Increase in Thrombomodulin Concentrations After Pulmonary Thromboendarterectomy in Chronic Thromboembolic Pulmonary Hypertension

STUDY OBJECTIVES

The objectives of the study were as follows: (1) to identify differences in endothelial dysfunction and altered hemostasis in patients with chronic thromboembolic pulmonary hypertension (CTEPH) compared with patients with acute pulmonary thromboembolism (APTE) uncomplicated by pulmonary arterial hypertension, by measuring the concentrations of thrombomodulin (TM), a receptor for thrombin and a major anticoagulant proteoglycan on the endothelial membrane, and other plasma factors of coagulation and fibrinolysis; and (2) to examine the effects of thromboendarterectomy on TM levels as a parameter of endothelial cell injury leading to abnormal hemostasis as well as to examine the clinical significance of TM as a marker of endothelial injury.

DESIGN

Prospective comparison of concentrations of TM and other plasma parameters among patients with CTEPH or APTE and control subjects.

PARTICIPANTS

We studied 22 healthy subjects (ie, control subjects), 22 patients who had been clinically stabilized after APTE, and 44 patients with CTEPH. In 21 of the patients with CTEPH, measurements were repeated after they had undergone pulmonary thromboendarterectomy.

MEASUREMENTS AND RESULTS

Plasma concentrations of soluble TM in patients with CTEPH were measured and compared with those in patients with APTE. The mean (+/- SD) TM concentration in the CTEPH group (2.5 +/- 0.7 ng/mL) was significantly lower than that in the control group (4.0 +/- 0.6 ng/mL; p < 0.05). In contrast, the mean plasma TM concentration in the APTE group (4.6 +/- 1.9 ng/mL) was similar to that in the control group. After patients underwent pulmonary thromboendarterectomy, the mean TM concentration increased from 2.0 +/- 0.4 to 2.9 +/- 0.7 ng/mL (p < 0.05). In the CTEPH group, the plasma TM concentration was negatively correlated with mean pulmonary arterial pressure and total pulmonary resistance (p < 0.05).

CONCLUSIONS

A decreased plasma TM concentration may reflect pulmonary vascular endothelial dysfunction leading to altered anticoagulant and fibrinolytic function in CTEPH, which rarely develops after APTE. Plasma TM measurements may be useful in distinguishing CTEPH with severe pulmonary hypertension from recurrent APTE.

Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men

OBJECTIVE

To investigate the association between serum gamma-glutamyltransferase (GGT) and risk for development of diabetes.

DESIGN

Longitudinal study (followed from 1994 to 2001).

SETTING

A work site in Japan.

SUBJECTS

A total of 2918 Japanese male office workers aged 35-59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1-6.9 mmol L-1), type 2 diabetes (a fasting plasma glucose concentration of >/=7.0 mmol L-1 or receipt of hypoglycaemic medication), medication for hypertension or hepatitis, alanine aminotransferase concentrations higher than three times the upper limit of the reference range or a history of cardiovascular disease at study entry.

MAIN OUTCOME MEASURE

Incidence of IFG or type 2 diabetes over a 7-year period.

RESULTS

With adjustment for potential risk factors for diabetes, the relative risk for IFG compared with serum GGT <16 U L-1 was 1.23 (95% CI, 0.79-1.90), 1.50 (CI, 0.97-2.32) and 1.70 (CI, 1.07-2.71) with serum GGT of 16-24, 25-43 and >/=44 U L-1, respectively (P for trend = 0.014). The respective relative risks for type 2 diabetes compared with serum GGT <16 U L-1 were 2.54 (CI, 1.29-5.01), 2.64 (CI, 1.33-5.23) and 3.44 (CI, 1.69-6.70) (P for trend = 0.002). From stratified analyses by body mass index (BMI) and alcohol intake, a stronger linear association between serum GGT and development of IFG or type 2 diabetes was found in men with a BMI >/=23.2 kg m-2 in both those who drank <46 and >/=46 g day-1 of ethanol.

CONCLUSIONS

The risk for development of IFG or type 2 diabetes increased in a dose-dependent manner as serum GGT increased in middle-aged Japanese men. The increased relative risk for IFG or type 2 diabetes associated with serum GGT was more pronounced in obese men.

Recent developments in diagnostic imaging techniques and management for acute pulmonary embolism: multicenter registry by the Japanese Society of Pulmonary Embolism Research

OBJECTIVE

There are many reports on the diagnosis and management of acute pulmonary embolism (APE), but there have been no investigations concerning the actual conditions in which recent developments in diagnostic imaging techniques and therapies have been applied in clinical practice. The present study was designed to investigate the changes in diagnostic imaging techniques and therapies for APE.

METHODS AND PATIENTS

Three hundred and nine APE patients diagnosed during January 1994-October 1997 (Group 1) were compared with 257 APE patients diagnosed during November 1997-October 2000 (Group 2) in terms of the diagnostic imaging techniques and therapies for APE.

RESULTS

Compared with Group 1, pulmonary angiography and contrast-enhanced computed tomography were more frequently performed for diagnosis in Group 2 [45.3% vs 56.8% (p = 0.0069) and 13.9% vs 57.6% (p < 0.0001), respectively]. Heparin and vena cava filter were used more often in Group 2 [74.4% vs 82.1% (p = 0.033) and 18.4% vs 33.9% (p < 0.0001), respectively]. The frequency of thrombolytic therapy was unchanged between the two groups. Warfarin use in discharged patients increased from 71.9% to 83.8% (p = 0.0022). However, the examination rates for deep vein thrombosis (DVT) were low (60.8% in Group 1 and 65.4% in Group 2, p = 0.29) and unchanged using any imaging techniques.

CONCLUSION

The diagnostic imaging techniques for APE increased in variety and the management has improved, while the diagnosis for DVT remains unchanged.

Hemodynamic and hormonal effects of beraprost sodium, an orally active prostacyclin analogue, in patients with secondary precapillary pulmonary hypertension

Earlier studies have shown that administration of beraprost sodium (BPS), an orally active prostacyclin analogue, improves hemodynamics in patients with primary pulmonary hypertension (PH), but it is not known whether BPS has beneficial effects in secondary precapillary PH. The present study investigated the hemodynamic and hormonal parameters of 18 patients with secondary precapillary PH (8 patients with chronic thromboembolic PH, 7 with collagen vascular disease, and 3 with residual PH after surgery for atrial septal defect). Hemodynamics were repeatedly measured by right heart catheterization. Treatment with BPS improved New York Heart Association (NYHA) functional class in 10 of the 18 patients and significantly decreased pulmonary vascular resistance by 17% (12.9+/-1.1 to 10.7+/-1.2 Wood units, p<0.01). Circulating brain natriuretic peptide and uric acid significantly decreased from 246+/-61 to 215+/-65 pg/ml and from 6.5+/-0.6 to 5.3+/-0.3 mg/dl, respectively. In summary, BPS therapy improved NYHA functional class, hemodynamics, and hormonal parameters in patients with secondary precapillary PH. Thus, oral administration of BPS may be a new therapeutic strategy for the treatment of secondary precapillary PH.

Effect of orally active prostacyclin analogue on survival in patients with chronic thromboembolic pulmonary hypertension without major vessel obstruction

OBJECTIVES

This study investigated whether treatment with beraprost sodium (BPS), an orally active prostacyclin analog, improves hemodynamics and survival in patients with peripheral-vessel chronic thromboembolic pulmonary hypertension (CTEPH), for which there is no surgical option.

BACKGROUND

Oral administration of BPS has been shown to improve the hemodynamics and prognosis in patients with primary pulmonary hypertension; however, whether BPS has beneficial effects in CTEPH remains unknown.

METHODS

Forty-three patients with peripheral-vessel CTEPH were classified into two groups: patients treated with BPS (BPS group, n = 20) and those without BPS (conventional group, n = 23). Baseline demographic and hemodynamic data did not significantly differ between the two groups.

RESULTS

BPS therapy improved New York Heart Association functional class in 10 patients (50%) and significantly decreased total pulmonary resistance from 18 +/- 6 to 15 +/- 8 Wood units (p < 0.05) [mean +/- SD]. Sixteen patients died of cardiopulmonary causes in the conventional group during a mean follow-up period of 58 +/- 45 months. In contrast, only three patients died of cardiopulmonary causes in the BPS group during a mean follow-up period of 44 +/- 30 months. The absence of BPS therapy, elevated total pulmonary resistance, heart rate, and age were independently related to the mortality by Cox proportional hazard analysis. The 1-year, 3-year, and 5-year survival rates for the BPS group were 100%, 85%, and 76%, respectively, compared to 87%, 60%, and 46% in the conventional group.

CONCLUSIONS

This preliminary study suggests that oral administration of BPS may improve hemodynamics and survival in patients with peripheral-vessel CTEPH, for which there is no surgical option.

Association of alcohol consumption with white blood cell count: a study of Japanese male office workers

OBJECTIVES

To investigate the association of alcohol consumption with white blood cell (WBC) count.

DESIGN

Cross-sectional study.

SETTING

A work site in Japan.

SUBJECTS

A total of 5218 Japanese male office workers aged 23-59 years who participated in annual health examinations.

MAIN OUTCOME MEASURES

Subjects were classified as nondrinkers, or current drinkers who averaged <12, 12-22, 23-34, 35-45, 46-68 or > or = 69 g day(-1) of ethanol. The association between alcohol consumption and WBC count was examined by smoking status.

RESULTS

After controlling for age, body mass index, systolic blood pressure, and levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and fasting plasma glucose, WBC count showed a negative dose-response relation with alcohol consumption in each smoking status. The WBC count increment per category of alcohol intake (x10(9) cells L(-1)) was -0.07 [95% confidence interval (CI), -0.11 to -0.04] for never smokers, -0.11 (95% CI, -0.15 to -0.06) for ex-smokers, and -0.04 (-0.08 to -0.00) for current smokers. For current smokers, additional adjustment for cigarettes smoked per day heightened the magnitude of these associations [the respective WBC count increment (x10(9) cells L(-1)), -0.07 (95% CI, -0.11 to -0.03)]. The risk for high WBC count (fifth quintile) also showed a negative linear trend related to alcohol intake in each smoking status.

CONCLUSIONS

The WBC count was inversely associated with alcohol consumption in both nonsmokers and smokers. In view of the firm association of WBC count with the increased risk of coronary heart disease, alcohol consumption seems to have a favourable impact on the link between WBC count and the risk of cardiovascular disease.

Prostacyclin therapy before pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension

OBJECTIVES

The continuous IV administration of prostacyclin improves pulmonary hemodynamics and prognosis in patients with primary pulmonary hypertension. We investigated whether the administration of prostacyclin therapy to patients before they undergo pulmonary thromboendarterectomy ameliorates pulmonary hypertension in patients with the most severe form of chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS

Of the 33 patients with CTEPH who were candidates for pulmonary thromboendarterectomy, 12 patients with severe pulmonary hypertension (pulmonary vascular resistance, > 1,200 dyne. s. cm(-5)) received IV prostacyclin prior to undergoing pulmonary thromboendarterectomy. Right heart catheterization and plasma brain natriuretic peptide (BNP) measurements were repeated at baseline, immediately before surgery, and 1 month after surgery.

RESULTS

During a mean (+/- SEM) follow-up period of 46 +/- 12 days, the IV administration of prostacyclin resulted in a 28% decrease in pulmonary vascular resistance (1,510 +/- 53 to 1,088 +/- 58 dyne. s. cm(-5); p < 0.001) before surgery. Prostacyclin therapy markedly decreased plasma BNP level (547 +/- 112 to 188 +/- 30 pg/mL; p < 0.01), suggesting improvement in right heart failure. Pulmonary thromboendarterectomy caused a further reduction of pulmonary vascular resistance (302 +/- 47 dyne. s. cm(-5)) and plasma BNP levels (60 +/- 11 pg/mL) compared to each preoperative value (p < 0.05). Operative mortality rates were relatively low (8.3%) in patients with the most severe form of CTEPH.

CONCLUSION

The IV administration of prostacyclin caused beneficial hemodynamic effects in patients with severe CTEPH and may serve as pretreatment for patients undergoing pulmonary thromboendarterectomy.

Pulmonary vasodilator response to adrenomedullin in patients with pulmonary hypertension

This study sought to investigate pulmonary vasodilator responses to intrapulmonary and intravenous infusion of adrenomedullin (AM) in patients with pulmonary hypertension. In 10 patients with pulmonary hypertension, blood flow velocity in a segmental pulmonary artery was measured using a Doppler flow wire during intrapulmonary infusion of AM, acetylcholine (ACh), and adenosine triphosphate (ATP). The hemodynamic effects of intravenously administered AM (0.05 microg/kg/min) were examined in another 5 patients with primary pulmonary hypertension. Intrapulmonary infusion of AM, ACh or ATP caused a significant dose-dependent increase in blood flow velocity in a segmental pulmonary artery, respectively. The increase in flow velocity with AM at 10(-8) mol/l (41 +/- 6% of the baseline value) was comparable to that with ACh at 10(-4) mol/l (39 +/- 11%) and that with ATP at 10(-5) mol/l (36 +/- 14%), suggesting a strong pulmonary vasodilator activity of AM. Intravenous infusion of AM produced a 41% increase in cardiac index (p < 0.05) and a 30% decrease in pulmonary vascular resistance (p < 0.05) with a 3% reduction in mean pulmonary arterial pressure (p = NS). These results suggest that, on a molar basis, AM may have much more potent pulmonary vasodilator activity than ACh and ATP, and thus may have beneficial hemodynamic effects in patients with pulmonary hypertension.

B-Thalassaemia: A Case Report

A case report of B-thalassaemia intermedia was diagnosed in a 22 years women old Nepalese on the basis of the investigations of blood, bone marrow, haemoglobin electrophoresis and X-rays with clinical findings.

Effects of continuous IV prostacyclin in a patient with pulmonary veno-occlusive disease

Pulmonary veno-occlusive disease (PVOD) is a rare but life-threatening disease. Although prostacyclin (PGI(2)) attenuates pulmonary hypertension and improves the prognosis in patients with primary pulmonary hypertension, little information is available regarding the effect of PGI(2) on patients with PVOD. This report describes a patient with severe PVOD who showed marked improvement in exercise capacity and pulmonary hemodynamics with continuous IV PGI(2) treatment. Furthermore, he experienced no clinical events for 12 months and survived for 25 months after the initiation of PGI(2) therapy. These results suggest that continuous IV PGI(2) therapy may serve as a bridge to transplantation in some cases of PVOD.

Deconvolution processing of HAADF STEM images

A deconvolution processing of high-resolution high-angle annular dark field (HAADF) scanning transmission electron microscopy (STEM) images, combined with maximum entropy method, is applied to two experimental [0 11]-Si images; one having unresolved dumbbells and the other having resolved dumbbells and artificial bright spots. The deconvoluted images for these images show bright spots corresponding to the projected atomic columns and no artificial bright spots. Thus, the deconvolution processing provides almost a real projected atomic structure by eliminating effects of the probe function from HAADF STEM images.

Higher prevalence of obstructive airway disease in patients with thoracic or abdominal aortic aneurysm

BACKGROUND AND AIM

The risk factors of aortic aneurysm (AA) are comparable with those described for chronic obstructive pulmonary disease. This study was performed to determine whether patients with AA have a higher than average prevalence of obstructive airway disease.

METHODS

We performed pulmonary function tests in 240 consecutive patients (182 men and 58 women; age, 70 +/- 10 years) with thoracic or abdominal AA. The results were compared with those in individuals without obvious cardiovascular disease (control) and in patients with coronary artery disease who were matched for age, gender, smoking status, and other atherosclerotic risk factors.

RESULTS

Patients in the AA group had a lower forced expiratory volume in 1 second/forced vital capacity (%) and carbon monoxide diffusing capacity (%/predicted value) than did the control group (P <.01). The proportion of patients with airway obstruction, defined as forced expiratory volume in 1 second/forced vital capacity of 70% or less, was higher in the AA group (100/240; 42%) than in the control (51/223; 23%) and coronary artery disease (43/238; 18%) groups. Multiple logistic regression analysis results revealed that the presence of an AA and male gender were associated with a higher risk of airway obstruction (odds ratio, 2.928; 95% CI, 1.722 to 4.979; and odds ratio, 1.622; 95% CI, 1.055 to 2.493, respectively).

CONCLUSION

These data suggest that AA may be a risk factor indicative of the presence of chronic obstructive pulmonary disease. A higher prevalence of depressed pulmonary function should be suspected as a preoperative risk in presence of thoracic or abdominal AA as compared with other types of cardiovascular disorders.

Plasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy

BACKGROUND

Plasma brain natriuretic peptide (BNP), a cardiac hormone secreted mainly by the cardiac ventricles, has been shown to increase in proportion to the degree of cardiac overload. However, whether plasma BNP may serve as a marker for the efficacy of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension remains unknown.

METHODS

Plasma BNP level was measured in 34 patients with chronic thromboembolic pulmonary hypertension before and 1 month after pulmonary thromboendarterectomy. Right heart catheterization was also performed before and 1 month after the operation.

RESULTS

Preoperative plasma BNP level was significantly elevated in patients with chronic thromboembolic pulmonary hypertension compared with control patients (246 +/- 40 vs 13 +/- 2 pg/mL; p < 0.001; n = 34) and was positively correlated with total pulmonary resistance (r = 0.57; p < 0.001). After pulmonary thromboendarterectomy, plasma BNP level in survivors markedly decreased (220 +/- 31 to 54 +/- 9 pg/mL; p < 0.001; n = 32) in association with a reduction of total pulmonary resistance (15.6 +/- 1.0 to 4.5 +/- 0.3 Wood units; p < 0.001). The change in plasma BNP level was closely correlated with that in total pulmonary resistance (r = 0.63; p < 0.001). Importantly, a sustained elevation of plasma BNP (> or = 50 pg/mL) indicated the presence of residual pulmonary hypertension (> or = 5 Wood units) after operation (sensitivity = 73%; specificity = 81%).

CONCLUSIONS

Plasma BNP level was strongly associated with the severity of pulmonary hypertension in patients with chronic thromboembolic pulmonary hypertension and thereby may serve as a noninvasive marker for the efficacy of pulmonary thromboendarterectomy.

Quantitative analysis of lung perfusion in patients with primary pulmonary hypertension

The aim of this study was to evaluate quantitatively the heterogeneity of lung perfusion scans in patients with primary pulmonary hypertension (PPH) and to compare it with the severity of disease.

METHODS

Lung perfusion scans were obtained on 22 patients with PPH and 12 age-matched control subjects. The perfused area rates (PARs) were calculated by dividing the lung area in each 10% threshold width from 10% to 100% of maximal counts by total lung area. The total absolute difference in the PAR between each patient and the mean control value was assumed as the perfusion index of the lung (P index). The P index was compared with hemodynamic parameters and the right ventricular ejection fraction (RVEF), including 7 patients who received long-term vasodilator therapy.

RESULTS

The P index correlated significantly with mean pulmonary arterial pressure (P < 0.001) and RVEF (P < 0.05). In patients with vasodilator therapy, the P index was improved significantly after therapy (P < 0.05) and was associated with a reduction in pulmonary arterial pressure.

CONCLUSION

Quantitative assessment of lung perfusion irregularity might provide useful information about the severity of disease and the effect of therapy in addition to the routine visual representation.

White blood cell count and clustered features of metabolic syndrome in Japanese male office workers

We assessed the association of white blood cell (WBC) count with different components of metabolic syndrome (MS)-obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol levels, hypertriglyceridemia, high fasting plasma glucose levels and hyperuricemia-in 5275 Japanese male office workers aged 23-59 years. After controlling for age, smoking and alcohol intake, the relative risks for the presence of 1, 2, 3, 4 and > or =5 features of MS compared with the lowest quintile of WBC count increased in a dose-dependent manner as WBC count increased (P for trend < 0.001 for all) and the increased relative risks for clustered features of MS were more pronounced as the number of features of MS increased. The WBC count increments in subjects with 1, 2, 3, 4 and > or =5 features of MS were 0.28, 0.45, 0.68, 0.76 and 1.40 x10(9) cells/l, respectively, compared with the subjects without features of MS (P for trend < 0.001). These findings indicate a strong association between WBC count and clustered features of MS in middle-aged Japanese men.

Serum uric acid level increases in proportion to the severity of pulmonary thromboembolism

Serum uric acid (UA) has been proposed as a marker for impaired oxidative metabolism and the present study investigated whether serum UA level increases in proportion to the severity of pulmonary thromboembolism (PTE) in 193 patients. Serum UA was repeatedly measured after treatment of PTE in 76 patients. Right heart catheterization was performed in a subgroup of patients (n=104). Serum UA on admission was significantly elevated in patients with acute PTE (6.2+/-2.3 mg/dl) and those with chronic PTE (7.0+/-2.1 mg/dl) compared with age-matched controls (4.5+/-0.9 mg/ml). In particular, serum UA was markedly higher in the 27 patients who died during hospitalization than in the remaining survivors (8.3+/-2.2 vs 6.5+/-2.2 mg/dl, p<0.001). In acute PTE, serum UA negatively correlated with cardiac output, but not significantly with mean pulmonary arterial pressure. In chronic PTE, serum UA negatively correlated with cardiac output and positively correlated with mean pulmonary arterial pressure. Serum UA significantly decreased from 6.7+/-2.0 to 5.8+/-1.9 mg/dl with treatment, associated with an increase in cardiac output and in PaO2. Serum UA increases in proportion to the severity of PTE, and thereby may serve as a potential indicator of the efficacy of treatment of PTE.

Oral beraprost sodium improves exercise capacity and ventilatory efficiency in patients with primary or thromboembolic pulmonary hypertension

OBJECTIVE

To investigate the effect of beraprost sodium, an orally active prostacyclin analogue, on exercise capacity and ventilatory efficiency in patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension.

PATIENTS AND DESIGN

Symptom limited cardiopulmonary exercise testing was performed before and 3 (1) months (mean (SEM)) after beraprost treatment in 30 patients with precapillary pulmonary hypertension (14 with primary pulmonary hypertension and 16 with chronic thromboembolic pulmonary hypertension).

RESULTS

Long term treatment with beraprost resulted in significant increases (mean (SEM)) in peak workload (87 (4) W to 97 (5) W, p < 0.001) and peak oxygen consumption (peak VO2, 14.9 (0.7) ml/kg/min to 16.8 (0.7) ml/kg/min, p < 0.001). Beraprost decreased the ventilatory response to carbon dioxide production during exercise (VE-VCO2 slope, 42 (2) to 37 (1), p < 0.001). No significant difference in the responses of these variables to beraprost treatment was observed between patients with primary pulmonary hypertension and chronic thromboembolic pulmonary hypertension.

CONCLUSIONS

Oral administration of beraprost sodium may improve exercise capacity and ventilatory efficiency in patients with both primary and chronic thromboembolic pulmonary hypertension.

Poor prognosis and related factors in adults with Eisenmenger syndrome

BACKGROUND

Little information is available regarding the clinical history and long-term prognosis of patients with Eisenmenger syndrome without diagnosis until adulthood. The purpose of this study was to investigate the long-term prognosis and factors predictive of the prognosis in patients with Eisenmenger syndrome diagnosis in adulthood.

METHODS AND RESULTS

We retrospectively reviewed the clinical data of 106 patients with Eisenmenger syndrome diagnosis in adulthood. Presence of congenital heart defects had neither been noticed nor confirmed with cardiac catheterization until adulthood in most of the patients in our study. After the diagnosis was confirmed, 42 patients died during a mean follow-up period of 7.6 years. The mean survival time from diagnostic catheterization to death was 5.4 years in nonsurvivors. Survival rate was 98% at 1 year, 77% at 5 years, and 58% at 10 years, with the Kaplan-Meier method. Elevated right atrial pressure (>7 mm Hg) and reduced systemic blood flow (<2.9 L/min) were independently associated with increased mortality rate of adults with Eisenmenger syndrome.

CONCLUSION

Patients with Eisenmenger syndrome without diagnosis until adulthood had a poor prognosis. Reduced systemic blood flow and elevated right atrial pressure were associated with high mortality rates in adults with Eisenmenger syndrome.

Incidence and clinical characteristics of chronic pulmonary thromboembolism in Japan compared with acute pulmonary thromboembolism: results of a multicenter registry of the Japanese Society of Pulmonary Embolism Research

The incidence of acute pulmonary thromboembolism (APTE) in Japan is quoted as being extremely low compared with the United States, and the incidence and clinical characteristics of chronic pulmonary thromboembolism (CPTE) in Japan is unknown, so this study investigated these aspects of CPTE in 309 patients with APTE and 68 patients with CPTE. The ratio of the incidence of CPTE to APTE was 0.22 and there was no significant difference in age or sex between the APTE and CPTE patients. All of the predisposing factors for pulmonary thromboembolism, except for thrombophilia, were more frequently seen in the patients with APTE. There are some differences in the incidence and clinical characteristics of CPTE compared with APTE between Japanese and American patients in Japan, suggesting that the pathogenesis of CPTE in Japan may differ from that in the USA.

White blood-cell count and the risk of impaired fasting glucose or Type II diabetes in middle-aged Japanese men

AIMS/HYPOTHESIS

To investigate the association between white blood-cell (WBC) count and the development of diabetes, independent of cigarette smoking.

METHODS

We examined 2953 Japanese men who were office workers and between 35 and 59 years of age and who did not have impaired fasting glucose (IFG) (a fasting glucose concentration of 6.1-6.9 mmol/l), Type II (non-insulin-dependent) diabetes mellitus (a fasting glucose concentration of > or =7.0 mmol/l or more or receipt of hypoglycaemic medication), medication for hypertension, and a history of cardiovascular disease. Fasting glucose concentrations were measured at annual health examinations from May 1994 through May 2000.

RESULTS

After controlling for potential predictors of diabetes, the relative risk for IFG or Type II diabetes mellitus compared with a WBC count of less than 5.3-10(9) cells/l was 1.2 (95 %-CI, 0.6-2.3), 1.6 (CI, 0.8-3.1), and 2.5 (CI, 1.2-5.1) among non-smokers (p for trend = 0.009): and 1.0 (CI, 0.4-2.5), 2.3 (CI, 1.0-5.1), and 3.1 (CI, 1.4-7.1) among ex-smokers (p for trend = 0.001) with WBC counts of 5.3-6.1, 6.2-7.2, and 7.3-10(9) cells/l or more, respectively. Among current smokers, the respective multivariate-adjusted relative risks for IFG or Type II diabetes mellitus were 1.1 (CI, 0.6-2.1), 1.4 (CI, 0.8-2.4), and 1.2 (CI, 0.7-2.1) (p for trend = 0.460).

CONCLUSION/HYPOTHESIS

Although the selection of a rigorously normoglycaemic cohort might have had an influence on these observations, higher WBC counts seem to predict the development of IFG or Type II diabetes mellitus, primarily in non-smokers.

Hemodynamic, renal, and hormonal effects of ghrelin infusion in patients with chronic heart failure

Ghrelin is a novel GH-releasing peptide that may also induce vasodilation and a positive energy balance through GH-independent mechanisms. However, the hemodynamic, renal, and hormonal effects of ghrelin in patients with chronic heart failure (CHF) remain unknown. Accordingly, 12 patients with CHF were given an iv infusion of human ghrelin (0.1 microg/kg.min) or placebo. Ghrelin significantly decreased mean arterial pressure (-9 mm Hg, P < 0.05) without a significant change in heart rate. Ghrelin significantly increased cardiac index (+25%, P < 0.05) and stroke volume index (+30%, P < 0.05), although it did not significantly alter mean pulmonary arterial pressure or pulmonary capillary wedge pressure. Infusion of ghrelin induced a marked increase in serum GH level (15-fold), associated with slight increases in circulating epinephrine, ACTH, cortisol, and PRL. Infusion of ghrelin did not significantly alter urine volume, urinary sodium excretion, or creatinine clearance. These hemodynamic, renal and hormonal parameters remained unchanged during placebo infusion. In summary, iv infusion of ghrelin, a potent GH-releasing peptide, had beneficial hemodynamic effects in patients with CHF in the absence of renal effects.

Computer image analysis for prediction of carcass composition from cross-sections of Japanese Black steers

Carcasses from Japanese Black steers were used to obtain prediction equations for carcass composition from information derived by computer image analysis of carcass cross-section images. The total weights of lean, fat, and bone were obtained from the left sides of 55 carcasses (Data Set I) and 18 carcasses (Data Set II) by physical dissection. The information such as total lean, fat, and bone areas in the cross-sections; muscle area, muscle circumference, short and long radius axis lengths, and direction of long radius axis; and geometric distance between any two muscle centers of gravity was obtained by scanning and image analysis of pictures of the cross-sections of the beef side at the 6th/7th rib interface. The coefficients of determination of the multiple regression equations estimated from Data Set I for kilograms of lean, fat, and bone were 0.76, 0.82, and 0.69, respectively, whereas for the percentages of lean, fat, and bone they were 0.57, 0.66, and 0.42, respectively. The multiple regression equations from Data Set I was applied to Data Set II in order to test the applicability of the prediction equations obtained. The correlation coefficients between the value predicted by the multiple regression equation and the measurement obtained by physical dissection for kilograms of lean, fat, and bone were 0.71, 0.72, and 0.70, respectively, whereas those for the percentages of lean, fat, and bone were 0.63, 0.44, and 0.29, respectively. The results indicate that the information obtained from the carcass cross-sections by the computer image analysis method can be used to predict carcass composition in Japanese Black steers.

Hours of work and the risk of developing impaired fasting glucose or type 2 diabetes mellitus in Japanese male office workers

OBJECTIVE

To investigate the association between duration of overtime and the development of impaired fasting glucose (IFG) or type 2 diabetes mellitus (DM).

METHODS

A cohort of 1266 Japanese male office workers aged 35-59 years and free of IFG (fasting plasma glucose concentration 6.1-6.9 mmol/l), type 2 DM (fasting plasma glucose concentration of 7.0 mmol/l or more or taking hypoglycaemic medication), history of diabetes, or medication for hypertension were re-examined over 5 successive years after their initial examinations in 1994.

RESULTS

138 men developed IFG or type 2 DM during the 5736 person-years of follow up. After controlling for potential predictors of diabetes, the relative risks of IFG or type 2 DM, compared with those who worked <8.0 hours a day, were 0.82 (95% confidence interval (95% CI) 0.54 to 1.26), 0.69 (95% CI 0.38 to 1.26), 0.63 (95% CI: 0.37 to 1.09), and 0.50 (95% CI: 0.25 to 0.98) for those who worked 8.0-8.9, 9.0-9.9, 10.0-10.9, and of 11.0 hours or more a day, respectively (p for trend=0.020). 87 and 54 men developed IFG and type 2 DM during the 5817 and 5937 person-years of follow up, respectively. The multivariate adjusted relative risks of IFG tended to decrease with an increase in hours of overtime work a day, but did not reach significance (p for trend=0.202). On the other hand, the multivariate adjusted relative risks of type 2 DM significantly decreased with an increase in hours of overtime work a day (p for trend=0.014).

CONCLUSION

Longer overtime is a negative risk factor for the development of IFG or type 2 DM in Japanese male office workers.