Two Cases of Acquired High-Density Lipoprotein Deficiency with Immunoglobulin G4-Related Lecithin-Cholesterol Acyltransferase Autoantibody.

Lecithin-cholesterol acyltransferase (LCAT) plays a significant role in the progression from premature to mature high-density lipoprotein (HDL) in circulation. Consequently, primary or secondary LCAT deletion or reduction naturally results in low serum HDL cholesterol levels. Recently, rare cases of acquired HDL deficiency with LCAT autoantibodies have been reported, mainly from Japan, where LCAT autoantibodies of immunoglobulin G (IgG) caused the HDL deficiency. Here to our knowledge, we report for the first time two cases of acquired HDL deficiency caused by IgG4 linked LCAT autoantibodies with or without a high serum IgG4 level. Furthermore, these cases can extend to a new concept of "IgG4 autoimmune disease" from the viewpoint of verifying the serum autoantibody and/or renal histopathology.

The fasting 13C-glucose breath test is a more sensitive evaluation method for diagnosing hepatic insulin resistance as a cardiovascular risk factor than HOMA-IR.

BACKGROUND: Although we previously reported the fasting 13C-glucose breath test (FGBT) was useful for the diagnosis of hepatic insulin resistance (IR), there has been no report in an actual clinical setting. We therefore performed the FGBT in patients with heart disease to assess the difference in the diagnostic ability of HIR between the FGBT and HOMA-IR; we also assessed the relationship between the FGBT and known cardiovascular risk factors. METHODS: Two hundred patients (100 with ischemic heart disease [IHD], 50 with non-ischemic heart disease [NIHD], and 50 with non-cardiac lifestyle-related disease [NCD]) participated in this study. The data of 40 healthy volunteers [HV] was obtained in our previous study. We evaluated the 13C excretion rate at 120 min (C120) as the indicator of hepatic IR in the FGBT. RESULTS: The value of C120 in each disease group was significantly lower than in HV, but the HOMA-IR in the IHD and NCD groups was not significantly different from that in HV. The value of C120 significantly correlated with known cardiovascular risk factors. CONCLUSIONS: These results indicated the FGBT is more sensitive than HOMA-IR for evaluating hepatic IR as a cardiovascular risk factor and is likely useful for managing patients to prevent cardiovascular disease.

Effects of Mokuboito, a Japanese Kampo medicine, on symptoms in patients hospitalized for acute decompensated heart failure - A prospective randomized pilot study.

BACKGROUND: Although standard treatment for heart failure (HF) has been established, it remains difficult to relieve HF-associated symptoms in some patients. Kampo medicines have been used to treat various diseases; however, it remains unclear whether they are effective in HF patients. We therefore performed a prospective, randomized, controlled trial to investigate whether Mokuboito, a Kampo medicine, affected symptoms and other parameters in hospitalized patients with acute decompensated HF (ADHF), as compared to standard therapy alone. METHODS: Forty patients were allocated randomly to Group S (standard therapy alone) or Group M (oral administration of Mokuboito plus standard therapy). The primary outcome was changes in global clinical status based on a visual analog scale (VAS) from baseline at day 10 or discharge if earlier. RESULTS: The decrease in VAS score was significantly greater in Group M than Group S (p=0.001). Although there were no differences between the groups in changes in the secondary endpoints of body weight, peripheral edema, biochemical and echocardiographic parameters, left ventricular end-diastolic diameter, and serum total bilirubin levels were significantly reduced in Group M (p=0.038; 0.002, respectively) but not in Group S, implying that Mokuboito might attenuate organ congestion and cardiac preload. CONCLUSIONS: Oral administration of Mokuboito significantly improved ADHF-related symptoms. Our observations might provide the basis for a novel therapeutic strategy in hospitalized patients with ADHF.

Asynchrony between Antarctic temperature and CO2 associated with obliquity over the past 720,000 years.

The δD temperature proxy in Antarctic ice cores varies in parallel with CO2 through glacial cycles. However, these variables display a puzzling asynchrony. Well-dated records of Southern Ocean temperature will provide crucial information because the Southern Ocean is likely key in regulating CO2 variations. Here, we perform multiple isotopic analyses on an Antarctic ice core and estimate temperature variations at this site and in the oceanic moisture source over the past 720,000 years, which extend the longest records by 300,000 years. Antarctic temperature is affected by large variations in local insolation that are induced by obliquity. At the obliquity periodicity, the Antarctic and ocean temperatures lag annual mean insolation. Further, the magnitude of the phase lag is minimal during low eccentricity periods, suggesting that secular changes in the global carbon cycle and the ocean circulation modulate the phase relationship among temperatures, CO2 and insolation in the obliquity frequency band.

State dependence of climatic instability over the past 720,000 years from Antarctic ice cores and climate modeling.

Climatic variabilities on millennial and longer time scales with a bipolar seesaw pattern have been documented in paleoclimatic records, but their frequencies, relationships with mean climatic state, and mechanisms remain unclear. Understanding the processes and sensitivities that underlie these changes will underpin better understanding of the climate system and projections of its future change. We investigate the long-term characteristics of climatic variability using a new ice-core record from Dome Fuji, East Antarctica, combined with an existing long record from the Dome C ice core. Antarctic warming events over the past 720,000 years are most frequent when the Antarctic temperature is slightly below average on orbital time scales, equivalent to an intermediate climate during glacial periods, whereas interglacial and fully glaciated climates are unfavourable for a millennial-scale bipolar seesaw. Numerical experiments using a fully coupled atmosphere-ocean general circulation model with freshwater hosing in the northern North Atlantic showed that climate becomes most unstable in intermediate glacial conditions associated with large changes in sea ice and the Atlantic Meridional Overturning Circulation. Model sensitivity experiments suggest that the prerequisite for the most frequent climate instability with bipolar seesaw pattern during the late Pleistocene era is associated with reduced atmospheric CO2 concentration via global cooling and sea ice formation in the North Atlantic, in addition to extended Northern Hemisphere ice sheets.

Sulphate-climate coupling over the past 300,000 years in inland Antarctica.

Sulphate aerosols, particularly micrometre-sized particles of sulphate salt and sulphate-adhered dust, can act as cloud condensation nuclei, leading to increased solar scattering that cools Earth's climate. Evidence for such a coupling may lie in the sulphate record from polar ice cores, but previous analyses of melted ice-core samples have provided only sulphate ion concentrations, which may be due to sulphuric acid. Here we present profiles of sulphate salt and sulphate-adhered dust fluxes over the past 300,000 years from the Dome Fuji ice core in inland Antarctica. Our results show a nearly constant flux of sulphate-adhered dust through glacial and interglacial periods despite the large increases in total dust flux during glacial maxima. The sulphate salt flux, however, correlates inversely with temperature, suggesting a climatic coupling between particulate sulphur and temperature. For example, the total sulphate salt flux during the Last Glacial Maximum averages 5.78 mg m(-2) yr(-1), which is almost twice the Holocene value. Although it is based on a modern analogue with considerable uncertainties when applied to the ice-core record, this analysis indicates that the glacial-to-interglacial decrease in sulphate would lessen the aerosol indirect effects on cloud lifetime and albedo, leading to an Antarctic warming of 0.1 to 5 kelvin.

Organic acids and aldehydes in throughfall and dew in a Japanese pine forest.

We analyzed low molecular weight organic acids and aldehydes in throughfall under pine forest, and organic acids in dew on chemically inert surfaces and pine needle surfaces at urban- and mountain-facing sites of pine forest in western Japan. Low molecular weight organic acids and aldehydes accounted for less than 5% of the dissolved organic carbon in throughfall at both sites. Formaldehyde at both sites and formate at the mountain-facing site were found at significantly lower concentrations in throughfall than in rainfall, which may be explained by the degradation and/or retention of these components by the pine canopy as the incident precipitation passed through it. The oxalate concentration in throughfall was significantly higher than those in rainfall at both sites, suggesting that oxalate was derived from leaching from the pine foliage. At both sites, organic acid concentrations were higher in dew on the pine needles than in throughfall or dew on chemically inert surfaces. This could be due to the long contact time of dew on pine needles, during which leached substances from pine needles and dry deposits accumulated on their surfaces can dissolve into the small volume of dew. The role of enhanced concentrations of oxalate in an aqueous phase on the plant surfaces (e.g., dew) is discussed in relation to hydroxyl radical formation via the photo-Fenton reaction.

Rescue percutaneous thrombectomy system provides better angiographic coronary flow and does not increase the in-hospital cost in patients with acute myocardial infarction.

In acute myocardial infarction (AMI), slow flow (

[A case of basilar artery occlusion of traumatic vertebral artery dissection successfully managed by endovascular treatment].

The author describes a case of basilar artery occlusion caused by vertebral artery dissection with vertebral fracture. A 61-year-old man was admitted with neck pain after a traffic accident. His symptoms suddenly deteriorated and cerebral angiography revealed an occlusion of the right vertebral artery, and complete occlusion of the basilar artery. Local-arterial fibrinolysis with urokinase for basilar artery occlusion and angioplasty with the use of a self-expandable stent for the site of the vertebral artery dissection was performed, and the basilar artery was partially recanalized. The patient's symptoms gradually improved. It should be emphasized that in cases of acute cervical spine injury after major trauma, vertebral artery dissection should be considered. Local-arterial fibrinolysis and angioplasty using a self-expandable stent was regarded as a useful treatment for basilar artery occlusion caused by vertebral artery dissection, in the acute stage.