Partially unroofed coronary sinus and persistent left superior vena cava: intracardiac echocardiographic observation

Unroofed coronary sinus, a rare congenital anomaly first described by Raghib and colleagues1 in 1965, is a result of an embryologic error involving imperfect or complete failure of development of the left atriovenous fold, which is manifested as a focal (fenestration or partial unroofing of the coronary sinus) or complete absence of the coronary sinus septum. Before the era of echocardiography, precise diagnosis of this anomaly was possible only during surgical procedure or at autopsy. Since the advent of the echocardiography, several studies have reported the usefulness of two-dimensional transthoracic and transesophageal echocardiography in the diagnosis of unroofed coronary sinus. We describe the intracardiac echocardiographic delineation of partially unroofed coronary sinus and persistent left superior vena cava in a patient with atrioventricular nodal reentrant tachycardia. Incidental finding of the dilated coronary sinus during radio frequency ablation of the tachycardia led to the diagnosis of this unusual anomaly.

[Disturbance syndrome of temporomandibular joint in cleft lip and palate patients with crossbite]

The function of temporor-mandibular joint in unilateral cleft lip and palate (UCLP) palients with crossibite was studied in this paper. 29 UCLP patients with crossbite were examined clinically and with Mandibular Kinesiography and X-ray. The results were as bellow (1) Insidence of TMJDS in UCLP patients with crossbite was 75.8%. (2) The condyle of 17.8% patients moved distally and 35.7% of patients moved distally asymmetry. (3) The distance of mandibular border movements in cleft patients were in normal range. We conclude that insidence of TMJDS in UCLP patients were high and we should take it into consideration in the orthodontic treatment.

Dissection of retroesophageal aortic diverticulum and descending aorta in a patient with right aortic arch: magnetic resonance demonstration

An acute aortic dissection involved the retroesophageal aortic diverticulum (RAD) and descending thoracic aorta in a patient with right aortic arch. The RAD, which was separated into false and true lumens by an intimal flap-the classic diagnostic sign of aortic dissection-was overlooked on transesophageal echocardiography and computed tomography but was clearly depicted on magnetic resonance imaging (MRI). It was found that MRI can delineate the anatomy of a congenital arch anomaly complicated by great vessels disease.

[Effect of processing on the content of guanfu A in radix Aconiti coreani]

Quantitative determination of guanfu A in Radix Aconiti Coreani before and after processing has been made by dual-wavelength TLC-scanning. The results show that the content of guanfu A is about 0.144% before processing, and 0.106%-0.12% after steam processing (n = 4), which is greatly higher than other processed products. The average recovery rate is 97.64% (n = 5).

[Pharmacological comparative study on baiqian and baiwei]

The decoction of Cynanchum glaucescens and the ethanol extract of C. stauntonii show significant antitussive and expectorant actions. The decoctions of C. stauntonii or C. glaucescens have antiasthmatic and anti-inflammatory effects. The decoction of C. atratum has some expectorant effect but no antitussive or antiasthmatic actions. On the other hand, the decoction of C. versicolor cannot relieve cough nor sputum. The results indicate that both C. atratum and C. versicolor cannot be used as C. glaucescens or C. stauntonii.

Learning multiple causes by competition enhanced least mean square error reconstruction

In this paper we studied a self-organization principle that input should be best reconstructed from a factorial distributed hidden representation, which has been addressed in the literature recently. An auto-encoder network is trained by the Least Mean Square Error Reconstruction (LMSER) while the redundance in the representation is reduced by a proposed anti-Hebbian scheme, in which a penalty term called Receptive Field Overlapping Index (RFOI) is combined into the objective function for enhancing competition among nodes in the network. Our learning scheme provides a way for balancing the cooperation and competition necessary for the self-organization process thus realizes the multiple causes model, which accounts for an observed data by combining assertions from the discovered causes or features in the data. Our experiment results demonstrate again the powerful information processing capability inherent to the popular weighted sum followed by sigmoid squashing. Comparing with previous probability theory based multiple causes models, our scheme is much easier to implement and quite reliable.

[Transcriptional expression of oncogenes and Rb antioncogene in experimental atherosclerotic lesions]

Atherosclerosis (AS) is characterized by the proliferation of the smooth muscle cells (SMC) in the arterial wall. Its pathogenesis might be associated with overexpression of oncogenes in SMC. Gorden and Barrett et al found that sis mRNA level elevated in human atherosclerotic plaques 5-12 fold above level present in normal artery. But the transcriptional expression of c-fos, c-myc, c-jun, H-ras, v-erb-B oncogenes and Rb antioncogene in atherosclerotic lesion has not yet been reported. A study on these oncogenes and Rb gene expression in artherosclerotic lesions in rabbits fed on high cholesterol diet were assayed by the dot blot hybridization using alpha-32P-labelled oncogenes and Rb gene fragments as the probes. After fed with the high cholesterol diet for six months, the plasma cholesterol levels in AS rabbits were significantly increased (1300 +/- 240 mg/dl vs 67.1 +/- 11.5 mg/dl). The atherosclerotic plaques covered 91% +/- 11% of the intimal aortic surface of aorta thoracalis. The results showed that the atherosclerotic plaques contained 3-4 fold more v-sis, c-fos and c-myc mRNA (P < 0.01), 2 fold more c-jun and H-ras mRNA (P < 0.01), and less Rb mRNA (P < 0.05) than those in the normal aortic arteries. But the expression of v-erb-B gene in atherosclerotic plaques remained unchanged. These results indicate that the abnormal expression of v-sis, c-myc, c-fos, c-jun, and H-ras oncogenes and Rb antioncogene may play an important role in arterial SMC proliferation and pathogenesis of atherosclerosis.

Malignant fibrous histiocytoma of the left ventricle: a case report

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults, but is distinctly rare as a primary tumor of the heart. Herein we report a case of left ventricular MFH obstructing the outflow tract and presenting as congestive heart failure. Surgical removal of the mass confirmed the tissue diagnosis of MFH. To our knowledge, this is the first report of MFH originating from the left ventricle.

Characteristic distribution of circulating autoantibodies against G-protein coupled cardiovascular receptors in patients with idiopathic dilated and hypertrophic cardiomyopathy

Circulating autoantibodies against cardiovascular membrane receptors have been repeatedly demonstrated in a subgroup of sera of patients with idiopathic dilated cardiomyopathy. This short review summarizes the clinical findings on anti-receptor autoantibodies in patients with dilated cardiomyopathy.

Utility of 10 MHz ultrasound catheters in the intraaortic assessment of coronary artery ostial stenoses

Our preliminary observations show that intraaortic intravascular ultrasound using 10 MHz transducer catheters is safe and feasible in the assessment of coronary ostial lesions. This imaging modality is potentially useful in decision making regarding the choice of coronary intervention.

[Assignment of differentiation-relevant cDNA RA538 on human chromosomes by fluorescence in situ hybridization]

OBJECTIVE

To localize the differentiation-relevant cDNA RA538 (3.8kb) onto the human chromosome 8q2.

METHODS

A modified non-isotopic labeling technique was used.

RESULTS

The cDNA RA538 was obtained by subtraction hybridization from human esophageal cancer cell line EC8712 induced by retinoic acid. Fluorescence in situ hybridization (FISH) using double-labeled probes showed clear and paired hybridization signals at the corresponding regions of both two chromatids in 18 out of 60 metaphases examined. While by single-labeling, only 7 were positive in 60 metaphases observed and the fluorescent spots were seen only at one chromatid.

CONCLUSION

The modified FISH protocol is useful for mapping cDNA sequences of a few kilobases.

Modulation of brain catecholamine absorbing proteins by dopaminergic agents

Catecholamine absorbing proteins (CATNAPs) are localized in the brain and thus far have no known biochemical and pharmacological characteristics consistent with other receptor proteins or metabolic enzymes in the central nervous system. The oxidative metabolism of catecholamines in the brain, especially the catabolism of dopamine and its conjugation with metabolic brain proteins, results in the production of highly toxic free radicals. Since such processes are implicated in the pathophysiology of various neurodegenerative diseases, including parkinsonism, and since CATNAPs bind catecholamines with high affinity, there is a need to further investigate if these novel proteins could play a protective role against these harmful catecholamine metabolites. In this study, we demonstrate the purification, pharmacological characterization and modulation of CATNAPs, as the first steps necessary to elucidate the function of these proteins in the brain. First, CATNAPs were identified from tissues using [3H]N-n-propylnorapomorphine (a specific dopamine receptor agonist) and [125I]6-hydroxy-5-iodo[N(N-2,4-dinitro-phenyl)- aminopropyl]1,2,3,4-tetrahydronaphthalene ([125I]DATN; a highly specific ligand synthesized in our laboratory). Three proteins, with molecular masses of 47, 40 and 26 kDa, were identified and purified, which allowed for the subsequent production of antibodies against each of these CATNAPs. The effects of in vivo chronic administration of several dopaminergic agents on CATNAPs were also examined by Western immunoblotting. L-3,4-Dihydroxyphenylalanine (L-DOPA) treatment in rats resulted in the increase of all of the three proteins, as compared to controls. Treatment in rats with the dopamine depleting agent, reserpine, produced a significant decrease in all of the three CATNAPs. In addition, the effects of direct administration of apomorphine, dopamine, epinephrine, isopropylnorepinephrine, norepinephrine, N-n-propylnorapomorphine and 6-hydroxydopamine on CATNAP levels in rats were examined. Interestingly, we observed an increase (as compared to control) of the 47, 40 and 26 kDa proteins in animals treated with dopamine, norepinephrine, N-n-propylnorapomorphine and apomorphine. In contrast, animals treated with 6-hydroxydopamine showed significant decreases in the levels of all three proteins. It is evident that as the concentration of catecholamines increases, there is a corresponding increase in the levels of CATNAPs in the brain. These results clearly demonstrate the pharmacological modulation of CATNAPs by dopaminergic agents and suggest their possible role in the cytoprotection against damage caused by free radicals generated by oxidative stress.

[Comparison of diet, physical activity and serum lipids between Chinese and Japanese: Chengdu-Fukuoka Study]

A detailed diet history was taken from 326 Chinese adults, 116 college students in Chengdu, China, and 300 Japanese adults and 4529 college students in Fukuoka, Japan. Both populations consume high carbohydrate and low fat diet, but the Chinese diet was higher in carbohydrate, cereal energy/total energy ratio and polyunsaturated fatty acids/saturated fatty acids ratio, and lower in protein, fat and animal fat/total fat ratio compared to the Japanese diet. Cholesterol intake was significantly lower in Chinese than in Japanese (P < 0.001). Physical activity index in Chinese was higher than that in Japanese. Serum lipids and lipoprotein cholesterols were measured in the adults of Chinese and Japanese. Except the serum triglycerids level in female, the total cholesterol, TG, high density lipoprotein-cholesterol and low density lipoprotein-cholesterol levels in Chinese adults were lower than those in Japanese adults (P < 0.001). Since cholesterol is the major predisposing factor for coronary heart disease and the results of our study show that a high carbohydrate and low fat diet can be effective in lowering the cholesterol level in blood it will be of interest to see which kind of oriental dietary may be a preventive against coronary heart disease.

[Antitussive, expectorant and anti-inflammatory effects of rhizoma Cynanchi stauntonii]

Experiments indicated that the ethanol extract and ether extract from Rhizoma Cynanchi Stauntonii showed obvious antitussive and expectorant effects in mice with stomach administration. The antitussive effect of ethanol extract was stronger than the expectorant effect. The water extract showed a certain expectorant effect but no marked antitussive effect with oral administration. Obvious anti-inflammatory effect was observed on croton oil-caused mouse ear swell with intraperitoneal injection.

Usefulness of intracardiac echocardiography in complex transseptal catheterization during percutaneous transvenous mitral commissurotomy

OBJECTIVE

To examine the utility of intracardiac echocardiography in guiding complex transseptal catheterization of patients undergoing percutaneous transvenous mitral commissurotomy.

DESIGN

We assessed this procedure in high-risk patients in whom transseptal catheterization is technically complex and more demanding.

MATERIAL AND METHODS

Fifteen patients with mitral stenosis were studied. Twelve patients had giant left atria (70 mm or more), two had atrial septal aneurysms, and one had severe kyphoscoliosis. A newly developed 8-F 10-MHz intracardiac transducer catheter was placed in the right atrium through an 8-F Mullins sheath inserted from the left femoral vein. Echocardiographic images were used to confirm the septal position of the Brockenbrough needle tip before septal punctures.

RESULTS

Transseptal puncture was successful and uncomplicated in all 15 patients. Use of intracardiac echocardiography eliminated the need for atrial angiography. Before transseptal puncture, the needle tip was identified to be in contact with the atrial septum, as an echogenic point with its acoustic shadow and septal indentation. In addition, in the two patients with aneurysms, puncture of the thin-walled aneurysms was avoided.

CONCLUSION

Intracardiac echocardiography facilitates safe complex transseptal catheterization in patients with mitral stenosis and giant left atria, atrial septal aneurysms, or severe kyphoscoliosis.

Percutaneous transvenous mitral commissurotomy in patients with mitral stenosis and coexistent hyperthyroidism

Percutaneous transvenous mitral commissurotomy (PTMC) was performed successfully without complications in 3 patients with severe mitral stenosis and hyperthyroidism. All 3 patients had pliable, noncalcified mitral valves. One patient who had been treated with methimazole for 6 months was still in a hyperthyroid state when she presented with intractable congestive heart failure and was found to have severe mitral stenosis. The heart failure improved immediately after PTMC, but the patient remained in New York Heart Association functional class 2 until a euthyroid state was achieved with I131 therapy. In the other 2 patients, hyperthyroidism was unsuspected at the time of PTMC. Unexpectedly suboptimal symptom improvement led to the diagnosis of hyperthyroidism 1 month after the intervention. In all 3 patients, PTMC resulted in an immediate hemodynamic and clinical improvement. However, complete clinical improvement occurred only when euthyroid state was achieved after antithyroid treatment. The present study suggests that PTMC is a safe and effective intervention modality in patients with coexisting hyperthyroidism and severe mitral stenosis. The procedure may be considered a therapeutic option in patients with hyperthyroidism and severe mitral stenosis.

[Dental appliances for the treatment of obstructive sleep apnea syndrome]

This study combined the use of cephalometrics and overnight polysomnographic monitoring to analyze the effects of a dental appliance on airway, sleep and respiratory conditions in 10 patients with obstructive sleep apnea. The findings indicated that horizontal and vertical mean changes in mandibular position while the appliance was worn were 1.73 mm and 9.30 mm, respectively, the mean superior airway space increased by 2.80 mm (P < 0.01), while the mean middle airway space increased by 6.75 mm (P = 0.01), the inferior airway space, however, didn't change significantly when the appliance was worn. The average Apnea Index decreased by 15.98 events per hour when the appliance was worn (P < 0.01), the average Respiratory Disturbance Index decreased from 39.43 to 6.62 events per hour in 9 of 10 patients (P < 0.01, one patient didn't have recording of hypoventilation). the lowest SaO2 value increased from 73.87% to 85.50% (P < 0.01). The reduction in the rate of airway obstructive events is attributed to the effect of appliance on the orophargneal structures. The dental appliance is a conservative, successful treatment alternative that could benefit patients with obstructive sleep apnea syndrome.

Atrial septal motion in effusive--constrictive pericarditis: transesophageal echocardiographic study and hemodynamic correlation

Transesophageal echocardiography was performed in 7 patients with effusive-constrictive pericarditis to analyze atrial septal motion(ASM). In 3 patients, the ASM was found to be normal with atrial septum (AS) moving toward the right atrium from ventricular mid-systole to early-diastole and toward the left atrium from mid-diastole to early-systole. Respiration had little effect on the ASM. In 2 patients, a brisk inversion of ASM toward the left atrium at ventricular early-to-mid systole was noted during inspiration. In the other 2 patients, a sustained ASM toward the left atrium during ventricular systole was found. In 4 of these 7 patients, hemodynamic studies were performed simultaneously with the transesophageal echocardiography. The ASM reflected the pressure gradient between the left atrium (as measured by pulmonary arterial wedge pressure) and the right atrium. The augmented ASM toward the left atrium occurred as left atrial pressure decreased markedly during inspiration. In conclusion, the ASM in patients with effusive-constrictive pericarditis showed 3 patterns: normal, sustained systolic motion toward the left atrium and a brisk systolic displacement toward the left atrium during inspiration. The ASM reflects changes in the interatrial pressure gradient.

[Antifebrile and anti-inflammatory effects of radix Cynanchi atrati]

The water extract of Radix Cynanchi Atrati used as intraperitoneal injection has been proved to have an obvious antifebrile++ effect on rat fever caused by 15% yeast suspension hypodermic injection as well as a significant anti-inflammatory effect. But the antiferbrile effect of its ethanol extract is not clear.

[Swallowing pattern in skeletal Class III malocclusion]

In this research, we compared the swallowing pattern in 33 normal occlusion adults with that in 29 skeletal Class III malocclusion adults, using computerized videofluoscopy. We found that: 1) in skeletal Class III malocclusion patients, the tongue, the hyoid bone and the mandible were in much lower position than those in normal people at postural position. The gap separation between the upper and lower lip was much larger. So was the space between the upper and lower molars. During swallowing, the tongue tip moved upward and backward, and continually moved back along with the backward movement of the tongue dorsum. This was the typical tongue retraction swallowing pattern in Class III malocclusion. The lips kept separation during deglutition, so did the molar region. 2) Abnormal swallowing pattern in skeletal Angle Class III patients was the adaptable change with the dentoalveolar disharmony, while the long time abnormal swallowing could change dentoalveolar structure.

[The early treatment of unilateral crossbite]

Fifteen unilateral crossbite patients of primary and mixed dentition with mandibular asymmetry were treated by transverse expansion using removable appliance. Posteroanterior cephalometric analysis was utilized before and after treatment. The results suggested that after the correction of unilateral crossbite, the deviation of midsagittal mandibular total lenth decreased significantly. According to this study, early treatment of unilateral crossbite is indicated.

[Study on LDL receptors of liver non-parenchymal cells in hypertriglyceridemic rats induced by high carbohydrate diet]

In the present study, hypertriglyceridemia was induced by feeding S. D. rats with high carbohydrate diet (carbohydrate accounting for 80% of total calorie) for 5 days. Rat liver parenchymal cells (PC) and non-parenchymal cells (NPC) were prepared by collagenase method. Human plasma LDL, VLDL and HDL were isolated by density gradient ultracentrifugation method. 125I-LDL was labelled by ICI method. 125I-LDL binding to rat liver PC and NPC were measured by Goldstein and Brown's method. The results showed that both rat liver PC and NPC had LDL receptors to bind, uptake and degradate 125I labelled human plasma LDL. The Bmax of 125I-LDL binding to NPC was 7-fold higher than that of PC (P < 0.01), but the Kd values remained unchanged. The Bmax of 125I-LDL binding to liver NPC from hypertriglyceridemic rats was significantly higher than that of NPC from the normal diet (carbohydrate accounting for 60% of total calorie) rats (435.4 + 100.0 vs 307.1 +/- 76.8 ng/mg cell protein, n = 6, P > 0.05), but there was no difference in Kd between the HTG rats and normal rats (18.1 +/- 4.1 vs 17.2 +/- 4.0 micrograms/ml n = 6, P > 0.05). These results suggest that the increase in fractional catabolic rate of LDL in patients with hypertriglyceridemia reported by Vega and Grundy might be induced by the increase in number of LDL receptor on liver non-parenchymal cells.

[Effect of native and oxidation-modified LDL, VLDL and HDL on the morphological appearance and phenotype of cultured human arterial smooth muscle cells]

The arterial smooth muscle cells (SMC) are the predominant type of cells in atherosclerotic lesions, and their proliferation plays an important role in the process of AS genesis. We established the primary culture and sub-culture method for human arterial SMC and observed the effects of LDL, VLDL, HDL, OX-LDL, OX-VLDL and OX-HDL on the morphological appearance and phenotype of cultured human arterial SMC. The results revealed that the cells cultured in the medium containing OX-LDL, OX-VLDL and OX-HDL (25 micrograms/ml) became more irregular with long finger-like projects and lacked a bipolar shape, and the characteristic "hills" and "valleys" disappeared. LDL and VLDL also had the influence but in smaller degrees. HDL did not have any effect. The SMC cultured in the presence of OX-LDL (25 micrograms/ml) had less myofilaments and more endoplasmic reticulua, Golgi and mitochondria in cytoplasm compared with the cells in control group under electronmicroscope. These results suggest that the atherogenic role of LDL, VLDL, OX-LDL, OX-HDL, and OX-VLDL are closely related to their stimulating effects on the modulation of phenotype of arterial SMCs from "contractile" towards "synthetic".

[Masticatory efficiency in skeletal class III malocclusion]

In this research, we used the Gunne's spectrophotometry method to measure the masticatory efficiency in 30 skeletal Class III patients and in 55 normal people. After groups comparing and step wise-regression analysis, we found that masticatory efficiency in Class III malocclusion group was much lower than that in normal occlusion group, and the masticatory efficiency in Class III malocclusion was about 60% of that in normal peoples. Masticatory efficiency in male was higher than that in female.

[Primary-explant method of culturing human arterial smooth muscle cells]

The primary culture of human arterial smooth cells (SMC) was performed successfully using the primary-explant method. The cells formed "hills and valleys" characteristic of SMC; the myofilament bundles were observed in the cytoplasm of the cells under an electron microscope and the cells were stained red with Ma's method. The growing character of 35th passage SMC kept unchanged. In addition, some problems concerning the culture of human arterial smooth muscle cells are discussed.

Properties of G-protein modulated receptor-adenylyl cyclase system in myocardium of spontaneously hypertensive rats treated with adriamycin

Properties of the receptor--G protein--adenylyl cyclase system were studied in spontaneously hypertensive rats (SHR) and age-matched normotensive Wistar-Kyoto rats (WKY) treated with adriamycin (ADR, 1 mg/kg per week) for 12 weeks. An identical dosing schedule caused a significantly greater decline in body weight gain and a marked elevation of plasma norepinephrine level in SHR than in WKY. A significant increase in the messenger RNA encoding Gi-alpha 2 was found in SHR+ADR group. The activity of the adenylyl cyclase stimulated by guanyliminodiphosphate [Gpp(NH)p] was decreased by 49% in SHR and 73% in SHR+ADR. However, stimulated activities of adenylyl cyclase by both sodium fluoride and forskolin remained unchanged. Functional level of stimulatory G-protein (Gs) as measured by reconstitution assay in sarcolemmal membrane was unaltered among different groups. Furthermore, the density of beta-adrenoceptor was significantly decreased without change of its affinity. Muscarinic receptors exhibited a three-site affinity distribution in SHR+ADR whereas other groups displayed only two-site affinity distribution. These results suggest that SHR exhibited a depressed myocardial adenylyl cyclase signaling system which may not be due to the functional uncoupling of beta-adrenoceptors from Gs but to the increased inhibitory G-protein (Gi) activity as demonstrated by the increased mRNA of Gi-alpha 2, increased inhibition of Gpp(NH)p-mediated adenylyl cyclase and the super high affinity for carbachol of the muscarinic receptors. Decreased beta-adrenoceptor density and functional alteration of Gi might be regarded as the predisposing factors for the increased susceptibility of myocardium of SHR to ADR.

Immunocytochemical localization of M2 muscarinic receptors in rat ventricles with anti-peptide antibodies

We produced antibodies against a synthetic peptide corresponding to amino acids 168-192 of the second extracellular loop of the M2 human muscarinic receptor in rabbits. In immunoblot, affinity-purified antibodies specifically recognized a major band of rat ventricular muscarinic receptor protein with a molecular weight of about 80 KD. This recognition could be blocked by pre-incubation with peptide. Moreover, with both light (LM) and electron microscopic (EM) immunocytochemistry techniques, muscarinic receptors were detected on sarcolemma and T-tubules of rat cardiomyocytes. In addition, immunoreactions were localized in membranes of capillaries. Likewise, these reactivities were abolished by pre-incubation with peptide. These results suggest that the antibodies against the second extracellular loop of human M2 muscarinic receptor could specifically recognize rat ventricular muscarinic receptor protein and could be a powerful tool to study the fate of this receptor under different pathological or physiological conditions.

Urgent/emergent percutaneous transvenous mitral commissurotomy

Urgent/emergent percutaneous transvenous mitral commissurotomy (PTMC) was performed in 10 patients (two men and eight women, aged 21 to 60 yr). All patients had arterial hypoxemia and four required mechanical respirators. PTMC was performed in the semi-recumbent position in four patients. The seven patients with pliable valves (group 1) achieved good hemodynamic and echocardiographic results after PTMC, but one died 2 wk later because of sepsis complicating preexisting pneumonitis. The two pregnant patients uneventfully delivered normal babies at term. There was continued clinical improvement in the six surviving patients at last follow-up at 11 to 39 mon (median 26). Of the three patients with calcified valves and severe subvalvular lesions (group 2), the premoribund patient in whom last-resort PTMC created severe mitral regurgitation died 3 days later of multiple organ failure. The other two patients underwent mitral valve replacement 1-6 days later because of lack of clinical improvement due to creation of severe mitral regurgitation and ineffective mitral valve dilation, respectively. In conclusion, urgent/emergent PTMC is feasible and safe. However, its outcomes are dictated by the status of diseased mitral valve and coexisting illness.

Percutaneous transvenous mitral commissurotomy in patients with severe kyphoscoliosis

Because transseptal catheterization is felt to be contraindicated in patients with severe kyphoscoliosis, there have been no reports of percutaneous transvenous mitral commissurotomy performed in such patients. This report describes percutaneous transvenous mitral commissurotomy in three patients with severe thoracic kyphoscoliosis, with special emphasis on the transseptal puncture technique. Biplane right atrial angiography and the contrast septal flush method are very useful in landmark selection for a safe transseptal puncture.

Electrochemical sensor for heparin: further characterization and bioanalytical applications

Further studies regarding the potentiometric response to heparin of polymeric membranes doped with lipophilic quaternary ammonium salts are reported. Among a wide range of membrane formulations examined, optimum response toward macromolecular heparin is achieved using tridodecylmethylammonium chloride as the active membrane component within poly(vinyl chloride) or poly(vinyl chloride)/(vinyl acetate) films plasticized with dioctyl sebacate. Although such membranes are shown to exhibit a typical Hofmeister potentiometric selectivity pattern toward small inorganic and organic anions, a very large and reproducible response to heparin at submicromolar levels is observed in the presence of physiological saline (0.12-0.15 M NaCl), as well as in citrated whole blood. Equal response on a mass basis occurs with fragments of heparin's as small as 2500 Da. Complexation of heparin's anionic sites by macromolecules that bind heparin with high affinity (e.g., protamine and poly(L-lysine)) reduces the membrane electrode's heparin response, indicating that the electrode detects biologically available (unbound) heparin levels in solution. Quantitative potentiometric titrations of protamine with porcine mucosa heparin followed by the sensor yield stoichiometric values in good agreement with the literature. The biomedical utility of the sensor is demonstrated by measuring its response in whole blood from patients undergoing open heart surgery before and after heparin therapy and correlating such response to conventional blood clotting time measurements.

Pulmonary valvuloplasty in adults using the Inoue balloon catheter

This report describes a new balloon pulmonary valvuloplasty technique using the Inoue balloon catheter performed in 14 consecutive adult patients, aged 17-47 years (mean 27). The mean right ventricular systolic pressure and the pulmonary valvular peak-to-peak systolic gradient decreased from 102 +/- 41 to 52 +/- 19 mm Hg (p = 0.001) and 81 +/- 40 to 7 +/- 7 mm Hg (p = 0.0002), respectively. An infundibular peak-to-peak systolic gradient either developed (n = 13) or increased (n = 1). None of the patients were treated with beta-adrenergic blockers before or after the valvuloplasty. Eight patients underwent repeat hemodynamic study 12-30 months (mean 17) after treatment, and had no evidence of valvular restenosis. The mean right ventricular systolic pressure and the mean infundibular peak-to-peak systolic gradient decreased, compared to the values immediately after valvuloplasty (54 to 40 mm Hg, p = 0.03, and 28 to 10 mm Hg, p = 0.03, respectively). The study suggests that pulmonary valvuloplasty in adults using the Inoue balloon catheter technique is feasible, safe, and effective.

Two-dimensional echocardiographic observation of dehiscence of mitral plication annuloplasty suture

Echocardiographic findings of dehiscent suture from mitral plication annuloplasty have not been described. We herein describe transthoracic two-dimensional echocardiographic findings of an abnormal linear echo stretching across the mitral annulus in the left atrium in a 69-year-old male. This abnormal linear echo was confirmed to be a dehiscent plication suture at surgery.

Prognosis after a first Q-wave myocardial infarction in ethnic Chinese people: a prospective study

The prognosis after a first Q-wave myocardial infarction was investigated in 206 Chinese patients of 65 years or younger who had a predischarge cardiac catheterization and coronary angiography. Three patients studied were lost to follow-up. In the remaining 203 patients with ages of between 28 and 65 years, 101 (49.8%) had 0- or 1-vessel disease, 56 (27.6%) had 2-, and 38 (18.7%) had 3-vessel disease. Significant left main coronary artery stenosis was noted in 8 (3.9%). During a mean follow-up of 33 months, 33 (16.3%) patients had 36 episodes of cardiac events, and 16 (7.9%) died of cardiac causes. Stepwise logistic regression analysis revealed that the left ventricular ejection fraction and left main coronary artery disease were predictors of cardiac mortality, while age and the extent of coronary artery disease were predictors of total cardiac events. There was no variable that could predict recurrence of myocardial infarction.

[A study of accuracy of multiple-unit one-piece castings of fixed bridge]

We studied how the accuracy of the three-unit and four-unit bridges is affected by the three different sprue programmes and heat-treatment. The results of experiments are as follows. 1. In the two types of fixed bridge the accuracy of the lateral pouring sprue programme is greater than that of the top-pouring and bottom-pouring sprue programmes. 2. After the heat-treatment of the casting, the stresses are distributed again, so the accuracy of the casting becomes lesser. 3. The change in the measurement of the total and pontic lengths of multiple-unit fixed bridges generally causes a "fork shape" deformity.

Familial aggregation of oesophageal cancer in Yangcheng County, Shanxi Province, China

Oesophageal cancer is the second most common cause of cancer death in China and is particularly prevalent in northern China. Genetic factors have been studied less than environmental factors in the aetiology of this disease. This study was conducted to evaluate familial aggregation of oesophageal cancer. All households in Yangcheng County were interviewed in 1979 to determine family history of oesophageal cancer. In 1989, vital status for all family members from three Yangcheng villages was determined and re-interviews were conducted among families who reported a positive family history of oesophageal cancer in 1979. Risk of oesophageal cancer was evaluated by comparing family and individual rates of oesophageal cancer during the 1979-1989 interval stratified by the number of family members with oesophageal cancer prior to 1979. More families with prior oesophageal cancer history reported new oesophageal cancer deaths during the follow-up period than families without prior history (19% versus 5%). Oesophageal cancer rates increased with increasing positivity of family history, and adjustment for other risk factors did not substantially alter this result. We conclude that these data provide evidence for familial aggregation of oesophageal cancer.

Contrast transesophageal echocardiographic demonstration of coronary artery fistula within left atrial appendage thrombus in mitral stenosis

Coronary neovascularization and fistula formation arising from the left circumflex artery demonstrated by coronary angiography is a specific sign for the presence of left atrial appendage thrombus in patients with mitral stenosis. However, the fistula drainage site in the left atrium in relation to the thrombus cannot be ascertained by the angiographic method. We performed transesophageal echocardiography simultaneously with coronary angiography in five patients with severe mitral stenosis and left atrial appendage thrombus. The angiography showed coronary neovascularization and fistula arising from the left circumflex artery in three patients. In these three patients, the transesophageal echocardiography confirmed the presence of a coronary fistula by identifying contrast exuding from the surface of the thrombus. Thus we have shown for the first time the usefulness of contrast transesophageal echocardiography in imaging the exact drainage site of coronary artery fistula from left atrial appendage thrombus.

A strategy for isolating differentiation-inducing complementary DNAs from human esophageal cancer cell line treated with retinoic acid

Treatment of the human esophageal cancer cell line EC8712 with retinoic acid (RA) stopped the cell growth significantly and gave rise to terminal differentiation of the cells characterized by increased expression of involucrin gene. Two cDNA libraries were constructed from the parental and RA-treated cells respectively. Repeated subtractive hybridization of single-stranded plasmid DNA prepared from pooled colonies of cDNA library of the parental cells with cDNA probe generated from the RA-treated cells exhausted sequences common to both libraries of the cell. The unhybridized cDNA probe represented, therefore, the genes activated after RA-treatment. By using these enriched cDNAs as probe to screen the cDNA library constructed from the RA-treated cells thirty-nine positive colonies were obtained, of which two were specifically due to RA-induction. One of these two cDNA clones, designated as pRA538, has undergone further analysis and shown differentiation-inducing effect on parental cancer cells. A novel strategy for cloning genes involved in terminal differentiation of cancer cells is developed.

Developmental expression of the glial fibrillary acidic protein (GFAP) gene in the mouse retina

1. In the nervous system, Glial fibrillary acidic protein (GFAP) is a well-known, cell type-specific marker for astrocytes. 2. In the mammalian retina, Muller cells, the major class of retinal glia, do not express GFAP or contain only low amounts of this protein. In retinas with photoreceptor degeneration, however, high levels of GFAP are found. It is possible that GFAP synthesis in these retinas could result from "dedifferentiation" of Muller cells as a consequence of disruption of normal neuron-glia interactions. 3. We have carried out immunocytochemical and in situ hybridization studies to examine whether GFAP or its mRNA is expressed by retinal cells early in embryonic development. 4. Our results show that GFAP-containing cells, which are probably astrocytes, are found only in the ganglion cell and nerve fiber layers and that these cells appear after postnatal day-1 (P-1) and continue to form until P-10. 5. Astrocyte formation starts from the optic disc and moves toward the periphery of the retina at a rate of approximately 160-200 microns per day. 6. An unexpected result from these studies is that GFAP mRNA levels are high in the first week of birth and decline rapidly as the animal develops. 7. Finally, we did not find either GFAP or GFAP mRNA in retinal cells other than astrocytes during normal development.

Short- and long-term results of catheter balloon percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 219 patients with symptomatic, severe rheumatic mitral stenosis. There were 59 men and 160 women, aged 19 to 76 years (mean 43). Pliable, noncalcified valves were present in 139 (group 1), and calcified valves or severe mitral subvalvular lesions, or both, in 80 patients (group 2). Atrial fibrillation was present in 133 patients (61%) and 1+ or 2+ mitral regurgitation in 59 (27%). Technical failure occurred with 3 patients in our early experience. There was no cardiac tamponade or emergency surgery. The only in-hospital death occurred 3 days after the procedure in a group 2 premoribund patient in whom last-resort PTMC created 3+ mitral regurgitation. Mitral regurgitation appeared or increased in 72 patients (33%); 3+ mitral regurgitation resulted in 12 patients (6%). There were 3 systemic embolisms. Atrial left-to-right shunts measured by oximetry developed in 33 patients (15%). Immediately after PTMC, there were significantly reduced (p = 0.0001) left atrial pressure (24.2 +/- 5.6 to 15.1 +/- 5.1 mm Hg), mean pulmonary artery pressure (39.7 +/- 13.0 to 30.6 +/- 10.9 mm Hg) and mitral valve gradient (13.0 +/- 5.1 to 5.7 +/- 2.6 mm Hg). Mitral valve area increased from 1.0 +/- 0.3 to 2.0 +/- 0.7 cm2 (p = 0.0001) and cardiac output from 4.4 +/- 1.4 to 4.7 +/- 1.2 liters/min (p less than 0.01). The results mirrored clinical improvements in 209 patients (97%). Multivariate analysis showed an echo score greater than 8, and valvular calcification and severe subvalvular lesions as independent predictors for suboptimal hemodynamic results.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of arterial collagen nonenzymatic glycosylation (NEG) in the pathogenesis of diabetic macroangiopathy]

In this study, we found that 5-Hydroxymethylfurfural (5-HMF) released from aortic collagen was significantly increased in diabetic rats with diabetic duration of 4, 8, 12 weeks (P less than 0.001, P less than 0.001, P less than 0.001). Collagen-link fluorescence (CLF) was also increased in diabetic rats P less than 0.005, P less than 0.05, P less than 0.01 respectively). Mean collagen-content was higher in diabetic rats than in the controls (P greater than 0.05, P less than 0.01, P less than 0.01 respectively). In diabetic rats, the amount of 5-HMF was related to plasma glucose concentration (r = +0.52, P less than 0.01) and CLF (r = +0.58, P less than 0.01). There was a positive correlation between CLF and collagen-content in diabetic rats (r = +0.45, P less than 0.05). These results suggest that NEG do occur in arterial collagen. Advanced glycosylation end products could participate in glucose derived cross-link formation and accumulate through the lifetime of collagen, which may change the function and structure of collagen. The increase of collagen content of arterial wall in diabetic rats may probably have resulted from excessive formation of cross-links.