Impact of diabetes mellitus and poor glycemic control on the prevalence of left atrial low-voltage areas and rhythm outcome in patients with atrial fibrillation ablation

INTRODUCTION

Left atrial low-voltage areas (LVAs) are known to be correlated with atrial scarring and atrial fibrillation (AF) recurrence after ablation. However, the association between LVAs and glycemic status before ablation has not been fully clarified. The purpose of this study was to investigate associations among the prevalence of diabetes mellitus (DM), glycemic control, and the prevalence of LVAs in patients with AF ablation.

METHODS

In total, 912 (age, 68 ± 10 years; female, 299 [33%]; persistent AF, 513 [56%]) consecutive patients who underwent initial AF ablation were included. A preprocedure glycated hemoglobin A1c (HbA1c) ≥7% was set as the cutoff for poor glycemic control in patients with DM. LVAs were defined as areas with a bipolar voltage of <0.5 mV covering ≥5 cm2 of left atrium.

RESULTS

LVAs existed in 208 (23%) patients, and 168 (18%) patients had DM. LVAs were found more frequently in patients with DM and poor glycemic control. On multivariate analysis, DM with HbA1c ≥7% was an independent predictor of LVAs (odds ratio, 3.3; 95% confidence interval: 1.6-6.7; p = .001). In patients with LVAs, freedom from AF recurrence during the 24-month study period was significantly lower in patients who had DM with HbA1c ≥7% than in those without DM (37.9% vs. 54.7%, p = .02).

CONCLUSION

In patients with AF ablation, LVAs were found more frequently in patients with DM and poor glycemic control. DM with HbA1c ≥7% was an independent predictor of LVAs.

Two-year real world clinical outcomes after intravascular imaging device guided percutaneous coronary intervention with ultrathin-strut biodegradable-polymer sirolimus-eluting stent

BACKGROUND

There are little clinical data on imaging-guided percutaneous coronary intervention (PCI) 1 year after the biodegradable-polymer sirolimus-eluting stents (BP-SES) implantation, when the polymer disappears.

METHODS

We retrospectively analyzed 2455 patients who underwent successful PCI with BP-SES or durable-polymer everolimus-eluting stents (DP-EES) between September 2011 and March 2021, and compared 2-year clinical outcomes of BP-SES (n = 459) with DP-EES (n = 1996). The outcome measures were target lesion revascularization (TLR) and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis. Multivariate analysis using the Cox proportional hazard model and inverse probability weighting (IPW) analysis based on the propensity score were used to evaluate the clinical outcomes.

RESULTS

The 2-year cumulative incidences of TLR (BP-SES: 4.9% vs. DP-SES: 6.1%, p = 0.304) and MACE (10.3% vs. 12.5%, p = 0.159) were similar between the two groups. Multivariable and IPW analysis revealed the risks of TLR (p = 0.388 and p = 0.500) and MACE (p = 0.139 and p = 0.083) also had no significant difference. There was a significant interaction between none/mild and moderate/severe calcification with respect to MACE and TLR (adjusted p for interaction = 0.036 and 0.047, respectively). The risk of MACE was significantly lower in BP-SES than in DP-EES in lesions with none/mild calcification (adjusted hazard ratio [aHR]: 0.53; 95% confidence interval [CI]: 0.30-0.91), while it was similar in those with moderate/severe calcification (aHR: 0.95; 95% CI: 0.58-1.55).

CONCLUSIONS

Compared with DP-EES, BP-SES demonstrated durable 2-year clinical outcomes. However, BP-SES showed better clinical performance than DP-EES for lesions with none/mild calcification.

First isolation of Exophiala dermatitidis from a dog: identification by molecular analysis

The present study deals with the first isolation of Exophiala dermatitidis from a dog. The dog had a history of multicentric lymphoma for 4 months. On physical examination, 10-15 black or purple subcutaneous nodules were detected on the dorsum of the right neck. Microscopic examination of biopsy specimen from the nodules disclosed lymphocytes, neutrophils and moniliform hyphae. The colony of the clinical isolate was flat with black aerial hyphae and a wet margin after 2 weeks incubation on Sabouraud's dextrose agar at 27 degrees C. The microscopic examination of the clinical isolate revealed that hyphae were brown, septate, and smooth, producing branched or unbranched conidiospores laterally or on the apex. The conidia were one celled, subglobose, elliptical to cylindrical, smooth and hyaline. Nucleotide sequence analysis of the chitin synthase 2 (CHS2) gene fragments from the isolate and a reference strain of E. dermatitidis showed more than 99% similarity.

Characterization and expression of a Neurospora crassa ribosomal protein gene, crp-7

We have isolated and characterized a Neurospora crassa cytoplasmic ribosomal protein gene, named crp-7, which is found upstream of the photolyase gene. The deduced amino-acid sequence of this gene is highly homologous to the YS25 ribosomal protein of Saccharomyces cerevisiae. The crp-7 ORF consists of two exons which are separated by a short intron. The deduced polypeptide contains 87 amino acid residues and has a calculated molecular weight of 9.7 kDa. RFLP mapping showed that the crp-7 gene is located on the right arm of linkage group I. Southern blot hybridization analyses indicated that there is only one copy of the crp-7 gene in the N. crassa genome. Transcriptional elements, the Dde box, the Taq box and the CG element, that have been identified in other N. crassa ribosomal protein genes are observed in the promoter region of the crp-7 gene. The crp-7 mRNA levels were low in conidia and highest in young mycelia during vegetative growth. The mRNA levels of four r-protein genes, including the crp-7 gene, as well as the tef-1 gene encoding translational elongation factor 1 alpha, were raised following the treatment of mycelia with a low concentration of cycloheximide. This indicates that the expression of r-protein genes is under the control of so-called super-induction.

A comparison of epidemiologic, histologic, and virologic studies on Hodgkin's disease in western Kenya and Nagasaki, Japan

Rapid progress in molecular technologies has enabled the detection of several oncogenic viruses in various types of tumors. The pathogenesis of Hodgkin's disease is suggested to have a strong association with Epstein-Barr virus (EBV). However, Hodgkin's disease related to EBV shows a wide geographic variation in epidemiology. These variations among different populations suggest an interaction of environmental factors and a direct role of EBV infection. Therefore, we performed a comparative study on epidemiologic, histologic, and virologic features of Hodgkin's disease among those in the western part of Kenya and in Nagasaki, Japan. The age distribution of Hodgkin's disease showed a distinct peak in the 0-9-year-old age group in Kenya, and a higher and lower peak in the 60-69- and 30-39-year-old age groups, respectively, in Japan. The most common subtype of Hodgkin's disease in both countries was mixed cellularity, followed by nodular sclerosis, lymphocyte depletion, and lymphocyte predominance. Mixed cellularity showed a significantly high prevalence among Kenyan children nine years of age or younger. Using the in situ hybridization method, EBV-encoded RNA (EBER-1) was detected in 79% of the Kenyan cases and 59% of the Japanese cases, with the mixed cellularity subtype showing a strong correlation with EBER-1. There was 100% positivity in both countries in those less than nine years old. These results suggest that EBV plays a more direct role in the pathogenesis of Hodgkin's diseases in Kenya, especially in cases among young children and also in Japanese children. Environmental and/or genetic factors may have a role, in addition to EBV, in the pathogenesis of Hodgkin's disease, especially in Nagasaki, Japan.

Clinico-pathological predictive factors of response to interferon therapy in chronic hepatitis C

We performed a clinico-pathological study to determine which pre-treatment factors could predict the response to interferon (IFN) therapy in 55 Japanese patients with chronic hepatitis C. Responses to the IFN therapy were evaluated as sustained response, relapse and non-response by the presence or absence of serum hepatitis C virus (HCV) RNA during the course of treatment and at least 6-months post-treatment. The numbers of sustained response, relapse and non-response were 16 (29.0%), 25 (45.5%) and 14 (25.5%), respectively. Eight out of 16 sustained response cases (50%) showed HCV genotype III. Eight among 10 patients with HCV genotype III (80%) were sustained responders. HCV genotypes were found to be correlated with the response to the IFN therapy (p < 0.0001). None of the histological features, the types of the IFN therapy and other clinical factors showed significant differences. These findings suggest that outcome of the IFN therapy in chronic hepatitis C can be predicted by a virological factor, and that HCV genotype III is a useful predictor of a favorable outcome.

A simple method to assess osteoclast-mediated bone resorption using unfractionated bone cells

To determine osteoclastic bone resorption we established a simple assay system in which unfractionated cells obtained from femora of 13-day-old mice were cultured on a dentine slice and the number of osteoclasts and their induced pit area on the slices were measured. When the bone cells (1 x 10(5) cells/dentine slice) were cultured in the presence of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] or human parathyroid hormone (hPTH) for 4 days, at which time newly-formed osteoclasts were not detected, the pit area was dose-dependently increased, being a 4.3- or 4.1-fold respective increase over the control at a 10(-8) M concentration of hormones. Chick calcitonin (cCT) inhibited the osteoclastic bone resorption induced by either of these hormones. cCT alone also suppressed the bone resorption by the cells (3 x 10(5) cells/dentine slice). These findings indicate that 1,25(OH)2D3 or hPTH may mainly activate pre-existing osteoclasts, resulting in increased bone resorption, and that cCT may suppress this osteoclastic activity. When 1,25(OH)2D3 or hPTH was added to the cells pre-cultured in factor-free medium for 6 days, at which time pre-existing osteoclasts had almost degenerated, new osteoclasts were formed, resulting in an increase in pit formation. Thus this system is a useful method which could more sensitively evaluate the effects of hormones or factors on osteoclast formation and activation than other previous systems.

Murine recombinant leukemia inhibitory factor modulates inhibitory effect of 1,25 dihydroxyvitamin D3 on alkaline phosphatase activity in MC3T3-E1 cells

We demonstrated murine leukemia inhibitory factor (mLIF) mRNA in osteoblastic MC3T3-E1 cells, but not mLIF in their conditioned medium. Recombinant mLIF had an inhibitory effect on alkaline phosphatase (ALP) activity, but not on DNA synthesis, in these mLIF-free cells. This inhibitory effect was not prostaglandin E2 dependent. mLIF also modulated the inhibitory effect of 1,25 dihydroxyvitamin D3 [1,25(OH)2D3] on ALP activity, partly via down regulation of 1,25(OH)2D3 binding sites. These results suggest that LIF may play a role in regulating osteoblast differentiation.

Cryopexy enhances experimental autoimmune uveoretinitis (EAU) in rats

Treatment of rat eyes with cryopexy enhanced the development of experimental autoimmune uveitis (EAU) in these eyes. The enhancement of EAU by cryopexy was particularly pronounced when the disease was induced by active immunization in rats of a low responder strain (Wistar Furth), or by adoptive transfer with lymphocytes sensitized against S-antigen. The disease enhancement was expressed by earlier onset of clinical symptoms and by more severe inflammatory changes. Histological examination of cryopexy-treated eyes showed focal necrosis and inflammation, confined to the affected sites. Immunohistochemical analysis of the inflammatory infiltration revealed it consists mainly of macrophages and T-lymphocytes of the helper and suppressor subsets. In addition, increased expression of class II antigens was observed in affected areas, on both inflammatory and resident ocular cells. Using electron microscopy and Evans blue angiography we could show breakdown of the blood-retinal barrier at the treated sites. Histological examination of eyes with EAU following cryopexy showed localization of the early inflammation at the injured site. The data are interpreted to suggest that the enhanced EAU in cryopexy-treated eyes is mainly due to the breakdown of the blood-retinal barrier, the accumulation of lymphoid cells and the increased expression of class II antigens, which facilitates antigen presentation.

Expression of Ia antigen by ocular tissues of mice treated with interferon gamma

Intraperitoneal injections of interferon gamma (IFN-gamma) induced or enhanced the expression of Ia antigen by selected murine ocular tissues. In contrast, topical application of this lymphokine had no effect. Ia antigen expression was noted in most cellular components of the conjunctiva, iris, ciliary body, choroid and sclera of treated mice. Intense staining was also found in stromal cells of the cornea, but no Ia reactivity was detected in the corneal epithelium. The lack of staining in the corneal epithelium is in contrast to the strong reactivity in the adjacent conjunctival epithelium, as well as in the skin epithelium. There was no increase in the number of Langerhans cells in the peripheral cornea and limbus, or in their intensity of staining with the anti Ia antibodies. The pattern of Ia expression in ocular tissues of mice treated with IFN-gamma is similar to that of rats with experimental autoimmune uveoretinitis (EAU) except that Ia is expressed more regularly and with higher intensity by the retinal vascular endothelium of rats with EAU than by that of IFN-gamma-treated mice. The findings in the current study thus support the notion that IFN-gamma may be involved in immune-mediated inflammation in the eye.

Age and illuminance effects in the Farnsworth-Munsell 100-hue test

Seventy-five normal volunteers (20-78 yr) were tested on the Farnsworth-Munsell 100-hue test at each of five illuminance levels. Each cap score distribution was analyzed by fitting a two-cycle sine wave whose amplitude and phase characterize the polarity of the error distribution and its axis. Analysis of these parameters reveals a similarity between tritanlike defects in older groups and those of younger groups at lower illuminance levels. These data are also useful for specifying age norms for the polarity of the error distribution.

The nucleotide sequence of 5S rRNA from a red alga, Porphyra yezoensis

The nucleotide sequence of 5S rRNA from Porphyra yezoensis has been determined to be: pACGUACGGCCAUAUCCGAGACACGCGUACCGGAACCCAUUCCGAAUUCCGAAGUCAAGCGUCCGCGAGUUGGGUUAGU - AAUCUGGUGAAAGAUCACAGGCGAACCCCCAAUGCUGUACGUC. This 5S rRNA sequence is most similar to that of Euglena gracilis (63% homology).

[Studies on the classification of endometriosis]

A new classification system of endometriosis proposed by the American Fertility Society (AFS classification) was utilized to categorize patients with endometriosis after surgical treatment and the following results were obtained. 1. AFS classification system was useful to categorize patients with endometriosis, because of a simple and objective point system. 2. There were discrepancies in categorized patients between AFS system and a system proposed by Acosta et al. (Acosta's system). One-third of patients categorized as "Severe" by Acosta's system was classified to be "Moderate" by AFS system. These discrepancies occurred when lesion of endometriosis was just restricted within ovaries. 3. Conception was reduced once ovaries were involved and fecundability rate was significantly reduced if ovarian endometrioma was greater than 3cm in diameter. 4. Acosta's system revealed differences among fecundability rate among the different categories, however, AFS system could not demonstrate a direct correlation between the categories of endometriosis and fecundability rate.

The nucleotide sequence of chloroplast 4.5S rRNA from a fern, Dryopteris acuminata

The 4.5S rRNA was isolated from the chloroplast ribosomes from Dryopteris acuminata. The complete nucleotide sequence was determined to be: OHUAAGGUCACGGCAAGACGAGCCGUUUAUCACCACGAUAGGUGCUAAGUGGAGGUGCAGUAAUGUAUGCAGCUGAGGC AUCCUAAUAGACCGAGAGGUUUGAACOH. The 4.5S rRNA is composed of 103 nucleotides and shows strong homology with those from flowering plants.

Infertility and metroplasty

Various techniques of metroplasty were performed in 32 cases of double uterus. In these patients the fetal survival rate before the operation was nil, whereas post-operatively it reached as high as 92.6%. Strassmann's operation was carried out in 16 cases, Jones & Jones's modified method in 12 cases and Tompkins's operation in 4 cases. The merits and demerits and the applicability of each technique and the various types of uterine malformation are discussed. It is concluded that a correct diagnosis of uterine malformation can only be established by a combination of precise HSG with direct macroscopical observation of uterine body. The Strassmann transverse incision is well suited for a bicornuate uterus, and Jones & Jones's wedge-shaped fundal resection for a partial septate uterus. The postoperative deformation in the fundus uteri is most frequently seen after the application of Strassmann's method, and is much less common with the modified method of Jones & Jones. Metroplasty can be applied in such cases of uterine malformation as when primary sterility is complained of but where any other cause for sterility is ruled out or is deemed to be corrected. Maximum care should be taken to prevent postoperative adhesion. Three months is considered to be a sufficient period for postoperative contraception. The mode of delivery depends on the individual case, though cesarean section is recommended.

The nucleotide sequences of two tRNAAsn genes from tobacco chloroplasts

Recombinant plasmids which contain EcoRI fragments of tobacco chloroplast DNA carrying tRNA genes were constructed. Plasmids pTC211 and pTC293 contain the base sequences for tRNAAsn in their 1.4 and 1.1 Md EcoRI fragments, respectively. These two tRNA sequences are identical and are; 5'-TCCTCAGTAGCTCAGTGGTAGAGCGGTCGGCTGTTAACCGATTGGTCGTAGGTTCGAATCCTACTTGGGGAG-3'. Each tRNAAsn gene is located at about 0.9 kb apart from the distal end of each 5S rRNA gene and is coded for by the DNA strand opposite from that of the rRNA genes.

Hypothalamic function of secondary anovulatory women

In order to investigate the hypothalamic function of the women suffering from ovulatory defect, serial determinations of the serum gonadotropins (LH and FSH) were made over a period of 120 hrs following the intramuscular injection of estradiol benzoate (E.B.) 1 mg. Ten normal cycling women and 57 anovulatory women, excluding premature ovarian failure, were subjected to this study. The positive release of LH in serum (exceeds at least 150% of basal level) to E. B. were noted in follicular phase of the normal cycles, but not in luteal phase, and in 31 of 57 anovulatory women the release occurred between 48 to 96 hrs after the E.B. injection. The LH surge after EB. was difficult to provoke when the basal serum LH and estradiol (E2) levels were low as less than 10 mIU/ml and 50 pg/ml, respectively. Thirteen of 27 women, who showed LH surge, ovulated by Clomid. Only 3 of 17 women, who did not show LH surge to E.B., ovulated as a response to Clomid. Ten of 14 cases, who showed LH surge to E.B. but not ovulated by Clomid, revealed polycystic ovarian disease (PCO), and the responsiveness to E.B. and Clomid improved after wedge-resection of the ovaries. These results suggest that the serum E2 level is closely correlated with the ability for LH-RH production in hypothalamic "surge center" either primarily or secondarily, and that E.B. provocation test is useful to investigate the hypothalamic function of anovulatory patients and to preoperatively diagnose the PCO patients refractory to Clomid treatment.

Detection of subclinical abortion in infertile women by beta-hCG radioimmunoassay

Serum hCG was measured by specific beta-hCG radioimmunoassay during the late luteal phase in 58 infertile women recording the basal body temperature. As control, serum hCG was also measured during the 5th to 17th day after the basal body temperature shift in 18 normal pregnancy. In all normal pregnancy cases serum hCG was detected after the 9th day from basal temperature shift. Serum hCG was detected during the late luteal phase in 6 cases, including 2 cases succeeded in pregnancy in corresponding cycle, out of 58 infertile women. In spite of the hCG detection, the hyperthermic phase on BBT chart was not significantly prolonged in remaining 4 cases, in which the next menses took place as usual. Thus, so called subclinical abortion was suspected in these 4 cycles. This result suggests subclinical abortion might occur in infertile women. When hCG is detected during the late luteal phase, intensive treatment for the defective luteal function may salvage the endangered pregnancy. Since the incidence of hCG detection in this study was rather smaller than the previous reports, the major portion of causes of infertility might exist earlier or around the time of implantation of fertilized ovum.

[A simple method for estimating the day of ovulation by basal body temperature chart (author's transl)]

A new method for estimating the day of ovulation was assessed. The method is as follows; The range of hypothermic phase presumed 0.1 degrees C around mean basal body temperature of early 10 menstrual days. The day of ovulation was estimated by searching for the day which is followed by at least 4 consecutive days of rising temperature within the range of hypothermic phase. The accuracy of this method was assessed by comparing the basal body temperature and urinary luteinizing hormone (LH) peak day. The estimated day fell within 2 days during which the ovulation will occur most probably in 36 cycles (69%) and fell within 4 days around most expectable ovulation time in 46 cycles (88%). This result provide some insight into the limitation of the basal body temperature which is influenced by factors other than progesterone in determining the time of ovulation. But our simple objective method is useful in some cases than any other method determined by vague criteria.