Emergent angioplasty prevents left ventricular dilation in patients with acute anterior wall myocardial infarction and cardiogenic shock

BACKGROUND

Percutaneous transluminal coronary angioplasty (PTCA) reduces in-hospital mortality and improves long-term outcome in patients with acute myocardial infarction (MI) complicated by cardiogenic shock. However, no study has evaluated the effects of different reperfusion therapies on left ventricular (LV) dimension and cardiac function in long-term survivors of MI with cardiogenic shock.

HYPOTHESIS

We investigated the effects of PTCA on the development of LV dilation in patients who survived MI complicated by cardiogenic shock.

METHODS

We studied 34 patients with a first MI and cardiogenic shock in whom two-dimensional echocardiography was performed immediately after admission and 1 month after infarction. Group A consisted of 17 patients who underwent emergent PTCA during the acute phase of MI, and Group B consisted of 17 patients who did not undergo PTCA. We also studied 119 patients with a first uncomplicated acute anterior MI, including 53 who underwent PTCA (Group C) and 66 who did not (Group D). The length and wall thickness of the infarcted and noninfarcted endocardial segments were determined immediately after MI and 1 month later, and LV ejection fraction (LVEF) was measured during the chronic phase.

RESULTS

The lengths of the infarcted and noninfarcted endocardial segments were significantly greater in Group B than in the other three groups (p < 0.05). The LVEF was significantly lower in Group B than in the other three groups (p < 0.05).

CONCLUSIONS

We conclude that PTCA performed in patients during the acute phase of MI complicated by cardiogenic shock lowers in-hospital mortality and prevents both LV dilation and a decrease in LVEF.

Exercise-induced systolic dysfunction in patients with non-obstructive hypertrophic cardiomyopathy and mutations in the cardiac troponin genes

OBJECTIVES

The aim of this study was to investigate left ventricular (LV) function reserve in hypertrophic cardiomyopathy (HCM) patients with and without cardiac troponin gene mutations before transition to the dilated phase.

METHODS

LV ejection fraction (EF) was continuously evaluated in 52 patients with non-obstructive HCM during supine ergometer exercise using radionuclide ventricular function monitoring with a cadmium telluride detector (VEST). On the basis of genetic analysis, patients were divided into two groups: 10 with cardiac troponin gene mutations (group A) and 42 without these gene mutations (group B).

RESULTS

Exercise duration, peak exercise load, and heart rate during exercise did not differ between the two groups. The differences from baseline to peak exercise ofthe LV end-diastolic volume decreased similarly in the twogroups. In contrast, the difference of the LV end-systolicvolume in group A increased significantly compared withgroup B (17.7% (SD 12.7%) vs 3.4% (SD 13.2%);p=0.0031). Consequently, the difference of LVEF ingroup A decreased significantly in contrast with group B(-14.1% (SD 11.1%) vs -1.2% (SD 11.7%); p=0.0025).Additionally, the changes in LVEF and stroke volumedecreased significantly more in group A than in group B(-22.2% (SD 18.6%) vs -1.1% (SD 17.8%); p=0.0017and -12.9% (SD 21.7%) vs 12.3% (SD 24.4%);p=0.0042, respectively).

CONCLUSIONS

These results suggest that HCM patientswith cardiac troponin gene mutations may displayexercise-induced LV systolic dysfunction more frequentlythan HCM patients without this abnormality

Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: nationwide survey results over 30 years

Background

There are two distinct phenotypes of multiple sclerosis (MS) in Asians, manifesting as optic-spinal (OSMS) and conventional (CMS) forms. In Japan, four nationwide surveys of MS have been conducted. The first three were in 1972, 1982, and 1989, and we performed the fourth in 2004.

Results

The recent survey showed six main findings as follows: (1) a four-fold increase in the estimated number of clinically definite patients with MS in 2003 (9900; crude MS prevalence, 7.7/100,000) compared with 1972; (2) a shift in the peak age at onset from early 30s in 1989 to early 20s in 2003; (3) a successive proportional decrease in optic-spinal involvement in clinically definite patients with MS; (4) a significant north–south gradient for the CMS/OSMS ratio; (5) after subdivision of the mainland (30–45° North) into northern and southern parts at 37°N, northern-born northern residents (northern patients) showed a significantly higher CMS/OSMS ratio and higher frequency of brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) than southern-born southern residents (southern patients); (6) among northern patients, the absolute numbers of patients with CMS and those with Barkhof brain lesions rapidly increased with advancing birth year.

Conclusions

These findings suggest that MS phenotypes are drastically altered by environmental factors, such as latitude and “Westernization.”

Dietary intake and urinary excretion of selenium in the Japanese adult population: the INTERMAP Study Japan

OBJECTIVE

This study is to examine the relationship between dietary selenium intake and 24-h urinary selenium excretion in Japanese population samples participating in the INTERMAP Study.

METHODS

Using highly standardized methods, we assessed individual dietary selenium intake from four 24-h dietary recalls and measured urinary selenium excretion in two timed 24-h urine collections in 1145 Japanese participants (574 men and 571 women) ages 40-59 years in four areas of Japan.

RESULTS

The medians of dietary selenium intake were 177.5 microg/day in men and 139.8 microg/day in women; the medians of 24-h urinary selenium excretion were 127.9 microg/day in men and 109.4 microg/day in women, that is, urinary excretion was estimated to be 73% of dietary intake in men and 77% in women. Dietary selenium intake was significantly correlated with 24-h urinary selenium excretion (r=0.24 in men, r=0.18 in women; P<0.001). With dietary selenium intake and urinary selenium excretion expressed per kg of body weight, values were similar for men and women (dietary intake, 2.7 microg/kg body weight in men and 2.5 microg/kg body weight in women; urinary excretion, 2.0 microg/kg body weight in men and 2.0 microg/kg body weight in women).

CONCLUSION

Dietary intake and 24-h urinary excretion of selenium are related in the Japanese adult population.

Involvement of retinoic acid-inducible gene-I in inflammation of rheumatoid fibroblast-like synoviocytes

Interferon (IFN)-gamma is a major cytokine that regulates T helper 1-type immune reactions and serves as an important mediator in the pathogenesis of autoimmune diseases. Retinoic acid-inducible gene-I (RIG-I) is an IFN-gamma-inducible gene and known to be involved in the inflammatory and immune reactions. In the present study, we found high levels of RIG-I expression in synovial tissues of rheumatoid arthritis (RA), while the expression in osteoarthritis tissues was low. Treatment of cultured fibroblast-like synoviocytes with IFN-gamma markedly induced the expression of RIG-I. Knockdown of RIG-I in fibroblast-like synoviocytes, with specific siRNA, resulted in the inhibition of the IFN-gamma-induced expression of chemokine (C-X-C motif) ligand 10 (CXCL10)/IFN-gamma-inducible protein-10 (IP-10), a chemokine with chemotactic activity towards T cells. These findings suggest that RIG-I may play an important role in the pathogenesis of synovial inflammation in RA, at least in part, by regulating the IFN-gamma-induced expression of CXCL10/IP-10.

Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan

OBJECTIVES

To prospectively examine the association of cigarette smoking and alcohol drinking with oral and pharyngeal carcinogenesis, we analyzed data from a nation-wide large-scale cohort study in Japan.

METHODS

A total of 34 136 men and 43 711 women aged 40-79 years were included in the study. The Cox proportional hazard model was used to estimate the relative risk (RR) and 95% confidence interval (95% CI) of oral and pharyngeal cancer for smoking and drinking by sex, while adjusting for age, consumption of green tea, preference for salty foods, and consumption of green yellow vegetables.

RESULTS

Current smokers were found to have a higher risk of death caused by oral and pharyngeal cancer compared with non-smokers in both sexes: the RR was 2.6 (95% CI: 1.0-6.7) in men and 8.2 (95% CI: 2.1-32.1) in women. Men who drank more than 46 g ethanol per day had an approximately threefold increased risk of oral and pharyngeal cancer. Simultaneous exposure to both factors was significantly associated with an elevated risk of oral and pharyngeal cancer (RR: 3.3, 95% CI: 1.1-9.6).

CONCLUSIONS

The result supports the carcinogenic effect of cigarette smoking and alcohol drinking on the oral cavity and pharynx.

Endothelial dysfunction in adult patients with a history of Kawasaki disease

To assess the existence of endothelial dysfunction and the possibility of the early onset of atherosclerosis in the chronic stage of Kawasaki disease (KD), we examined endothelial function in adult patients late after the onset of KD. We evaluated two age-matched groups: 35 adult KD patients (KD group) (mean age, 27.0 years; mean interval time, 24.1 years), and 36 healthy adults (control group). To assess vascular endothelial function, flow-mediated dilatation (%FMD) of the brachial artery and urinary nitrites and nitrates (NOx) were examined. We also measured adhesion molecules and several coagulation-fibrinolysis markers. In addition, we measured high-sensitive C-reactive protein (hs-CRP) as a chronic inflammatory marker, and brachial-ankle pulse wave velocity (baPWV) as a marker for arterial stiffness. %FMD was significantly reduced in the KD group when compared with that of the control group (KD group, 10.4 +/- 2.6%; control group, 14.4 +/- 3.2%, p<0.05), particularly in patients with coronary artery lesions. Thrombin-antithrombin III complex values were higher in the KD group, although no significant differences were observed in the other markers for endothelial function. Hs-CRP was significantly elevated only in the patients with coronary aneurysms. Furthermore, in the male KD patients, the baPWV values were significantly higher than those in the control subjects. This study revealed that the adult patients with a history of KD had systemic vascular endothelial dysfunction, and also suggested that a history of KD was possibly one of the risk factors for early onset of atherosclerosis.

Geographic variation in soft tissue sarcoma patient follow-up

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Background: Of all newly diagnosed malignancies, 1% are soft tissue sarcomas (STS) and 59% of STS occur in the extremities. Most patients (80%) suffer recurrence within two years of potentially curative resection. Late recurrences at five years and beyond are not uncommon. Surveillance programs are designed to identify recurrence or new primaries early enough to positively impact survival and quality of life. Though published guidelines exist for extremity STS follow-up, adherence varies among physicians. Geographic factors were hypothesized to be potential predictors of this variation. Methods: The SSO membership (N=1592) was surveyed regarding postoperative STS surveillance using standardized clinical vignettes. Practice patterns were analyzed by metropolitan statistical area (MSA), managed care organization (MCO) penetration rate, and U.S. census region using repeated measures analysis of variance. The study endpoint was surveillance intensity. Results: Forty-five percent of SSO members (714) completed the survey; 343 (48%) performed sarcoma surgery. Of those who perform surgery, 318 (93%) follow their patients long-term. Mean follow-up intensity for the 12 modalities was highly correlated by tumor size, grade, and years after surgery. Controlling for tumor stage, grade, and year after surgery, geographic factors infrequently predicted surgeon self-reported surveillance intensity (p < .05). MSA was a significant predictor of office visit frequency. MCO penetration rate significantly predicted the frequency of urinalysis and site MRI. U.S. census region significantly predicted the frequency of LFTs. Two-way interaction effects were frequently significant. Few three-way interactions were examined due to sample size limitations. Conclusion: Geographic factors were generally not predictive of surgeon self-reported surveillance practice patterns for patients after curative-intent sarcoma surgery. Internship, residency, and fellowship locations may be important surgeon-specific aspects for future surveys.

No significant financial relationships to disclose.

A randomized prospective study on the use of 2 g-IVIG or 1 g-IVIG as therapy for Kawasaki disease

A single, 2 g/kg dose of immune globulin (IG), denoted 2 g-intravenous (IV)IG, has become a standard regimen for treating Kawasaki disease (KD) because of its highly preventive effect on coronary arterial lesions (CAL). However, IG is obtained from blood specimens, a drawback to many patients, and is also very expensive. This randomized prospective study reported here was carried out with the aim of developing a treatment regimen that would reduce the total dose of IG. The study tested two protocols (A: 2 g-IVIG; B: 1 g-IVIG) that included the strategy of administering additional IVIG to IVIG-resistant patients based on the criteria we described previously. In protocol A, an additional 2 g-IVIG was administered only once; in protocol B, the first additional IVIG was 1 g-IVIG and the second was 2 g-IVIG. One hundred and nine patients who were admitted before the seventh day of illness and had no CAL at the time of admission were enrolled in the study (protocol A: 54 patients; B: 55 patients). In the protocol A group, 7.4% (4/54) of the patients received 4 g/kg IG. In protocol B, 41.8% (23/55) were treated only with 1 g/kg IG, and 10.9% (6/55) received 4 g/kg IG. No significant differences were observed between the patients of the two subgroups receiving 4 g/kg IG in each protocol group. Discriminate analysis also suggested that 52.4% of the patients in the protocol A group could be treated only with 1 g/kg IG. On the other hand, no significant difference was observed in the incidence of aneurysms between patients in the protocol A group (1/54) and those in the protocol B group (4/55). Our protocol based on 1 g-IVIG, including additional IVIG, was assessed to be an effective treatment and to provide a considerably useful means to reduce the total dose of IG.

Effects of bilateral jugular vein ligation on local cerebral blood flow

The authors examined the effect of bilateral jugular vein ligation (JVL) on local cerebral blood flow (CBF). Local CBF was measured in the neocortex of the frontal lobe over a 1-week period in 10 freely moving male rats. Measurements were taken with the hydrogen clearance method before and after the rat underwent either an operation of bilateral JVL or a sham operation. After the sham operation, blood flow values did not change significantly compared with preoperative values. Blood flow values decreased rapidly in rats with JVL. For 3 hours after surgery, JVL values were significantly lower (p <0.05) than preoperative values were, then gradually they recovered and reached preoperative values within 48 hours. Histopathologic study showed no remarkable parenchymal damages in the brain of rats with JVL. These results show that bilateral JVL produces a reversible decrease in the CBF and does not cause histopathologic brain damages.

Characteristics of brachial-ankle pulse wave velocity in Japanese children

BACKGROUND

Measurement of pulse wave velocity (PWV) is a useful approach for evaluating the severity of atherosclerosis in adults, and, in particular, the measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple and practicable method. We attempted to investigate how baPWV in healthy children changes with age and gender, in order to assess baPWV in children with risk factors for the early progression of systemic atherosclerosis.

METHODS

We measured baPWV in 970 healthy Japanese children (500 boys and 470 girls), and set up the normal baPWV values of children on the basis of age and gender. We also performed linear regression analysis and step-wise multiple regression analysis for evaluating its correlation with baPWV and independent variables for baPWV in children.

RESULTS

The values of baPWV in children were higher in boys than in girls, and baPWV increased with age in both genders. Age, blood pressure and heart rate (HR) were significant determinants of baPWV in both male and female subjects, while the obesity index had no correlation with baPWV.

CONCLUSION

On the basis of these results, we suggest that baPWV in children is largely influenced by age and gender, and that baPWV gradually increased with age in both genders.

Segmental distribution of genes harboring a CpG island-like region on rice chromosomes

In plant genomes, there exist discrete regions rich in CpG dinucleotides, namely CpG clusters. In rice, most of these CpG clusters are associated with genes. Rice genes are grouped into one of the five classes according to the position of an associated CpG cluster. Among them, class 1 genes, which harbor a CpG cluster at the 5'-terminus, share similarities with human genes having CpG islands. In the present study, by analyzing plant genome sequence data, primarily from rice, we investigated the chromosomal distribution of genes of each class, mainly class 1 genes. Class 1 genes were not uniformly distributed across the rice genome, but were clustered into discrete chromosomal segments. EST-based analysis of the distribution of expressed genes indicates that this segmental distribution of class 1 genes caused a preferential distribution of expressed genes within class 1 gene-rich segments. We then compared the methylation status of genes of each class to examine the possibility that differential DNA methylation, if any, is relevant to the observed differential expression level of genes inside and outside the class 1 segments. The difference in the methylation level between these genes was revealed to be fairly small, which does not support the above-mentioned possibility.

PRKAR1A gene mutation in patients with cardiac myxoma

BACKGROUND

PRKAR1A gene encodes the type 1A regulatory subunit of protein kinase A. The mutation of this gene causes Carney complex which is an autosomal dominant multiple neoplasia syndrome characterized by spotty pigmentations, endocrine overactivity and cardiac myxoma. We hypothesized that cardiac myxoma may be associated with PRKAR1A gene mutation and determined whether mutation in the PRKAR1A gene is the cause of familial and sporadic cardiac myxoma.

METHODS

We studied seven patients (three males and four females) with cardiac myxoma. Two of them had familial cardiac myxoma complicated with Carney complex. The other five patients were characterized as sporadic cardiac myxomas. We analyzed the PRKAR1A gene of all patients by the polymerase chain reaction (PCR)-single-strand conformation method, followed with direct sequence analysis.

RESULTS

We identified a novel mutation (494delTG) in exon 4A of the PRKAR1A gene in the patients with Carney complex. A 16-year-old proband had a left atrial myxoma, pituitary adenoma and skin pigmentation. His father also had left atrial myxoma and skin pigmentation. In contrast, no mutations in the PRKAR1A gene were identified in the other five patients with sporadic cardiac myxomas.

CONCLUSIONS

These results suggest that mutation of the PRKAR1A gene may be associated with familial cardiac myxoma in Carney complex but may not be associated with sporadic cardiac myxoma.

Enhanced sonography using carbon dioxide gas for small hepatocellular carcinoma: a comparison study between pure carbon dioxide gas and carbon dioxide microbubbles

PURPOSE

To evaluate the feasibility of enhanced sonography using arterial injection of pure carbon dioxide gas (CO(2)) for detecting small hepatocellular carcinoma (HCC) nodules.

MATERIALS AND METHODS

We performed enhanced sonography on 51 HCC nodules of 35 patients with HCC. The patients underwent enhanced sonography with two methods: injection of pure CO(2) (26 nodules), or injection of CO(2) microbubbles (25 nodules) using CO(2) and soy bean oil. We observed the enhancement effect of HCC on enhanced sonography, and measured the accumulation time of CO(2) in the nodules.

RESULTS

Twenty-three nodules appeared hyperechoic on enhanced sonography, and 12 of the nodules could be found on enhanced sonography only. Sixteen of the hyperechoic nodules on baseline sonography revealed no enhancement. Multiple regression analysis with regard to the method of injection of CO(2), nodule location, and nodule size revealed that method (p<0.0001) and nodule size (p=0.02) remained significant. The accumulation time of CO(2) microbubbles in the nodules was 4.4+/-0.8 minutes, whereas pure CO(2) accumulation time was 14.7+/-1.5 minutes, significantly longer than the CO(2) microbubbles regardless of nodule size and location.

CONCLUSION

Enhanced sonography of arterial injection of pure CO(2) is a feasible technique for detecting small HCC nodules.

Rapidly progressive IgA nephropathy

A 14-year-old boy presented with macroscopic hematuria and a rapid deterioration in renal function. Percutaneous renal biopsy demonstrated severe crescentic IgA nephropathy (IgAN) with extensive (88%) glomerular crescent formation. After started intravenous administration of high-dose pulse methylprednisolone, severe nausea and general malaise accompanied by a rapid increase in Blood Urea Nitrogen (BUN) and serum creatinine levels appeared, however, the renal function ameliorated rapidly and fully recovered by following oral administration of corticosteroid. The clinical presentation of our case seems to be very remarkable compared to previously reported cases of rapidly progressive IgAN.

Long-Term Changes in Coronary Artery Aneurysms in Patients With Kawasaki Disease-Comparison of Therapeutic Regimens-

BACKGROUND

There are few studies of the therapeutic regimens for the prevention of stenotic transformation of aneurysms in Kawasaki disease (KD). The aim of this study was to assess the prophylactic effect of combined therapy in the acute stage and convalescent- to chronic-stage against the formation of stenotic lesions.

METHODS AND RESULTS

In 85 patients, 103 giant aneurysms (ANl), 46 medium-sized aneurysms (ANm), and 13 small aneurysms (ANs) were analyzed. With respect to therapy in the acute stage, no localized stenosis of ANl in the left coronary artery was noted in patients who received high-dose gamma globulin therapy (G). For ANm, the group (G) showed a significantly higher regression rate than the aspirin group and steroids group. Furthermore, no coronary artery occlusion/recanalization of ANl occurred with the prophylactic regimen of aspirin and warfarin {aw}. Prophylaxis {aw} and the prophylactic regimen of aspirin alone {a} significantly lowered the incidence compared with either the prophylactic regimen of warfarin {w} or no prophylaxis {n}. However, no significant differences were noted between prophylaxis {w} and {n}.

CONCLUSIONS

High-dose gamma globulin therapy in the acute stage of KD is the first choice for the prevention of stenotic transformation. Prophylaxis {aw} is recommended for ANl.

Individual and joint impact of family history and Helicobacter pylori infection on the risk of stomach cancer: a nested case-control study

We used 202 cases of stomach cancer and 394 controls nested within the Japan Collaborative Cohort Study For Evaluation of Cancer Risk (JACC study) to investigate whether family history has an independent effect on the risk of stomach cancer after controlling for the Helicobacter pylori infection. A positive history of stomach cancer in one or more first-degree relatives was associated with an increased risk of the disease in women, but not in men after controlling for H. pylori infection and other confounding variables. Women with both a family history and H. pylori infection were associated with more than five-fold increased risk of the disease (OR 5.10, 95% CI 1.58–16.5) compared to those without these factors. These results suggest the existence of inherited susceptibility to the disease in women, and that measurements of H. pylori infection together with the family history allow meaningful evaluation of risk beyond that provided by either factor alone.