Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis.

BACKGROUND: The aim of this study was to assess the echocardiographic characteristics of chronic hemodialysis (HD) patients with end-stage renal disease (ESRD) in a multicenter prospective cohort study.Methods and Results:Three hundred and fifteen patients with ESRD (67.9±10.6 years, 47.6% male) on chronic HD for ≥1 year were examined on transthoracic echocardiography, including Doppler-derived aortic valve area (AVA) measurement. Only 11.5% and 3.4% of all patients had normal left ventricular (LV) geometry and normal LV filling pattern, respectively. The majority of patients had aortic and mitral valvular calcification, and approximately 50% of all 315 patients had aortic valve narrowing with AVA <2.0 cm2. Patients were divided into 3 groups according to AVA index tertile: group 1, highest tertile; group 2, middle tertile; and group 3, lowest tertile. Group 3 was older, had a greater cardiothoracic ratio on chest X-ray, higher plasma brain natriuretic peptide and total LV afterload, and lower stroke volume index than the other 2 groups. Age and intact parathyroid hormone (PTH) level were independently associated with low AVA index. CONCLUSIONS: Patients with ESRD on chronic HD have a high prevalence of cardiac structural and functional abnormalities including calcified aortic sclerosis. High age and PTH were associated with aortic valve narrowing in these patients.

Holmium laser enucleation of the prostate as a secondary surgery following prostatic urethral lift.

Introduction: Prostatic urethral lift is a treatment option for benign prostatic hyperplasia, yet information on surgeries following this procedure is scarce. Case presentation: A 71-year-old man with persistent urinary retention following prostatic urethral lift underwent a secondary holmium laser enucleation of the prostate. The morcellation procedure, complicated by the presence of implants from the previous surgery, broke the morcellator blade. The fragmented blade was successfully retrieved without any organ damage. Postoperatively, the patient encountered no complications and showed improvement in his urinary symptoms. Conclusion: This case highlights the potential risk of device breakage when a secondary surgery, specifically the morcellation process, is performed following prostatic urethral lift. Care must be taken to prevent interaction between the implants and the morcellator. Our case demonstrates the efficacy of holmium laser enucleation of the prostate as a salvage surgical intervention for patients in whom prostatic urethral lift has failed.

Optimizing first trocar access for robot-assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar.

OBJECTIVES: A pre-equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot-assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. PATIENTS AND METHODS: A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. RESULTS: The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. CONCLUSIONS: OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.

[Drug delivery to the colon using novel one-step, dry-coated tablets (OSDrC)].

One-step dry-coated tablets (OSDrC), which are useful as colon-targeting drugs, were prepared using Eudragit L 100-55 (Eud-L) and chitosan (Chit) as an outer layer. The lag time of OSDrC with an outer layer of Eud-L : Chit at a ratio of 3 : 1 in each test medium was greater than the gastric emptying time in the first fluid simulating the stomach and was greater than the small intestine transit time in phosphate buffer (pH 7.4) simulating the small intestine. Drug-release profiles of OSDrC were evaluated under test conditions considering the amount of gastric acid and bile acid, as well as the amount of fluid in the colon. The lag time of OSDrC was greater than the gastric emptying time in test medium simulating the stomach and greater than the small intestine transit time in test medium simulating the small intestine, although it was affected by the amount of gastric acid and bile acid. Drug release from OSDrC was completed within the colonic transit time in the test medium simulating the colon, although it was affected by the amount of fluid in the colon. Therefore the prepared OSDrC were found to permit drug delivery to the colon.

The relationship between aortic augmentation index and pulse wave velocity: an invasive study.

OBJECTIVES: The aortic augmentation index (AI) and aortic pulse wave velocity (PWV) are known to be indicators of arterial stiffness. However, it is not clear whether aortic AI and PWV reflect aortic stiffness in similar ways. We investigated the relationship between aortic AI and PWV by measuring them directly using a catheter technique. DESIGN AND METHODS: Forty-one patients, aged 34-79 years, were studied during diagnostic cardiac catheterization. Aortic pressures were measured using a catheter-tip manometer at two points, one in the ascending aorta and one 40 cm distally in the descending aorta. Aortic AI was defined as the difference between early and late pressure peaks divided by the pulse pressure of the ascending aorta. Aortic PWV was calculated as the distance between the two measuring sites divided by the transit time. We also examined the effects of vasodilatation on AI and PWV by the intra-aortic administration of nitroglycerin in 15 patients. RESULTS: AI was significantly related to age, systolic aortic pressure, heart rate, left ventricular ejection time, and height. Aortic PWV showed an association only with age and systolic aortic pressure. There was no significant relationship between aortic AI and PWV (r = 0.28, NS). Nitroglycerin also produced different effects on aortic AI and PWV: aortic AI was significantly decreased (-0.17, P < 0.01) after nitroglycerin, but PWV remained unchanged (+0.4 m/s, NS). CONCLUSIONS: Aortic AI and PWV cannot be used interchangeably as an index of arterial stiffness. AI may not be a true indicator of arterial stiffness, but an index of wave reflection including PWV.

High-resolution fluorescent analysis of microsatellite instability in gastric cancer.

BACKGROUND: Microsatellite instability (MSI) is associated with various human malignancies and regarded as reflecting cellular deficiency in DNA mismatch repair (MMR). Analysis of MSI has been prevalent in the field of oncology, and numerous data have accumulated in the literature. It has been reported that the MSI+ phenotype is relatively frequent in gastric cancer. The reported frequencies of MSI+ gastric tumors, however, are diverse. AIM AND METHODS: To determine the frequencies of the MSI+ phenotype and defective MMR in gastric cancer, we examined tumors derived from 167 patients with sporadic gastric cancer, using our unique fluorescent technique, 'high-resolution fluorescent microsatellite analysis'. RESULTS: High-resolution fluorescent microsatellite analysis allowed us the unequivocal designation of MSI. The frequencies of MSI-H and MSI-L were 11 and 9.6%, respectively. In addition to the distinction based on the frequency of microsatellite changes, MSI was classifiable into two distinct categories, type A and type B, according to the mode of length changes in the dinucleotide microsatellites. Type A and type B MSI were observed in 14 and 6.6%, respectively. The overall frequency of MSI was 21%. Intriguingly, MSI did not correlate with any of commonly used clinicopathological variables. In addition, neither MSI-H nor MSI-L correlated with family history of malignancies or patient history of multiple cancers. Instead, type B MSI was significantly more frequent in patients with family history of gastric cancer. Type A MSI appeared to occur more frequently in tumors of patients with a history of double cancer, which, however, was not statistically significant. CONCLUSION: In gastric cancer, contribution of defective MMR to the risk of multiple cancer or familial predisposition appears more limited than has been expected. The relationship between MSI and high risk of cancer may have been oversimplified, at least in gastric cancer.

[Preparation and release profile of colon-targeting drug delivered as novel one-step dry-coated tablets (OSDrC)].

One-Step Dry-Coated tablets (OSDrC) of a colon-targeting drug were prepared using Eudragit L 100-55 (Eud-L) and chitosan (Chit) as the outer layer. Lag time in the 1st fluid, which simulated the stomach, was affected by differences in the pores occurring as a result of Chit dissolution. The dissolution rate of Chit was decreased by the addition of Eud-L. On the other hand, lag times in phosphate buffer (pH 7.4) simulating the small intestine, and in the 2nd fluid simulating the colon, were affected by differences in the pores occurring as a result of Eud-L dissolution and Chit swelling. The lag time of OSDrC with an outer layer of Eud-L:Chit at a ratio of 3:1 in each test medium was greater than the gastric emptying time in the 1st fluid and the small intestine transit time in phosphate buffer (pH 7.4). Furthermore, lag times were similar when test media were changed sequentially. Therefore, it is possible to deliver colon-targeting drugs as OSDrC with an outer layer of Eud-L:Chit at 3:1.

Cone weights for the two cone-opponent systems in peripheral vision and asymmetries of cone contrast sensitivity.

In understanding the basis of the changes in human color vision across eccentricity, one key piece of information remains unknown, whether the relative cone weights of the two cone opponent mechanisms vary. Here we measure detection threshold contours within three planes in a 3-dimensional cone contrast space to reveal the L, M and S-cone weights to the two cone opponent mechanisms, L/M and S/(L+M). We find these remain constant across eccentricity suggesting the underlying structures of the cone opponent mechanisms are invariant. The contrast sensitivities of two poles of the S-cone opponent mechanism also remain symmetrical, whereas small asymmetries develop in L/M opponency from about 15 degrees.

Squash xylem sap has activities that inhibit proliferation and promote the elongation of tobacco BY-2 cell protoplasts.

To elucidate the physiological functions of the substances in xylem sap, we analyzed the biological activities of xylem sap from squash (Cucurbita maxima Duch.) root using tobacco BY-2 (Nicotiana tabacum L. cv. Bright Yellow 2) cell protoplasts. When BY-2 cell protoplasts were cultivated with the total substance of squash xylem sap, the protoplasts elongated remarkably, and cell division was inhibited. Although trans-zeatin riboside (ZR), the most abundant cytokinin in squash xylem sap, had a concentration-dependent effect similar to that of total squash xylem sap, ZR concentrations several orders of magnitude greater than those found endogenously in squash xylem sap (i.e. 2 x 10(-8) M) were required to affect the growth of BY-2 cell protoplasts. The ability to stimulate cell elongation and inhibit cell division in BY-2 cell protoplasts was observed for the ethyl acetate phase fraction (pH 2) of squash xylem sap and an acetonitrile-eluate fraction from reverse-phase chromatography. The xylem sap also showed inhibitory activity for auxin-induced elongation of excised cucumber hypocotyls. These results suggest that an organic substance other than ZR is produced in the root and transported to above-ground organs through the xylem via the transpiration stream, where it is involved in regulating cell proliferation and elongation in the shoot, possibly as an auxin antagonist.

Effect of antisense oligodeoxynucleotide for sepiapterin reductase on the viability of PC12 cells in the presence of exogenous carbonyl compounds.

Sepiapterin reductase (SPR) is known as an essential enzyme for the biosynthesis of tetrahydrobiopterin. SPR belongs to the short-chain dehydrogenase/reductase (SDR) family and also reduces various exogenous carbonyl compounds including phenylpropanedione. We found in the present study that phenylpropanedione decreased the rate of proliferation of PC12 cells and that this rate was further diminished by the transfection of the cells with antisense oligodeoxynucleotide for SPR mRNA. When the cells were treated with N-acetylserotonin, a specific inhibitor of SPR, in the presence of phenylpropanedione, the cell number decreased to almost the same level as when the cells were transfected with the antisense oligodeoxynucleotide. Thus, the SDR activity of SPR in PC12 cells may serve for detoxification of exogenous carbonyl compounds besides functioning as a specific enzyme for the formation of tetrahydrobiopterin.

Biological significance of localized Type IV scirrhous gastric cancer.

The prognosis of type IV scirrhous gastric cancer (SGC) is extremely poor. Linitis plastica (LP), the so-called 'leather bottle stomach', is believed to be a typical case of SGC, which is usually diagnosed as a far-advanced gastric cancer. The pathogenesis of this disease remains unclear. Although typical SGC often invades the entire stomach, atypical cases show SGC localized to one region of the stomach. The aim of the present study was to investigate localized SGC (LSGC) and its biological significance. A total of 509 patients with advanced gastric cancer who underwent gastrectomy were evaluated. These patients were divided into three groups as follows: 19 patients with type IV scirrhous lesions invading the whole stomach (defined as LP), 60 patients with type IV scirrhous lesions localized in less than two thirds of the stomach (defined as LSGC) and the remaining 430 patients with all other types of gastric cancer (OGC), and then clinicopathologically compared. Results showed that LP had deeper invasion (p=0.006), more frequent peritoneal dissemination including positive cytology (p=0.01 and p=0.018) and lower curability (p=0.03) compared with LSGC, whereas LSGC showed a higher malignant potential in a number of clinicopathological factors compared with OGC. Univariate analysis showed that survival in patients with LP was significantly poorer than in those with LSGC (p=0.002) whose survival was, in turn, inferior to those with OGC. By contrast, LSGC was not a prognostic factor in SGC according to the multivariate analysis. The findings of this study suggested that the malignant status of LSGC differs from that of LP, and that curative gastrectomy is effective in improving the outcome for LSGC but not for LP, as LSGC may represent the prelinitis condition.

Complete recovery from aneurysmal subarachnoid hemorrhage associated with out-of-hospital cardiopulmonary arrest.

Out-of-hospital cardiopulmonary arrest (OHCPA) because of aneurysmal subarachnoid hemorrhage (SAH) is almost always fatal, because devastating SAH causes OHCPA and the brain damage is aggravated by OHCPA. We report a rare case of a 63-year-old female patient who survived SAH-induced ventricular fibrillation OHCPA without neurologic sequelae. Early brain computed tomography scans were needed for the diagnosis, as most of SAH seemingly disappeared within 7 h after the onset and was associated with acute coronary syndrome-like findings. This case shows that even less severe SAH can cause ventricular fibrillation OHCPA and takotsubo cardiomyopathy, and that early diagnosis and appropriate treatment following immediate, successful resuscitation may lead to a surprisingly favorable outcome.

Does L/M cone opponency disappear in human periphery?

We have assessed the optimal cone contrast sensitivity across eccentricity in human vision of the two cone-opponent mechanisms [L/M or red-green, and S/(L + M) or blue-yellow] and the luminance mechanism. We have used a novel stimulus, termed a 'sinring', that is a radially modulated sine-wave arc, Gaussian enveloped in both angular and radial directions. This stimulus overcomes the problem inherent in Gabor stimuli of confounding stimulus spatial frequency, size, and eccentricity and so allows contrast sensitivity to be tracked accurately into the periphery. Our results show that L/M cone opponency declines steeply across the human periphery and becomes behaviourally absent by 25-30 deg (in the nasal field). This result suggests that any L/M cone-opponent neurons found in primate peripheral retina beyond this limit are unlikely to be significant for colour contrast detection measured behaviourally.

Color appearance in the entire visual field: color zone map based on the unique hue component.

To provide the fundamental data for a color zone map, the color appearances of nearly unique hue stimuli presented over the entire visual field were qualitatively and quantitatively evaluated by hue and saturation judgments, blackness evaluation, and categorical color naming. The hue of red and green stimuli shifts toward a unique yellow, while that of yellow and blue does not change with an increase in eccentricity. The saturation of all the stimuli falls with an increase in the eccentricity in all directions. On the basis of the unique hue component, color zone maps for red, dark yellow, yellow, green, and blue stimuli are drawn. All the color zone maps extend over a wider region in the temporal and lower directions than in the nasal and upper directions of the visual field. The results are compared with the color zones of previous studies. The relationship between the color zones and the color categorization, as well as the underlying mechanisms of reduced saturation and hue shift, is discussed.

S-1 in the treatment of advanced and recurrent gastric cancer: current state and future prospects.

BACKGROUND: S-1 (TS-1) is a novel oral anticancer drug. Because of the excellent results of phase II studies, we continued to prescribe S-1 for advanced or recurrent gastric cancer after we participated in the phase I and II studies. METHODS: Twenty-nine patients with advanced or recurrent gastric cancer were treated with S-1. Clinicopathological features, survival, and adverse reactions were analyzed. RESULTS: One course of treatment consisted of 40, 50, or 60 mg/body twice a day for 28 days followed by withdrawal for 2 weeks. The mean number of treatments was 3.6 courses (range, 1-12 courses). The response rate was 37.9% (11 partial responses [PRs] in 29 patients). Although the response rate of patients who did not receive prior chemotherapy was 47.6% (10 PRs in 21 patients), that of patients with prior chemotherapy was 12.5% (1 PR in 8 patients). The median survival time was 14.1 months, and that of patients who responded to treatment was 22.1 months, which was significantly longer than that of nonresponder patients. One-year and 2-year survivals in the 29 patients were 50.2% and 24.3%, respectively. Adverse reactions were noted in 17 of 29 patients, and the most frequent one was leukocytopenia. Only 2 patients experienced grade 3 leukocytopenia and neutrocytopenia. CONCLUSION: Because of the high response rate and low incidence of severe adverse reactions, S-1 is a first-line chemotherapy that can be used for outpatients, especially for patients without prior chemotherapy. As the response rate for patients with prior chemotherapy was low, combined therapy with S-1 is worth evaluating for these patients.