Effects of Calcium Channel Blocker Azelnidipine on Experimental Abdominal Aortic Aneurysms

PURPOSE

Azelnidipine has recently been recognized in vascular remodeling. However, the effects of azelnidipine on aneurysmal disease have not yet been studied. The aim of this study was to evaluate whether azelnidipine can inhibit a further expansion of aneurysmal disease.

METHODS

Experimental abdominal aortic aneurysms (AAAs) were created in a rat model by perfusing elastase. The rats in the first group received no treatment (n=10). In the second group (n=10) azelnidipine (2 mg/kg) was administered to the animals from 3 days before perfusion. The aortic diameter (AD) was measured at the time of initial surgery and death on postoperative day 14. The production of matrix metalloproteinases (MMP)-2 and -9 was analyzed by gelatin zymography.

RESULTS

The aortic diameter was smaller in the azelnidipine group than in the control (7.875+/-1.454 vs 10.745+/-0.551 mm, P<0.01). the active MMP-2 and MMP-9 levels decreased in the azelnidipine group. Hematoxylin-eosin and elastin staining revealed fewer changes in the inflammatory infiltrate and degradation of elastin in the azelnidipine group.

CONCLUSION

Azelnidipine reduced the expansion of experimental AAAs. Azelnidipine therefore appears to influence the inflammatory oxidative response seen in AAAs while also decreasing the MMP-2 and MMP-9 levels. In addition, azelnidipine inhibited aortic dilatation.

Mid-term results of valve replacement with the ATS valve: a seven-year follow up

BACKGROUND AND AIM OF THE STUDY

The ATS open pivot bileaflet valve has been the prosthesis of choice at the authors' hospital since 1997. Herein is presented a retrospective analysis of the mid-term results of valve replacement with the ATS valve prosthesis.

METHODS

Between 1997 and 2005, a total of 280 patients (mean age 58.3 years) underwent valve replacement with the ATS valve; these included 133 aortic valve replacements (AVR), 115 mitral valve replacements (MVR), and 32 double (aortic plus mitral) valve replacements (DVR). Preoperatively, 162 patients (57.9%) were in NYHA functional class II, 97 (34.6%) in class III, 19 (6.8%) in class IV, and two (0.7%) in class V. Atrial fibrillation was detected in 105 patients (37.5%), and significant coronary artery disease was found concomitantly in 13 (4.6%). Postoperative anticoagulant therapy consisting of warfarin and an antiplatelet drug was usually instituted on the first postoperative day, and the International Normalized Ratio maintained between 1.6 and 2.5.

RESULTS

Overall hospital mortality was 3.6% (n = 10). Hospital survivors were followed for a mean period of 4.2 years (maximum 10 years); the total follow up was 1,127.9 patient-years (pt-yr). Follow up was complete for 267 patients (98.9%). Actuarial survival at seven years was 87.1% for AVR, 79.8% for MVR, and 90.1% for DVR. The probability of freedom from valve-related death at seven years was 96.7% for AVR, 94.4% for MVR, and 100% for DVR. The linearized rates for postoperative complications were thromboembolism 1.2%/pt-yr, major bleeding 0.7%/pt-yr, prosthetic valve endocarditis 0.2%/pt-yr, non-structural dysfunction 0.7%/pt-yr, and reoperation 0.5%/pt-yr. Structural valve failure was not encountered.

CONCLUSION

This clinical experience with the ATS open pivot heart valve demonstrated low rates of adverse events and valve-related complications.

A case of unilateral leg edema due to abdominal aortic aneurysm with aortocaval fistula

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), and its preoperative diagnosis is often difficult. A 71-year-old woman was admitted to our hospital due to unilateral leg edema. Abdominal computed tomography (CT) showed an abdominal aortic aneurysm (AAA), a common iliac aortic aneurysm (CIAA) and ACF was suspected. Digital subtraction angiography (DSA) was performed, enabling us to identify the region of ACF with AAA preoperatively. ACF is associated with high mortality because it is difficult to control venous bleeding from ACF. Detailed preoperative diagnosis of ACF can provide many advantages to control bleeding from ACF during an operation.

Analysis of hTERT mRNA expression in biliary tract and pancreatic cancer

BACKGROUND/PURPOSE

Telomerase, an enzyme that prevents the loss of telomere regions consisting of TTAGGG repeats, which maintain the stability of cells, is considered to be involved in cell immortality and cancer growth. Recent genetic analysis has shown that the mRNA for the catalytic subunit of human telomerase reverse transcriptase (hTERT) is expressed in many cancer tissues.

METHODS

In this study, we measured hTERT mRNA levels in bile samples from patients with pancreatobiliary disease, and we combined the hTERT mRNA analysis with conventional cytology to achieve an accurate preoperative diagnosis. Bile samples were obtained from 19 patients with biliary tract cancer, 6 with gallbladder cancer, 10 with pancreatic cancer, 1 with gastric cancer, and 10 with benign disease. These samples were examined cytologically, and analyzed for hTERT mRNA levels.

RESULTS

The Combination of cytological examination and hTERT mRNA analysis achieved a positive rate of 78.9% in diagnosing biliary tract cancer, significantly improving the diagnostic accuracy over that for either method alone (P = 0.01). The diagnostic sensitivity for malignant disease was 66.6%, also significantly improving the diagnostic accuracy compared with either method alone (P = 0.001).

CONCLUSIONS

The combination of cytological examination and hTERT mRNA analysis appeared useful for the preoperative diagnosis of malignant biliary tract diseases, but was not superior to diagnostic imaging studies, and therefore remains an adjunct to cytological examination. Further studies should lead to improvements in the combination's diagnostic capabilities.

[Aortic valve replacement with a small valve prosthesis: a review of clinical and echocardiographic studies for impact of prosthesis-patient mismatch]

Aortic valve replacement (AVR) has become standard therapy for treating diseases of the aortic valve. However, the selection of a prosthetic valve is considered to be an important factor determining postoperative recovery of cardiac function and quality of life, because the use of small valve prostheses may cause residual obstruction to left ventricular outflow. The situation in which "the effective prosthetic valve area, after insertion into the patient, is less than that of a normal human valve," has been described as "prosthesis-patient mismatch (PPM)." The most commonly used measure of PPM is the valve effective orifice area indexed to body surface area (EOAI), and PPM is generally defined as EOAI < or =0.85cm(2)/m(2). In this paper, we review clinical and echocardiographic studies of small valve prostheses in the aortic position to investigate the clinical impacts of PPM on short- and long-term outcomes after AVR. Some studies have shown decreased symptom resolution, poor regression of left ventricular mass, or decreased survival with an EOAI < or =0.85cm(2)/m(2), while others have observed no adverse effects of PPM on short- and long-term results of AVR. Therefore, even in Western countries, in studies involving large numbers of patients, conclusions drawn concerning the impact of PPM differ greatly among reports. In conclusion, it is desirable to examine in detail, in many patients, whether the use of prosthetic valves with EOAI < or =0.85cm(2)/m(2) is also a risk factor for poor prognosis in Japanese patients, whose body size is in general smaller than that of Western patients.

A Shorter Skin Incision Technique for the Repair of Infrarenal Abdominal Aortic Aneurysms

PURPOSE

We evaluated the effectiveness of a shorter skin incision technique for the treatment of infrarenal abdominal aortic aneurysms (AAA). The aim of the present study was to evaluate whether or not the difference in the length of the skin incision contributed to an early recovery after the operation.

METHODS

Between October 2001 and December 2004, we performed 105 elective repairs for AAA. The patients were divided into three groups according to the length of the skin incision as follows: group A, less than 15 cm, group B, from 15 cm to less than 20 cm, and group C, 20 cm or more.

RESULTS

There was no significant difference in the intraoperative course among the three groups. The duration of paralytic ileus was shorter in group A than in group C (2.0 +/- 0.9 days versus 3.2 +/- 2.3 days; P = 0.0428). Although the periods before removal of nasogastric suction and before starting a solid diet were slightly shorter in group A than in groups B and C, there were no statistically significant differences.

CONCLUSION

We define minimally invasive vascular surgery as surgery performed with a small abdominal skin incision that does not expose the intestine to air while providing a good operative field that does not place any undue stress on the surgeon.

Concomitant traumatic aortic valve and coronary artery injury

A 79-year-old man, who had sustained nonpenetrating chest trauma 1 month previously, was admitted for dyspnea. Echocardiography demonstrated prolapse of the noncoronary aortic cusp with severe regurgitation. Aortography showed no intimal flap in the ascending aorta. Coronary arteriography showed dissection extending from the left main trunk to the proximal circumflex artery. At surgery, no abnormalities were found in the aortic wall or around the left coronary ostium. Avulsion of the commissure between the right coronary cusp and the noncoronary cusp from its aortic wall attachment was detected. Aortic valve replacement and coronary artery bypass grafting were performed.

359 THE EFFICIENT MAINTENANCE OF OXYGEN CONSUMPTION BY PORCINE OOCYTES RELATES TO THE HIGH COMPETENCE OF OOCYTE MATURATION

We succeeded in noninvasively and quantitatively determining the oxygen consumption rate of single bovine oocytes and embryos by scanning electrochemical microscopy (SECM). Results from our earlier studies with bovine embryos established a positive relationship between oxygen consumption and embryo quality by using SECM (Abe et al. 2004 J. Mamm. Ova Res. 21, 22–30). However, the oxygen consumption of porcine oocytes and the relationship between oxygen consumption and oocytes quality were still unclear. The aims of this study were: (1) to assess the oxygen consumption of single porcine cumulus–oocyte complexes (COCs) and oocytes; and (2) to examine the change of oxygen consumption of oocytes during IVM. The COCs collected from 2–5 mm follicles of a porcine ovary were classified into four grades according to morphological criteria (A, compact multilayered cumulus; B, 3 to 5 layers of compact cumulus; C, less than 3 layers of cumulus, including small areas of denuded zonae pellucidae; and D, completely or mostly denuded). Oxygen consumption of these COCs was measured using by the SECM system (HV-403; Research Institute for Functional Peptides, Yamagata, Japan). After the measurement, cumulus cells were removed from COCs mechanically, and oxygen consumption of the oocytes was evaluated. The COCs were cultured in TCM-199 supplemented with 10% porcine follicular fluid and 10 IU mL-1 eCG. After IVM, oxygen consumption and ATP content of the oocytes were determined. ATP content was measured using a commercial assay kit (Promega K.K. Japan, Chuo-Ku, Tokyo, Japan) based on the luciferin-luciferase reaction. Moreover, distribution of active mitochondria in the oocytes during IVM was investigated using MitoTracker Orange staining (Invitrogen Japan K.K., Tokyo, Japan). The rates of oxygen consumption and oocyte maturation of higher-graded COCs and oocytes tended to be higher. In matured oocytes with a first polar body, oxygen consumption (F × 10-14 mol s-1) was maintained at a high level during IVM (GV oocytes: 0.60 ± 0.03; matured oocytes: 0.57 ± 0.01). ATP content (pmol/oocyte) of matured oocytes was significantly increased by IVM culture (GV oocytes: 1.16 ± 0.11; matured oocytes: 2.06 ± 0.06). On the other hand, in non-matured oocytes without a first polar body, oxygen consumption (0.31 ± 0.04) and ATP content (1.51 ± 0.21) were significantly lower than in matured oocytes. The mitochondrial distribution pattern of the oocytes during IVM was changed into an aggregated type (mitochondria distributed to the inner region of the cytoplasm with aggregation of larger fluorescent areas) from a peripheral type (mitochondria evenly distributed to the periphery of the cytoplasm) through a semi-peripheral type (mitochondria distributed to the periphery of the cytoplasm with small spots of fluorescence intensity). However, most of non-matured oocytes showed a semi-peripheral type. These results demonstrated that the oocytes with high oxygen consumption and ATP levels showed higher competence of oocyte maturation. Furthermore, these findings suggest that mitochondrial reorganization may be partly related to the oxygen consumption and consequently the quality of porcine oocytes.

22 RESPIRATORY ACTIVITY AND ULTRASTRUCTURAL FEATURES OF BOVINE SOMATIC NUCLEAR TRANSFER EMBRYOS

We succeeded in determining oxygen consumption of individual bovine embryos non-invasively and quantitatively by scanning electrochemical microscopy (SECM). Recently, we have found that there is a close relationship between high oxygen consumption and developmental ability of bovine IVF embryos. However, the relationship between the respiratory activity and the quality of bovine embryos reconstructed by somatic cell nuclear transfer (SCNT) is still unclear. The aims of this study were: (1) to assess the oxygen consumption of single bovine SCNT and IVF embryos; and (2) to examine the ultrastructural features of SCNT embryos. Bovine oocytes were matured in IVMD101 medium (Research Institute for the Functional Peptides, Yamagata, Japan) and enucleated. The recipient oocytes were activated by treatment with Ca ionophore A23187 and then incubated with IVMD101 containing cycloheximide. Single donor cells (fibroblasts derived from an adult cow) were placed into the perivitelline space of the enucleated oocytes and the two cells were fused by electrofusion. The nuclear transfer embryos were cultured in IVD101 medium without bovine cumulus/granulosa cell co-culture in a humidified atomosphere of 5% CO2/95% air at 38.5�C. Oxygen consumption rates by whole embryos were quantified individually by the SECM measuring system. Some of these embryos were prepared for observation by transmission electron microscopy. Statistical analyses were performed using one-way analysis of variance (ANOVA) and Fisher

Influence of angiogenesis by implantation of bone marrow mononuclear cells in the rat ischemic heart

Bone marrow implantation (BMI) enhances angiogenesis in several animal models of ischemic diseases, and it is currently applied in the clinical treatment of humans. However, the mechanisms of this effect have not yet been fully described. Rat bone marrow mononuclear cells (BM-MNCs) were obtained by Histopaque density gradient centrifugation and injected directly into the ischemic myocardium of the test rats (BMI group), which were then examined and compared with the groups that received surgery only (Controls) or surgery and an injection of phosphate buffered saline (PBS group). Cardiac function was evaluated by echocardiography, and neovascularization was examined both histologically and immunohistochemically before, 1 day after, and 7 or 28 days after the operation. BM-MNCs were analyzed by fluorescence staining for the endothelial cell marker CD31 and alkaline phosphatase (ALP). The mechanisms of angiogenesis were examined by gene expression analysis. In the BMI group, cardiac function parameters at 7 days after operation were significantly improved and the number of capillaries in the myocardium was significantly larger than that in the PBS and Control groups. Gene analysis showed the expression of 12 genes in the BMI group 7 days after operation. The implantation of BM-MNCs into the myocardiumin cases of acute infarction enhances cytoprotection and angiogenesis by affecting gene expression.

204 RELATIONSHIP BETWEEN RESPIRATORY ACTIVITY AND THE PREGNANCY RATE OF BISECTED BOVINE EMBRYOS IN VIVO

Oxygen consumption is an important indicator of the metabolic activity of living cells, which may provide valuable information for evaluating embryo quality. We have found that the bovine embryos with high oxygen consumption possess stronger potential for further development. However, the relationship between respiratory activity and the pregnancy rate of embryos is still unclear. In this study, we investigated the respiration rates of bisected bovine embryos and the pregnancy rates of demi-embryos after embryo transfer. Compact morula-stage embryos were bisected evenly by micro glass needle. One hundred bisected embryos were incubated for 24 h in embryo culture medium (IVD101; Research Institute for the Functional Peptides, Yamagata, Japan) at 39�C under 5% CO2, 5% O2, 90% N2. After the incubation, demi-embryos were classified into 2 groups: blastocoel-formed (BC) and blastocoel-not-formed (CM) embryos. Oxygen consumption rates of demi-embryos were measured by scanning electrochemical microscopy (SECM; Hokuto Denko Corporation, Tokyo, Japan). Within 3 h after the measurement, 80 demi-embryos were transferred into recipient cows (one demi-embryo/one recipient) at 7–8 days after estrus. Recipient cows were diagnosed for pregnancy by ultrasonography approximately 40 days after estrus. Statistical difference was analyzed by Tukey's post-hoc test and chi-square test. A total of 27 recipient cows became pregnant; the pregnancy rates for cows with CM and BC demi-embryos were 40.6% (13/32) and 29.2% (14/48), respectively. Mean oxygen consumption rates (� 10-14 mol s-1) in pregnant and non-pregnant cows were 0.47 and 0.39 for CM demi-embryos and 0.63 and 0.52 for BC demi-embryos, respectively. Retrospective analysis showed that the respiratory activity of demi-embryos in the pregnant group was higher than those in the non-pregnant group. In particular, the pregnancy rates for demi-embryos with respiratory activity higher than 0.35 in CM and 0.40 in BC groups were 52.0% (13/25) and 35.9% (14/39), respectively. On the other hand, cows with demi-embryos having an oxygen consumption rate under 0.35 in CM (n = 7) and 0.40 in BC (n = 9) groups did not become pregnant. These results demonstrated that bovine demi-embryos with higher respiratory activity showed a high pregnancy rate after embryo transfer. It is generally known that the pregnancy rate after the transfer of bisected embryos is lower than that of whole embryos. The measurement of oxygen consumption by SECM procedures is a useful tool to assess the quality of pre-implantation embryos and may contribute to the improvement of the success rate for bisected embryo transfer.

Moderate cerebral venous congestion induces rapid cerebral protection via adenosine A1 receptor activation

Stroke is a devastating complication in cardiovascular surgery, and neuronal damage is worsened by intracranial pressure elevation caused by cerebral venous circulatory disturbances (CVCD). However, we have previously reported that CVCD before cerebral ischemia decreases the infarct area. In the present study, focal cerebral ischemia was induced in spontaneously hypertensive rats by filament insertion through the carotid artery. Rats were divided into the following four groups: sham-operated, mild or severe venous congestion (VC), and DPCPX. The DPCPX group received the adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX) prior to mild VC. Behavior, infarct volume, edema and S-100 protein were evaluated among the four groups. The infarct volume rates in mild VC and severe VC groups were significantly less than that in sham-operated and DPCPX groups. However, the mortality of the severe VC group worsened in a time-dependent manner. We observed a significant decrease in edema in the mild VC group compared to the DPCPX group. Behavioral scores also indicated that the mild VC group had fewer neurological deficits than the other three groups, including the DPCPX group. We were able to induce rapid cerebral protection via adenosine A1 receptor activation by administering an appropriate degree of VC prior to cerebral ischemia produced by middle cerebral artery occlusion. Our work suggests possible mechanisms by which such effective VC may lead to cerebral protection and adenosine A1 receptor activation.

In vivo recellularization of plain decellularized xenografts with specific cell characterization in the systemic circulation: histological and immunohistochemical study

Decellularized biological scaffolds have been used for the tissue engineering of heart valves with good results in the pulmonary circulation. However, little information is available on the recellularization of plain decellularized biological scaffolds in the systemic circulation. The aim of this study was to determine whether plain decellularized xenografts (PDXs) can recellularize with specific cell characterization in the systemic circulation. The xenogenic aortic valved conduit grafts of rabbits were implanted in the abdominal aorta of dogs after decellularization. The grafts were explanted at 4, 12, or 24 weeks after implantation for histological, immunohistochemical examination, scanning electron microscope, and Western blot analysis. Although the valvular structures were completely lost after implantation, supravalvular conduits showed normal shapes and endothelialization. The PDXs were repopulated with basic vascular cell components in approximate natural proportions without immunological responses. The PDXs had been recellularized with specific cell characterization in the systemic circulation.

Eccrine porocarcinoma and Bowen's disease arising in a seborrhoeic keratosis

An association between seborrhoeic keratosis (SK) and malignant tumours is considered to be rare. We observed a case of eccrine porocarcinoma and Bowen's disease (BD) occurring synchronously, forming one lesion in a SK on the abdomen. It is controversial whether malignant neoplasms arising in SK occur only by chance or if pre-existing SK plays a role in pathogenesis. This case suggests an implication of pre-existing SK in the subsequent development of both BD and eccrine porocarcinoma.

Double-orifice repair for left atrioventricular valve regurgitation in atrioventricular septal defect: report of two cases

We describe two patients who successfully underwent a surgically created double-orifice repair using the edge-to-edge repair for residual left atrioventricular valve (LAVV) regurgitation in an atrioventricular septal defects (AVSD). Both patients had previously received patch closure of the AVSD and partial closure of a cleft of the LAVV. Preoperatively, echocardiography showed a wide open cleft and remarkable dilatation of the LAVV annulus. Doppler study revealed severe regurgitation through the cleft and the central portion of the LAVV orifice and no intracardiac shunt. Postoperative echocardiography showed a remarkable decrease of the AV valve regurgitation to none or trivial levels without stenosis of the LAVV in both patients. Among several valve-sparing techniques, our experience suggests that the surgically created double-orifice repair is one of the most effective reparative procedures for LAVV regurgitation in AVSD.

Leaflet Movement of the ATS Valve in the Aortic Position: Unique Behavior Observed in 19-mm Valves

BACKGROUND

Leaflet opening angles of ATS valves in vivo tend to be less than those reported by the manufacturer, and there is a wide variation in opening angles even among valves of the same size.

METHODS

Leaflet movement of aortic ATS valves was evaluated by cineradiography in 77 patients. The mean period from valve replacement to cineradiography was 40.2 months, and during that period, the ATS valve was replaced due to prosthetic valve obstruction in 1 of the 77 patients.

RESULTS

In 76 patients with a normally functioning ATS valve, the mean opening angle of 19-mm valves (66.3 degrees +/- 2.3 degrees) was significantly less (p < 0.0001) than that of ATS valves 21 mm or larger (72.2 degrees +/- 3.8 degrees in 21-mm, 72.4 degrees +/- 2.8 degrees in 23-mm, and 72.8 degrees +/- 2.9 degrees in 25-mm valves). No significant differences were found in the opening angles of ATS valves 21 mm or larger, and the opening angles exceeded 65 degrees in all 69 patients with valves in this category. In one case of obstruction in a 21-mm valve, the opening angle was 57.5 degrees. The closing angle was 24.9 degrees +/- 1.3 degrees, which corresponded well with the manufacturer's in vitro data.

CONCLUSIONS

The opening angle in the 19-mm ATS aortic valve is significantly less than that in valves 21 mm or larger, and an opening angle of less than 65 degrees probably indicates prosthetic valve obstruction in aortic ATS valves sized 21 mm or larger.

The Prostacyclin Analog Beraprost Sodium Augments the Efficacy of Therapeutic Angiogenesis Induced by Autologous Bone Marrow Cells

Implantation of autologous bone marrow (BM) mononuclear cells (MNCs) has been shown to augment neovascular formation in ischemic tissues in experimental animals and in humans. Prostaglandin derivatives improve the symptoms of patients with critical limb ischemia, possibly by their vasodilating and antiplatelet actions. We therefore examined whether therapeutic angiogenesis by implantation of autologous BM-MNCs would be enhanced by beraprost sodium (BPS), using a rabbit ischemic hindlimb model. Ischemia was induced by surgical resection of the left femoral artery. Twenty-five New Zealand white rabbits were divided into four groups. The first group (BM group, n = 4) received autologous BM-MNCs (2 x 10(6)/animal) implanted into the ischemic tissue 1 week after limb ischemia. The second group (BM+BPS group, n = 8) received BPS injected into the dorsal skin (300 microg/kg daily) starting 1 week before limb surgery. This group received BM-MNC implantation 1 week after surgery. Daily injection of BPS was continued until the end of the protocol. The third group (BPS group, n = 8) received BPS injected into the dorsal skin (600 microg/kg daily) starting 1 week before limb surgery. The fourth group received saline as a control (n = 4). The extent of angiogenesis in the ischemic hindlimb was assessed using the angiographic score (AS), ischemic/normal limb calf blood pressure ratio (CBPR), and tissue capillary density. Four weeks after limb ischemia, the ischemic/normal CBPR was highest in the BM+BPS group, followed by the BPS, BM, and control groups (0.56 +/- 0.16, 0.51 +/- 0.25, 0.44 +/- 0.15, and 0.30 +/- 0.10, respectively). The AS was also the greatest in the BM+BP group, followed by the BM, BP, and S group (1.63 +/-0.21, 1.31 +/- 0.25, 1.26 +/- 0.21 and 0.80 +/- 0.10, respectively). The TCD was greatest in the BM+BP group, followed in by the BM, BP, and S group? (46 +/- 4.1, 34 +/- 0.7, 33 +/- 6.9, and 19 +/- 1.8 per field, respectively). BP treatment is an effective means to enhance the efficacy of therapeutic angiogenesis induced by autologous BM-MNCs implantation in ischemic hindlimb tissues.

Effects of nicorandil preconditioning on membrane dystrophin

OBJECTIVE

Dystrophin is an integral membrane protein that stabilizes the sarcolemmal membrane integrity, and its loss may be involved in the mechanism of ischemia and reperfusion injury. It has been reported that ischemic preconditioning is related to the preservation of membrane dystrophin during ischemia and reperfusion. Preconditioning with nicorandil, a mitochondrial K(ATP) channel opener, may attenuate the injury by preventing a disturbance in the level of this membrane-associated protein.

METHODS

The isolated rat hearts were subjected to 60 min of cardioplegic arrest, followed by 60 min of reperfusion. The hearts were divided into the following three groups according to the drugs given before cardioplegic arrest. The control group received saline intravenously 30 min before heart isolation. The nicorandil group received nicorandil (0.3 mg/kg) intravenously 30 min before isolation. The 5-HD group received 5-hydroxydecanoate (1 mg/kg) intravenously, a mitochondrial K(ATP) channel blocker, 5 min before nicorandil administration. Cardiac function, myocardial metabolism, dystrophin distribution and protein levels of dystrophin were assessed before and after cardioplegic arrest.

RESULTS

The nicorandil group showed significantly better cardiac function and a significant reduction in creatine kinase release during reperfusion. After 60 min of cardioplegic arrest, dystrophin, which was distributed predominantly in the sarcolemmal membrane before ischemia, was translocated to the costameric cytoskeleton in all groups. During reperfusion, the level of membrane dystrophin remained decreased in the majority of cardiomyocytes in the control and 5-HD groups, whereas it was restored to nearly the baseline level in the nicorandil group. The immunoblot analysis supported this result.

CONCLUSIONS

Depletion of sarcolemmal membrane dystrophin occurred during cardioplegic arrest and reperfusion. Nicorandil preconditioning may attenuate ischemia and reperfusion injury by maintaining the membrane structural integrity.

Introduction of transesophageal electrocardiography to surgery for continuous atrial fibrillation

The purpose of this study was to assess esophageal electrocardiographic characteristics of atrial fibrillation, and compare these results with outcomes of surgical interventions. We analyzed 158 patients, who were operated on for valvular heart disease and continuous atrial fibrillation. Recently, 57 patients were examined by transesophageal electrocardiography. The results of surgery and the relation between transesophageal electrocardiography and restoration to a sinus rhythm were analyzed. One-hundred and twenty-three patients (77.8%) had been restored to a sinus rhythm in the early stage and 116 patients (73.9%) in the late stage after operation. The restoration rate to a sinus rhythm was 77.0% in the maze procedure and 81.3% in pulmonary vein isolation. According to the form of f-waves obtained from the transesophageal electrocardiography, in patients with a regular f-wave pattern, the sinus rhythm was completely restored after maze or pulmonary vein isolation. By using transesophageal electrocardiography preoperatively, it may be possible to decide before surgery which operative procedure should be used, maze or pulmonary vein isolation.

Tumor growth suppression in pancreatic cancer by a putative metastasis suppressor gene Cap43/NDRG1/Drg-1 through modulation of angiogenesis

Cap43 has been identified as a nickel- and calcium-induced gene, and is also known as N-myc downstream-regulated gene 1 (NDRG1), Drg-1 and rit42. It is also reported that overexpression of Cap43 suppresses metastasis of some malignancies, but its precise role remains unclear. In this study, we asked how Cap43 could modulate the tumor growth of pancreatic cancer. Stable Cap43 cDNA transfectants of pancreatic cancer cells with Cap43 overexpression showed similar growth rates in culture as their control counterparts with low Cap43 protein level. By contrast, Cap43 overexpression showed a marked decrease in tumor growth rates in vivo. Moreover, a marked reduction in tumor-induced angiogenesis was observed. Gelatinolytic activity by matrix metalloproteinase-9 and invasive ability in Matrigel invasion activity were markedly decreased in pancreatic cancer cell lines with high Cap43 expression. Cellular expression of matrix metalloproteinase-9 and two major angiogenic factors, vascular endothelial growth factor and interleukin-8, were also significantly decreased in cell lines with Cap43 overexpression as compared with their parental counterparts. Immunohistochemical analysis of specimens from 65 patients with pancreatic ductal adenocarcinoma showed a significant association between Cap43 expression and tumor microvascular density (P = 0.0001) as well as depth of invasion (P = 0.0003), histopathologic grading (P = 0.0244), and overall survival rates for patients with pancreatic cancer (P = 0.0062). Thus, Cap43 could play a key role in the angiogenic on- or off-switch of tumor stroma in pancreatic ductal adenocarcinoma.

Infection management in a patient with a left ventricular assist device: a case report of long-term cefazolin sodium hydrate administration

A 55-year-old woman suffered from a bloodstream infection (Staphylococcus aureus), which originated from pump inflow and outflow skin exits, from 4 months after a parocorporeal left ventricular assist device (LVAD) had been implanted. In addition to local irrigation, repeated administration of a weekly unit of cefazolin hydrate was temporarily effective, but fever frequently recurred. Because short-term antibiotic administration had limited effectiveness, a much longer-term course of cefazolin was begun at 14 months post-LVAD implantation and was planned to continue until future transplantation. Unfortunately, the patient died from a cerebral embolism at 19 months after LVAD implantation; long-term consecutive cefazolin administration had suppressed the infection for over 5 months without side effects. To treat intractable LVAD-associated bloodstream infection, long-term administration of a narrow-spectrum beta-lactam drug is an effective option.

Effective detection of the epidermal growth factor receptor mutation in pathologic specimens of non-small cell lung cancer patients by a rapid and sensitive detection system, the peptide nucleic acid-locked nucleic acid PCR Clamp

20113

Background: EGFR mutations link to the responsiveness to gefitinib, so it is important to get result of EGFR mutations more rapidly and sensitively. Methods: We screened 14 trans-bronchial lung biopsy (TBLB) specimens of non-small cell lung cancer (NSCLC) patients; 10 patients responded to gefitinib and 4 patients did not respond to gefitinib. We examined exons 18 through 21 (the area of the EGFR gene coding for the tyrosine kinase domain) both by the PNA-LNA PCR clamp method and the conventional sequence method. Results: We found five different mutations in 9 patients of 10 who responded to gefitinib by the PNA-LNA PCR clamp method, but only in 7 patients by the conventional sequence method. Detected mutations were the point mutation of exon 18(719S) and exon 21(858R), deletions of exon 19 (E746-A750del (nt2235–2249), E746-A750del (nt2236–2250), L747-E749del A750P). All 4 patients who did not respond to gefitinib were not detected any EGFR mutations either by the PNA-LNA PCR clamp method or by the conventional sequence method. We could get result for 2 days by the PNA-LNA PCR method, but by 7 days by the conventional sequence method routinely. Conclusions: The PNA-LNA PCR clamp method is more sensitive and rapid than the conventional sequence method. The detected EGFR mutations have good relation to gefitinib response.

No significant financial relationships to disclose.

Aortic valve replacement after esophagectomy with substernal gastric tube reconstruction

A 67-year-old woman with a history of esophagectomy with substernal gastric tube (GT) reconstruction and left lower lobectomy required aortic valve replacement (AVR) for aortic valve regurgitation and stenosis. Through a median sternotomy (MS) with cardiopulmonary bypass (CPB), we performed AVR without injury to the GT. Careful peeling of the GT and detailed information of the operative field by multidetector-row computed tomography (MDCT) scan enabled us to carry out the operation safely in the usual operative view.

Long-term survivors after valve replacement with a Starr-Edwards mitral disk valve prosthesis

We report four long-term survivors after valve replacement with a Starr-Edwards (S-E) mitral caged-disk valve. A model 6520 disk valve, size 3M, had been used in all of the four patients. Of the four patients, three underwent replacement of the disk valves 23, 24, and 26 years after mitral valve replacement (MVR), respectively. A pacemaker was implanted in the remaining patient 33 years after MVR. The S-E disk valves were considered hemodynamically slightly stenotic compared with modern bileaflet valves. No disk wear was detected in any of the three explanted valves, and in the remaining patient, a noninvasive evaluation of the disk showed that it was functioning normally. These results suggest the favorable long-term durability of the S-E disk valve.