Periodontitis Is Associated with Chronic Obstructive Pulmonary Disease.

Although they are known to share pathophysiological processes, the relationship between periodontitis and chronic obstructive pulmonary disease (COPD) is not fully understood. The aim of the present study was to test the hypothesis that periodontitis is associated with a greater risk of development of COPD, when smoking is taken into account. The analysis in a 5-y follow-up population-based cohort study was based on 900 community-dwelling Japanese adults (age: 68.8 ± 6.3 [mean ± SD], 46.0% male) without COPD aged 60 or older with at least 1 tooth. Participants were classified into 3 categories according to baseline periodontitis severity (no/mild, moderate, and severe). COPD was spirometrically determined by a fixed ratio of <0.7 for forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and by FEV1/FVC below the lower limit of normal. Poisson regression was used to calculate the relative risk (RR) of developing COPD according to the severity of periodontitis. The population attributable fraction (PAF) was also calculated. During follow-up, 22 (2.4%) subjects developed COPD. Compared with no/mild periodontitis subjects, a significantly increased risk of COPD occurred among severe periodontitis subjects (RR = 3.55; 95% confidence interval [CI], 1.18 to 10.67), but no significant differences were observed between the no/mild and moderate categories (RR = 1.48; 95% CI, 0.56 to 3.90). After adjustment for potential confounders, including smoking intensity, the relationship between severe periodontitis and risk of COPD remained significant (RR = 3.51; 95% CI, 1.15 to 10.74). Likewise, there was a positive association of periodontitis severity with risk of COPD ( P for trend = 0.043). The PAF for COPD due to periodontitis was 22.6%. These data highlight the potential importance of periodontitis as a risk factor for COPD.

[How to protect the surgeons' faces against spurting blood from the ascending aorta].

The blood spurting from the ascending aorta is uncomfortable for cardiac surgeons. To protect the surgeons' faces from this spurting blood, we use a longitudinal half of a plastic bottle, which is semi see-through. While the assistant is holding this device above the ascending aorta, the surgeons can proceed the operation with good surgical view.

[One stage repair for extensive aortic aneurysm using the pull-through technique].

We describe 2 cases of extensive aortic aneurysm. One was an 88-year-old female with a diagnosis of a rupture of the distal descending aortic aneurysm and the distal arch aneurysm. The 2nd case was a 68-year-old female who had undergone graft replacement of the ascending aorta for acute type A dissection 5 years before. She was diagnosed with an enlarging aneurysm of the false lumen from the transverse arch to the distal descending aorta. We performed 1 stage replacement of the aortic arch and the descending thoracic aorta by using the pull-through technique with a long elephant trunk (LET) through a median sternotomy under selective cerebral perfusion. Distal anastomosis of LET was done by posterior mediastinal approach. Postoperative courses were uneventful without neurological deterioration or respiratory distress.

Serum levels of resistin and adiponectin in women with periodontitis: the Hisayama study.

Resistin and adiponectin, recently discovered adipokines, are secreted from adipose tissue, with postulated opposing functions in insulin resistance and inflammation. More recently, an abundance of resistin was detected in macrophages, which suggests its important role in inflammation. The aim of this study was to clarify circulating serum adipokine levels in women with periodontitis. Thirty-four women with moderate to severe periodontitis and 42 control individuals with healthy gingiva (50- to 59-year-old women) were selected. The serum level of adipokines was analyzed between groups, along with the obesity index, smoking status, and age. Having periodontitis was significantly associated with an increased level of resistin, both in bivariate (OR, 3.0; 95% CI, 1.2-7.6) and multivariate (adjusted OR, 3.1; 95% CI, 1.1-8.6) analyses. The association of periodontitis with a decreased level of adiponectin did not reach statistical significance. It was concluded that an increased serum resistin level in middle-aged Japanese women with periodontitis may affect systemic health.

[Successful total arch replacement for a 92-year-old woman with acute Stanford A aortic dissection: report of a case].

We reported a successful case of emergent total arch replacement for a nonagenarian with acute Stanford A aortic dissection. A 92-year-old woman complained of general fatigue, with hypotension. Echocardiography showed moderate pericardial effusion and aortic regurgitation. Computed tomography (CT) scan showed widely extended aortic dissection from the ascending aorta to descending thoracic aorta, and cardiac tamponade. An emergent total arch replacement was performed under hypothermic selective cerebral perfusion with bladder temperature of 22.5 degrees C. Although she suffered from pneumothorax, renal insufficiency and gastrointestinal (GI) bleeding postoperatively, she tolerated the operation and complications, well. She is now leading a good life with the same level of activities of daily living (ADL) as preoperative one.

[Removal of methicillin-resistant staphylococcus aureus infected pacemaker leads under cardiopulmonary bypass: report of a case].

A 71-year-old man, who underwent an intravenous pacemaker implantation previously, suffered from fever and local infection of the generator pocket. A blood culture showed positive for methicillin-resistant staphylococcus aureus (MRSA). He underwent removal of total pacemaker system under cardiopulmonary bypass support successfully. Two leads were tightly adhered to the right atrial free wall, tricuspid valve and right ventricular trabeculation. Postoperative course was uneventful with administration of antibiotics for 5 weeks. Removal under cardiopulmonary bypass is considered to be an effective procedure for treatment of patients with infected pacemaker lead.

[Mid-term outcome of aortic arch operation for true aneurysms; using an axillary artery perfusion].

To prevent cerebral infarction during perioperative period, we have used an axillary artery for systemic perfusion and selective cerebral perfusion for aortic arch operation. Since 1996, 34 aortic arch operations were performed in our institution. Simultaneous 5 CABGs, 4 AVRs, 2 aortic root replacements and 1 MVR were performed. There were 2 hospital deaths (5.9%, sepsis and acute heart failure) and only 1 (2.9%) cerebral infarction. There were no deaths in patients over 75 years of age and in patients with extensive aneurysm which were replaced by 2-staged operation. Overall 3 years survival was 94.1% with no further death. We conclude that aortic arch operation through an axillary artery perfusion and with hypothermic selective cerebral perfusion can be performed with very low mortality and morbidity.

Morphogenetic activity of extracellular matrices on cultured podocytes. Laminin accelerates podocyte process formation in vitro.

Morphogenetic effects of various extracellular matrix proteins on the renal podocyte were investigated using the conditionally immortalized podocyte cell line. Podocytes were plated on glass coverslips and coated with the following matrix proteins: laminin-10/11, laminin-1, fibronectin, collagen type IV, collagen type I. Three hours after plating, podocytes on laminins developed prominent processes, while those on other matrix proteins started to elongate processes after two days. Vinculin-immunolabeling showed that podocytes plated on laminins possessed thin rod-shaped focal contacts, whereas those on fibronectin showed large dot-shaped focal contacts. Inhibition of serine/threonine protein kinases induced podocyte process formation in an extracellular matrix-independent manner. The present study reveals the significance of laminin on podocyte morphogenesis in vitro, and shows that different extracellular matrix proteins trigger different intracellular signals governing podocyte morphogenesis. Taken together with our previous studies, podocyte process formation is thought to be regulated by protein Ser/Thr phosphorylation.

Concomitant aortic arch and root replacement using a stentless xenograft for acute type A dissection.

A 78-year-old woman with an aortic root aneurysm and aortic regurgitation developing acute type A dissection successfully underwent aortic root replacement using a stentless xenograft during core cooling, followed by total aortic arch replacement under selective cerebral perfusion with deep hypothermia. This bioprosthesis can be used in the same way as a free-hand homograft and potentially provides an aggressive, safe option for acute aortic dissection requiring aortic root reconstruction in elderly patients.

Characteristics of patients complaining of halitosis and the usefulness of gas chromatography for diagnosing halitosis.

OBJECTIVE: The purpose of this study was to examine the characteristics of patients complaining of halitosis and to evaluate the diagnostic accuracy of 3 methods of measuring halitosis. STUDY DESIGN: The actual degree of halitosis was determined through use of an organoleptic test in 155 patients aged 46 +/- 17 years (mean +/- SD). The volatile sulfur compounds (VSCs) were determined with gas chromatography and with sulfide monitoring. RESULTS: The organoleptic test revealed that 55% of the subjects had either no mouth odor or slight mouth odor. There was a significant correlation between the organoleptic score and the total VSC level as determined through use of other methods. The critical discrimination value of the total VSC level was calculated to be 0.057 ppm for gas chromatography and 0.117 ppm for sulfide monitoring; high sensitivity and specificity were obtained when the gas chromatography value was used. The amount of tongue coating was significantly greater in the halitosis-positive group than in the halitosis-negative group, whereas there was no difference in salivary flow rate between the 2 groups. CONCLUSION: These results indicate that determining VSCs with gas chromatography is a useful means of diagnosing halitosis.

Isolation of the third component of complement and its derivative with anaphylatoxin-like activity from the plasma of the newt Cynops pyrrhogaster.

The third component of complement (C3) of a newt, Cynops pyrrhogaster, was purified using a fast protein liquid chromatography technique. The purified newt C3 consists of two polypeptide chains (the molecular masses of the alpha and beta-chains of C3 were 120,000 and 70,000, respectively) linked by disulfide bonds. The alpha-chain retained an internal thiolester bond that was cleaved with methylamine, and the N-terminal amino acid sequence of the alpha-chain was XVQLIDAKAGKAAKF. Digestion of newt C3 with trypsin yielded fragments that induced significant histamine release from newt peritoneal cells. These results indicate that newt C3 retains structural and functional properties shared with mammalian C3.

Two distinct mechanisms underlie the stimulation of neurotransmitter release by phorbol esters in clonal rat pheochromocytoma PC12 cells.

Phorbol ester treatment induces the phosphorylation of SNAP-25 at Ser(187) and the potentiation of Ca(2+)-induced dopamine (DA) and acetylcholine (Ach) release from PC12 cells. In order to evaluate the functional consequences of phosphorylation, quantitative analysis was carried out using an anti-phosphopeptide antibody that specifically recognizes SNAP-25 phosphorylated at Ser(187). DA and ACh release, assayed in low-K(+) as well as high-K(+) solution, increased by treating the cells with phorbol-12-myristate-13-acetate (PMA); however, the stimulation of high-K(+)-dependent release occurred at lower concentrations and with shorter exposures to PMA than that of the basal release in low-K(+)-solution. The PMA-induced phosphorylation of SNAP-25 did not correlate with the potentiation of high-K(+)-dependent neurotransmitter release. The potentiation of high-K(+)-dependent DA release by phorbol 12,13-diacetate (PDA), a water soluble phorbol ester, almost completely disappeared within 1 min after washing PDA in the presence of okadaic acid, conditions under which the phosphorylation of SNAP-25 persisted for at least 15 min. PMA-induced phosphorylation of SNAP-25 was inhibited by staurosporine, however, the potentiation of high-K(+)-dependent DA release was suppressed only partially. These results indicate that protein kinase activation does not account for a large fraction of the phorbol ester-induced potentiation of depolarization-dependent neurotransmitter release from PC12 cells.

Comparative study of the N-glycans of human monoclonal immunoglobulins M produced by hybridoma and parental cells.

Cell-cell hybridization is one method of establishing cell lines capable of producing an abundance of antibodies. In order to clearly characterize antibodies produced by hybridomas, the influence of cell-cell hybridization on the glycosylation of produced antibodies should be studied. In this report, we describe structural changes of the N-glycans in immunoglobulin M (IgM) produced by a hybridoma cell line termed 3-4, which was established through hybridization of an IgM-producing Epstein-Barr virus transformed human B-cell line termed No. 12, and a human myeloma cell line termed P109. We analyzed the structures of sugar chains on the constant region of the mu-chain of IgMs produced by parental No. 12 cells and hybridoma 3-4 cells. In both parental cells and hybridoma cells, the predominant structures at Asn171, Asn332, and N395 were fully galactosylated biantennary complex types, with or without core fucose and/or bisecting GlcNAc. However, the amount of bisecting GlcNAc was markedly decreased in the hybridoma cells. Therefore, the activity of UDP-N-acetylglucosamine:beta-D-mannoside beta-1,4-N-acetylglucosaminyltransferase (GnT-III) responsible for the formation of bisecting GlcNAc was measured in parental cells and hybridoma cells. No. 12 cells showed some GnT-III activity, whereas P109 cells showed no such activity. The corresponding level of activity observed in hybridoma 3-4 cells was much lower than that in No. 12 cells. The above results demonstrated a reduction in the intracellular activity of GnT-III in the hybridoma cells, which was largely due to the influence of P109 cells. Moreover, the sugar chain structures of IgMs produced by the cells reflected the level of GnT-III activity.

An ileostomy at the aganglionic ileum for total colon aganglionosis.

For the initial management of total colon aganglionosis (TCA), an ileostomy is usually created at the distal end of the ganglionic bowel, which is associated with profuse diarrhea resulting in a water and electrolyte imbalance as well as malnutrition during the ileostomy period. An ileostomy at the aganglionic ileum several centimeters toward the anal side of the transition for TCA is thus expected to cause bowel retention without any bowel obstruction and to facilitate water reabsorption in the small bowel. We performed this procedure in 2 babies with TCA. The length of the aganglionic ileum was 50 cm and 10 cm, respectively. The ileostomies were made 5 cm distal to the transition at 1 month and 1 day after birth, respectively. Oral feedings were well tolerated, resulting in adequate weight gain and the stools were semisolid during the ileostomy periods. Definitive operations using the Duhamel procedure with a right colon patch graft without the creation of a new ileostomy were successfully performed at 7 and 3 months of age, respectively. The postoperative courses were satisfactory. An ileostomy at the aganglionic ileum appears to be the method of choice as initial management for patients with TCA.

A case of biliary atresia with cystic dilatation of the extrahepatic bile duct and polysplenia syndrome.

A 79-day-old girl presented with jaundice and acholia. Laboratory findings disclosed elevated levels of bilirubin, transaminases, and gamma-glutamyl transferase. A chest X-ray film showed dextrocardia. A computed tomographic scan revealed a cystic mass at the porta hepatis, multiple spleens in the right side of the abdomen, and absence of the inferior vena cava. Under the diagnosis of biliary atresia (BA) (I-cyst) associated with polysplenia syndrome, a hepatic portojejunostomy was performed at 80 days of age. The postoperative course was uneventful, and the jaundice cleared. Although the occurrence of associated anomalies in BA is rare, polysplenia is most commonly seen, and its incidence is reported to be 2% to 10%. Patients with BA and polysplenia usually have a poor prognosis, however, this patient may have a good prognosis due to uneventful recovery from the jaundice.

Optimal blood flow for cooled brain at 20 degrees C.

BACKGROUND: Optimal conditions for deep hypothermic perfusion and protective brain blood flow remain unclear. METHODS: Dogs (n = 52) underwent 120 minutes of cardiopulmonary bypass at 20 degrees C with perfusion flow rates of 2.5, 5, 10, 20, 40, and 100 mL x kg(-1) x min(-1). We examined the effect of the various flow rates and different perfusion pressures on brain blood flow, metabolism, and intracellular pH. RESULTS: The brain was ischemic and acidotic when the perfusion flow rate was less than 5 mL kg(-1) x min(-1) and pressure was less than 10 mm Hg. When perfusion pressure was higher than 10 mm Hg, cerebral cortex blood flow was more than 9 mL x 100 g(-1) x min(-1) and intracellular pH, higher than 6.95. The cerebral metabolic rate for oxygen decreased at a flow rate of 2.5 mL x kg(-1) min(-1). The cerebral metabolic ratio of glucose to oxygen and the cerebral vascular resistance were lowest when perfusion pressure was 10 to 30 mm Hg. Full-flow (100 mL x kg(-1) x min(-1)) perfusion caused paradoxical brain acidosis; a flow of 40 mL x kg(-1) x min(-1) provided the best results. CONCLUSIONS: Both extremely low-flow perfusion and excessive perfusion cause brain acidosis. Low-flow perfusion at a pressure of 20 mm Hg provides cerebral vasorelaxation and aerobic metabolism during operations at 20 degrees C.

[A case of lung cancer (small cell carcinoma) occurring esophago-pericardial fistula and purulent pericarditis].

A 72-year-old woman who had had an endoscopic sclerotherapy for esophageal varices presented with high fever and severe cough. Chest X-ray and CT demonstrated a pneumopericardium and pericardial effusion. Esophagoscopy and esophagography revealed an esophageal perforation into the pericardial cavity and into the lung. Consequently, drainage and irrigation of the pericardial cavity and mediastinum were done for MRSA infection. However, these procedures failed to reduce the inflammation, and she expired because of liver failure soon after placing a covered stent in the esophagus. Postmortem examination revealed small cell carcinoma in the left lung invading into the esophagus and pericardium.