Effects of Arterial Stiffness on Cerebral WM Integrity in Older Adults: A Neurite Orientation Dispersion and Density Imaging and Magnetization Transfer Saturation Imaging Study

BACKGROUND AND PURPOSE

Arterial stiffness is reported to be able to cause axonal demyelination or degeneration. The present study aimed to use advanced MR imaging techniques to examine the effect of arterial stiffness on the WM microstructure among older adults.

MATERIALS AND METHODS

Arterial stiffness was measured using the cardio-ankle vascular elasticity index (CAVI). The high-CAVI (mean CAVI ≥ 9 points) and the low-CAVI groups (mean CAVI < 9 points) were created. The neuronal fiber integrity of the WM was evaluated by neurite orientation dispersion and density imaging and magnetization transfer saturation imaging. Tract-Based Spatial Statistics and the tracts-of-interest analysis were performed. Specific WM regions (corpus callosum, internal capsule, anterior thalamic radiation, corona radiata, superior longitudinal fasciculus, forceps minor, and inferior fronto-occipital fasciculus) were selected in the tracts-of-interest analysis.

RESULTS

In Tract-Based Spatial Statistics, the high-CAVI group showed a significantly lower myelin volume fraction value in the broad WM and significantly higher radial diffusivity and isotropic volume fraction values in the corpus callosum, forceps minor, inferior fronto-occipital fasciculus, internal capsule, corona radiata, and anterior thalamic radiation than the low-CAVI group. In tracts-of-interest analysis using multivariate linear regression, significant associations were found between the mean CAVI and radial diffusivity in the anterior thalamic radiation and the corona radiata; isotropic volume fraction in the anterior thalamic radiation and the corona radiata; and myelin volume fraction in the superior longitudinal fasciculus (P < .05). Additionally, partial correlation coefficients were observed for the significant associations of executive function with radial diffusivity and myelin volume fraction (P < .05).

CONCLUSIONS

Arterial stiffness could be associated with demyelination rather than axonal degeneration.

Decrescent intensity training concurrently improves maximal anaerobic power, maximal accumulated oxygen deficit, and maximal oxygen uptake

This study aimed to investigate the effects of a gradually decreasing intensity training from that corresponding to maximal anaerobic power (MAnP) to that of near maximal oxygen uptake ([Formula: see text]) (decrescent intensity training) on MAnP, maximal accumulated oxygen deficit (MAOD), and [Formula: see text] in untrained young men. Seventeen untrained young men were randomly divided into either a training (TR; n = 9) group or a control (CON; n = 8) group. The TR group performed the decrescent intensity training, whereas the CON group did not perform any exercises. The mean training time per session throughout the training period was 275 ± 135 s. There was a Group × Time interaction for both absolute and relative (p < 0.01) values of [Formula: see text], MAOD, and MAnP. The TR group had significantly increased values for all variables after the 8-week training program, and the relative values of all variables were significantly higher in the TR group than in the CON group. Muscle thicknesses in the anterior and posterior aspects of the thigh and maximal isokinetic knee extension and flexion strengths improved only in the TR group (p < 0.05). A single-exercise training with gradually decreasing intensity from that corresponding to the MAnP to that of approximately 100% [Formula: see text] improves MAnP, MAOD, and [Formula: see text] concurrently, despite the short training time per session.

Energy expenditure, recovery oxygen consumption, and substrate oxidation during and after body weight resistance exercise with slow movement compared to treadmill walking

The benefit of body weight resistance exercise with slow movement (BWRE-slow) for muscle function is well-documented, but not for energy metabolism. We aimed to examine physiological responses [e.g., energy expenditure (EE), respiratory exchange ratio (RER), and blood lactate (La)] during and after BWRE-slow compared to EE-matched treadmill walking (TW). Eight healthy young men (23.4 ± 1.8 years old, 171.2 ± 6.2 cm, 63.0 ± 4.8 kg) performed squat, push-up, lunge, heel-raise, hip-lift, and crunch exercises with BWRE-slow modality. Both the concentric and eccentric phases were set to 3 s. A total of three sets (10 repetitions) with 30 s rest between sets were performed for each exercise (26.5 min). On another day, subjects walked on a treadmill for 26.5 min during which EE during exercise was matched to that of BWRE-slow with the researcher controlling the treadmill speed manually. The time course changes of EE and RER were measured. The EE during exercise for BWRE-slow (92.6 ± 16.0 kcal for 26.5 min) was not significantly different from the EE during exercise for TW (95.5 ± 14.1 kcal, p = 0.36). BWRE-slow elicited greater recovery EE (40.55 ± 3.88 kcal for 30 min) than TW (37.61 ± 3.19 kcal, p = 0.029). RER was significantly higher in BWRE-slow during and 0-5 min after exercise, but became significantly lower during 25-30 min after exercise, suggesting greater lipid oxidation was induced about 30 min after exercise in BWRE-slow compared to TW. We also indicated that BWRE-slow has 3.1 metabolic equivalents in average, which is categorized as moderate-intensity physical activity.

Regulation of Perfusion Pressure during Cardiopulmonary bypass using Sevoflurane

In hypothermic cardiopulmonary bypass (CPB), various vasodilators are used to control the perfusion pressure. These agents, however, often decrease the pressure excessively, and the low perfusion pressure may persist until the end of CPB. In this study we evaluate the safety and characteristics of the regulation of perfusion pressure during CPB using a volatile anesthetic, sevoflurane which has an extremely low partition coefficient. Twenty adult patients who underwent cardiac surgery were studied. Sevoflurane was applied by a vaporizer inserted into the oxygenator gas supply line. Pump flows were fixed at 2.4 L/min/m2 during the hypothermic period. Sevoflurane concentration was adjusted to keep mean arterial pressure (MAP) between 40 and 70 mmHg during CPB. Hemodynamic and metabolic parameters were measured and compared to the group we previously treated with chlorpromazine. In all cases, MAP could be maintained adequately. In the sevoflurane group, systemic vascular resistance indices (SVRI) during the rewarming period and at the end of CPB were higher, and doses of norepinephrine needed at the end of CPB were significantly lower than in the chlorpromazine group. The regulation of perfusion pressure during CPB using sevoflurane was safe and could easily maintain adequate SVRI.

Heat stress-induced phosphorylation of FoxO3a signalling in rat skeletal muscle

AIM

A recent study demonstrated that FoxO3a was directly induced by the overexpression of Hsp72 in rat soleus muscle. However, whether heat stress treatment induces FoxO3a phosphorylation in rat skeletal muscle remains unclear. This study examined the effects of heat stress on the regulation of the FoxO3a signalling pathway in rat skeletal muscle.

METHODS

Thirty-two male Wistar rats (15 weeks old) were randomly assigned into two groups; sedentary control group (Sed, n = 8) and experimental group (n = 24). After an overnight fast, one leg of each rat (HS leg) in the experimental group was immersed in hot water (43 °C) for 30 min, and the soleus and plantaris muscles in both legs were removed immediately (0 min), 30 min, 60 min, or 24 h after the heat stress (n = 6 each group). The contralateral, non-heated leg in the experimental group served as an internal control (CT leg).

RESULTS

Heat stress treatment resulted in a significant increase in FoxO3a phosphorylation (Ser253) in the soleus and plantaris muscles of heat-stressed legs after 24 h. Hsp72 expression in heat-stressed legs was significantly higher at 60 min and 24 h in these muscles. Activation of the PTEN/Akt and MEK/ERK pathways was also observed in these muscles immediately after stress, but not at 24 h. There were no differences in FoxO1 and AMPKα phosphorylation in either muscle.

CONCLUSION

Heat stress in rat skeletal muscle induces phosphorylation of FoxO3a signalling, and it may be related to Hsp72 upregulation, and the activation of the PTEN/Akt and MEK/ERK pathways.

Efficacy of Whole Bowel Irrigation Using Solutions with or without Adsorbent in the Removal of Paraquat in Dogs

1 The efficacy of whole bowel irrigation with a solution containing either polyethylene glycol (PEG) with electrolyte or an adsorbent (Kayexalate™) with a cathartic (sorbitol) was investigated in 18 dogs who had been given 250 mg kg -1 paraquat dichloride via a jejunal tube to eliminate the influence of gastric absorption.

2 Plasma paraquat concentrations 2 and 3 h after the initiation of bowel irrigation and at the end of the study (5 h later) were significantly lower in the bowel irrigation groups than in the control (no bowel irrigation) group.

3 The total body clearances of paraquat in the bowel irrigation groups were significantly greater than in the control group.

4 There were no significant differences between the two different irrigation solution groups in plasma paraquat concentration, the area under the plasma concentration time curve and the total body clearance.

5 In the PEG with electrolyte group, about 70% of the administered dose of paraquat was removed by means of bowel irrigation (n=4).

6 The adjunction of the adsorbent had no beneficial effects.

7 Haemodynamic changes associated with whole bowel irrigation were unremarkable except that right atrial and pulmonary arterial pressures were elevated in the latter part of the study.

Traditional and ankle-specific vertical jumps as strength-power indicators for maximal sprint acceleration

AIM

This study aimed to determine the demand of strength-power capabilities represented by traditional and ankle-specific vertical jump modalities ‑ squat jump (SJ), counter-movement jump (CMJ), rebound-continuous jump (RJ), rebound-continuous ankle jump (AJ) ‑ relative to sprint acceleration ability during the entire acceleration phase of maximal sprint.

METHODS

Nineteen male sprinters performed a 60-m maximal sprint and various vertical jumps. Correlation coefficients among the vertical jump performances and between those and the 60-m sprint time and sprint acceleration at each step were calculated.

RESULTS

There were significant relationships between the 60-m sprint time and SJ height, CMJ height, AJ height, and AJ index. AJ height and index had no correlation with any other jump variables. Acceleration was significantly correlated with SJ height from the 6th to the 10th steps (r=0.48-0.51) and with CMJ height from the 5th to the 11th steps (r=0.46-0.54). Acceleration was also correlated with the AJ index from the 14th to the 19th steps (r=0.48-0.54). Acceleration had no correlation with the RJ index at any step.

CONCLUSION

The results suggest that the AJ allows assessment of different reactive strengths compared with traditional jump modalities. To accelerate effectively, the explosive strengths of the SJ and CMJ are important during the early stage of acceleration (from 6.6±0.4 to 17.5±0.8 m), and the reactive strength represented by the AJ is necessary during the later stage of acceleration (from 23.4±1.0 to 33.7±1.4 m). Sprinters and coaches should be aware of the different demands of strength-power capability for effective acceleration.

Effects of walking combined with restricted leg blood flow on mTOR and MAPK signalling in young men

Walking combined with blood flow reduction (BFR-walk) elicits muscle hypertrophy. However, the skeletal muscle intracellular signalling behind this response is currently unknown.

AIM

To investigate the effects of BFR-walk on mechanistic target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK) signalling pathways in young men.

METHODS

Six young men performed 20 min of treadmill walking at 55% of their predetermined maximum oxygen uptake. A pressure cuff belt was applied to the most proximal thigh of only one leg (BFR-Leg, external compression was 240 mmHg), whereas the other leg (CON-Leg) was without BFR during walking. Muscle biopsies were taken from the vastus lateralis of the CON-Leg before exercise and in both legs 3 h after exercise.

RESULTS

Erk1/2 phosphorylation levels were significantly (P < 0.05) increased after exercise in both legs; however, only the BFR-Leg saw an increased phosphorylation of p38. For mTOR signalling, there were no changes in Akt, mTOR or S6K1 phosphorylation levels before or after walking. However, eEF2 phosphorylation level was significantly (P < 0.05) lower for the BFR-Leg 3 h after walking compared with CON-Leg.

CONCLUSION

BFR-walk exercise may activate some intracellular signalling cascades that are associated with muscle hypertrophy in young men.

Association of acceleration with spatiotemporal variables in maximal sprinting

This study clarified the association between acceleration and the rates of changes in spatiotemporal variables on a step-to-step basis during the entire acceleration phase of maximal sprinting. 21 male sprinters performed a 60-m sprint, during which step-to-step acceleration and rates of changes in step length (RSL) and step frequency (RSF) were calculated. The coefficients of correlation between acceleration and other variables were tested at each step. There were positive correlations between acceleration and the RSF up to the second step. Acceleration was positively correlated with the RSL from the 5(th) to the 19(th) step. At the third and from the 16(th) to the 22(nd) step and from the 20(th) to the 21(st) step, there was no significant correlation, but weak relationships were found between acceleration and the RSF and RSL. The results suggest that the acceleration phase can be divided into 3 sections, and for sprinting to be effective, it is important to accelerate by increasing the step frequency to the third step, increasing the step length from the 5(th) to the 15(th) step, and increasing the step length or frequency (no systematic relative importance of step length or frequency) from the 16(th) step in the entire acceleration phase.

Effect of NS-018, a selective JAK2V617F inhibitor, in a murine model of myelofibrosis

A single somatic mutation, V617F, in Janus kinase 2 (JAK2) is one of the causes of myeloproliferative neoplasms (MPNs), including primary myelofibrosis, and the JAK2V617F mutant kinase is a therapeutic target in MPN. However, inhibition of wild-type (WT) JAK2 can decrease the erythrocyte or platelet (PLT) count. Our selective JAK2 inhibitor, NS-018, suppressed the growth of Ba/F3 cells harboring JAK2V617F more strongly than that of cells harboring WT JAK2. The 4.3-fold JAK2V617F selectivity of NS-018 is higher than the 1.0- to 2.9-fold selectivity of seven existing JAK2 inhibitors. NS-018 also inhibited erythroid colony formation in JAK2V617F transgenic mice at significantly lower concentrations than in WT mice. In keeping with the above results, in a JAK2V617F bone marrow transplantation mouse model with a myelofibrosis-like disease, NS-018 reduced leukocytosis and splenomegaly, improved bone marrow fibrosis and prolonged survival without decreasing the erythrocyte or PLT count in the peripheral blood. By exploring the X-ray co-crystal structure of NS-018 bound to JAK2, we identified unique hydrogen-bonding interactions between NS-018 and Gly993 as a plausible explanation for its JAK2V617F selectivity. These results suggest that NS-018 will have therapeutic benefit for MPN patients through both its efficacy and its reduced hematologic adverse effects.

Heat stress activates the Akt/mTOR signalling pathway in rat skeletal muscle

AIM

It is well known that various stimuli, such as mechanical stress and nutrients, induce muscle hypertrophy thorough the Akt/mTOR signalling pathway, which is a key mediator of protein synthesis and hypertrophy in skeletal muscle. It was recently reported that heat stress also induces an increase in muscle weight and muscle protein content. In addition, heat stress enhances Akt/mTOR signalling after one bout of resistance exercise. However, it remains unclear whether increased temperature itself stimulates the Akt/mTOR signalling pathway.

METHODS

Forty-two male Wistar rats (279.5 ± 1.2 g) were divided into a control group (CON) or one of five thermal stress groups at 37, 38, 39, 40 or 41 °C (n = 7 each group). After overnight fasting, both legs were immersed in different temperatures of hot water for 30 min under sodium pentobarbital anaesthesia. The soleus and plantaris muscles were immediately removed from both legs after the thermal stress.

RESULTS

The phosphorylation of mTOR or 4E-BP1 and heat shock protein (HSP) expression levels were similar among groups in both the soleus and plantaris muscles. However, Akt and p70S6K phosphorylation significantly increased at 41 °C in the soleus and plantaris muscles. Moreover, we observed a temperature-dependent increase in Akt and p70S6K phosphorylation in both muscles.

CONCLUSION

Our data indicate that the altered temperature increased phosphorylation in a temperature-dependent manner in rat skeletal muscle and may itself be a key stimulator of Akt/mTOR signalling.

Effect of lidocaine on dynamic changes in cortical reduced nicotinamide adenine dinucleotide fluorescence during transient focal cerebral ischemia in rats

Rats were subjected to 90min of focal ischemia by occluding the left middle cerebral and both common carotid arteries. The dynamic changes in the formation of brain ischemic areas were analyzed by measuring the direct current (DC) potential and reduced nicotinamide adenine dinucleotide (NADH) fluorescence with ultraviolet irradiation. In the lidocaine group (n=10), 30min before ischemia, an intravenous bolus (1.5mg/kg) of lidocaine was administered, followed by a continuous infusion (2mg/kg/h) for 150min. In the control group (n=10), an equivalent amount of saline was administered. Following the initiation of ischemia, an area of high-intensity NADH fluorescence rapidly developed in the middle cerebral artery territory in both groups and the DC potential in this area showed ischemic depolarization. An increase in NADH fluorescence closely correlated with the DC depolarization. The blood flow in the marginal zone of both groups showed a similar decrease. Five minutes after the onset of ischemia, the area of high-intensity NADH fluorescence was significantly smaller in the lidocaine group (67% of the control; P=0.01). This was likely due to the suppression of ischemic depolarization by blockage of voltage-dependent sodium channels with lidocaine. Although lidocaine administration did not attenuate the number of peri-infarct depolarizations during ischemia, the high-intensity area and infarct volume were significantly smaller in the lidocaine group both at the end of ischemia (78% of the control; P=0.046) and 24h later (P=0.02). A logistic regression analysis demonstrated a relationship between the duration of ischemic depolarization and histologic damage and revealed that lidocaine administration did not attenuate neuronal damage when the duration of depolarization was identical. These findings indicate that the mechanism by which lidocaine decreases infarct volume is primarily through a reduction of the brain area undergoing NADH fluorescence increases which closely correlates with depolarization.

Detection of RB, p16/CDKN2 and p15(INK4B) gene alterations with immunohistochemical studies in human prostate carcinomas

To examine the status of cell cycle-inhibitory genes in human prostate carcinoma, we investigated alterations of RE (retinoblastoma), p16/CDKN2 and p15(INK4B) genes in 32 adenocarcinomas with immunohistochemistry. PCR-single-strand conformation polymorphism (SSCP) was used to examine all 27 exons of the RE gene, exons 1 to 3 of the p16/CDKN2 gene and exons 1 and 2 of the p15(INK4B) gene for mutations. Loss of heterozygosity (LOH) for the RE gene was probed by restriction fragment length polymorphism (RFLP) analysis. In addition, coordinate samples were subjected to immunohistochemical studies for reactivity to RE and p16 protein. The RE gene alterations were detected in 5 of the 32 tumors (16%); of these, only one mutation, a missense substitution, occurred within an exon. The remaining four single base insertions or deletions were found within introns of the RE gene and no mutational event was detected in its promoter region. LOH involving intron 17 of RB was detected in three cases of 10 informative tumors (30%). Intragenic mutations were also present in 3 of the 32 tumors in the p16/CDKN2 gene. In contrast, no mutational events were found in the p15(INK4B) gene in the tumors. Only one tumor had both a p16/CDKN2 mutation and LOH of the RE gene. Expression of pRB was absent or reduced in 16 cancers, while p16 expression was present in all cases to varying degrees. The results suggest that p16/CDKN2 gene mutations occur rarely and intragenic mutation, but not LOH,of the RE gene is not required in prostatic tumorigenesis.

Satellite cell pool enhancement in rat plantaris muscle by endurance training depends on intensity rather than duration

AIM

Increases in the number of satellite cells are necessary for the maintenance of normal muscle function. Endurance training enhances the satellite cell pool. However, it remains unclear whether exercise intensity or exercise duration is more important to enhance the satellite cell pool. This study examined the effects of different intensity and duration of endurance training on the satellite cell pool in rat skeletal muscle.

METHODS

Forty-one 17-week-old female Sprague-Dawley rats were assigned to control (n = 8), high intensity and high duration (n = 7), high intensity and low duration (n = 8), low intensity and high duration (n = 9) and low intensity and low duration (n = 9) groups. Training groups exercised 5 days per week on a motor driven treadmill for 10 weeks. After the training period, animals were anaesthetized and the plantaris muscles were removed, weighed and analysed for immunohistochemical and histochemical properties.

RESULTS

Although no significant differences were found in muscle mass, mean fibre area and myonuclei per muscle fibre between all groups, the percentage of satellite cells was significantly higher in the high-intensity groups than in the other groups (P < 0.05).

CONCLUSION

Increases in the satellite cell pool of skeletal muscle following endurance training depend on the intensity rather than duration of exercise.

The apelin/APJ system induces maturation of the tumor vasculature and improves the efficiency of immune therapy

Immature and unstable tumor vasculature provides an aberrant tumor microenvironment and leads to resistance of tumors to conventional therapy. Hence, normalization of tumor vessels has been reported to improve the effect of immuno-, chemo- and radiation therapy. However, the humoral factors, which can effectively induce maturation of tumor vasculature, have not been elucidated. In this study, we found that the novel peptide apelin and its receptor APJ can induce the morphological and functional maturation of blood vessels in tumors. This apelin-induced tumor vascular maturation enhances the efficacy of cancer dendritic cell-based immunotherapy and significantly suppresses tumor growth by promoting the infiltration of invariant natural killer T cells into the central region of the tumor and thereby robustly inducing apoptosis of tumor cells. Additionally, we showed APJ expression to be enhanced in the tumor endothelium in comparison with normal-state endothelial cells. These findings provide a new target for tumor vascular-specific maturation, which is expected to improve the efficacy of conventional cancer therapies.

Effects of ageing and endurance exercise training on alpha-actinin isoforms in rat plantaris muscle

AIM

We recently reported that α-actinin adaptation occurs at the isoform level. This study was undertaken to clarify the effects of: (1) ageing-induced shift of myosin heavy chain (MyHC) composition and (2) endurance exercise training on α-actinin isoforms in rat plantaris muscle.

METHODS

Adult (18 mo) and old (28 mo) male Fischer 344 rats were assigned to either sedentary control or endurance exercise training groups. Animals in the training groups ran on a treadmill for 8 week with training intensity adjusted to be equal for adult and old groups. After the training was completed, the plantaris muscles were taken for analyses of α-actinin-2, α-actinin-3, and MyHC composition and metabolic enzyme activities.

RESULTS

The proportion of type IIb MyHC was lower, and that of type I MyHC was higher in old animals than in adult animals. α-actinin-3 was significantly lower in old animals than in adult animals. No significant difference was found in α-actinin-2 and citrate synthase (CS) activity between adult and old animals. Citrate synthase activity was higher in trained animals than in sedentary animals. Endurance training produced a fast-to-slow shift within type II MyHC isoforms in both adult and old animals. α-actinin-2 was significantly higher in trained animals than in sedentary animals. No significant difference was found in α-actinin-3 between trained and sedentary animals.

CONCLUSION

These results support the α-actinin adaptation at the isoform level and show that the α-actinin-3 expression depends on the amount of type II MyHC, whereas α-actinin-2 expression is associated with improvement of muscular aerobic capacity.

High susceptibility to severe infectious complications at reinduction chemotherapy in patients who relapse after stem cell transplantation

Patients who relapse after stem cell transplantation (SCT) usually appear to be liable to severe infectious complications at reinduction chemotherapy compared to patients at the first induction therapy, though this is not statistically substantiated. The aim of this study was to analyze episodes of infectious complications during reinduction chemotherapy among patients who relapsed after SCT compared with those at the first induction chemotherapy. Between February 1988 and March 2004, 145 children received SCT, and 17 (12 with hematologic malignancies and 5 with solid tumors) were enrolled as eligible subjects for this study. Positive blood cultures (sepsis) were present in six patients exclusively at the reinduction therapy but none at the first induction (P = .009). Three of the six patients progressed to septic shock. Moreover, all patients positive for blood cultures were those with hematologic malignancy (P = .007), and every patient with septic shock had received allogenic transplantation. Our results showed that reinduction chemotherapy needs attention for severe infectious complications, particularly among patients with hematologic malignancies receiving allogenic transplantations. Possible immaturity of the reconstructed systemic immune system and/or insufficient recovery of mucosal protective functions in the patients after SCT are discussed in view of their high susceptibility to severe infectious complications.

Different adaptations of alpha-actinin isoforms to exercise training in rat skeletal muscles

AIM

Alpha (alpha)-actinins are located in the skeletal muscle Z-line and form actin-actin cross-links. Mammalian skeletal muscle has two isoforms: alpha-actinin-2 and alpha-actinin-3. However, the response of alpha-actinin to exercise training is little understood. Therefore, the current study examined the effects of exercise training on the expression level of two alpha-actinin isoforms in skeletal muscles.

METHODS

Twelve male Wistar rats were assigned randomly to a control (C; n = 6) or exercise training (T; n = 6) group. After T animals were trained on an animal treadmill for 9 weeks, alpha-actinin-2 and alpha-actinin-3 levels in the plantaris, white and red gastrocnemius muscles were analysed. In addition, changes in the myosin heavy chain (MyHC) composition were assessed, and muscle bioenergetic enzyme activities were measured.

RESULTS

Results show that exercise training increased alpha-actinin-2 expression levels in all muscles (P < 0.05). However, no significant difference was found in alpha-actinin-3 expression levels between C and T animals. Subsequent MyHC analyses of all muscle showed an MyHC shift with direction from IIb to IIa. Furthermore, enzymatic analysis revealed that exercise training improved enzyme activities related to aerobic metabolism.

CONCLUSION

The results of this study demonstrate that exercise training alters the expression level of alpha-actinin at the isoform level. Moreover, the increase in expression levels of alpha-actinin-2 is apparently related to alteration of skeletal muscle: its aerobic capacity is improved.

Phase II trial of adjuvant hyperthermic intraperitoneal chemotherapy with three drugs for the prophylactic treatment of carcinomatosis after resection of advanced gastric cancer

e15588

Background: This prospective study was performed to assess the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) with three drugs in patients with curative resection of T3 or T4 advanced gastric cancer. Methods: Patients with curative resection of clinically T3 or T4 advanced gastric cancer were required to be under 75 years of age and to have adequate organ function. After the curative resection of gastric cancer with D2 lymph node dissection and the reconstruction of the alimentary tract, HIPEC was carried out for 30 minutes with 50mg of CDDP, 10mg of MMC, and 1000mg of 5-FU in 5 L saline maintained at 42–43°C. Patients were given an adjuvant S-1 treatment after surgery. Primary endpoint of this study was overall survival. Results: A total of 29 patients were eligible. Pathologically, 8 patients had sub-serosal invasion (pT2(ss)), 18 patients had serosal invasion (pT3), and 3 patients had adjacent organ invasion (pT4). These patients included pT2(ss)pN0 (n=2), pT2(ss)pN1 (n=6), pT3pN0 (n=4), pT3pN1 (n=9), pT3pN2 (n=5), pT4pN0 (n=1), and pT4pN1 (n=2). Median follow-up period was 44 months (10–72 months). Overall 5- year survival rate in all eligible patients was 89.5%. Overall 5-year survival rate in patients with pT2(ss), pT3, or pT4 was 100%, 82.4%, or 100%, respectively. Three patients with pT3 had recurrence of pleural dissemination (n=1), lymph node metastases (n=1), or pulmonary metastases and peritoneal dissemination (n=1). A total of 7 patients had postoperative complications such as continuous pancreatic juice secretion (13.8%), abdominal abscess (10.3%), leakage of the anastomosis (3.4%), and pulmonary insufficiency (10.3%). Conclusions: The present study suggests that HIPEC with three drugs after curative resection of advanced gastric primary cancer is associated with improved overall survival with an acceptable morbidity.

No significant financial relationships to disclose.

Regenerating gene 1α (REG 1α) expression and new treatment strategies in early non-small cell lung cancer

e22178

Background: Regenerating gene (REG) I was originally isolated as an endogenous growth factor from pancreatic islet β cells. REG Iα protein is suggested to be involved in carcinogenesis in various gastroenterologic tissues. In the present study, to elucidate roles for REG Iα in non-small cell lung cancer (NSCLC), we investigated REG Iα expression in NSCLCs, focusing especially on its relationship with prognosis. Methods: We enrolled 70 NSCLCs (adenocarcinoma (AC)(n=48) and squamous cell carcinoma (SCC)(n=22)) who received surgery at Nara Medical University Hospital. Total RNA was extracted from each tumor tissue and corresponding normal lung tissue (NL)(n=70), cDNA was then reverse-transcribed from total RNA, and quantitative real-time reverse transcriptase-polymerase chain reaction was then carried out. The expression level of REG Iα in each sample was normalized with respect to that of β-actin, and the cutoff level was set at average+3SD expression of the 70 NLs. We also examined the relationship between REG 1α expression in the tumor tissue and the prognosis. Results: Six (12.5%) of the 48 ACs and 5 (22.7%) of the 22 SCCs were positive for REG Iα gene, and which is higher than that of NLs (2 of 70: 2.9%). After median follow-up of 26.2 months, 12 patients died due to disease progression. The survival rate among the REG 1α positive patients was significantly worse than among the REG 1α negative patients in ACs (P<0.05), and not significantly but worse in SCCs (P=0.07). In case of stage I, none of REG 1α negative patient died in both ACs and SCCs compared with 4 patients died of positive patients (AC:2, SCC:2), and also the survival rate among the REG 1α positive patients was significantly worse than among the negative patients in ACs (P<0.01) and SCCs (P<0.05). Disease free survival of REG 1α positive patients was also worse than negative patients in ACs (P<0.05) and SCCs (P=0.16). Conclusions: REG Iα expression in NSCLCs may be the risk factor for poor prognosis, and we anticipate that it will enable us to provide more appropriate and individualized treatment to patients of early NSCLC.

No significant financial relationships to disclose.

Identification of the distal dural ring with use of fusion images with 3D-MR cisternography and MR angiography: application to paraclinoid aneurysms

BACKGROUND AND PURPOSE

The distal dural ring (DDR) represents the anatomic border between the extradural and intradural internal carotid arteries (ICAs). The purpose of this study was to examine whether 3D-MR cisternography and MR angiography (MRA) fusion images can identify the boundary between the CSF and the cavernous sinus, which might represent the DDR.

MATERIALS AND METHODS

Thirty-six consecutive patients with 39 ICA aneurysms were examined with use of MR fusion images with 3D-cisternography and MRA on a 1.5T unit. Two neuroradiologists evaluated the configuration of the carotid cave and the location of the aneurysms on fusion images and classified them as intradural, transdural, and extradural aneurysms.

RESULTS

The borderline between the CSF and the cavernous sinus was visualized on fusion images in all patients. The carotid cave configuration in 72 ICAs was classified as having no dent (n = 31), a shallow dent (n = 27), and a deep dent (n = 14). The MR fusion images led to the classification of 39 ICA aneurysms as 21 intradural, 6 transdural, and 12 extradural. The interobserver agreement of MR fusion images was excellent (kappa = 0.80).

CONCLUSIONS

Fusion images with 3D-cisternography and MRA yielded clear visualization of the boundary between the suprasellar cistern and cavernous sinus indicating the DDR. This imaging technique may provide additional information in consideration of a treatment option for paraclinoid aneurysms.

Subtraction 3D CT angiography with the orbital synchronized helical scan technique for the evaluation of postoperative cerebral aneurysms treated with cobalt-alloy clips

BACKGROUND AND PURPOSE

CT angiography (CTA) has been used for the evaluation of intracranial aneurysms and recently has been applied to assess postoperative aneurysms treated with titanium-alloy clips. We investigated the clinical usefulness of subtraction CTA by using the orbital synchronized helical scan technique (OSHST) for evaluating intracranial aneurysms surgically treated with cobalt-alloy clips.

MATERIALS AND METHODS

We scanned an agar gel phantom with a cobalt-alloy clip mounted in the center by using subtraction CT with and without OSHST. Eighteen patients (20 aneurysms) who underwent surgery with cobalt-alloy clips were postoperatively evaluated with subtraction CTA with OSHST, and the results were compared with those from digital subtraction angiography. Two neuroradiologists independently evaluated the 3D CTA images and source images with and without subtraction for the presence of residual flow in the aneurysm and stenotic change in parent or neighboring arteries.

RESULTS

For the phantom study, significantly fewer artifacts from clips were noted on images obtained by using subtraction CT with OSHST than on those obtained without OSHST. For the clinical study, subtraction CTA with OSHST also showed fewer clip artifacts than did conventional CTA. Image quality was poor, and we were unable to diagnose residual neck for 5% (1/20) with subtraction CTA with OSHST and 75% (15/20) with conventional CTA. For evaluation of adjacent vessels, image quality was poor for none (0/20) with subtraction CTA with OSHST and for 55% (11/20) with conventional CTA. For subtraction CTA with OSHST, sensitivity in detecting residual neck was 1.0, and specificity was 0.94. For conventional CTA, sensitivity and specificity were both 0.25.

CONCLUSIONS

OSHST is a useful technique for subtracting cobalt-alloy clips, and subtraction CTA with OSHST is available for evaluating aneurysms after clipping with cobalt-alloy clips.

[Coronary artery bypass grafting for simultaneous subacute stent thrombosis after sirolimus-eluting stent implantation]

An 82-year-old man developed simultaneous stent thrombosis 11 days after the implantation of a sirolimus-eluting stent (SES) in the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The patient immediately underwent percutaneous coronary intervention; however, his condition became critical due to the development of recurrent stent thrombosis, and emergent coronary artery bypass grafting with saphenous vein grafts was performed. Postoperative angiography showed good patency of both grafts; thrombus formation in the LAD and RCA was negative. Since the patient had a history of liver dysfunction due to ticlopidine administration, the thienopyridine derivative was not administered; this was believed to be the main cause of subacute stent thrombosis. He was administered aspirin, cilostazol, and sarpogrelate instead. A good postoperative course was achieved only using aspirin. This case demonstrates that simultaneous SES thrombosis in multivessel lesions poses a life-threatening situation.

Acute coronary artery dilation due to Kawasaki disease and subsequent late calcification as detected by electron beam computed tomography

We wanted to clarify the relationships between the degree of acute coronary artery dilation caused by Kawasaki disease and subsequent late calcification. Electron beam computed tomography (EBCT) was used to study 79 patients who had previously undergone selective coronary angiograms less than 100 days after the onset of Kawasaki disease. The EBCT was performed using an Imatron C-150 with a 100-ms exposure time and consecutive images at 6-mm intervals. The interval from the onset of Kawasaki disease to EBCT ranged from 2 to 242 months (median, 103 months). The maximum diameters of the right coronary, the left anterior descending, and the left circumflex arteries, as well as the bifurcation of the left coronary artery were measured in the initial coronary angiograms. A total of 250 branches, including 53 left coronary arteries, were measured, and the relationship between the degree of the initial coronary artery dilation and subsequent calcification in the branches and left coronary artery was analyzed. The coronary arterial diameter of all branches that eventually calcified was 6 mm or greater. The incidence of calcification in branches measuring 6 mm or greater on the initial coronary angiogram was 12% at 5 years, 44% at 10 years, and 94% at 20 years (n = 141). Dilation greater than 6 mm is associated with a high probability of late calcification.

Comparison of Gd-DTPA-induced signal enhancements in rat brain C6 glioma among different pulse sequences in 3-Tesla magnetic resonance imaging

BACKGROUND

T1-shortening contrast media are routinely used in magnetic resonance (MR) examinations for the diagnosis of brain tumors. Although some studies show a benefit of 3 Tesla (T) compared to 1.5T in delineation of brain tumors using contrast media, it is unclear which pulse sequences are optimal.

PURPOSE

To compare gadopentetate dimeglumine (Gd-DTPA)-induced signal enhancements in rat brain C6 glioma in the thalamus region among different pulse sequences in 3T MR imaging.

MATERIAL AND METHODS

Five rats with a surgically implanted C6 glioma in their thalamus were examined. T1-weighted brain images of the five rats were acquired before and after Gd-DTPA administration (0.1 mmol/kg) using three clinically available pulse sequences (spin echo [SE], fast SE [FSE], fast spoiled gradient echo [FSPGR]) at 3T. Signal enhancement in the glioma (E(T)) was calculated as the signal intensity after Gd-DTPA administration scaled by that before administration. Pulse sequences were compared using the Tukey-Kramer test.

RESULTS

E(T) was 1.12+/-0.05 for FSE, 1.26+/-0.11 for FSPGR, and 1.20+/-0.11 for SE. FSPGR showed significantly higher signal enhancement than FSE and comparable enhancement to SE.

CONCLUSION

FSPGR is superior to FSE and comparable to SE in its ability to delineate rat brain C6 glioma in the thalamus region.

Preoperative visualization of the artery of Adamkiewicz by intra-arterial CT angiography

BACKGROUND AND PURPOSE

CT and MR angiographies have been reported to visualize the artery of Adamkiewicz (AKA) noninvasively to prevent spinal cord ischemia in surgery of thoracic descending aortic aneurysms. The purpose of this work was to compare the usefulness of CT angiography (CTA) with intra-arterial contrast injection (IACTA) with that of conventional CTA with intravenous contrast injection (IVCTA).

MATERIALS AND METHODS

We enrolled 32 consecutive patients with thoracic or thoracoabdominal aortic aneurysms who were scheduled for surgical repair or endovascular stent-graft treatment. All of the CTA images were obtained using a 16-detector row CT scanner and 100 mL of contrast material (370 mg/mL) injected at a rate of 5 mL/s. Contrast was injected via the antecubital veins of 15 patients and via a pig-tail catheter placed at the proximal portion of the descending aorta in 17 patients who underwent IVCTA and IACTA, respectively. Two datasets were reconstructed from 2 consecutive scans. The AKA was identified as a characteristic hairpin curved vessel in the anterior midsagittal surface of the spine and by the absence of further enhancement in the second rather than in the first phase. Continuity between the AKA and aorta was confirmed when the vessel could be traced continuously by paging the oblique coronal multiplanar reconstruction or original axial images.

RESULTS

Intra-arterial contrast injection was significantly more sensitive in identifying the AKA than IVCTA: 16 (94.1%) of 17 versus 9 (60.0%) of 15 (P = .033). Continuity between the AKA and aorta through intercostal or lumbar artery was confirmed in 14 (87.5%) of 16 and 5 (55.6%) of 9 of the IACTA and IVCTA groups, respectively.

CONCLUSION

Intra-arterial contrast injection detected the AKA at a high rate and verified continuity from the aorta to the AKA.

[Emergent coronary artery bypass grafting in a survivor of out-of-hospital cardiac arrest]

We report a case of emergent coronary artery bypass grafting (CABG) in a survivor of an out-of-hospital cardiac arrest. A 64-year-old male driver lost consciousness and collapsed in a rice paddy field. A bystander placed him in a car and immediately started cardiopulmonary resuscitation after confirming the presence of pulselessness and apnea. Emergency medical service providers performed a defibrillation of ventricular fibrillation by using an automated external defibrillator (AED), and the patient was transferred to the critical care center in our hospital. Coronary angiography revealed a thrombus in the left main trunk (LMT), total occlusion of the left anterior descending artery (LAD) and the right coronary artery (RCA), and 90% stenosis of the left circumflex artery (Cx). Since the patient recovered consciousness 1 hour after admission and did not undergo any critical trauma, an on-pump CABG was performed for 3 vessels. He was discharged on the postoperative day 23, and he resumed a normal life.