Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation

Background

Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation.

Purpose

The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation.

Methods

From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV.

Result

Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002).

Conclusion

Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI.

Funding Acknowledgement

Type of funding source: None

Effect of intestinal helminthiasis on nutritional status of schoolchildren

This study was conducted in a rural agricultural area in Siniloan, Republic of the Philippines. The subjects were the school children. The nutritional status of 58 children infected with helminthiasis (Ascaris lumbricoides and Trichuris trichiura) was compared with that of 19 uninfected controls. Prevalence of Ascaris and Trichuris was 40.3% and 71.4% respectively, and 36.4% of infected children had both Ascaris and Trichuris infections. Statistically significant evidence of an adverse effect of helminthiasis on serum albumin levels was found, but no child had inadequate levels of other nutrients. Although helminthic infections increase the level of immunoglobulin E (IgE) in children endemically exposed to these parasites, there was no significant difference in the serum IgE among Ascaris or Trichuris infected groups in this study.

[Effects of low concentration of styrene monomer vapor on pregnancy]

To investigate the effects of exposure to styrene vapor on pregnancy, mice proved to be pregnant were exposed to 0, 2, 20 and 100 ppm styrene continuously for 24 hours during the period from day 0 to day 15 of gestation. A special small exposure chamber which can accurately maintain a constant low concentration of styrene vapor was made and used in the experiment. 1) In the 100 ppm group, hyperkinesis was presented in the chamber during the exposure period and inhibition of body weight gain was found (p < 0.01). No deaths occurred in any of the groups. 2) At necropsy of dams, no significant difference was found between the styrene exposed groups and the control group in any of the fertility indices, number of implantations, number of live fetuses, percentage of resorptions, or in the percentage of dead fetuses. The 100 ppm group showed lower fetal and placental weights (p < 0.01). 3) Gross necropsy of dams in the 100 ppm group showed significantly decreased adipose tissue. The liver, kidney and spleen weights were also low (p < 0.01). 4) When exposed to 100 ppm, which corresponds to 5 times the permissible concentration, i.e., 20 ppm, for 24 hours, non-pregnant dams showed no abnormality, while pregnant dams showed inhibition of body weight gain and significantly lower fetal and placental weights and maternal organ weights. Therefore, careful consideration should be given to exposure of women of childbearing age to styrene.

Itai-itai disease is not associated with polymorphisms of the estrogen receptor alpha gene

Itai-itai (or ouch-ouch) disease is a syndrome accompanied by bone mineral disorders, and which may be related to oral cadmium exposure. Itai-itai predominantly affects postmenopausal women with a history of multiple childbirths. Recently, it has been reported that polymorphisms of the estrogen receptor alpha (ERalpha) gene are associated with postmenopausal reduction of bone mineral density in Japanese women. However, estrogen receptors have never been studied in itai-itai disease. In this study, we examined the genotypic distributions of PvuII and XbaI restriction fragment length polymorphisms (RFLPs) of the ERalpha gene in patients with itai-itai disease and compared them with those of control subjects. The RFLPs are represented here as Pp (PvuII) and Xx (XbaI); the capital and small letters signify the absence and presence of restriction sites, respectively. The genotypic distributions of the patient group were: PP, 14.8%; Pp, 55.6%; pp, 29.6%; XX, 7.4%; Xx, 29.6%; and xx, 63.0%. These distributions were similar to those observed for the control groups, hence no pattern of genotypic distribution was observed that could be related to itai-itai disease. We conclude that RFLPs of the ERalpha gene may not be associated with itai-itai disease.

Dust concentration around the sites of demolition work after the Great Hanshin-Awaji Earthquake

The total dust concentration and the particle size distribution were determined around die sites of demolition associated with the Great Hanshin-Awaji Earthquake, which occurred on January 17, 1995. The total dust concentrations ranged from 0.20 to 0.23 mg/m(3), being about 1.2 to 2.2 times that in die non-demolition area, and intermediate particles (2.1-11.0μm) made up a large proportion of the dust. The dust concentrations were not influenced by the weather on the day preceding measurement around the sites of demolition of concrete buildings, whereas the values decreased to about half around die sites of demolition of wooden buildings, nearly the same concentration in the control areas, when it had rained on the previous day. The dust concentrations increased compared with that in an average year but to The degree of die upper limit of die environmental standard (1 hr-value<0.20 mg/m(3)) . The dust due to the smoke of Mt. Sakurajima in the surrounding areas accounted for a higher proportion of large particles (<11.0>m) than in the earthquake-devastated area. The concentration of respirable dust (<;7.07>m) in a worker engaged in demolition was 4.0 mg/m(3), being twice the recommended concentration (2 mg/m(3)) of the Japan Society for Occupational Health. It was thus considered that workers should use a respiratory protective device.

[Screening test by statistically reducing the number of the State-Trait Anxiety Inventory (STAI) items]

The purpose of the study is to find a method of mental examination which can be simply performed concurrently with physical examination during a regular check-up. On a regular check-up, the state-trait anxiety inventor (STAI) was administered to 264 construction workmen engaged in reconstruction work for the Hanshin Awaji Great Earthquake. Data on a total of 40 STAI items, i.e., 20 state anxiety (A-State) items and 20 trait anxiety (A-Trait) items were subjected to multiple regression analysis and five items were extracted from A-State and five from A-Trait items as a practical tool for a simple screening test. The contribution rates of the respective five items for the total score were 90.0% for A-State and 88.5% for T-State. The correlation coefficients, r, between predicted and observed values were 0.949 (p < 0.01) for A-State and 0.940 (p < 0.01) for A-Trait. Because of certain degrees of validity and reliability of each five-item system, it is considered that this method is useful as a simple screening test to roughly grasp the mental health of subjects and can be utilized for mental health care at offices.

Effect of cadmium administration and aging on the concentration of essential metals in liver and kidney

To investigate the changes in the concentration of essential metals in organs caused by exposure to cadmium (Cd) and by aging, Cd was administered subcutaneously in single doses of 0.3, 0.9 and 2.7 nig/kg to female rats 10 and 40 weeks of age. The animals were sacrificed on the 7th day after the administration. The concentration of Cd, zinc (Zn), copper (Cu), iron (Fe) and manganese (Mn) in the liver and the kidney was determined and the relations between the concentration of Cd and that of other metals were investigated.1) In 10-week-old rats, the amount of Cd accumulated in the liver and the kidney increased linearly with increasing doses of Cd, while in 40-week-old rats, suppressed accumulation of Cd in the liver and increased accumulation of Cd in the kidney were found after administration of the high dose.2) The concentration of Zn in the liver and the kidney both increased with increasing doses of Cd. There was no age-related difference.3) The concentration of Cu in the liver increased in the animals which received the intermediate and the high dose, irrespective of age. The concentration of Cu in the kidney showed no changes caused by Cd administration or by aging.4) The concentration of Fe in the liver increased in both 10-week-old and 40-week-old rats which received the high dose. The concentration was higher in 40-week-old rats than in 10-week-old rats. The Fe concentration in the kidney and the Mn concentration in the liver and the kidney was not affected by Cd administration or by aging.5) Discriminant analysis, by age, suggested that the amount of metals in the liver and the kidney was more likely to be affected by exposure to Cd in young individuals and less likely to be affected by exposure to Cd with the increase of age.

Effect of iron as a new type of phosphate binder in hemodialysis patients

Hyperphosphatemia is one of the major problems requiring management in the majority of hemodialysis patients and they require phosphate-binding agents to control the hyperphosphatemia. Aluminum hydroxide and calcium compounds are used currently as phosphate-binding agents to treat hyperphosphatemia, but these compounds can cause undesirable side effects. Therefore, the development of new phosphate-binding agents is imperative. It is well known that oral and intravenous administration of iron causes hypophosphatemia. We hypothesized that this side effect of iron may be beneficial for the treatment of hyperphosphatemia in hemodialysis patients. Consequently, we conducted a fundamental and clinical investigation of the effects of iron administration. Membrane permeability of phosphorus in a mixture of sodium ferrous citrate and dessicated aluminium hydroxide in the presence of hydrogenated lecithin as a phosporic compound was examined. Fifteen patients undergoing hemodialysis were treated with 150 mg of sodium ferrous citrate given orally for eight weeks. The permeability of the filtering membrane to phosphorus decreased in accordance with the dosage of sodium ferrous citrate and dessicated aluminum hydroxide. The degree of phosphate-binding effect of sodium ferrous citrate was larger than that of dessicated aluminum hydroxide. Serum phosphorus decreased significantly during the experiment. These results suggest that the oral administration of sodium ferrous citrate as a new phosphate binder is a useful therapeutic method for hemodialysis in patients with hyperphosphatemia.

Evidence for an increased intracellular free calcium concentration in platelets of bronchial asthma patients

The pathogenesis of bronchial asthma is not yet fully understood. Recently much attention has been given to the hypothesis that intracellular free calcium ([Ca2+]i) metabolism is abnormal in various diseases. In this study we investigated whether [Ca2+]i exists abnormally in subjects with bronchial asthma. The [Ca2+]i in 32 treated or untreated subjects with bronchial asthma were compared with 63 normal subjects. Resting levels of [Ca2+]i were estimated by loading the fluorescent indicator Fura-2 in washed platelets. The [Ca2+]i level in the control subjects was 129.7 +/- 18.0 nM (mean +/- SD). However, in that of the bronchial asthma patients was 152.7 +/- 44.1 nM, significantly higher than that of the control subjects (p < 0.05). It is well recognized that an increase of [Ca2+]i in vascular smooth muscle involves contraction. The findings suggest that the same phenomenon is quite possible in the tracheal smooth muscle and that it plays an important role in the pathogenesis of bronchial asthma.

Structural organization of the gene for CD40 ligand: molecular analysis for diagnosis of X-linked hyper-IgM syndrome

CD40 ligand (CD40L) on activated T cells plays a crucial role for Ig heavy-chain class switching and the mutation of the gene for this ligand in the X-chromosome causes immunodeficiency with hyper-IgM (X-HIM). We isolated and characterized the human genomic clone for CD40 L to obtain information about the transcriptional regulatory regions of the gene and to develop a molecular diagnostic method for X-HIM patients. The genomic DNA isolated was over 12 kb long containing 5 exons that cover full sequence of mRNA for the ligand. DNA motif analysis based on transcription factor database revealed the presence of a GATA 1 box at around -265 bp. The typical TATA box, CAT site or GC rich region was not found in the 5' flanking region. However, two possible TATA like sequences were found at around -27 and -136 bp. Using the oligonucleotide primers corresponding to the introns, we performed a PCR-SSCP analysis of each exon from a patient with X-HIM syndrome and detected abnormality in exon 5. When sequenced, dinucleotide deletion in this exon was found in the patient and in one X allele of his mother as the only different sequence from that of the control gene. This procedure is simple and could be used for diagnosis of the X-HIM syndrome.

[Changes in metal distribution in organs of cadmium-administered and copper-deficient rats]

To investigate the effect of Cu deficiency on the distribution of metals in organs when Cd was administered, 8-week-old female rats of the SD strain were fed a Cu-deficient diet (0.5 ppm Cu) or a basal diet (3.5 ppm Cu) and given 50 oral doses of 200 micrograms/rat of Cd. Then, the concentrations of Cd, Zn, Cu, Fe, Ca, Mn and Mg in each tissue were determined. In the Cu-deficient state, the serum Cu concentration was decreased and it was further decreased by Cd administration to about 1/4 of the normal value. The accumulation of Cd in the liver and kidney was increased by Cu deficiency. Cu deficiency caused decreases in the Cu concentration of the liver, kidney, brain, lung and pancreas. The administration of Cd caused additional remarkable decreases in the Cu concentration in the blood as well as in the hematopoietic organs, such as liver and spleen. Fe was increased by the Cu deficiency in the brain, heart, pancreas and muscle, though this increase was inhibited by Cd administration. The changes in tissue Fe were more greatly affected by Cd administration than by Cu deficiency. The Zn concentration was increased in the liver and kidney by Cd administration but was not affected by Cu deficiency. Mn, Ca and Mg concentrations showed no changes caused by Cu deficiency or Cd administration.

Increased frequency of non-insulin-dependent diabetes mellitus among narcoleptic patients

Forty-eight narcoleptic patients were randomly selected from a group of 197 narcoleptic outpatients, and a 50-g oral glucose tolerance test (OGTT) was performed. Blood glucose levels were determined by oximetry before and 30, 60, and 120 min after the glucose administration. Serum insulin concentrations (IRI) were determined by enzyme immunoassay, and an insulinogenic index (II) was calculated. (II = the ratio of IRI increment to blood glucose increment in 30 min following glucose load). From the results of the OGTT, six patients with definite diabetes mellitus (DM) were identified (12.5%, 4 men and 2 women) according to World Health Organization criteria (1980). The II of the DM patients was significantly low, with an average of 0.13 +/- 0.03. From recent data in the literature on the prevalence of DM in the general Japanese adult population (1.75-5.5%), it was concluded that the frequency of DM among our randomly selected narcoleptic patients was significantly increased. The positive results for diabetes in our six narcoleptic patients could not be attributed to obesity, because there was no difference between the obesity indices of DM and nonDM narcoleptic patients, nor was there a difference between the frequency of DM in obese and nonobese patients.

Microbial Resolution of α-Hydroxy Acids by Enantiospecifically Dehydrogenating Bacteria from Soil

Thirty-three bacterial strains were isolated from soil, utilizing optically asymmetric degradation of dl -2-hydroxy-4-methylpentanoic acid ( dl -HMPA) as the screening probe. Those strains were distributed in the following group and genera: Coryneform and Bacillus, Pseudomonas, and Streptomyces. Among them, the most potent strains, Bacillus freudenreichii NRS-137KH20B and Brevibacterium albidum NRS-130KH20B, could perform the resolution of more than 30 g of dl -HMPA per liter within 4 to 5 days of fermentation. Optically pure l - and d -HMPA enantiomers were obtained in more than 80% theoretical yield, whereas the transformed enantiomer was almost quantitatively recovered as 2-oxo-4-methyl-pentanoic acid in the culture broth. The enantiospecific dehydrogenation responsible for this resolution reaction had a rather wide substrate specificity on straight or branched aliphatic C 4 to C 16 2-hydroxy acids, exhibiting the optima at chain lengths of either C 7 or C 5 , although the enantiospecificity was not changed by chain length. The process was thus successfully extended to the preparation of optically pure C 5 to C 9 2-hydroxy acids.

Regio-Selective 10-Hydroxylation of Patchoulol, a Sesquiterpene, by Pithomyces Species

Of some 350 microorganisms screened, four strains of Pithomyces species were found to carry out regio-selective hydroxylation of patchoulol, a sesquiterpene, to 10-hydroxypatchoulol: Pithomyces sp. NRJ201, P. chartarum NRJ210, and, to a lesser extent, P. cynodontis ATCC 26150 and P. atro-olivaceus IFO 6651 were found to catalyze this reaction. A method has been developed by which 10-hydroxypatchoulol was obtained in 25 to 45% yields in 1- to 5-liter fermentation jars at 2 to 4 g of patchoulol per liter and isolated as pure material in 30% yields.

Stimulatory effect of chelating agents and mesoxalate on the in vivo release of insulin in the pancreas of the dog. The possible role of amino acids

Plasma ILA has been assayed in the blood of the pancreatic vein in dogs by measuring the fall in blood glucose level in hypophysectomized-adrenodemedullated rats. The infusion of EDTA, L-histidine, glycine and L-leucine into the pancreatic artery increased the ILA in the pancreatic effluent, the increase being most pronounced fifteen to thirty minutes after the cessation of a ten-minute infusion. No increase in the ILA was observed in the pancreatic vein draining the nonperfused pancreatic area. Mesoxalate stimulated the release of insulin, but its effect was not characteristic of the chelating agents with respect to time course of action. Vagotomy abolished the effect of both chelating agents and mesoxalate. These findings indicate the in vivo stimulation of the release of biologically active insulin by chelating agents and mesoxalate.

Effect of adrenal steroids on glucose kinetics in normal and diabetic dogs

The rates of endogenous glucose production, utilization, the amount of the intermixing glucose (“pool”) and the apparent distribution space were measured in conscious, trained normal and depancreatized dogs by the method of successive measured injections of tracer. During the intravenous infusion of hydrocortisone or methylprednisolone both the rates of glucose production and utilization fell in normal dogs. Since the same effect was obtained during the infusion of hydrocortisone in depancreatized dogs this effect of adrenal steroids does not seem to be due to an extra release of insulin.

In normal dogs, daily injections of 4 mg. per kilogram of methylprednisolone for one week significantly increased the rates of glucose production and utilization and also the amount of intermixing glucose and the apparent glucose space, without any significant change in the concentration of glucose in the blood plasma. Prolongation of methylprednisolone treatment for a second week caused a further increase in all four parameters again with no change in plasma glucose level. The intravenous infusion of glucose was found to diminish the rate of endogenous glucose production to the same degree before as after one week of methylprednisolone treatment. In diabetic dogs deprived of insulin, two daily injections of methylprednisolone increased the rate of glucose production and the plasma concentration but not the apparent distribution space of glucose. These experiments indicate that in dogs the homeostasis of plasma glucose level is maintained in spite of markedly increased gluconeo genesis if pancreatic function is unimpaired.