[Permanent Pacemaker Implantation for Sick Sinus Syndrome After Maze Procedure].

OBJECTIVES: This study aimed to investigate incidence and risk factors for permanent pacemaker implantation for sick sinus syndrome( SSS) after maze procedure. METHODS: Medical records of 59 patients who underwent maze procedure for atrial fibrillation at our hospital from 2018 to 2022 were retrospectively reviewed. RESULTS: Mean age was 70 years and 32 patients (54%) were male. Major cardiac procedure was mitral valve surgery in 43( 72%). Radiofrequency ablation device was used in 35( 59%) and cryoablation was used in 24 (41%). Nineteen patients (32%) required temporary pacing after surgery;7 for type Ⅰ or Ⅱ SSS, 9 for type Ⅲ SSS and 3 for bradycardiac atrial fibrillation. Of these, all the 7 patients with type Ⅰ or Ⅱ SSS regained sinus rhythm, whereas 2 with type Ⅲ SSS underwent permanent pacemaker implantation. Overall, permanent pacemaker was implanted in 3( 5%). Forty-six patients( 78%) were in sinus rhythm at the outpatient clinic after surgery. CONCLUSIONS: Type Ⅰ or Ⅱ SSS after maze procedure is likely to resume sinus rhythm at the time of discharge whereas type Ⅲ is not. For type Ⅲ SSS after maze procedure, adequate anti-arrhythmic medication early after surgery may be required to avoid permanent pacemaker implantation.

Severe biliary hemorrhage after metal stent placement into the bile duct.

Sugimoto and colleagues report a rare case of life-threatening biliary hemorrhage as a complication of stent placement into the bile duct in a patient undergoing chemotherapy. The report illustrates that, if a patient placed metal stent shows an unexplainable anemia, biliary hemorrhage should be considered even without extravasation or pseudoaneurysms.

Preventive Effect of Epigallocatechin Gallate, the Main Component of Green Tea, on Acute Lung Injury Caused by Air Pollutants.

Reducing the health hazards caused by air pollution is a global challenge and is included in the Sustainable Development Goals. Air pollutants, such as PM2.5, induce respiratory and cardiovascular disorders by causing various inflammatory responses via oxidative stress. Catechins and polyphenols, which are components of green tea, have various protective effects, owing to their antioxidant ability. The main catechin in green tea, epigallocatechin gallate (EGCG), is potentially effective against respiratory diseases, such as idiopathic pulmonary fibrosis and asthma, but its effectiveness against air-pollution-dependent lung injury has not yet been investigated. In this study, we examined the effect of EGCG on urban aerosol-induced acute lung injury in mice. Urban aerosol treatment caused increases in inflammatory cell counts, protein levels, and inflammatory cytokine expression in the lungs of ICR mice, but pretreatment with EGCG markedly suppressed these responses. Analyses of oxidative stress revealed that urban aerosol exposure enhanced reactive oxygen species (ROS) production and the formation of ROS-activated neutrophil extracellular traps (NETs) in the lungs of mice. However, ROS production and NETs formation were markedly suppressed by pretreating the mice with EGCG. Gallocatechin gallate (GCG), a heat-epimerized form of EGCG, also markedly suppressed urban aerosol-dependent inflammatory responses and ROS production in vivo and in vitro. These findings suggest that EGCG and GCG prevent acute lung injury caused by urban aerosols through their inhibitory effects on ROS production. Thus, we believe that foods and medications containing EGCG or GCG may be candidates to prevent the onset and progression of acute lung injury caused by air pollutants.

Influence of cardiac function on image quality in coronary computed tomography angiography.

PURPOSE: To evaluate the correlation between cardiac functional parameters and image quality in coronary computed tomography angiography (CCTA). MATERIAL AND METHODS: Sixty-six patients who underwent both CCTA and echocardiography were included. The coronary artery attenuation values and contrast-to-noise ratios (CNR) were measured in the proximal right coronary arteries (RCA) and left main (LM) trunk. Then, the averages of the mean values derived from RCA and LM were calculated. The cardiac output (CO), left atrial (LA) volume, and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were measured by echocardiography. The relationship of cardiac parameters with arterial attenuation and CNR were assessed by Pearson's correlation, Spearman's rank correlation and multivariable linear regression analysis adjusted for age, gender, body surface area and heart rate. RESULTS: The coronary artery attenuation value was negatively correlated with CO (r = -0.30, p = 0.01) and LA volume (r = -0.37, p = 0.002). CNR was negatively correlated with LA volume (r = -0.4, p = 0.001) and E/e' (r = -0.27, p = 0.03). These associations remained significant in the multivariable analysis. CONCLUSION: CO and diastolic function had an impact on image quality of CCTA. Adjusting CCTA protocol may improve image quality in patients with known diastolic dysfunction or reduced cardiac output.

Association of Aortic Arch Width Assessed by Noncontrast Cardiac Computed Tomography With Cardiac Remodeling, Cardiac Function, and Atherosclerosis in a Japanese Cohort.

PURPOSE: Age-related aortic changes are related to adverse cardiac remodeling and reduced cardiac function. Here, we aim to assess the correlations between aortic arch width (AAW) and left ventricular (LV) remodeling and LV function as well as coronary artery calcification (CAC). MATERIALS AND METHODS: This retrospective study included 194 patients (ages, 67±12 y) who underwent both coronary computed tomography angiography and echocardiography. The AAW is defined as the longest width between the ascending and descending aorta on a transaxial noncontrast coronary computed tomography angiography image at the level of the pulmonary artery bifurcation. Left ventricular mass, relative wall thickness ratio, left ventricular ejection fraction, left atrial volume, and early mitral inflow velocity to mitral annular early diastolic velocity ratio (E/e') were evaluated by echocardiography. CAC was assessed by Agatston score. The relationships between AAW and echocardiography parameters were assessed, and adjusted for demographic data and cardiovascular disease risk factors by multivariate linear regression analysis. RESULTS: AAW (mean±SD, 11.6±1.4 cm) was positively correlated with left ventricular mass (r=0.28, P<0.0001), left atrial volume (r=0.28, P<0.0001), and E/e' (r=0.21, P<0.01). These correlations remained significant after adjustment for demographic data and cardiovascular disease risk factors. There was no correlation between AAW and left ventricular ejection fraction or relative wall thickness. There was a significant difference of AAW between the groups with Agatston score <100 and those with Agatston score ≥100, and this difference persisted after adjustment for all covariates (P<0.01). CONCLUSION: Greater AAW was significantly associated with LV remodeling and impaired function as well as advanced CAC.

Uniformly-sized, molecularly imprinted polymers for (-)-epigallocatechin gallate, -epicatechin gallate and -gallocatechin gallate by multi-step swelling and polymerization method.

Uniformly-sized, molecularly imprinted polymers (MIPs) for (-)-epigallocatechin gallate (EGCg), -epicatechin gallate (ECg) and -gallocatechin gallate (GCg) were prepared by a multi-step swelling and polymerization method using 2-vinylpyridine as a functional monomer, ethylene glycol dimethacrylate as a cross-linker and cyclohexanol as a porogen. Molecular recognition abilities of the obtained MIPs were evaluated in liquid chromatography using a mixture of ethanol and water, or ethanol as the eluent. Each MIP gave the highest molecular recognition ability for the respective template molecule. In addition, (-)-EGCg and -ECg had the same configuration (2R,3R) at positions 2 and 3, and therefore resulting in high cross reactivity each other. However, (-)-GCg, which has different configuration at position 2 with (-)-EGCg and -ECg, showed low cross reactivity with them. On the other hand, those MIPs showed no molecular recognition against (-)-epigallocatechin and -epicatechin, which have no gallate group at position 3. These results indicate that the MIPs prepared can recognize configuration at position 2 and a gallate group at position 3. Furthermore, the MIP for (-)-GCg could be successfully used for isolating (-)-EGCg and -ECg from green tea extract.

Sedative effects of the jasmine tea odor and (R)-(-)-linalool, one of its major odor components, on autonomic nerve activity and mood states.

We investigated the effects of the odor of jasmine tea on autonomic nerve activity and mood states in a total of 24 healthy volunteers. We used the odor of jasmine tea at the lowest concentration that could be detected by each subject but that did not elicit any psychological effects. R-R intervals and the POMS test were measured before and after inhalation of the odors for 5 min. Both jasmine tea and lavender odors at perceived similar intensity caused significant decreases in heart rate and significant increases in spectral integrated values at high-frequency component in comparison with the control (P < 0.05). In the POMS tests, these odors produced calm and vigorous mood states. We also examined the effects of (R)-(-)-linalool, one of its major odor components, at the same concentration as in the tea, and (S)-(+)-linalool. Only (R)-(-)-linalool elicited a significant decrease in heart rate (P < 0.05) and an increase in high-frequency component in comparison with the controls, and produced calm and vigorous mood states. Thus, the low intensity of jasmine tea odor has sedative effects on both autonomic nerve activity and mood states, and (R)-(-)-linalool, one of its components, can mimic these effects.

Xanthine oxidase inhibitors from the leaves of Lagerstroemia speciosa (L.) Pers.

Xanthine oxidase (XOD) is a key enzyme playing a role in hyperuricemia, catalyzing the oxidation of hypoxanthine to xanthine and then to uric acid. This study aimed to identify the XOD inhibitors from the leaves of Lagerstroemia speciosa (L.) Pers. (Lythraceae), which was traditionally used as a folk medicine in the Philippines. Using a bioassay-guided fractionation technique, two active compounds were isolated from the aqueous extracts of the Lagerstroemia speciosa leaves, namely valoneic acid dilactone (VAD) and ellagic acid (EA). The result demonstrated that the XOD-inhibitory effect of VAD was a stronger than that of allopurinol, a clinical drug used for XOD inhibitor, with a non-competitive mode for the enzyme with respect to xanthine as the substrate. These results may explain and support the dietary use of the aqueous extracts from Lagerstroemia speciosa leaves for the prevention and treatment of hyperuricemia.

Heat-epimerized tea catechins rich in gallocatechin gallate and catechin gallate are more effective to inhibit cholesterol absorption than tea catechins rich in epigallocatechin gallate and epicatechin gallate.

It has been known that tea catechins, (-)-epicatechin (1), (-)-epigallocatechin (2), (-)-epicatechin gallate (3), and (-)-epigallocatechin gallate (4) are epimerized to(-)-catechin (5), (-)-gallocatechin (6), (-)-catechin gallate (7), and (-)-gallocatechin gallate (8), respectively, during retort pasteurization. We previously reported that tea catechins, mainly composed of 3 and 4, effectively inhibit cholesterol absorption in rats. In this study, the effect of heat-epimerized catechins on cholesterol absorption was compared with tea catechins. Both tea catechins and heat-epimerized catechins lowered lymphatic recovery of cholesterol in rats cannulated in the thoracic duct and epimerized catechins were more effective than tea catechins. The effect of purified catechins on micellar solubility of cholesterol was examined in an in vitro study. The addition of gallate esters of catechins reduced micellar solubility of cholesterol by precipitating cholesterol from bile salt micelles. Compounds 7 and 8 were more effective to precipitate cholesterol than 3 and 4, respectively. These observations strongly suggest that heat-epimerized catechins may be more hypocholesterolemic than tea catechins.

[Isolation and quantitative analysis of the alpha-amylase inhibitor in Lagerstroemia speciosa (L.) Pers. (Banaba)].

Banaba [Lagerstroemia speciosa (L.) Pers.] has been used as a folk medicine for diabetes in the Philippines. Using bioassay-guided separation, valoneaic acid dilactone (1) was isolated from the leaves as a potent alpha-amylase inhibitor. A simple and efficient method for the quantitative determination of valoneaic acid and its derivatives in Banaba extract was established. Valoneaic acid exists as the structural part of the polyphenols, which like flosin A, reginin A, and lagerstroemin, are characteristic constituents of Banaba. These derivatives were hydrolyzed to valoneaic acid by HCl and extracted with 2-butanone. This extract was subjected to HPLC analysis, and the contents of valoneaic acid determined as the whole valoneaic acid contents. Using this method, the whole valoneaic acid contents were measured in eight Banaba leaf decoctions. The alpha-amylase-inhibiting activities of the decoctions were dependent on the whole valoneaic acid contents. In addition, a strong linear correlation was observed between the whole valoneaic acid contents and total polyphenol contents. This analytical procedure is applicable to the chemical evaluation of Banaba.

Autonomic nervous responses according to preference for the odor of jasmine tea.

The effect of jasmine tea odor on the autonomic nervous system was investigated by a power spectral analysis of the heart rate variability. We assigned eight volunteers to two groups with either a predilection for or antipathy toward the jasmine tea odor. We tested both high- and low-intensity jasmine tea odors. The low-intensity odor was produced by diluting 20-fold the jasmine tea used for the high-intensity odor test. The low-intensity odor produced an increase in parasympathetic nervous activity in both the predilection and antipathy groups. The high-intensity odor produced an increase in parasympathetic nervous activity in the predilection group, but an increase in sympathetic nervous activity in the antipathy group. The odor of Chinese green tea, a basic ingredient of jasmine tea, produced no effects similar to those of the jasmine tea odor. These results suggest that the jasmine tea odor activated the parasympathetic nerve, whereas the higher-intensity odor activated the sympathetic nerve in those subjects who disliked the odor.

Identification of potent odorants in Chinese jasmine green tea scented with flowers of Jasminum sambac.

The odorants in Chinese jasmine green tea scented with jasmine flowers (Jasminum sambac) were separated from the infusion by adsorption to Porapak Q resin. Among the 66 compounds identified by GC and GC/MS, linalool (floral), methyl anthranilate (grape-like), 4-hexanolide (sweet), 4-nonanolide (sweet), (E)-2-hexenyl hexanoate (green), and 4-hydroxy-2,5-dimethyl-3(2H)-furanone (sweet) were extracted as potent odorants by an aroma extract dilution analysis and sensory analysis. The enantiomeric ratios of linalool in jasmine tea and Jasminum sambac were determined by a chiral analysis for the first time in this study: 81.6% ee and 100% ee for the (R)-(-)-configuration, respectively. The jasmine tea flavor could be closely duplicated by a model mixture containing these six compounds on the basis of a sensory analysis. The omission of methyl anthranilate and the replacement of (R)-(-)-linalool by (S)-(+)-linalool led to great changes in the odor of the model. These two compounds were determined to be the key odorants of the jasmine tea flavor.

Inhibition by theanine of binding of [3H]AMPA, [3H]kainate, and [3H]MDL 105,519 to glutamate receptors.

In an investigation of the mechanisms of the neuroprotective effects of theanine (gamma-glutamylethylamide) in brain ischemia, inhibition by theanine of the binding of [3H](RS)-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA), [3H]kainate, and [3H](E)-3-(2-phenyl-2-carboxyethenyl)-4,6-dichloro-1-H-indole-2-carboxylic acid (MDL 105,519) to glutamate receptors was studied in terms of its possible inhibiting effects on the three receptor subtypes (AMPA, kainate, and NMDA glycine), with rat cortical neurons. Theanine bound the three receptors, but its IC50 of theanine was 80- to 30,000-fold less than that of L-glutamic acid.