[Constrictive pericarditis after minimally invasive coronary artery bypass grafting: report of a case]

Constrictive pericarditis (CP) after off-pump coronary bypass surgery, especially after minimally invasive direct coronary artery bypass (MIDCAB), had rarely been reported. We presened a surgically treated case of CP after MIDCAB via left anterior small thoracotomy. A 57-year-old man underwent MIDCAB with placement of an internal mammary artery to the left anterior descending coronary artery uneventfully. Four years after the operation, he began to experience exertional dyspnea. Computed tomography of the chest showed pericardial thickening. Cardiac catheterization revealed elevation and equalization of the pressures in the 4 chambers, as well as low cardiac output. Pericardiectomy using cardiopulmonary bypass through a median sternotomy was performed successfully without injury to the bypass graft. Postoperative hemodynamic measurements were improved. The patient has resumed normal activity and remained free from heart failure for over 5 years.

Omega-3 polyunsaturated fatty acids ameliorate the severity of ileitis in the senescence accelerated mice (SAM)P1/Yit mice model

Clinical studies using omega-3 polyunsaturated fatty acids (omega3-PUFA) to Crohn's disease (CD) are conflicting. Beneficial effects of dietary omega3-PUFA intake in various experimental inflammatory bowel disease (IBD) models have been reported. However, animal models of large intestinal inflammation have been used in all previous studies, and the effect of omega3 fat in an animal model of small intestinal inflammation has not been reported. We hypothesized that the effects of omega3 fat are different between large and small intestine. The aim of this study was to determine whether the direct effect of omega3 fat is beneficial for small intestinal inflammation. Senescence accelerated mice (SAM)P1/Yit mice showed remarkable inflammation of the terminal ileum spontaneously. The numbers of F4/80-positive monocyte-macrophage cells as well as beta7-integrin-positive lymphocytes in the intestinal mucosa were increased significantly compared with those in the control mice (AKR-J mice). The area of mucosal addressin cell adhesion molecule-1 (MAdCAM-1)-positive vessels was also increased. The degree of expression levels of monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6 and interferon (IFN)-gamma mRNA were increased significantly compared with those in the control mice. The feeding of two different kinds of omega3 fat (fish-oil-rich and perilla-oil-rich diets) for 16 weeks to SAMP1/Yit mice ameliorated inflammation of the terminal ileum significantly. In both the omega3-fat-rich diet groups, enhanced infiltration of F4/80-positive monocytes/macrophages in intestinal mucosa of SAMP1/Yit mice cells and the increased levels of MCP-1, IL-6 and IFN-gamma mRNA expression were ameliorated significantly compared with those in the control diet group. The results suggest that omega3 fat is beneficial for small intestinal inflammation by inhibition of monocyte recruitment to inflamed intestinal mucosa.

Survey on pamphlet use explaining breast cancer operations in Japan

BACKGROUND

The burden on hospitals to provide information has been increasing. This study examined the demands of surgeons and patients using a pamphlet explaining breast cancer operation procedures.

METHODS

A questionnaire with an eight-page pamphlet was sent to 367 hospitals with surgery departments in Aichi and Gifu prefectures in Japan. The same pamphlet and a self-administered anonymous questionnaire were also sent to 173 members of a breast cancer patient association, who had undergone breast cancer operations and lived in the same prefectures.

RESULTS

Responses to the questionnaire from 196 hospitals (53%) and 122 patients (71%) were analyzed. Breast cancer operations were conducted at 8 departments of 5 university hospitals, 37 governmental hospitals, 25 non-profit hospitals, and 66 private hospitals, a total of 1 36 hospitals. Among them, 34 hospitals participated in clinical trials. Fourteen hospitals had already used pamphlets as a tool for the explanation of breast cancer operation procedures. Hospitals having experienced special discussion with patients regarding the operation procedure were few, and only two hospitals reported claims or lawsuits concerning the operation procedure. About 60% of the hospitals wished to use the pamphlet, while 86% of the patients answered that it would have been useful if handed out before the operation. These patients stated that hospitals should provide this kind of pamphlet to breast cancer patients before operations.

CONCLUSIONS

It was clearly demonstrated that the great majority of hospitals in Japan lacked the basic tools for information provision on breast cancer operation procedures, while patients want enough information for self-determination.

Relationship between baseline cerebral blood flow and vascular responses to changes in PaCO2 measured by positron emission tomography in humans: implication of inter-individual variations of cerebral vascular tone

AIM

Inter-individual variations in normal human cerebral blood flow (CBF) at rest condition have been reported. Inter-individual variation of cerebral vascular tone is considered to contribute to this, and several determinants of cerebral vascular tone have been proposed. In the present study, the relationship between CBF and cerebral vascular tone to inter-individual variation at rest condition was investigated using positron emission tomography (PET).

METHODS

CBF was measured using PET with H(2) (15)O in each of 20 healthy subjects (20-28 years) under three conditions: at rest (baseline), during hypercapnia and during hypocapnia. The vascular response to change in P(a)CO(2) was calculated as the percentage changes in CBF per absolute change in P(a)CO(2) in response to hypercapnia and hypocapnia.

RESULTS

A significant negative correlation between baseline CBF and the vascular response to hypocapnia was observed in the thalamus, temporal cortex, parietal cortex, occipital cortex and cerebral cortex (P < 0.05). A trend towards negative correlation between baseline CBF and the vascular response to hypocapnia was observed in the cerebellum and putamen (P < 0.1). A significant negative correlation between baseline CBF and the vascular response to hypercapnia was observed in the occipital cortex (P < 0.05). No significant correlation was observed between baseline CBF and haemoglobin concentration, and P(a)CO(2).

CONCLUSION

These findings support the assumption that cerebral vascular tone might incline towards vasoconstriction and vasodilatation when baseline CBF is low and high between individuals respectively. Although several determinants of cerebral vascular tone have been proposed, the mechanism of such inter-individual differences in cerebral vascular tone is unknown.

Navigation for laparoscopic gastrectomy with 3-dimensional computed tomography (3D-CT)

BACKGROUND/AIMS

Early-stage gastric cancer is one relatively well-explored target for laparoscopic resection. Systemic lymphadenectomy is considered an essential component of gastrectomy, however, it may not be easy even with extensive experience. It is convenient for the laparoscopists, therefore, to be given preoperatively thorough information regarding the vessels anatomy of the celiac branches around the stomach for each patient.

METHODOLOGY

Between July 2001 and January 2006, 41 patients with gastric carcinoma scheduled for surgery underwent 3-dimensional computed tomography (3D-CT) examination at Nagoya University Hospital. From the 3D-CT images, information regarding the vessels that are dissected during surgery for gastric cancer was obtained, and the branching patterns of those were analyzed.

RESULTS

The left gastric artery and the right gastroepiploic artery were detected in all 41 cases, while the right gastric artery was detected only in 22 cases (53.7%). Variations in the origin of the left gastric and right gastroepiploic arteries were not observed. However, there was a considerable variation in the origin of the right gastric artery, with 50.0% branching from the proper hepatic artery, 22.7% from the left hepatic artery, and 13.6% from the gastroduodenal artery. In 4 cases (9.7%), the left hepatic artery was found to originate from the left gastric artery.

CONCLUSIONS

Preoperative knowledge of the basic vascular patterns obtained through 3D-CT imaging is a useful guide to safely perform laparoscopic gastrectomy, although further improvements in the processing of more detailed imaging is needed.

Primary phacoemulsification and aspiration combined with 25-gauge single-port vitrectomy for management of acute angle closure

PURPOSE

To describe a technique using phacoemulsification and aspiration (PEA) combined with 25-gauge single-port vitrectomy as a primary treatment for acute angle closure (AAC).

METHODS

Seventeen consecutive cases of AAC were treated with 1) transconjunctival limited single-port vitrectomy with a 25-gauge vitrector and 2) transcorneal PEA and cortex removal followed by implantation of foldable intraocular lenses (IOL).

RESULTS

Intraocular pressure (IOP) control was achieved in all 17 eyes examined. Mean preoperative IOP was 51.8+/-13.1 mmHg, and mean IOP on postoperative day 1 was 18.3+/-8.5 mmHg. Additional anti-glaucoma surgery was necessary in one eye. IOL could not be implanted because of zonular dialysis in one eye. Postoperative complications were seen in three cases (one retinal hemorrhage and two papilledema).

CONCLUSIONS

The PEA procedure is efficient as a primary treatment of AAC. Single-port vitrectomy with a 25-gauge vitrector facilitated PEA and IOL implantation.

[Evaluation of paravalvular leakage occurring after the 3rd mitral valve replacement]

We evaluated the frequency of paravalvular leakage (PVL) in 21 patients who had undergone mitral valve replacement (MVR) 3 times or more in our department between January 1981 and December 2003. Of these 21 patients, 5 underwent MVR 4 times, including the one who underwent the 5th MVR. Seven (38%) of 18 patients who had successfully undergone MVR 3 times and all 2 patients who had successfully undergone MVR 4 times developed PVL. PVL recurred in 6 (67%) of 9 patients who had undergone the 3rd MVR due to the occurrence of PVL. However, PVL recurred in only 1 (11%) of 9 patients who had undergone the 3rd MVR due to some postoperative complications other than PVL. Among 10 patients who developed PVL after the 1st or 2nd MVR, PVL recurred in 7 patients after the 3rd MVR. However, among 8 patients who did not develop PVL after the 1st or 2nd MVR, PVL occurred after the 3rd MVR only in 1 patient. These findings suggest that repeated MVR increases the incidence of PVL, and that patients with a past history of PVL are at a higher risk of developing PVL after repeated MVR.

Generation of anti-tumour effector T cells from naïve T cells by stimulation with dendritic/tumour fusion cells

Tumour-draining lymph node T cells are an excellent source of effector T cells that can be used in adoptive tumour immunotherapy because they have already been sensitized to tumour-associated antigens in vivo. However, such tumour-specific immune cells are not readily obtained from the host due to poor immunogenicity of tumours and reduced host immune responses. One obstacle in implementation of adoptive immunotherapy has been insufficient sensitization and expansion of tumour-specific effector cells. In this study, we aim to improve adoptive immunotherapy by generating anti-tumour effector T cells from naïve T lymphocytes. We attempted to achieve this by harnessing the advantages of dendritic cell (DC)-based anti-cancer vaccine strategies. Electrofusion was routinely employed to produce fusion cells with 30-40% efficiency by using the poorly immunogenic murine B16/F10 cell line, D5 cells, and DC generated from bone marrow cells. CD62L-positive T cells from spleens of naïve mice and the fusion cells were cocultured with a low concentration of IL-2. After 9 days of culture, the antigen-specific T cells were identified with an upregulation of CD25 and CD69 expression and a downregulation of CD62L expression. These cells secreted IFN-gamma upon stimulation with irradiated tumour cells. Moreover, when transferred into mice with 3-day established pulmonary metastases, these cells with coadministration of IL-2 exhibited anti-tumour efficacy. In contrast, naïve T cells cocultured with a mixture of unfused DC and irradiated tumour cells did not exhibit anti-tumour efficacy. Our strategy provides the basis for a new approach in adoptive T cell immunotherapy for cancer.

The effect of hydrogen evolution reaction on conductance quantization of Au, Ag, Cu nanocontacts

We have mechanically fabricated Au, Ag, and Cu nanocontacts in solution under electrochemical potential control. At the hydrogen evolution potential, fractional conductance peaks appeared near 0.5 G(0) (G(0) = 2e(2)/h) in the conductance histogram of Au and Cu. This fractional conductance peak was not observed in the conductance histogram of Ag. In the case of Au nanocontacts in 50 mM H(2)SO(4) solution, a 0.1 G(0) peak appeared in the conductance histogram, as well as the 0.5 G(0) peak. The origin of the fractional conductance peak and its metal dependence are discussed based on previously reported values of metal-hydrogen binding energy, which was estimated by the exchange current density for the hydrogen evolution reaction.

Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery

BACKGROUND

Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported.

STUDY DESIGN

Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors.

RESULTS

Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor.

CONCLUSIONS

Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.

Molecular phylogeny of Trypanosoma cruzi from Central America (Guatemala) and a comparison with South American strains

Molecular phylogenetic analysis was carried out for 21 strains of Trypanosoma cruzi, nine of which were obtained from Guatemala and 12 from South America. Phylogenetic trees were constructed using the nucleotide sequences of two nuclear gene regions, dihydrofolate reductase-thymidylate synthase (DHFR-TS) and trypanothione reductase (TR), and contiguous portions of two mitochondrial genes, cytochrome oxidase subunit II (COII) and reduced nicotinamide adenine dinucleotide dehydrogenase subunit 1 (ND1). Possible genetic exchange between the rather divergent lineages of T. cruzi II from South America was suggested in the trees of the two nuclear genes. T. cruzi I strains obtained from Guatemala and Colombia were identical in all the genes examined, but other T. cruzi I isolates from South America were rather polymorphic in the DHFR-TS and mitochondrial genes. No genetic exchange was identified between T. cruzi I populations from Central and South America in the present study.

Do all angiotensin II type 1 receptor blockers have the same beneficial effects?

Angiotensin II type 1 (AT(1)) receptor blockers (ARBs) are highly selective for the AT(1) receptor, which is a member of the G protein-coupled receptor superfamily (GPCRs), and block the diverse effects (hypertension, hypertrophy, heart failure, proteinuria etc.) of angiotensin II. Many ARBs are in clinical use and have been shown to be safe and effective. Over the past several years, reports have discussed the different degrees of the beneficial effects of ARBs. As ARBs do not all have the same effects, the benefits conferred by ARBs may not be class effects. These different effects may be due to differences in the molecular characteristics of ARBs. The results reported by Le et al. in this issue highlight the different characteristics of two ARBs, olmesartan and telmisartan, and suggest that the higher degree of insurmountability, slower dissociation, and higher affinity of olmesartan compared to telmisartan for AT(1) receptors may help it to form a tight binding complex with this receptor. A better understanding of the different molecular mechanisms for each ARB could be useful for the treatment of patients.

Rotational fluctuation of molecules in quantum clusters. II. Molecular rotation and superfluidity in OCS-doped helium-4 clusters

In this paper, quantum fluctuations of a carbonyl sulfide molecule in helium-4 clusters are studied as a function of cluster size N in a small-to-large size regime (2<or=N<or=64). The molecular rotation of the dopant shows nonmonotonic size dependence in the range of 10<or=N<or=20, reflecting the density distribution of the helium atoms around the molecule. The size dependence on the rotational constant shows a plateau for N>or=20, which is larger than the experimental nanodroplet value. Superfluid response of the doped cluster is found to show remarkable anisotropy especially for N<or=20. The superfluid fraction regarding the axis perpendicular to the molecular axis shows a steep increase at N=10, giving the significant enhancement of the rotational fluctuation of the molecule. On the other hand, the superfluid fraction regarding the axis parallel to the molecular axis reaches 0.9 at N=5, arising from the bosonic exchange cycles of the helium atoms around the molecular axis. The anisotropy in the superfluid response is found to be the direct consequence of the configurations of the bosonic exchange cycles.

Rotational fluctuation of molecules in quantum clusters. I. Path integral hybrid Monte Carlo algorithm

In this paper, we present a path integral hybrid Monte Carlo (PIHMC) method for rotating molecules in quantum fluids. This is an extension of our PIHMC for correlated Bose fluids [S. Miura and J. Tanaka, J. Chem. Phys. 120, 2160 (2004)] to handle the molecular rotation quantum mechanically. A novel technique referred to be an effective potential of quantum rotation is introduced to incorporate the rotational degree of freedom in the path integral molecular dynamics or hybrid Monte Carlo algorithm. For a permutation move to satisfy Bose statistics, we devise a multilevel Metropolis method combined with a configurational-bias technique for efficiently sampling the permutation and the associated atomic coordinates. Then, we have applied the PIHMC to a helium-4 cluster doped with a carbonyl sulfide molecule. The effects of the quantum rotation on the solvation structure and energetics were examined. Translational and rotational fluctuations of the dopant in the superfluid cluster were also analyzed.