Formation of Pt decorated Ni-Pt nanocubes through low temperature atomic diffusion--time-resolved elemental analysis of nanoparticle formation.

The formation process of Pt decorated Ni-Pt nanocubes was investigated by analysing the elemental distribution of Ni and Pt in the particles obtained from time-resolved in situ sampling during the synthesis in the oleylamine-1-heptanol system. The analysis confirmed the formation of Pt(core)-Ni(shell) nanoparticles at the initial stages of the reaction. However, as the reaction time progressed, the Pt atoms at the centre diffused outward and reached the corners and edges of the particle, whose shape changed from nearly spherical at the initial stages of the reaction to a perfect cube at the end of the reaction, forming a Ni rich cube (core)-Pt(cage). The cage obtained by dissolving the Ni rich cube was composed mainly of Pt and the Ni content in the frame was a mere 12%. The catalytic activity of the Pt cage was measured using cyclic voltammetry. The initial measurements suggested that the activity was comparable to some of the commercially available Pt catalysts.

Contribution of fetal ANXA5 gene promoter polymorphisms to the onset of pre-eclampsia.

OBJECTIVE: A common haplotype M2 consisting of minor SNP alleles located in the ANXA5 gene promoter region has been described as a risk factor for various obstetric complications such as recurrent pregnancy loss, pre-eclampsia and pregnancy-related thrombophilic disorder. However, the question of whether it is the maternal or fetal genotype that contributes to the onset of these disorders remains to be resolved. METHODS: We analyzed ANXA5 gene variants in the blood and placental tissues from pre-eclampsia patients and normotensive controls. ANXA5 expression was examined by qRT-PCR, Western blotting and immunostaining. Results were compared between M2 and non-M2 carriers. RESULTS: The M2 haplotype was found to be significantly frequent in placentas from pre-eclamptic patients relative to the controls (25.5% versus 10%, P = 0.044), In contrast, no significant differences were observed in maternal blood (13.0% versus 11.3%, P = 0.597). The placental expression of ANXA5 mRNA was found to be lower in M2 carriers. When examined by Western blot and immunostaining, the ANXA5 protein levels were found to be affected more by the placental than the maternal genotype. Histological examination of the placentas from the pre-eclamptic patients demonstrated that a placental M2 haplotype correlated more closely than maternal M2 with the severity of perivillous fibrin deposition. CONCLUSIONS: Although preliminary, these results suggest that hypomorphic M2 alleles in the in placental ANXA5 promoter, whether transmitted maternally or paternally, might be an essential determinant of an increased risk of pre-eclampsia via local thrombophilia at the feto-maternal interface.

Upregulation of HtrA4 in the placentas of patients with severe pre-eclampsia.

High temperature requirement A (HtrA) family proteins are serine proteases that may serve in the quality control of misfolded or mislocalized proteins. Recently, possible involvements of HtrA1 in the normal development of the placenta and in the pathogenesis of pre-eclampsia were reported. In this study, we characterized HtrA4, a previously uncharacterized HtrA protein family member, in pre-eclampsia. Elevated expression levels of placental HtrA4 in pre-eclampsia patients were observed by qRT-PCR. Western blotting also showed an increased production of HtrA4 at the protein level in pre-eclamptic placentas. In normal chorionic villi, HtrA4 protein was more abundant in the cytoplasm of cytotrophoblasts than in syncytiotrophoblasts. In contrast, the amount of HtrA4 protein in syncytiotrophoblasts was dramatically increased in pre-eclamptic placentas. Circulating HtrA4 was detected at higher levels in sera from women with pre-eclampsia than from those with normotensive pregnancies. Serum HtrA4 levels were higher in patients with early onset and inversely correlated with the weights of the newborn and placenta. Furthermore, serum levels correlated with serum PAPP-A and PAPP-A2 levels, indicating a functional role for HtrA4 in the common pathway. These data suggest that increased HtrA4 may be involved in the onset of pre-eclampsia, and elevated levels in sera imply a potential application as a biomarker for this disorder.

[Pneumothorax due to pulmonary metastasis of gingival carcinoma: report of a case].

A 72-year-old woman developed left pneumothorax 14 months after the first operation of a gingival carcinoma. The chest X-ray films and computed tomographic scans on admission revealed left pneumothorax and 2 lesions with a thin-walled cavity in the upper lung field. They seemed to be pulmonary metastasis from a carcinoma of gingiva and one of them ruptured into the pleural cavity. As airleak continued after tube thoracostomy, wedge resections of 2 lesions were performed through thoracotomy. Postoperative histological examination revealed that both of the lesions were moderately differentiated squamous cell carcinoma and they were the same histological findings as the gingival carcinoma excised previously. Pulmonary metastasis from a carcinoma of gingiva is rare, while it may be thought 1% of metastatic lung tumors. And also pulmonary metastasis is unusual cause of pneumothorax, especially without chemotherapy for it. We reported the very rare case of pneumothorax due to pulmonary metastasis from a carcinoma of gingiva.

[Surgery for intrathoracic recurrence and second primary tumors in resected lung cancer].

From 1986 to 2000, 42 patients (3.7%) underwent resection for intrathoracic recurrence or second primary lung cancer. Survival in 27 patients with recurrent diseases was 60% at 5 years and 35% at 10 years compared with 65% at 5 and 10 years for 15 patients with metachronous lung cancers morphologically. Ten patients had the second operation less than 2 years since the first operation, 19 patients between 2 and 5 years, and 13 patients more than 5 years, while these 5-year survivals were 72%, 53%, 67% respectively. At the first operation lobectomy was performed in 39 patients (93%), wedge resection or segmentectomy in 3. The reoperation was 14 lobectomy or completion pneumonectomy, 24 wedge or segmentectomy (57%), and 4 other procedures, while these 5-year survivals were 35%, 73%, and 100% respectively. The 5-year survival was 78% for 27 patients with stage I disease and 26% for 10 patients with stage III disease at the first operation, compared with 55% for 30 patients with stage I and 53% for 9 patients with stage III at the reoperation. These data suggest that limited resection is recommended for intrathoracic recurrent diseases and metachronous multiple lung cancers whenever possible.

[Surgery for synchronous primary lung cancers and intrapulmonary metastases].

Between 1988 and 2000, 1,040 patients with primary lung cancer underwent pulmonary resection at Nagaoka Red Cross Hospital. Thirty-one (2.9%) patients had synchronous primary lung cancer (group A) and 78 patients (7.5%) had intrapulmonary metastases (group B). The 5-year and 10-year survival rate for group A was 64% and 56% respectively and for group B 37% and 32% respectively. The patients in group A showed a better survival rate in the different lobes (80% at 5 years) than in the same lobe (55%), while those in group B gave reverse results (31% and 42%). In group A, the patients had a better survival rate in the different histology (73% at 5 years) than in the same histology (45%). The 5-year survival was 65% for 20 patients with stage I disease, 75% for 4 patients with stage II disease, 43% for 75 patients with stage III and 25% for 10 patients with stage IV. These data suggest that synchronous primary lung cancer had a better prognosis than primary lung cancer with satellite nodules, but the histological discrimination between multiple lung cancers and intrapulmonary metastases was uncertain.

[Long-term results of valve-retaining homograft and xenograft patch for transannular reconstruction of the right ventricular outflow tract in tetralogy of Fallot].

Thirteen patients with tetralogy of Fallot underwent reconstruction for hypoplastic right ventricular outflow tract using a preserved homograft or xenograft patch with single or double cusps. Homografts and xenografts preserved in 70% ethanol were implanted in 10 patients, and xenografts treated with glutaraldehyde were used in 3 patients. All the patients are doing well in their profession without one who died 18 years after operation. Valve-retaining homograft and xenograft patches provided excellent early hemodynamic function, but did not prevent pulmonary insufficiency late after the operation. Both homograft and xenograft cusps tended to degenerate several years after implantation, but cusp failure was not accompanied by outflow stenosis.

[Assessment of induction therapy and resection in stage IIIb non-small cell lung cancer].

Twelve patients with stage IIIb non-small cell lung cancer underwent induction therapy and resection from January 1990 to July 1998. They were divided into two groups; group A (n = 5) received two (to four) preresectional cisplatin and videsine chemotherapy, group B (n = 7) received chemoradiotherapy (radiation with concurrent low-dose-daily cisplatin). All patients in both groups had clinically down-stage and had no major side effects preventing surgery. 3 patients underwent radical pneumonectomy and 9 patients had radical lobectomy with no operative mortality. In 9 patients the disease was pathologically downstaged. Overall five-year survival was 27%, while in group A it was 50%. In group B 2-year survival was 18% and the longest survivor had pulmonary recurrence four years after surgery. Our data show better prognosis in group A than in group B. This results suggest that chemotherapy may be superior pre-resectional therapy to chemoradiotherapy.

[Effect of preoperative chemotherapy for bulky N2 non-small-cell lung cancer].

The effect of chemotherapy as the adjuvant therapy to bulky N2 disease (stage IIIA) non-small-cell lung cancer was examined. From January 1992 to December 1996, 464 patients with non-small-cell lung cancer underwent surgery. Seven patients (1.5%) with N2 disease (stage IIIA) received two cycles of preresectional cisplatin and vindesin chemotherapy, followed by standardized surgical resection (Group A). 46 patients (9.9%) had pathological N2 disease (T1-3, M0) after surgery (Group B). In Group A a complete resection was accomplished in two patients (28.6%), and five patients had incomplete resection with a deseased margin, followed thoracic irradiation 60 to 75 Gy. In three patients in Group A the N2 disease was pathologically downstaged to N1 or N0 disease. Overall survival at five years in Group A and in Group B was 48% and 39%, and median survival time was 49 months and 38 months. Although complete resection rate was lower in Group A (28.6%) than in Group B (78.2%), there was no significant difference between five year survival and median survival time in Group A and Group B. These data may be thought to suggest that induction chemotherapy in Group A was effective on occult micrometastatic disease.

[Two cases of descending necrotizing mediastinitis].

Descending necrotizing mediastinitis (DNM) is relatively rare inflammatory lesion with high mortality unless an appropriate surgical treatment is undertaken. Recently we successfully treated two surgical cases of DNM. In both cases, the disease started with pharyngeal abscess, and the mediastinal swelling followed. The surgery consisted with neck drainage and the mediastinal drainage through thoracotomy at the same time. A continuous mediastinal irrigation was performed postoperatively, and both patients recovered well. Immediate drainage of the primary lesion and the mediastinum is important once the diagnosis of DNM is established.

Asymptomatic hyponatremia due to inappropriate secretion of antidiuretic hormone as the first sign of a small cell lung cancer in an elderly man.

A 72-year-old man was hospitalized with asymptomatic hyponatremia. Despite hyponatremia, urinary sodium excretion with urine osmolality exceeding plasma osmolality persisted. Plasma vasopressin levels were high and independent of plasma osmolality during hypertonic saline infusion. Computed tomography of the chest showed enlarged mediastinal and right hilar lymph nodes. Microscopically, a specimen of lymph nodes obtained by biopsy represented vasopressin-producing small cell lung carcinoma. Chemotherapy plus irradiation improved the hyponatremia. Thus, careful evaluation is necessary to determine the cause of hyponatremia disorders in elderly patients.

[A role of limited operation for non-small cell lung cancer at present].

Our indication of limited operation is passive. Twenty-three patients with stage I non-small-cell lung cancer underwent a limited resection from 1983 to 1995. They were divided into two groups: group A (n = 12) included the elderly patients with the smaller nodule (< or = 2 cm), group B (n = 11) included the patients with decreased pulmonary function or important heart disease. Overall four-year survival was 67%, while the survival in group A was better than that in group B. The rate of local recurrence was 30.4% in both groups and second primary lung cancer occurred in two cases. We conclude that the limited operation played an important role in surgical treatment of patients with non-small cell lung cancer, especially with the smaller nodule (< or = 2 cm).

Effect of cardiopulmonary bypass on cytokine release and adhesion molecule expression in alveolar macrophages. Preliminary report in six cases.

Although recent studies have shown that adhesion molecules on alveolar macrophages are important in a variety of pulmonary diseases, there have been few studies on the phenotypic and functional changes of alveolar macrophages during cardiopulmonary bypass. To investigate the possible role of alveolar macrophages in activating pulmonary immunity during cardiopulmonary bypass, we measured the expression of adhesion molecules on alveolar macrophages and peripheral blood monocytes in patients undergoing cardiopulmonary bypass. Antigens were stained with monoclonal antibodies against adhesion molecules, and the expression of antigens was quantified by flow cytometry as the ratio of specific to nonspecific linear fluorescence. On alveolar macrophages obtained after the release of aortic cross-clamp, macrophages as compared with alveolar macrophages obtained before cardiopulmonary bypass, there was a significant enhancement of CD11a, CD11b, CD11c, and CD18. In addition, alveolar macrophages, but not peripheral monocytes, produced higher levels of TNF-alpha and IL-8 when they were cultured in vitro. A higher expression of CD11 and CD18 on alveolar macrophages and enhanced production of cytokines after release of the aortic cross-clamp may contribute to immune activation in lung by macrophage-lymphocyte interaction.

[Development of a blood cardioplegia delivery system for children].

We have developed a blood cardioplegia delivery system for children. Essential points of a delivery system in pediatric cardiac surgery are (1) a small amount of priming volume of a delivery system, and (2) slow, steady infusion of a cardioplegic solution. We changed a heat exchanger to a smaller one for reduction of priming volume, and changed a roller pump tube to a smaller one for slow, steady infusion. Thus, priming volume of a delivery system has reduced from 180 to 100 ml, and we can infuse a cardioplegic solution at a steady rate less than 10 ml/min. Our clinical experience with this system suggests that this blood cardioplegia delivery system is useful for pediatric cardiac surgery.

Transapical aortic cannulation in pediatric patients.

We describe transapical aortic cannulation in pediatric patients. This technique may help to establish cardiopulmonary bypass in small children in whom aortic root cannulation is undesirable or not feasible.

[DDD pacemaker implantation in the patient underwent Maze procedure].

We reported a 26-year-old man with mitral regurgitation and sick sinus syndrome. He underwent VVI pacemaker implantation, and admitted to our hospital due to congestive heart failure. Echocardiography and cineangiography revealed severe mitral regurgitation. Mitral valvuloplasty and modified Maze procedure were performed, and a DDD pacemaker was implanted after cardiopulmonary bypass. We recognized cross stimulation 7 months after operation. The reason of the cross stimulation was the position of the implanted atrial lead, which was the low right atrium. Thus, an atrial lead of DDD pacemaker should be carefully implanted in the patients underwent Maze procedure.

Closure of a ventricular septal defect in a patient with von Willebrand disease.

Few reports of open heart surgery being performed in patients with von Willebrand disease (vWD) have been documented. We describe herein the case of a 5-year-old girl with a ventricular septal defect (VSD) and vWD who underwent patch closure under cardiopulmonary bypass (CPB). The hematological parameters relating to vWD, namely, factor VIII, von Willebrand factor, and factor VIII-related antigen were monitored perioperatively. These laboratory findings were elevated after the termination of CPB, and consistently maintained within the normal range for 4 months postoperatively. The operation was successfully completed without the administration of factor VIII concentrates or homologous blood products.

The influence of a heparin-coated oxygenator during cardiopulmonary bypass on postoperative lung oxygenation capacity in pediatric patients with congenital heart anomalies.

BACKGROUND: Cardiopulmonary bypass (CPB) causes an inflammatory response and remarkably depresses the oxygenation capacity of the lung in pediatric patients with pulmonary hypertension. Although a heparin-coated circuit is more biocompatible than an uncoated circuit, the beneficial effect of a heparin-coated circuit on the postoperative lung function in the pediatric patients remains unknown. METHODS: Sixty patients younger than 3-years-old undergoing heart operations for ventricular septal defect were divided into three groups: group I = children (n = 11) without pulmonary hypertension who underwent CPB with an uncoated oxygenator; group II = children (n = 32) with pulmonary hypertension who underwent CPB with an uncoated oxygenator; and group III = children (n = 17) with pulmonary hypertension who underwent CPB with a heparin-coated oxygenator. A respiratory index (RI) was used to assess the oxygenation capacity of the lung. RESULTS: RI in group II was significantly higher than in group I and intubation time in group II was significantly longer than in group I. There was a positive correlation between preoperative pulmonary-systemic blood pressure ratio and RI at 3 hours post-CPB. Three and six hours post-CPB, RI in group III was significantly lower than in group II, but there was no significant difference in RI between both groups at 12 hours post-CPB. CONCLUSIONS: Pulmonary hypertensive pediatric patients were vulnerable to postperfusion lung injury. Beneficial effects of a heparin-coated oxygenator in a CPB circuit was limited to the early hours post-CPB and the postoperative clinical course was not modified by the heparin-coating of a membrane oxygenator.

Induction of right ventricular hypertrophy in neonatal guinea pigs by monocrotaline.

The purpose of this study was to develop an experimental model of neonatal right ventricular hypertrophy which was similar to human congenital heart disease associated with pulmonary hypertension. Monocrotaline (200 mg/kg), a pyrrolizidine alkaloid, was injected into neonatal Hartley guinea pigs on the day of delivery. The occurrence of pulmonary hypertension and right ventricular hypertrophy was confirmed by pressure studies and a determination of the right ventricular wet weight and myocyte diameter on the seventh day after delivery. Right ventricular systolic pressure was significantly increased at 7 days after monocrotaline treatment compared with the untreated control group. The ratio of right ventricular systolic pressure to left ventricular systolic pressure, an indicator of pulmonary hypertension, was significantly elevated from 0.32 +/- 0.02 in the controls to 0.59 +/- 0.03 in the monocrotaline group. Right ventricular wet weight was also significantly increased, indicating right ventricular hypertrophy. The diameter of cardiac myocytes was significantly increased in the right ventricle, and was decreased in the left ventricle and interventricular septum in the monocrotaline group. Neonatal guinea pigs developed pulmonary hypertension and marked right ventricular hypertrophy within 1 week after treatment with monocrotaline. This simple experimental model may have features similar to those of human congenital heart disease associated with pulmonary hypertension.

Blalock-Taussig operation with an assist of venovenous extracorporeal membrane oxygenation.

Three infants with congenital cyanotic heart disease encountered severe hypoxemia during a Blalock-Taussig shunt procedure using a right thoracotomy approach. Pericardiotomy was performed and venovenous extracorporeal membrane oxygenation was instituted using right atrial canulation. The shunt procedure was completed with good oxygenation and hemodynamic stability in all cases. Venovenous extracorporeal membrane oxygenation can be easily established in the right thorax, and is an effective support technique for unexpected hypoxemia encountered during systemic-to-pulmonary artery shunt operations.