Effects of statin therapy on abdominal aortic aneurysm growth: a meta-analysis and meta-regression of observational comparative studies.

OBJECTIVE: To determine whether statin therapy reduces the growth rate of small abdominal aortic aneurysms (AAAs). DESIGN: A meta-analysis and a meta-regression of comparative studies. MATERIALS: Eligible studies were randomized controlled trials or observational comparative studies of statin therapy versus placebo or no statin, enrolling individuals with small (<55 mm in diameter) AAAs and reporting AAA growth rate as an outcome. METHODS: Study-specific estimates (standardized mean differences [SMDs]) were combined in the fixed- and random-effects model. RESULTS: Seven adjusted and 4 unadjusted observational comparative studies enrolling 4647 patients with a small AAA were identified. Pooled analysis of all 11 studies suggested a significant reduction in AAA growth rate among patients assigned to statin therapy versus no statin (SMD, -0.420; 95% confidence interval [CI], -0.651 to -0.189). Combining the 7 high-quality studies providing adjusted data for growth rates generated an attenuated but still statistically significant result favoring statin therapy (SMD, -0.367; 95% CI, -0.566 to -0.168). The meta-regression coefficient for the baseline diameter was statistically significant (-0.096; 95% CI, -0.132 to -0.061). CONCLUSION: Statin therapy is likely effective in prevention of the growth of small AAAs, and may be more beneficial as the baseline diameter increases.

Plasma fibrinogen and D-dimer concentrations are associated with the presence of abdominal aortic aneurysm: a systematic review and meta-analysis.

OBJECTIVES: To summarise the present evidence for an association between circulating fibrinogen or D-dimer and presence of abdominal aortic aneurysm (AAA) presence. DESIGN: MEDLINE database was searched to identify all case-control studies that compared plasma fibrinogen or D-dimer concentrations between patients with AAA and subjects without AAA. For each study, data regarding fibrinogen or D-dimer concentrations in both the AAA and control groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted average of logarithmic MDs in both fixed- and random-effects models. RESULTS: Our search identified 10 eligible studies including 834 cases with AAA and 6971 controls without AAA for fibrinogen and six studies including 264 patients with AAA and 403 subjects without AAA for D-dimer. Pooled analysis demonstrated significantly higher fibrinogen (fixed-effects MD, 0.37gl(-1); 95% CI: 0.30-0.44gl(-1)) and D-dimer (random-effects MD: 415.36ngml(-1); 95% CI: 128.97-701.76ngml(-1)) concentrations in the AAA group than those in the control group. CONCLUSIONS: We found that plasma fibrinogen and D-dimer concentrations are likely to be higher in cases with AAA than control subjects. Higher plasma fibrinogen and D-dimer concentrations may be associated with the presence of AAA.

Laparoendoscopic Single-site Plus 1-port Donor Nephrectomy: Division of Roles to Shorten Warm Ischemic Time.

BACKGROUND: In this study we present our new surgical procedure, laparoendoscopic single-site surgery plus 1 for donor nephrectomy (LESS+1-DN), which shortens warm ischemic time (WIT) and improves surgical outcomes. METHODS: From January 2013 to February 2017, 15 patients who underwent LESS-DN and 41 patients who underwent LESS+1-DN at our institution were evaluated retrospectively. Patients were divided into 3 groups: group A, 15 cases of LESS-DN; group B, the first 15 patients who underwent LESS+1-DN; and group C, 26 patients who underwent subsequent LESS+1-DN. To reduce WIT, we clearly defined the roles of the surgeon and first assistant in the 26 subsequent LESS+1-DN cases. The surgeon dissected the renal pedicle and harvested the kidney graft using a recovery bag and the first assistant held the recovery bag. RESULTS: The mean operative time in group C (213.7 minutes) was significantly shorter than that in groups A (253.3 minutes) and B (253.8 minutes). The WIT in group C (195.2 seconds) was significantly shorter than that in groups A (389.8 seconds) and B (313.2 seconds). Open conversion was required in 1 case in group A. None of the donors required conversion to open surgery and no perioperative complications occurred in groups B and C. Linear regression analysis of the LESS+1-DN operative times and consecutive case numbers demonstrated a shallow learning curve (R2 = 0.392, P < .05). CONCLUSION: Our new procedure that divides the roles of the operator and the first assistant contributed significantly to a shortening of WIT. Dividing roles can facilitate a safer laparoscopic donor nephrectomy.

A cellular protein which is coprecipitated with HTLV-I rex protein in the presence of the target mRNA.

We examined the cellular protein(s) which can associate with Rex protein of human T cell leukemia virus type I (HTLV-I), using Rex-maltose binding protein (MBP) fusion protein. Immunoprecipitation of RexMBP with anti-MBP antibody revealed that a 24 kD protein (p24) associated with RexMBP only in the presence of Rex-responsive mRNA. The fact that p24 was present in both the nucleus and the cytoplasm is consistent with a role of Rex in the nucleo-cytoplasmic transport of viral mRNAs. P24 did not interact with nonfunctional Rex mutant proteins even if they had RNA binding activity in vitro. These results suggest the possible involvement of p24 in the Rex function through a complex formation with Rex on Rex-responsive mRNA.

[Primary neurogenous sarcoma of the lung; report of a case].

We report a case of a 27-year-old woman with primary neurogenous sarcoma of the lung. She had no symptoms but an abnormal shadow of the right lower lung field on the chest X-ray. Chest computed tomography (CT) revealed a well defined round mass, 20 mm in maximum diameter, at the right S9. Pathological study of the specimen obtained by CT-guided percutaneous needle biopsy showed undefferentiated carcinoma. Positron emission tomography (PET) disclosed intensely increased uptake of fluoro-2-deoxy-D-glucose (FDG) at the lung lesion without other abnormal uptakes. The patient underwent right lower lobectomy of the lung and mediastinal lymph nodes dissection. Results from immunohistological study yielded a definitive diagnosis of neurogenous sarcoma. Postoperative course was uneventful, and there has been no evidence of recurrence and metastasis for more than a year after the surgery. Reported cases of primary neurogenous sarcoma of the lung are reviewed.

A meta-analysis of the association of primary abdominal wall hernia with abdominal aortic aneurysm.

AIM: Aim of the study was to determine whether primary abdominal wall hernia (AWH) is associated with abdominal aortic aneurysm (AAA) presence, we performed a meta-analysis of studies investigating the association with primary AWH and AAA. METHODS: Medline and Embase were searched through January 2014 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a comparative study; the study population was patients with AAA and subjects without AAA or patients with primary AWH and subjects without primary AWH; and outcomes included primary AWH incidence in both the AAA and control groups or AAA incidence in both the primary AWH and control groups. For each study, data regarding primary AWH incidence in both the AAA and control groups were used to generate unadjusted odds ratio (OR) and 95% confidence intervals (CIs). RESULTS: Of 151 potentially relevant articles screened initially, 14 eligible studies were identified and included. A pooled analysis of all the 14 studies demonstrated significantly higher primary AWH incidence in the AAA group than that in the control group in the random-effects model (OR 2.32; 95% CI, 1.72 to 3.14; P for effect <0.00001; P for heterogeneity <0.00001). When data from 5 studies reporting adjusted ORs and other 9 studies were combined separately, primary AWH was significantly associated with AAA presence. Eliminating 3 large-size population-based studies did not substantially change the pooled estimate. CONCLUSION: Primary AWH appears to be associated with AAA presence.

A meta-analysis of circulating homocysteine levels in subjects with versus without abdominal aortic aneurysm.

The aim of this paper was to summarize the present evidence for an association between circulating total homocysteine (tHcy) levels and abdominal aortic aneurysm (AAA) presence, we performed a meta-analysis. MEDLINE and EMBASE were searched through December 2013. Search terms included homocysteine, hyperhomocysteinemia, hyperhomocysteinaemia, and abdominal aortic aneurysm. Eligible studies were case-control or population-screening studies reporting circulating tHcy levels in cases with AAA and subjects without AAA. For each study, data regarding plasma or serum tHcy levels in both the AAA and control groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Further, adjusted and unadjusted odds ratios (ORs) with 95% CI of AAA incidence for subjects with hyperhomocysteinemia were extracted. Of 42 potentially relevant articles screened initially, 9 eligible studies enrolling 1643 cases with AAA and 5460 subjects without AAA were identified and included. A pooled analysis demonstrated significantly greater circulating tHcy levels in the AAA than control group (SMD, 0.58; 95% CI, 0.36 to 0.79; P<0.00001). Another pooled analysis demonstrated a statistically significant 3.1-fold increase in AAA incidence for subjects with hyperhomocysteinemia (OR, 3.07; 95% CI, 1.59 to 5.92; P=0.0008). In conclusion, greater circulating tHcy levels are associated with AAA presence.

A meta-analysis of the association of obesity with abdominal aortic aneurysm presence.

AIM: The aim of this paper was to determine whether obesity is associated with abdominal aortic aneurysm (AAA) presence. We performed the first meta-analysis of currently available studies. METHODS: MEDLINE and EMBASE were searched through January 2014. Eligible studies were comparative studies comparing body mass index (BMI) in patients with AAA to that in subjects without AAA or estimating a relative risk of AAA prevalence for subjects with obesity (high BMI). RESULTS: Of 183 potentially relevant articles screened initially, 19 eligible studies enrolling 29,120 patients with AAA and 3,163,575 subjects without AAA were identified and included. A pooled analysis demonstrated no statistically significant difference between BMI in the AAA group and that in the control group: mean difference, 0.46 kg/m2; 95% confidence interval, -0.07 to 1.00 kg/m2; P=0.09. Another pooled analysis demonstrated that obesity was unassociated with a statistically significant increase in AAA prevalence: odds ratio, 1.07; 95% confidence interval, 0.94 to 1.22; P=0.30. There was no evidence of significant publication bias: P=0.69 and 0.90 for mean difference and odds ratio, respectively. CONCLUSION: Obesity appears to be unassociated with AAA presence.

A contemporary meta-analysis of the association of diabetes with abdominal aortic aneurysm.

AIM: Aim of the present study was to determine whether diabetes is independently and inversely associated with prevalence of abdominal aortic aneurysm (AAA). We performed a meta-analysis of contemporary literature in which adjusted (but not unadjusted) relative risk estimates are available. METHODS: MEDLINE and EMBASE were searched from January 1999 to April 2014 using Web-based search engines (PubMed and OVID). Studies considered for inclusion met the following criteria: the design was a prospective-cohort, population-screening, or case-control study; the study population was individuals with and without diabetes or AAA; and outcomes included adjusted (but not unadjusted) relative risks for prevalence/incidence of AAA in patients with diabetes versus subjects without diabetes. Study-specific adjusted relative risk estimate were combined using inverse variance-weighted average of logarithmic odds ratios (or hazard ratios) in the random-effects model. RESULTS: Of 324 potentially relevant articles screened initially, 13 eligible studies were identified and included. A pooled analysis of all the 13 studies demonstrated that diabetes was significantly associated with lower prevalence of AAA (odds ratio, 0.59; 95% confidence interval, 0.52 to 0.67; P<0.00001). When data from 6 prospective-cohort, 5 population-screening, and 2 case-control studies were separately pooled, diabetes was also significantly associated with lower prevalence of AAA (P for subgroup differences =0.05). CONCLUSION: Diabetes appears to be inversely associated with prevalence of AAA.

Mesenteric malperfusion complicated with type A acute aortic dissection.

Type A acute aortic dissection (AAAD), involving the ascending aorta, is one of life-threatening disorders. Emergent surgery, such as graft replacement of the aortic root, ascending aorta, aortic arch, or these combinations, is routinely performed to avoid sudden death due to free rupture, cardiac tamponade, or coronary obstruction. Even though appropriate surgery is immediately completed, however, operative mortality remains high, between 15% and 30%. Furthermore, mesenteric malperfusion, bringing about enteric ischemia, occurs unusually in AAAD with far and away higher mortality. In the present article, we reviewed contemporary evidence regarding incidence, mortality, and treatment of mesenteric malperfusion complicated with AAAD. The incidence and early mortality rate of mesenteric malperfusion complicated with AAAD was 4% and 68%, respectively. Patients with mesenteric malperfusion had a 9.7-fold risk of mortality relative to those without it. Evidence regarding optimal treatment of mesenteric malperfusion complicated with AAAD is very limited.

Aortoduodenal syndrome.

Duodenal obstruction caused by abdominal aortic aneurysm (AAA), i.e. "aortoduodenal syndrome," first described by Osler in 1905 is a rare clinical entity, with only several dozens of cases reported in the literature. In the present paper, we systematically searched literature and reviewed them. Databases including MEDLINE and EMBASE were searched from January 1981 to April 2014 using Web-based search engines (PubMed and OVID). Eighteen papers reported 21 cases with aortoduodenal syndrome. Mean age of patients was 74.5±8.4 years, 71.4% of patients were men, and mean AAA diameter was 7.2±2.1 cm. We also discussed confusion between aortoduodenal syndrome and "superior mesenteric artery syndrome" associated with AAA.

Serum hepatocyte growth factor in patients with peripheral arterial occlusive disease.

Hepatocyte growth factor (HGF) is a multifunctional protein implicated in tissue regeneration, wound healing, and angiogenesis. We measured serum HGF concentrations in 37 patients with peripheral arterial occlusive disease (PAOD). Among them, 36 patients underwent arteriography. Serum HGF concentrations were also measured in 40 control subjects who remained free of vascular, liver, kidney, or lung disease. Patients with PAOD showed elevated serum HGF concentrations compared with control subjects (0.40+/-0.02 vs. 0.19+/-0.01 ng/mL; P<0.001). Serum HGF concentrations were significantly higher in smokers compared with nonsmokers (0.45+/-0.03 vs. 0.35+/-0.02 ng/mL; P = 0.003). The serum HGF concentrations in patients with collaterals tended to be higher than those in patients without collaterals (0.43+/-0.03 vs. 0.35+/-0.02 ng/mL; P = 0.06). Moreover, in patients who underwent bypass surgery or angioplasty, serum HGF concentrations decreased from 0.41+/-0.03 to 0.21+/-0.04 ng/mL after treatment (P<0.001). Serum HGF may be an useful marker for the diagnosis of PAOD. HGF may play an important role in angiogenesis and collateral vessel growth in PAOD.

Mapping of a gene responsible for the difference in amylopectin structure between japonica-type and indica-type rice varieties.

The present investigation revealed that the alk and gel(t) genes, which cause the differences between a japonica rice variety Nipponbare and an indica rice variety Kasalath in terms of the disintegration of endosperm starch granules in alkali solution and their gelatinisation in a 4 M urea solution, respectively, cosegregated in backcross inbred lines derived from a cross between the two varieties. The segregation pattern of the profile for amylopectin chain-length, which was distinguished by enrichment in short chains of DP<==11 and depletion in intermediate-size chains of 12<==DP<==24 in japonica as compared with indica, was exactly the same as those of the above physico-chemical properties of starch granules, and the gene was designated as acl(t). Gene-mapping analysis showed that the starch synthase IIa ( SSIIa) gene is located at the alk locus on chromosome 6 in the rice genome. These results lead us to the possibility that different alleles of the SSIIa gene are responsible for differences in amylopectin structure between the two varieties, in that SSIIa plays a distinct role in the elongation of short chains within clusters (A+B(1) chains) of amylopectin. It is proposed that the activity of SSIIa in japonica rice is reduced in amount or functional capacity relative to the activity of this enzyme in indica rice. This, in turn, would explain why starch from japonica rice has a lower gelatinisation temperature than starch from indica rice and is more susceptible to disintegration in alkali or urea. The evidence for this hypothesis is that the alk(t), gel(t), acl(t) and SSIIa genes all map to the same locus.

Purification and characterization of a novel secondary fimbrial protein from Porphyromonas gingivalis strain 381.

We previously reported the existence of two different kinds of fimbriae expressed by Porphyromonas gingivalis ATCC 33277. In this study, we isolated and characterized a secondary fimbrial protein from strain FPG41, a fimA-inactivated mutant of P. gingivalis 381. FPG41 was constructed by a homologous recombination technique using a mobilizable suicide vector, and failed to express the long fimbriae (41-kDa fimbriae) that were produced on the cell surface of P. gingivalis 381. However, short fimbrial structures were observed on the cell surface of FPG41 by electron microscopy. The fimbrial protein was purified from FPG41 by DEAE-Sepharose CL-6B column chromatography. The secondary fimbrial protein was eluted at 0.15 M NaCl, and the molecular mass of this protein was approximately 53 kDa as estimated by SDS-PAGE. An antibody against the 53-kDa fimbrial protein reacted with the short fimbriae of the FPG41 and the wild-type strain. However, the 41-kDa long fimbriae of the wild-type strain and the 67-kDa fimbriae of ATCC 33277 did not react with the same antibody. Moreover, the N-terminal amino acid sequence of the 53-kDa fimbrial protein showed only 2 of 15 residues that were identical to those of the 41-kDa fimbrial protein. These results show that the properties of the 53-kDa fimbriae are different from those of the 67-kDa fimbriae of ATCC 33277 as well as those of the 41-kDa fimbriae.

Chemical structure of the 2-keto-3-deoxyoctonate region of lipopolysaccharide isolated from Porphyromonas (Bacteroides) gingivalis.

Structural analysis of the 2-keto-3-deoxyoctonate region of lipopolysaccharide (LPS) isolated from Porphyromonas (Bacteroides) gingivalis was carried out. The substitution of the polysaccharide portion on the KDO was determined by gas chromatography/mass spectrometry of the product obtained by sequential derivatization of the LPS, including dephosphorylation, permethylation, carboxyl reduction, partial hydrolysis, carbonyl reduction, complete hydrolysis and O-acetylation. It was revealed that the KDO carries the polysaccharide on its position C5 and is phosphorylated on either position C7 or C8, although its exact position is not determined. The structure of the KDO region of P. gingivalis LPS in Gram-negative bacterial LPS had not hitherto been elucidated.

Construction of a plasmid vector for transformation of Porphyromonas gingivalis.

A host-vector system for transformation of Porphyromonas gingivalis was constructed using a set (1) strains that can incorporate plasmid DNA by electroporation regardless of its source and (2) stable vector plasmids with a selectable marker. First, restriction-negative mutants were isolated, because P. gingivalis possesses restriction modification systems by which DNA introduced by transformation even from heterologous strains of the same species is excluded. For screening of the mutants, plasmid pE5-2 was employed since it could be transconjugated (mobilized) to P. gingivalis from Escherichia coli and is able to replicate in this species, albeit not stably. pE5-2 DNA prepared from E coli was introduced by electroporation into chemically mutagenized P. gingivalis cells. By this method, three putative restriction-negative clones were selected. These strains exhibited a capacity for electroporation with plasmid DNAs both from E. coli and from various P. gingivalis strains at a similar efficiency. Using one of the derivatives thus obtained, YH522, we then screened for plasmids that could replicate stably in P. gingivalis. Since no plasmids were found from P. gingivalis, cryptic plasmids from other species of black-pigmented oral anaerobic rods were examined for their ability to transform P. gingivalis. A series of plasmids constructed by ligation with pBR322 for replication in E. coli and the EcoRI-B fragment from pBF4 containing erythromycin resistance were prepared from E. coli and were used for electroporation of P. gingivalis. Among these, a recombinant plasmid containing the replicon of pYHBA1 from Porphyromonas asaccharolytica, designated pYH400, was found to be incorporated into the restriction-negative P. gingivalis strain and replicated stably. This set of recipient strains and stable plasmids with a selectable marker constitutes the first practical host-vector system for this species.