently associated in the dynamical association. 2) The dynamical association is very robust against variation of distributed parameters. Property 1) is achieved by introducing the next two operation modes with inverse N-shaped function into the dynamics of the proposed network. 1) When the state of the network is close enough to a stored pattern at a time step, the state is forced to evolve at the next time step. 2) The state of the network converges to a stored one while it is not close to any stored patterns. By considering these two operation modes, the frequency of associating stored patterns is increased. The authors emphasize the property 2) which is very important for a silicon implementation of the proposed network. In the silicon implementation, parameters of the network must be represented by transistors, resistors, capacitors, and other electric components which exhibit variation in their characteristics. Thus the second property guarantees the easy silicon implementation of the nonequilibrium network proposed in this paper.

Effect of famotidine and lansoprazole on serum phosphorus levels in hemodialysis patients on calcium carbonate therapy

AIMS

Histamine H2 receptor antagonists (HRA) or proton pump inhibitors (PPI) are frequently administered to patients on hemodialysis, because their intestinal mucosa is fragile. Although three studies have indicated that concomitant HRA administration causes a decrease in the binding of phosphate by calcium carbonate, the HRA doses tested in these studies were 2-4 times higher than the recommended dose for hemodialysis patients. In addition, it remains unclear whether PPI therapy affects serum phosphate levels in hemodialysis patients taking calcium carbonate. Accordingly, the aim of this study was to evaluate the influence of lansoprazole and the recommended dose of famotidine on serum phosphate and calcium levels in hemodialysis patients.

METHODS

The study included 115 hemodialysis patients who were taking calcium carbonate and who were also treated with either famotidine (10 mg/day) or lansoprazole (30 mg/day). Changes of the mean serum phosphate and calcium levels over 2 months before and after the start of famotidine or lansoprazole therapy were compared. The same parameters were also compared when famotidine was switched to lansoprazole.

RESULTS

The mean serum phosphate level increased significantly after administration of either famotidine or lansoprazole (by 6.6 +/- 21.9% or 13.0 +/- 26.3%, p = 0.032 and p = 0.029, respectively). The mean serum calcium level was unchanged after administration of famotidine, but showed a significant decrease after administration of lansoprazole (by 3.44 +/- 7.73%, p = 0.013). Therefore, the calcium x phosphorus product was significantly increased by administration of famotidine, but not by administration of lansoprazole (6.68 +/- 23.37% and 8.73 +/- 27.41%, p = 0.046 and p = 0.251, respectively). When famotidine was switched to lansoprazole, the serum phosophate level did not change, but serum calcium decreased significantly by 3.8 +/- 13.0% (p = 0.0006).

CONCLUSION

Not only administration of 20 mg/ day of famotidine as previously reported, but also 10 mg/day of this drug (the recommended dose for hemodialysis patients) caused a significant increase of serum phosphate in patients taking calcium carbonate. PPIs have been reported to show no effect on the serum phosphate level, but 30 mg/day of lansoprazole also caused a significant increase of serum phosphate in patients taking calcium carbonate.

Foliar trichome- and aquaporin-aided water uptake in a drought-resistant epiphyte Tillandsia ionantha Planchon

The atmospheric epiphyte Tillandsia ionantha is capable of surviving drought stress for 6 months or more without any exogenous water supply via an as of yet to be determined mechanism. When plants were soaked in water for 3 h, leaves absorbed a remarkably large amount of water (30-40% on the basis of fresh weight), exhibiting a bimodal absorption pattern. Radiolabeled water was taken up by the leaves by capillary action of the epidermal trichomes within 1 min (phase 1) and then transported intracellularly to leaf tissues over 3 h (phase 2). The removal of epidermal trichome wings from leaves as well as rinsing leaves with water significantly lowered the extracellular accumulation of water on leaf surfaces. The intracellular transport of water was inhibited by mercuric chloride, implicating the involvement of a water channel aquaporin in second-phase water absorption. Four cDNA clones (TiPIP1a, TiPIP1b, TiPIP1c, and TiPIP2a) homologous to PIP family aquaporins were isolated from the leaves, and RT-PCR showed that soaking plants in water stimulated the expression of TiPIP2a mRNA, suggesting the reinforcement in ability to rapidly absorb a large amount of water. The expression of TiPIP2a complementary RNA in Xenopus oocytes enhanced permeability, and treatment with inhibitors suggested that the water channel activity of TiPIP2a protein was regulated by phosphorylation. Thus, the high water uptake capability of T. ionantha leaves surviving drought is attributable to a bimodal trichome- and aquaporin-aided water uptake system based on rapid physical collection of water and subsequent, sustained chemical absorption.

Effect of colestimide therapy for glycemic control in type 2 diabetes mellitus with hypercholesterolemia

Colestimide is a new anion-exchange resin used to lower serum cholesterol in Japan. Because of its excellent compliance, colestimide can replace cholestyramine. To clarify the effect of colestimide on glycemic controls, colestimide (3 g/day) or pravastatin (10 mg) was given orally to patients with type 2 diabetes treated with oral hypoglycemic agents or insulin who had low-density lipoprotein (LDL) cholesterol levels exceeding 3.6 mmol/l. In the colestimide groups, fasting plasma glucose concentrations had decreased significantly from 8.5 +/- 1.4 to 7.7 +/- 1.5 mmol/l at 3 months (P<0.05), as had glycated hemoglobin (HbA1c) from 7.7 +/- 0.7% to 6.8 +/- 0.5%, for an 8% reduction (P<0.01). Fasting plasma glucose and HbA1c did not change in the pravastatin group. Total cholesterol and LDL-cholesterol decreased significantly (P<0.01) with either medication, with similar reduction rates for both drugs. Doses of oral hypoglycemic agents and insulin did not change during the study, and body weight remained stable. Considering that patients with type 2 diabetes often have hyperlipidemia, colestimide therapy may have a clinically useful dual action in such patients.

Role of fibroblast growth factor-23 in peripheral vascular calcification in non-diabetic and diabetic hemodialysis patients

INTRODUCTION

Fibroblast growth factor (FGF) 23 is a recently identified circulating factor that regulates phosphate (Pi) metabolism. Since the derangement of Pi control is an important risk factor for vascular calcification, we investigated the importance of plasma FGF-23 in the development of vascular calcification in the aorta and peripheral artery in hemodialysis patients with and without diabetes mellitus (DM).

METHODS

Male hemodialysis patients with DM (n=32) and without DM (n=56) were examined. Plasma samples were obtained before the start of dialysis sessions, and the FGF-23 levels were determined by enzyme-linked immunosorbent assay. Roentgenography of the aorta and hand artery was performed, and visible vascular calcification was evaluated by one examiner, who was blinded to the patient characteristics.

RESULTS

In the 56 non-DM hemodialysis patients, vascular calcification was found in the hand artery in 5 patients (8.9%) and in the aorta in 23 patients (41.1%). These levels were significantly lower (p<0.05) than in the 32 DM patients, of whom, 19 (59.4%) and 21 (65.6%) had vascular calcification of the hand artery and aorta, respectively. Multiple regression analyses performed separately in the non-DM and DM patients showed that the plasma FGF-23 level, CaxPi product, and body weight are independent factors significantly associated with hand-artery calcification and that diastolic blood pressure is associated with aorta calcification in non-DM patients. In DM patients, the plasma FGF-23 level and hemodialysis duration emerged as independent factors associated with hand-artery calcification and diastolic blood pressure was associated with aorta calcification. The independent association of the plasma FGF-23 level with hand-artery calcification was retained in both non-DM and DM patients when adjusted for the CaxPi product.

CONCLUSION

Our findings show that the plasma FGF-23 level is an independent factor negatively associated with peripheral vascular calcification in the hand artery, but not in the aorta, in both male non-DM and DM hemodialysis patients, even when adjusted for the CaxPi product. This study raises the possibility that the plasma FGF-23 level may provide a reliable marker for Moenckeberg's medial calcification in male hemodialysis patients, independent of its regulatory effect on Pi metabolism.

Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy

PURPOSE

To compare the efficacy and safety of 25-gauge vitrectomy with 20-gauge vitrectomy for macular pucker.

DESIGN

Randomized clinical study.

METHODS

Sixty-seven eyes (67 patients) with macular pucker were prospectively and randomly assigned to undergo 20-gauge vitrectomy or 25-gauge vitrectomy as a control group. Main outcome measurements consisted of best-corrected visual acuity (BCVA), mean induced astigmatism, total operation time, and postoperative complications.

RESULTS

The mean BCVA at baseline and at one month and six months after surgery was 20/78, 20/62, and 20/42, respectively, in the 20-gauge group, and 20/85, 20/45, and 20/40 in the 25-gauge group. A significant difference in change in the logarithm of the minimal angle of resolution of BCVA between 20-gauge and 25-gauge was found at one month (-0.10 vs -0.269, P < .001), but not at six months (-0.327 vs -0.276, P > .01).

CONCLUSIONS

If faster visual improvement is desired, 25-gauge vitrectomy may be preferable to 20-gauge vitrectomy for macular pucker.

Prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among the elderly in a Japanese village

PURPOSE

To study the prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among elderly residents of a Japanese village and to examine the correlation between radiographic evidence of abnormality and lower back pain.

METHODS

205 men (mean age, 70.7 years) and 323 women (mean age, 70.5 years) in a Japanese village participated in this cross-sectional study. Plain lateral radiographs were taken from the lower thoracic spine to the sacral spine. They were evaluated by 3 independent orthopaedic surgeons for degree of osteoarthritis (using Weiner grading system) and the presence of osteoporotic vertebral fractures and spondylolisthesis.

RESULTS

The prevalence of osteoarthritis in elderly Japanese villagers was 38.3%, whereas that of osteoporotic vertebral fractures and spondylolisthesis was 17.8% and 8.9%, respectively. There was no significant difference in osteoarthritis between men and women, but osteoporotic vertebral fractures and spondylolisthesis were significantly more common in females (p<0.01). No significant correlation was observed between lower back pain and radiographic evidence of degenerative spinal disease.

CONCLUSION

The prevalence of spondylolisthesis in elderly Japanese was much lower than that in whites or African Americans. The prevalence of osteoarthritis or osteoporotic vertebral fractures was comparable with other English or US studies. Radiographic evidence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis is not necessarily associated with lower back pain.

Anti-hyperglycemic effects of plum in a rat model of obesity and type 2 diabetes, Wistar fatty rat

Dried plums, considered a healthy food in the West and used as medicine in India, contain phenolic compounds with protective actions against age-related diseases. Effects of oral plum ekisu (concentrated juice) on lipid and glucose tolerance were assessed in insulin-resistant obese Wistar fatty rats. Plum ingestion decreased blood glucose (P < 0.05) and plasma triglyceride concentrations (P < 0.01) compared with controls. Plum treatment for 2 weeks reduced areas under the curve (AUCs) for glucose and insulin during a glucose tolerance test. In db/db mice, plum decreased these AUCs, and also blood glucose during an insulin tolerance test. Plum treatment significantly increased plasma adiponectin concentrations and PPARgamma mRNA expression in adipose tissue from Wistar fatty rats. Plum thus may increase insulin sensitivity in these rats via adiponectin-related mechanisms.

Influences of Statins on Glucose Tolerance in Patients with Type 2 Diabetes Mellitus

Atorvastatin is frequently administered for the treatment of hypercholesterolemia associated with type 2 diabetes mellitus. However, a marked deterioration of glycemic control has been reported in some patients treated with atorvastatin. No study has been done to determine whether atorvastatin adversely affects glycemic control. In this study, we retrospectively compared an atorvastatin-treated group (Group A, n = 76) with a pravastatin-treated group (Group P, n = 78) to examine the effects of the 2 statins on glycemic control from the onset of administration to 3 months thereafter. No change occurred in the antidiabetic drug dose in 62 patients of Group A and 68 patients of Group P. In those patients, arbitrary blood glucose levels increased from 147 +/- 50 (mean +/- SD) mg/dL to 177 +/- 70 mg/dL in Group A and from 140 +/- 38 mg/dL to 141 +/- 32 mg/dL in Group P. HbA(1c) increased from 6.8 +/- 0.9% to 7.2 +/- 1.1% in Group A and from 6.9 +/- 0.9% to 6.9 +/- 1.0% in Group P. The increase was significant only in Group A, and the extent of the increase was also significantly greater in Group A. These results suggest a predisposition to a deterioration of glycemic control in type 2 diabetic patients treated with atorvastatin.

Promotive effect of auxins on UDP-glucose: flavonol glucosyltransferase activity in Vitis sp. cell cultures

The addition of 2,4-dichlorophenoxyacetic acid (2, 4-D) to Vitis sp. cell cultures significantly enhanced the production of quercetin 3,7,4'-tri-O-glucoside, 3,7-di-O-glucoside and 3,4'-O-glucoside from quercetin. This enhancement of glucosylation by 2,4-D was also observed in cell cultures of other plant species. The activity of UDP-glucose: flavonol glucosyltransferase (UFGT) in cell-free extracts of Vitis sp. cell cultures increased approximately 10-fold, 48 h after the addition of 2,4-D to the culture medium. The UFGT activity increased linearly up to 15 h and showed a maximal response to the addition of 10-50 mg/l of 2,4-D at 48 h. The promotive effect of 2,4-D was inhibited by cycloheximide suggesting that de novo protein synthesis was involved in this phenomenon. Interestingly, similar promotive effects on the UFGT activity were observed for other phytohormones such as kinetin and several anti-auxins.

Responses of transformed root culture of Atropa belladonna to salicylic acid stress

The effect of salicylic acid (SA) on tropane alkaloid production and the responses to SA stress of transformed root cultures of Atropa belladonna (belladonna) were investigated. Treatment of A. belladonna transformed roots with 0.2 mM SA did not have any effect on tropane alkaloid production, but two compounds were produced in the medium. These were identified as the SA derivatives methylsalicylate and methyl-o-methoxybenzoate by high-resolution mass spectrometry and UV spectrometry. In contrast, treatment with 2 mM salicylic acid stimulated tropane alkaloid release from the transformed roots into the medium by up to 35% of the total alkaloids after 24 h, and the SA derivatives were not observed in the medium. These results revealed that transformed root of A. belladonna exhibits distinct by different responses to SA stress depending on the SA concentration.

Interactions between clarithromycin and digoxin in patients with end-stage renal disease

OBJECTIVE

To report a significant increase in the serum levels of digoxin associated with the use of clarithromycin in six patients undergoing renal replacement therapy.

CASE SUMMARY

All six patients were males with end-stage renal disease and in need of renal replacement therapy. Four patients were anuric. The mean age was 78.8 +/- 5.8 (66-83) years. All patients except one, who was treated by hemofiltration, were treated by hemodialysis. All patients except one, who had been treated with metildigoxin (0.35 mg/week), were also taking digoxin (0.375 mg/week). Clarithromycin was administered at a dose of 200-400 mg/day for the treatment of bronchitis in all patients. The concomitant administration of clarithromycin increased serum digoxin levels from 1.8-4.0-fold in all cases. In two of six cases, a high probability of digoxin intoxication and suspicion of digoxin intoxication was evident. In three of six cases, serum digoxin levels increased within 12 days after the co-administration of clarithromycin, while in the other three cases, serum digoxin levels were increased 53-190 days after the administration of clarithromycin.

CONCLUSION

The simultaneous administration of clarithromycin caused an increase in digoxin levels in six patients undergoing renal replacement therapy. The increase in the serum digoxin can be attributed to the inhibition of P-glycoprotein in the intestine and/or bile capillary rather than the kidney by clarithromycin since renal function was dramatically impaired, and four of the patients were anuric. The issue of why serum digoxin levels were increased so late in three patients undergoing renal replacement is unclear. However, this interaction seemed to be clinically significant even in ESRD patients, whose renal function was highly impaired. The simultaneous use of digoxin and clarithromycin should be avoided even in patients undergoing renal replacement therapy whose renal function is impaired, since digoxin levels may increase unexpectedly.

Microvascular density of rapidly destructive arthropathy of the hip joint

PURPOSE

To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head.

METHOD

Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted.

RESULT

The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count.

CONCLUSION

These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.

Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus

Bone disease in hemodialysis (HD) patients with type 2 diabetes mellitus (DM) is characterized by low bone turnover (Inaba M, et al. Am J Kidney Dis 2002; 39:1261-1269), although their bone quality is yet to be determined. The present study was designed to examine whether the prevalence of vertebral fracture in female HD patients with type 2 DM, age 65 years and older, might be increased, and the relation of this fracture to bone mineral density (BMD) determined by dual X-ray absorptiometry (DXA), since few data are available on the effect of DM on bone strength at lumbar spine. The prevalence of vertebral fracture in type 2 DM HD patients was 32.3%, which was greater than that of non-DM HD patients (13.3%) when adjusted for age and HD duration. Logistic regression analysis elucidated the presence of DM and age as independent risk factors for an increased prevalence of vertebral fracture in HD patients. In non-DM HD patients, those with vertebral fracture showed age significantly higher and BMD in either lumbar spine or distal one third of radius significantly lower than the respective value in those without fracture. However, in DM HD patients, neither BMD in lumbar spine nor distal one third of radius was significantly lower in those with vertebral fracture than in those without. Furthermore, age did not differ significantly between DM HD patients with and without fracture. In conclusion, female type 2 DM HD patients, age 65 years and older, showed significantly higher incidence of vertebral fracture than non-DM HD patients. Although age and low BMD emerged as independent risk factors for vertebral fracture in non-DM HD patients, those factors failed to be a risk factor in DM HD patients, suggesting that BMD determined by DXA might not be reliable in assessing bone strength in DM HD patients.

Phosphatidylinositol 3-kinase in angiotensin II-induced hypertrophy of vascular smooth muscle cells

Activation of 4E-binding protein 1 (4E-BP1) by growth factors regulates protein synthesis in vascular smooth muscle cells. The interaction between G protein-coupled receptors and activated 4E-BP1 is unclear. We examined phosphadityl inositol (PI) 3-kinase in angiotensin II-induced 4E-BP1 phosphorylation in cultured rat vascular smooth muscle cells. Angiotensin II time and dose dependently stimulated phosphorylation of 4E-BP1 through the angiotensin AT(1) receptor. Pretreatment with wortmannin or 2-(4-Morpholinyl)-8-phenyl-4H-1-benzopyran-4-one (LY294002), a PI 3-kinase inhibitor, suppressed angiotensin II-induced phosphorylation, but a mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinases (ERK) kinase-1 (MEK-1) inhibitor, 2'-Amino-3'-methoxyflavone (PD98059), and a p38 MAPK inhibitor, 4-(4-Fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(4-pyridyl)1H-imidazole (SB203580), had no effect. With regard to the involvement of mammalian target of rapamycin (mTOR) and p70 S6 kinase, angiotensin II-induced phosphorylation was abolished by pretreatment with rapamycin, but not by tosylphenylalanine chloromethyl ketone or tosyllysine chloromethyl ketone. Ca(2+) was involved, since intracellular Ca(2+) chelation inhibited angiotensin II-induced phosphorylation while a Ca(2+) ionophore, A23187, stimulated phosphorylation. Thus, angiotensin II induces the phosphorylation of 4E-BP1 via the PI 3-kinase/mTOR pathway, but not via ERK or p70 S6 kinase.

Multicoated Contact Lens for Bimanual Vitreous Surgery Without Endoillumination

We developed a new multicoated contact lens for use with the bimanual vitrectomy technique. The new lens is made of quartz, and its multicoated surface has properties that decrease light reflection and increase light absorption. The lens is placed on the cornea, and the coaxial light from the operating microscope alone enables surgeons to obtain a clear image of the retinal surface. This new vitrectomy contact lens is very useful for the treatment of eyes with proliferative membranes and allows surgeons to perform vitrectomy by using both hands.

Daily nasal inoculation with the insulin gene ameliorates diabetes in mice

The present study examined the feasibility of liposome-mediated gene transfer via nasal administration, for treating insulin-dependent diabetes mellitus. The rat insulin gene was packed under control of the CMV promoter, complexed with DC-chol/DOPE-based liposomes and administered daily via the nasal route in mice made severely diabetic by streptozocin. Sustained expression of the insulin gene was achieved and insulinopenia, ketonuria and death were prevented. Hyperglycemia and body weight reduction were significantly suppressed without evidence of hypoglycemia throughout the experimental period. RT-PCR and FISH analysis indicated that insulin was produced in the alveolar epithelial cells of the lung. Liposome-mediated in vivo gene transfer via nasal administration may provide an efficacious route for delivery of hormonal and other gene products into the blood stream.

The incidence of deep vein thrombosis after hip and knee arthroplasties in Japanese patients: a prospective study

PURPOSE

To document the incidence of proximal deep vein thrombosis and pulmonary embolism in 58 consecutive Japanese patients undergoing total hip arthroplasty or total knee arthroplasty.

METHODS

Patients were routinely examined for proximal deep vein thrombosis by B-mode ultrasonography before and after surgery. Those patients who had ultrasonographic findings of deep vein thrombosis were also investigated for pulmonary embolism by ventilation-perfusion lung scan.

RESULTS

The incidence of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty were 9.1% and 4.0% respectively, and the incidence of pulmonary embolism were 3.0% and 0%, respectively. There were no cases of fatal pulmonary embolism.

CONCLUSION

The incidence of deep vein thrombosis and pulmonary embolism in Japanese patients may have increased over the last few decades.