ITPKC and CASP3 polymorphisms and risks for IVIG unresponsiveness and coronary artery lesion formation in Kawasaki disease.

Functional single-nucleotide polymorphisms (SNPs) in inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) (rs28493229) and caspase-3 (CASP3) (rs113420705; formerly rs72689236) are associated with susceptibility to Kawasaki's disease (KD). To evaluate the involvement of these 2 SNPs in the risk for intravenous immunoglobulin (IVIG) unresponsiveness, we investigated 204 Japanese KD patients who received a single IVIG dose of 2 g kg(-1) (n=70) or 1 g kg(-1) daily for 2 days (n=134). The susceptibility allele of both SNPs showed a trend of overrepresentation in IVIG non-responders and, in combined analysis of these SNPs, patients with at least 1 susceptible allele at both loci had a higher risk for IVIG unresponsiveness (P=0.0014). In 335 prospectively collected KD patients who were treated with IVIG (2 g kg(-1)), this 2-locus model showed a more significant association with resistance to initial and additional IVIG (P=0.011) compared with individual SNPs. We observed a significant association when all KD patients with coronary artery lesions were analyzed with the 2-locus model (P=0.0031). Our findings strongly suggest the existence of genetic factors affecting patients' responses to treatment and the risk for cardiac complications, and provide clues toward understanding the pathophysiology of KD inflammation.

Normal dispersion femtosecond fiber optical parametric oscillator.

We propose and demonstrate a synchronously pumped fiber optical parametric oscillator (FOPO) operating in the normal dispersion regime. The FOPO generates chirped pulses at the output, allowing significant pulse energy scaling potential without pulse breaking. The output average power of the FOPO at 1600 nm was ∼60 mW (corresponding to 1.45 nJ pulse energy and ∼55% slope power conversion efficiency). The output pulses directly from the FOPO were highly chirped (∼3 ps duration), and they could be compressed outside of the cavity to 180 fs by using a standard optical fiber compressor. Detailed numerical simulation was also performed to understand the pulse evolution dynamics around the laser cavity. We believe that the proposed design concept is useful for scaling up the pulse energy in the FOPO using different pumping wavelengths.

Intake of purple sweet potato beverage affects on serum hepatic biomarker levels of healthy adult men with borderline hepatitis.

OBJECTIVE: To examine the effect of purple sweet potato (PSP) beverage rich in acylated anthocyanins on serum hepatic biomarkers in healthy Japanese men. DESIGN: A randomized, double-blind, placebo-controlled, parallel study. SETTING: Kumamoto in Japan. SUBJECTS: Healthy adult men (30-60 years) with borderline hepatitis who had one or more of serum gamma-glutamyl transferase (GGT), aspertate aminotransferase (AST) and alanine aminotransferase (ALT) levels over normal ranges, and who were negative for hepatitis virus were openly recruited by an advertisement. Of the 48 persons enrolled, 38 (mean age 43.0 years (30-54 years)) completed the study. METHODS: The subjects were randomly assigned to the PSP group and the placebo group. During the 8-week intervention, the subjects in the PSP group consumed two bottles of the PSP beverage with acylated anthocyanins (200.3 mg anthocyanins per 125 ml per bottle) per day, and the subjects in the placebo group, two bottles of a placebo beverage (1.7 mg anthocyanins per 125 ml per bottle). All of the data measured were analyzed by two-way repeated measures analysis of variance (ANOVA) with groups and times. The data of the hepatic markers were analyzed using the Dunnett multiple comparison among the time points and t-test between groups at the same time point. Two-sided P<0.05 were defined as the level of significance. RESULTS: Serum GGT, AST and ALT levels showed interactions (P<0.05) between the beverage groups and time; the others were not affected. The PSP beverage group showed lower hepatic marker levels than the placebo group during the ingestion period, particularly the GGT level (-14.1 IU/l, 95% Confidence intervel (CI) -25.4 to -2.7, P=0.017 at 2 weeks; -16.8 IU/l, 95% CI -36.2 to 2.5, P=0.081 at 4 weeks; -26.7 IU/l, 95% CI -47.6 to -5.7, P=0.014 at 6 weeks and -27.9 IU/l, 95% CI -49.9 to -5.9; P=0.014 at 8 weeks). No correlation between alcohol consumption and each hepatic biomarker level before and after the ingestion was observed. CONCLUSION: The intake of the PSP beverage significantly decreased the serum levels of hepatic biomarkers, particularly the GGT level, in healthy men with borderline hepatitis.

p53AIP1 expression can be a prognostic marker in non-small cell lung cancer.

AIMS: p53AIP1 is a potential mediator of p53-dependent apoptosis that is mutated in many kinds of carcinoma. To investigate the role of this gene for non-small cell lung cancer, we compared the relationship between p53AIP1 gene expression and clinicopathological status of lung cancer. MATERIALS AND METHODS: Seventy samples from non-small cell lung cancer patients were obtained between 1997 and 2003. For quantitative evaluation of RNA expression by polymerase chain reaction (PCR) we used the Taqman PCR methods. Exons 5-8 of the p53 gene were analysed using PCR-single-stranded conformation polymorphism and sequenced for mutation analysis. RESULTS: p53AIP1 gene expression levels in the lymph node metastasis-positive group were significantly lower than in the negative group (positive 35.1+/-83.9; negative 64.2+/-113.4; P=0.0486). The overall survival of the p53AIP1 low expression group was significantly worse than that of the p53AIP1 high expression group (P=0.0206). In the multivariate Cox proportional hazard model, p53AIP1 (P=0.0489) was the independent predictor for overall survival. When we investigated mutation analyses of the p53 gene, we could find several point mutations in 15.7% of all samples. However, there was no relationship between p53AIP1 expression and p53 status. CONCLUSIONS: These data suggest that the p53AIP1 gene is important for non-small cell lung cancer progression and may be a possible prognostic marker.

[Bronchial lipoma treated by surgical resection; report of a case].

We report a case of bronchial lipoma, which relapsed after endoscopic treatment, and was treated by surgical resection. An abnormal shadow on chest X-ray was noted at the annual medical checkup of a 44-year-old man. Chest computed tomography (CT) demonstrated a tumor in the right basal bronchus and linear opacity on the peripheral side of that tumor. Bronchoscopic examination demonstrated a smooth polipoid tumor occluding the right basal lobe bronchus. Bronchoscopic biopsy specimens were not sufficient for histological diagnosis. We performed endobronchial resection of the tumor using electrosurgical snare, but 2 months after endoscopic treatment, the tumor relapsed. We therefore performed right S(9+10) segmentectomy. The tumor was 11 x 9mm in size and the histological diagnosis was an endobronchial lipoma. More than 4 years after resection, the patient is alive without recurrence.

Plasma angiotensin II concentrations in the early neonatal period.

BACKGROUND: There have been only a few reports on the renin-angiotensin system in low birthweight infants; in particular, plasma angiotensin II concentrations have not been studied. AIM: To investigate plasma angiotensin II concentrations in early neonatal infants including low birthweight infants. METHODS: Forty six patients were studied, of whom 14 weighed not less than 2500 g (normal birth weight), 16 weighed less than 2500 g but not less than 1500 g (moderately low birth weight), and 16 weighed less than 1500 g (very low birth weight). Blood samples were collected twice, on day 0 and day 7. Angiotensin II concentration was assayed using an enzyme immunoassay kit with a microplate. RESULTS: Geometric means of angiotensin II concentrations on day 7 were 19 pg/ml in the normal birthweight group, 28 pg/ml in the moderately low birthweight group, and 76 pg/ml in the very low birthweight group. The concentrations on day 7 in the very low birthweight group were significantly higher than those in the normal birthweight and moderately low birthweight groups (p = 0.005, p = 0.031). There were significant correlations between angiotensin II concentration on day 7 and gestational age (r(s) = -0.4, p = 0.007) and birth weight (r(s) = -0.36, p = 0.016). CONCLUSIONS: Specific physiological conditions associated with a very low birth weight are thought to be responsible for the increased concentration of angiotensin II on day 7. It is necessary to measure angiotensin II concentration for a longer period after birth and study the factors that could influence it.

[Thoracolithiasis detected during video-assisted thoracoscopic surgery for spontaneous pneumothorax: report of a case].

A 32-year-old male was admitted to our hospital for treatment of right recurrent spontaneous pneumothorax. Chest X-ray showed right pneumothorax but chest X-ray and computed tomography (CT) examinations did not demonstrate intrathoracic abnormal mass shadow or abnormal calcifications. We performed video-assisted thoracoscopic surgery for spontaneous pneumothorax. At surgery, an egg-shaped milky white free mass was found in the thoracic cavity, and easily removed. This substance was hard and smooth on the surface and measured 12 x 9 mm. Histologically this mass was composed of fatty necrosis surrounded by hyalinized connective tissue. These findings led to a diagnosis of thoracolithiasis. Thoracolithiasis without any history of chest trauma or intervention is pathologically rare, with only 15 cases including our case in Japan, having been reported in the literature to date.

[Right delayed traumatic diaphragmatic hernia; report of a case].

An 80-year-old woman was admitted to our hospital with abnormal shadow on chest X-ray 8 years after a chest trauma during which multiple ribs on the right side were fractured causing hemothorax. A diagnosis of right delayed traumatic diaphragmatic hernia was based on the findings on plain X-ray and multislice computed tomography. We performed surgery via thoracic approach with thoracoscopic assist. The transverse colon, liver, and omentum were dislocated into the right thoracic cavity and hardly adhered to the lung. We successfully repaired the ruptured diaphragm. The postoperative course was uneventful and the patient was discharged on the 33rd postoperative day.

High-normal blood pressure is associated with new-onset electrocardiographic left ventricular hypertrophy.

Whether high-normal blood pressure (BP) is a predictor of new-onset electrocardiographic (ECG)-left ventricular hypertrophy (LVH) is not known. A total of 4112 subjects who underwent physical examinations were enrolled in this study. BP was measured on entry. Standard 12-lead ECG was recorded at initial evaluation and 3 years later. BP categories were defined on the basis of the 2013 European Society of Hypertension/European Society of Cardiology guidelines. Of the 4112 subjects, 133 developed ECG-LVH 3 years later. Crude cumulative prevalence rates of new-onset ECG-LVH were 2.0% for the optimal BP group, 3.2% for the normal BP group, 5.1% for the high-normal BP group and 5.0% for the hypertension group. After adjustment for age, gender, body mass index, smoking, low-density lipoprotein cholesterol, log-transformed high-density lipoprotein cholesterol, log-transformed triglycerides, estimated glomerular filtration rate, haemoglobin A1c, haemoglobin, uric acid and antihypertensive medication use, compared with the optimal BP group, the odds ratios of new-onset ECG-LVH for the normal BP, high-normal BP and hypertension groups were 1.52 (95% confidence interval (CI): 0.93-2.49, P=0.094), 2.38 (95% CI: 1.40-4.03, P=0.001) and 2.44 (95% CI: 1.43-4.18, P=0.001), respectively. Even high-normal BP was significantly associated with the presence of new-onset ECG-LVH.

A critical arginine residue in cytosolic aspartate aminotransferase from pig heart.

Reaction of the pyridoxal form of cytosolic aspartate aminotransferase from pig heart with 1,2-cyclohexanedione or other alpha-dicarbonyls led to a progressive decrease in the enzymic activity toward natural dicarboxylic substrates. The inactivation was prevented by the presence of dicarboxylic substrate analogs. The dependence of the inactivation rate on the cyclohexanedione concentration indicated that the modifying reagent forms a dissociable complex with the enzyme prior to the inactivation. These saturation kinetics were observed also with other alpha-dicarbonyls tested. The inactivation was fully accounted for by the modification of a single arginine residue per monomeric unit of the enzyme. Activities for alpha, beta-elimination reaction with 3-chloro-L-alanine and transamination with L-alanine did not decrease but appeared to increase considerably with the progress of the arginine modification. In these aberrant reactions, affinity for the monocarboxylic substrates was higher with the modified enzyme than with the native unmodified enzyme. Glutamate or aspartate was still capable of reacting with the pyridoxal form of the extensively modified enzyme to produce the pyridoxamine form at a rate comparable to that of the reaction with 3-chloro-L-alanine or L-alanine. Succinate, glutarate, maleate, 2-methylaspartate or erythro-3-hydroxy-aspartate which bind strongly to the native enzyme and thus acts as potent inhibitors in the reactions with monocarboxylic substrates did not exhibit any appreciable inhibitory effect on these reactions catalyzed by the arginine-modified enzyme. Proton NMR spectroscopy demonstrated that succinate strongly interacts with the native enzyme to generate substantial changes in the enzyme spectra whereas there was no such evidence for the specific interaction with this dicarboxylate with the arginine-modified enzyme.

Transesophageal echocardiographic diagnosis of thoracic aortic dissection with the completely thrombosed false lumen: differentiation from true aortic aneurysm with mural thrombus.

The conventional criteria of aortic dissection with a completely thrombosed false lumen by transesophageal echocardiography is separation of the intima from the layer of thrombus; however, it is not always easy to distinguish from true aortic aneurysm with mural thrombus. Thus we proposed a new transesophageal echocardiographic diagnostic criteria. Seventeen operative patients with suspected subacute or chronic thoracic aortic dissection in whom it was difficult to exclude true aortic aneurysm with mural thrombus underwent transesophageal echocardiography. In thoracic aortic dissection with in completely thrombosed false lumen, the inner lesion surface composed of intima may be smooth and crescent-shaped thrombus may appear inside the wall surface. Therefore our criteria were on the basis of any two of the following: (1) high-echogenic lesion surface, suggesting intima, over the thrombus, (2) smooth lesion surface, and (3) crescent-shaped thrombus. Imaging data were referenced to intraoperative findings. According to the present criteria only two out of 17 patients were misdiagnosed, whereas according to the conventional criteria six patients were misdiagnosed. The sensitivity was significantly higher than when the conventional criteria were used (90% versus 40%; p < 0.05), whereas the specificity was similar. We conclude that the present transesophageal echocardiographic criteria for detection of thoracic aortic dissection with a completely thrombosed false lumen is clinically useful.

Evaluation of prototype equipment for digital subtraction angiography in diagnosing intracranial lesions.

Two prototype units for digital subtraction angiography have been developed by Japanese manufacturers. Their performance in demonstrating various intracranial lesions in 121 patients was evaluated. Comparison with conventional selective catheter angiography was possible in 77 patients. Digital subtraction angiography proved useful in preoperative evaluation of pituitary tumors when transsphenoidal surgery was being considered; demonstration of faint tumor stains which might be missed on conventional angiography; demonstration of larger aneurysms, arteriovenous malformations, and tumors as a screening technique; demonstration of abnormalities involving the dural sinuses; and follow-up of patients after surgery or embolization.

The value of digital subtraction angiography in peripheral vascular diseases.

The iliac and subclavian arteries and their distal branches were studied by digital subtraction angiography (DSA) in 79 patients and the results compared with conventional angiograms for 35 patients. Techniques, results, advantages and disadvantages are described. DSA (both intravenous and intra-arterial) looks very promising in the diagnosis of peripheral vascular disease.

Benefits of rate-responsive pacing in patients with sick sinus syndrome.

The effect of changing a rate-responsive pacemaker program (which reacts to evoked QT interval) to fixed-rate ventricular pacing was studied in 10 patients with sick sinus syndrome (SSS). After the patients had been in the rate-responsive mode (VVIR) for at least one year, the exercise capacity (maximal oxygen consumption [peak VO2], anaerobic threshold [AT], and cardiac output [CO] at these points) was examined. Three hours later on the same day, the pacemaker was reprogrammed to the fixed-rate pacing (VVI) and the exercise capacity was examined again (VVI-S). One month later, a similar exercise test was also done in the VVI mode (VVI-L). There was no significant difference in peak VO2 and AT between VVIR and VVI-S, but both peak VO2 and AT were significantly lower in VVI-L than in VVIR. However, there were no significant differences in the CO at peak VO2 or AT between any of the pacing modes. These findings indicate that a VVIR pacemaker should not be reprogrammed to the VVI mode in SSS patients, because the change can cause the exercise capacity to deteriorate.

MR visualization and clinical significance of the anterior longitudinal epidural venous plexus in cervical extra-axial lesions.

A thin band of intermediate signal intensity behind the cervical vertebral bodies, demonstrated on sagittal MR images, was attributed to the anterior longitudinal epidural venous (AEVP). Percentage visualization and clinical significance of this structure were evaluated in extra-axial lesions of the spinal cord. In review of 50 normal controls, the percentage visualization of this structure at each cervical vertebral level was 25.5% on T1 weighted sagittal SE images, while that of T2 or proton density weighted SE images was 26.0%. AEVP was demonstrated by sagittal MRI in 29 of 128 extra-axial lesions of the cervical cord (22.7%), including cervical spondylosis, ossification of the posterior longitudinal ligament (PLL), herniated disk and spondylosis at a single level. AEVP in these conditions was often thickened compared with normal controls, probably due to venous engorgement and contribution of the dura mater and PLL. Posterior displacement of this structure or "lifted band appearance" indicated herniated disk or posteriorly protruding osteophyte, demonstrating true anteroposterior diameter of the spinal canal. Demonstration of AEVP on sagittal MRI was important in the diagnosis of extra-axial lesions of the cervical cord.

Percutaneous transluminal angioplasty of the ilio-femoro-popliteal arteries: initial and long-term results.

Percutaneous transluminal angioplasty has been widely used for dilatation and recanalization of occluded or stenosed vessels, but clinical experience in Japan is not extensive. Follow-ups of 78 ilio-femoro-popliteal angioplasties were performed for up to 51 months to assess the initial and long-term results. The initial technical success rate was 91%. The three-year cumulative patency rate was 75%. This study demonstrates that the long-term results of PTA of ilio-femoro-popliteal arterial lesions are competitive with reconstructive surgery. PTA should be the treatment of choice in patients with atherosclerotic narrowing or occlusion of the lower extremities.

[Assessment of the relation between bone mineral metabolism and mitral annular calcification or aortic valve sclerosis in elderly patients].

We assessed the effect of bone mineral metabolism on mitral annular calcification (MAC) and aortic valve sclerosis (AVS) in elderly patients. Both MAC and AVS were derived by 2-D echocardiography and bone mineral content (BMC) of vertebral body was obtained by quantitative computed tomography using a calibrated phantom system. The 162 patients were classified according to the echocardiographic finding into three groups; CNT group consisted of the 79 control patients (31 males, 48 females) without MAC or AVS. MAC group: 42 patients (11 males, 31 females) with MAC, and AVS group: 41 patients (19 males, 22 females) with AVS. The results were as follows: 1) The incidence of MAC and AVS in both males and females were increased in proportion to aging. 2) The incidence of MAC in females (31%) was higher than that of males (18%). 3) The AVS in males (31%) was more frequent than that in females (22%). 4) In females of eighth and ninth decades, the BMC in MAC group was significantly decreased than that in CNT group, but not different in males. 5) In both males and females, the BMC in AVS group was not significantly different from that in CNT group. These results suggest that the MAC may be attributed to the ectopic deposit, probably related to the de-calcification from the spinal bone. On the other hand, the AVS may be caused by the other factors, mainly prolonged and sustained pressure or stress loading.