The risk factors for hepatic steatosis in patients with primary aldosteronism.

Patients with primary aldosteronism (PA) are complicated by metabolic syndrome more frequently than those without PA. Hyperaldosteronism has been reported to be associated with a higher prevalence of non-alcoholic fatty liver disease (NAFLD). We aimed to clarify the risk factors for hepatic steatosis in the two subtypes of PA, comparing the status of hepatic steatosis in each of these subtypes. This was a retrospective observational study. We enrolled patients with an aldosterone producing adenoma (APA) (n = 33) or idiopathic hyperaldosteronism (IHA) (n = 56). Hepatic fat content was evaluated using the ratio of liver to spleen (L/S) X-ray attenuation on unenhanced computed tomography. L/S ratio <1.0 was utilized for assessing as hepatic steatosis. Age, sex distribution, visceral fat percentage (VF%), and visceral fat area (VFA) did not differ between patients with the two PA subtypes. The percentages of patients with L/S ratio <1.0 was not different between the two subtypes (APA: 21.2 % (7/33) vs. IHA: 19.6 % (11/56), p = 1.00). In both subtypes, the L/S ratio negatively correlated with VF% (APA: r = -0.66, p < 0.001; IHA: r = -0.66, p < 0.001) and with VFA (APA: r = -0.44, p < 0.01; IHA: r = -0.37, p < 0.01). The status of hepatic steatosis, evaluated using L/S ratio, did not differ between patients with APA or IHA. Hepatic steatosis was affected by the amount of visceral fat.

Plasma Testosterone Levels Increase with Expression of Male Ornaments During Mating, but not Incubation, in Japanese Barn Swallows.

Recent experimental studies involving the manipulation of sexual traits have demonstrated that sexual trait expression feeds back to testosterone levels, perhaps via social interactions, reinforcing the linkage between sexual trait expression and testosterone levels during the mating period. However, information on this reinforcement under the natural variation of sexual traits remains limited. Using Japanese barn swallows, Hirundo rustica gutturalis, in which extra-pair paternity is quite rare (< 3%), we studied the relationship between plasma testosterone level and a male sexual trait, throat patch size, during the mating and incubation periods. Given the importance of social interaction, we predicted that this relationship should be intense during the mating period, but not the incubation period, due to reduced social interaction during the latter. We found low plasma testosterone levels during the incubation period compared with those in the mating period, and plasma testosterone levels were significantly positively related to throat patch area during the mating period, but not the incubation period. Similar relationships were found in another sexual trait, the size of white tail spots. During the incubation period, body condition, instead of male sexual trait expression, was negatively related to plasma testosterone level, indicating that an intrinsic link, rather than reinforcement, is important during this period. These relationships are consistent with the hypothesis that social interaction reinforces the relationship between sexual traits and plasma testosterone levels. The current study provides evidence for a highly variable relationship between testosterone and ornamentation across breeding periods in the natural variation of sexual traits.

Eumelanin levels in rufous feathers explain plasma testosterone levels and survival in swallows.

Pigment-based plumage coloration and its physiological properties have attracted many researchers to explain the evolution of such ornamental traits. These studies, however, assume the functional importance of the predominant pigment while ignoring that of other minor pigments, and few studies have focused on the composition of these pigments. Using the pheomelanin-based plumage in two swallow species, we studied the allocation of two pigments (the predominant pigment, pheomelanin, and the minor pigment, eumelanin) in relation to physiological properties and viability in populations under a natural and sexual selection. This is indispensable for studying the evolution of pheomelanin-based plumage coloration. Pheomelanin and eumelanin share the same pathway only during their initial stages of development, which can be a key to unravel the functional importance of pigment allocation and thus of plumage coloration. Using the barn swallow, Hirundo rustica, a migratory species, we found that plasma testosterone levels increased with increasing the proportion of eumelanin pigments compared with pheomelanin pigments, but not with the amount of pheomelanin pigments, during the mating period. In the Pacific swallow Hirundo tahitica, a nonmigratory congener, we found that, during severe winter weathers, survivors had a proportionally smaller amount of eumelanin pigments compared with pheomelanin pigments than that in nonsurvivors, but no detectable difference was found in the pheomelanin pigmentation itself. These results indicated that a minor pigment, eumelanin, matters at least in some physiological measures and viability. Because the major pigment, pheomelanin, has its own physiological properties, a combination of major and minor pigments provides multiple information to the signal receivers, potentially enhancing the signaling function of pheomelanic coloration and its diversification across habitats.

Relationship Between Visceral Fat and Plasma Aldosterone Concentration in Patients With Primary Aldosteronism.

CONTEXT: The involvement of visceral fat in aldosterone secretion has not been reported in patients with primary aldosteronism (PA). Patients with PA are complicated by metabolic syndrome more frequently than those without PA. An excess of visceral fat has been hypothesized to cause an elevation of aldosterone secretion in patients with PA. OBJECTIVES: To clarify the role of visceral fat in the pathophysiology of PA, we investigated the correlation between plasma aldosterone concentration (PAC) and visceral fat parameters in patients with PA. DESIGN: This retrospective observational study comprised 131 patients diagnosed with PA between April 2007 and April 2017 at Sapporo City General Hospital. We divided participants into two PA subtypes, aldosterone-producing adenoma (APA; n = 47) and idiopathic hyperaldosteronism (IHA, n = 84), utilizing adrenal venous sampling. We analyzed the correlations of PAC with visceral fat percentage (VF%), visceral fat area (VFA), and subcutaneous fat area, by evaluating computed tomography studies in each subtype group. RESULTS: Patients with IHA showed a positive correlation of PAC with VF% (r = 0.377, P < 0.001) and VFA (r = 0.443, P < 0.001). The correlation was not evident in patients with APA. CONCLUSIONS: This study revealed a relationship between visceral adipose tissue and aldosterone production only in patients with IHA.

Low HDL-cholesterol, hypertension and impaired glucose tolerance as predictors of acute myocardial infarction in northern area of Japan.

Acute myocardial infarction (AMI) has gradually been increasing in Japan; however, since the burden of Japanese residents for risk factors (RFs) of AMI, such as hypercholesterolemia, is chronologically less accumulated compared with American and European people, their RFs of AMI may be different from those in western countries. To answer this question, a retrospective community-based study was carried out enrolling 722 first time AMI patients in Hokkaido, the northern island of Japan. As controls, 1748 age-, sex- and residence-matched subjects were randomly chosen from a data-base of a health check-up organization. We assessed associations between premorbid variables and the RFs for AMI. In men, the most important predictor reflected by high odds ratio (OR) was low HDL-cholesterol (HDL-C). Hypertension (HT) and impaired glucose tolerance (IGT) were also independent RFs. In women, HT represented the highest OR, and low HDL-C, high triglyceride (TG) and IGT followed. Total cholesterol (TC) was a negative predictor for AMI in both sexes, because mean TC level of AMI patients was less than that of controls probably because of acute phase reaction. Thus, low HDL-C, HT, IGT and high TG, which represent the state of metabolic syndrome, were important predictors of AMI. And it was suggested that low HDL-C plays a pivotal role in a population whose TC level is not high.

Insulin resistance relates to acetylcholine-induced microvascular vasoconstriction in a patient with vasospastic angina: potential implication of causalities between hyperinsulinemia and coronary microcirculation failure.

Coronary vasomotor response to acetylcholine infusion was studied in a 69-year-old currently smoking man with enhanced insulin response to oral glucose load. Coronary angiogram showed no significant stenoses. Immediately after 20 microg acetylcholine infusion in the right coronary artery, angiographic no-flow, ischemic electrocardiographic changes, and anginal pain developed in the absence of epicardial coronary obstruction. While intracoronary infusion of isosorbide dinitrate was only partially effective, intracoronary infusion of nicorandil, an agent known to improve coronary microcirculation, completely resolved these changes. This is the first case reported so far suggesting that enhanced insulin response may be associated with acetylcholine-induced microvascular vasoconstriction. Microvascular vasoconstriction must be considered when a patient with insulin resistance presents with chest pain.

Impact of a bidirectional approach via radial and popliteal arteries for the treatment of chronic total occlusion of lower limb artery: A case report.

A 49-year-old man with poorly controlled diabetes was admitted to Kushiro Rosai Hospital, Hokkaido, Japan after scalding both feet with boiling water. Because of poor healing, he was assessed for peripheral arterial disease. Angiography revealed total occlusion of the right common and external iliac arteries, diffuse stenosis of the right superficial femoral artery, focal stenosis of the left common iliac artery and chronic total occlusion of the left superficial femoral artery. A staged procedure with bidirectional approach via the radial and popliteal arteries was attempted. During the procedures, the patient was in the prone position on the catheterization table, and bidirectional guidewire manipulation was performed. All of the lesions were successfully stented. The patient was not required to change positions during the procedure, which can be performed by a single operator. The bidirectional approach is effective in the setting of transcatheter treatment of chronic total occlusive disease.

Induction of c-fos mRNA expression by pure pressure overload in cultured cardiac myocytes.

Mechanical stress by pressure overload due to hypertension or valvular heart disease such as aortic valve stenosis induces cardiac hypertrophy. It has been well established that the mechanical stretch of cardiac myocytes in vitro induces hypertrophic responses such as the expression of immediate early response genes including c-fos. However, it remains uncertain whether the mechanical forces due to pure atmospheric pressure can induce similar responses in cardiac myocytes. We thus cultured rat neonatal cardiac myocytes in an atmospheric pressure chamber apparatus and determined the effects of pure pressure stress on c-fos gene expression. Pressures greater than 80 mmHg enhanced c-fos mRNA after 30 minutes. These results suggest that pure atmospheric pressure overload can also induce early hypertrophic responses in cardiac myocytes.

Revascularization of malignant coronary instent restenosis resulting from Takayasu's arteritis using sirolimus-eluting stents.

A 37 year-old female who had suffered from arteritis for 20 years underwent a Bentall operation. Since severe stenosis was observed in her left main coronary artery (LMCA) the following year, a minimally invasive direct coronary artery bypass (MIDCAB) operation was performed. Unfortunately, she again complained of angina about 6 months after the second surgery and coronary angiography (CAG) revealed that her left internal thoracic artery graft was totally occluded. Although a 4.0 x 15 mm S670 stent was placed in her LMCA, the LMCA re-stented every 3 months and she underwent reintervention 8 times. We placed 2 sirolimus-eluting stents for treating the LMCA using the culottes stenting technique. CAG 6 months after the index procedure showed no stenosis at her LMCA. Sirolimus-eluting stents were effective for treating stenosis resulting from arteritis as well as that caused by atherosclerosis.

Angiotensin converting enzyme inhibitors attenuated the expression of G-protein coupled receptor kinases in heart failure patients.

BACKGROUND: There are few biological markers, which strictly show the severity of congestive heart failure (CHF). METHODS AND RESULTS: Lymphocyte G-protein coupled receptor kinase (GRK) mRNA expression was measured by quantitative reverse transcription-polymerase chain reaction in 15 CHF patients: 5 patients classified as New York Heart Association class-II treated with angiotensin converting enzyme inhibitor (ACEI) (IIA), 5 patients in class-II without ACEI (IIC), and 5 patients in class-III treated with ACEI (IIIA). GRK mRNA level in IIIA was significantly higher than those in IIA (p<0.05). GRK mRNA level in IIA were significantly lower than those in IIC (p<0.05). CONCLUSIONS: The expression level of lymphocyte GRK might show the severity of CHF, and ACEI treatment could reduce the level of GRK in CHF patients.

Mural thrombus in an ectatic right coronary artery caused acute myocardial infarction at downstream coronary artery.

A 72-year-old woman was admitted to our institution because of sudden chest pain. Emergency coronary angiography revealed thrombotic occlusion of the distal right coronary artery. A large cylindrical thrombus was retrieved from her distal right coronary artery using a thrombus aspiration catheter. IVUS showed minimal atherosclerosis and moderate ectatic change at the proximal right coronary artery. A reconstructed IVUS image also showed that a mural thrombus with abrupt ending was still retained at the ectatic segment. Based on this evidence, coronary ectasia was thought to be the primary cause for the thrombus formation and acute myocardial infarction in this case.

Chronic beta-adrenergic receptor stimulation enhances the expression of G-Protein coupled receptor kinases, GRK2 and GRK5, in both the heart and peripheral lymphocytes.

BACKGROUND: Enhanced expression of G protein-coupled receptor kinase (GRK) has been reported in failing hearts and in the present study the stability of enhanced GRK mRNA expression, and the correlation between the expression level of GRK mRNA in peripheral lymphocytes and in the heart were both evaluated. METHODS AND RESULTS: Isoproterenol was injected into rats for 2 weeks, and then GRK5 mRNA was assessed by quantitative reverse transcriptase-palymerase chain reaction. An enhanced expression of cardiac GRK5 mRNA was observed even after 4 weeks of recovery. The isoproterenol-induced increased expression of GRK2 and GRK5 mRNA was equally observed in the heart and lymphocytes, and there was a close correlation between the heart and lymphocytes in the level of expression of each GRK mRNA. CONCLUSIONS: The GRK mRNA level is maintained at a high level for a long period without continuous beta-adrenergic receptor stimulation. The level in circulating lymphocytes could be used as a surrogate marker to estimate the level of cardiac GRK expression and, presumably, the beta-adrenergic receptor function of cardiomyocytes.

Successful covering of a hepatic artery aneurysm with a coronary stent graft.

In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was though more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

A case of accordion phenomenon accompanied by severe transmural myocardial ischemia.

Percutaneous coronary intervention was performed in a severely tortuous right coronary artery (RCA). Immediately after straightening its tortuousity by using two guidewires, angiographic slow flow, ischemic electrocardiographic changes, and anginal pain developed. This is a rare case who had severe myocardial ischemia caused by the accordion phenomenon.

Side branch protection with hydrophilic polymer coated guide wire during cutting balloon angioplasty of a bifurcated lesion.

Cutting balloon angioplasty (CBA) was performed in a patient with in-stent restenosis (ISR) which had an important side branch. We used a hydrophilic polymer-coated guide wire for side branch protection during CBA. After CBA was successfully performed, the cutting balloon and guide wire were microscopically examined and proven to have suffered minor damage which, in itself, did not disturb the procedure. Hydrophilic polymer-coated wire might be an effective and safe choice for ISR which needs to be treated by CBA while protecting an important side branch.

Wire-induced myocardial ischemia: a novel approach to create myocardial ischemia in rats.

BACKGROUND: Animal models are indispensable in order to investigate the mechanism of various diseases and to explore the counter measures for those disease states. Although there are several animal models of ischemic heart diseases, surgical interventions required to create myocardial ischemia sometimes give rise to a problem in the yield of model. This study describes a new technique for inducing myocardial ischemia in rats. METHODS AND RESULTS: A 0.014-inch guidewire was introduced via the carotid artery and selectively advanced into the coronary arteries under fluoroscopy. Transmural myocardial ischemia was confirmed by ST-segment elevation and by the appearance of left ventricular wall motion abnormalities on the echocardiogram. Reversibility of the wire-induced myocardial ischemia was demonstrated by complete resolution of both ST-segment elevation and wall motion abnormalities after removing the wire. CONCLUSION: Wire-induced myocardial ischemia was reproducible and is less invasive than conventional ischemic models in rats. This method is a powerful and useful tool for the investigation of ischemic heart disease in small animals.