Effectiveness of Saireito, a Traditional Japanese Kampo Herbal Medication, on Pacemaker-Related Pleural Effusion: A Case Report.

BACKGROUND Post-cardiac injury syndrome, including pleural effusion as a delayed complication of permanent pacemaker implantation, has rarely been reported. To resolve pleural effusion, prolonged chest tube placement is often required. Anti-inflammatory agents combined with diuretics are also often prescribed. Saireito, a Japanese herbal medication, which is a combination of Goreisan and Shousaikoto, has both anti-inflammatory and water-modulation properties and has been used for edema (lymph edema, cerebral edema) and inflammation (chronic nephritis). CASE REPORT We describe a 71-year-old woman with a history of syncope and bradycardia who underwent dual permanent pacemaker implantation (placed in the right chest because of a persistent left superior vena cava) without complications. Two months later, she came to the hospital as an outpatient with a dry cough, and was diagnosed with right-sided pleural effusion. A pleural fluid analysis revealed exudative effusion, according to Light's criteria. The fluid was negative for infectious etiology. Chest X-ray, computed tomography, and echocardiography revealed no signs of pericardial effusion or perforation of the pacemaker lead to outside the heart. The pleural effusion persisted despite use of anti-inflammatory medication for several weeks and diuretics for a short period. Saireito was administered with good response; the pleural effusion resolved completely and there was no deterioration of renal function. CONCLUSIONS The present case highlights the clinical significance of Saireito as an effective therapeutic agent for late-onset pacemaker-related pleural effusion, without adverse effects such as renal dysfunction.

A Case of Takotsubo Cardiomyopathy with a Rare Transition Pattern of Left Ventricular Wall Motion Abnormality.

BACKGROUND Takotsubo cardiomyopathy is characterized by apical ballooning and excessive constriction of the base of heart. However, reverse takotsubo cardiomyopathy, wherein ballooning from the mid-ventricle to the base of the heart occurs with excessive constriction of the apex, has also been reported. We report a case of a transition from atypical wall motion abnormality to a typical takotsubo cardiomyopathy pattern. CASE REPORT A 54-year-old woman was following excessive sugar and dietary restrictions because of concerns regarding her blood sugar levels while receiving treatment for diabetes at another hospital. She presented at our hospital with general malaise and chest discomfort after several days of significantly increased workload. On admission, blood tests showed elevated cardiac enzymes. Electrocardiogram showed ST elevation of V2-V3 and poor R-wave enhancement of the anterior precordial lead. Coronary angiography showed no significant stenosis; however, left ventricular (LV) angiography showed a decrease in mid-ventricular wall motion. On the basis of these findings, she was diagnosed with a reverse takotsubo cardiomyopathy. We initiated conservative treatment for her condition. During her treatment, the LV wall motion showed a typical pattern of the apical ballooning that is characteristic of takotsubo cardiomyopathy. This LV wall motion was normalized on day 22 of the onset. CONCLUSIONS We observed a rare case of takotsubo cardiomyopathy where the pattern of LV wall motion abnormality changed over time. This case suggests that it is necessary to follow up LV abnormality over time rather than rely on single-point observations in cases with takotsubo cardiomyopathy.

[Influence of Different Contrast Agent Concentrations and Injection Protocols on Dynamic Contrast Enhanced MRI of Prostate: Equimolar Comparison of 1.0M Gadobutrol and 0.5M Gadolinium Chelates].

The purpose of this study was to evaluate the enhancement profile of 1.0M gadobutrol (high concentration: HC) in comparison to 0.5M gadopentetate dimeglumine and gadoterate meglumine (low concentration: LC) in dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) of prostate. In total, 48 patients who were diagnosed with prostate cancer by radiologist were included. Each patient was examined after intravenous injection of 0.1 mmol/kg body weight contrast agent with flow rate of 1.5 (HC) or 3.0 mL/s (LC). Circular regions of interest were placed at prostate cancer (PCa) and normal peripheral zone (normal PZ) in DCE-MRI. The enhancement curves were calculated as a relative enhancement. Statistical analysis was performed by Mann-Whitney U test (p<0.05 were considered significant). As a result, the enhancement at first phase of HC was significantly lower compared with LC in PCa (HC, 0.47; LC, 0.85; p=0.029), and in normal PZ (HC, 0.12; LC, 0.22; p=0.033). The enhancement of HC in PCa was significantly higher compared with LC at late phase. Although not significant, a similar tendency was observed in normal PZ. The present study suggested that the enhancement profile with HC was higher at late phase but the rise of the enhancement curve with HC tended to be delayed.

Effects of Parenteral Amino Acid Administration on the Postoperative Nutritional Status and Wound Healing of Protein-Malnourished Rats.

In Japan, parenteral nutrition (PN) solutions are frequently administered to patients in the postoperative short-term period. In these cases, amino acid-containing peripheral parenteral nutrition (PPN) solutions, amino acid-free maintenance solutions or combinations of the two are used. However, consensus regarding the most beneficial solution for these patients is lacking. Here, we examined the nutritional status and wound healing outcomes in protein-malnourished rats receiving postoperative administrations of PPN solution, maintenance solution or combinations of the two solutions. Protein malnutrition was induced in Sprague-Dawley rats by feeding an AIN-93G-based low-protein diet (5% casein) for 2 wk. After laparotomy, dorsal skin incision, and placement of a jugular vein catheter, the rats were divided into 3 groups. Each group was administered 113 kcal/kg/d, with group A receiving maintenance solutions without amino acid, group B receiving PPN with 1.5% amino acid, and group C receiving PPN with 3% amino acid. After 5 d post-operative administration, we measured the tensile strength of the wound area, skeletal muscle weights, and nutritional parameters. Significantly higher plasma nutritional parameters and gastrocnemius and extensor digitorum longus (EDL) muscle weights were observed in groups B and C than in group A. Group C exhibited significantly elevated tensile strength of the wound area along with up-regulation of type I collagen mRNA expression compared to group A. These findings demonstrate the nutritional status and wound healing benefits of short-term postoperative administration of PPN solutions containing amino acids in protein-malnourished rats.

The voltage-gated sodium channel activator veratrine induces anxiogenic-like behaviors in rats.

In this study, we investigated the anxiogenic-like effects of systemically administered veratrine in rat models of anxiety. In the light/dark test, veratrine (0.6 mg/kg, s.c.) significantly and dose-dependently decreased the time rats spent in and the number of entries into a light box 30 min after administration, suggesting that veratrine increases anxiety-like behaviors. These findings were also supported by results from the elevated-plus maze test and the tail-swing behavior test. In addition, veratrine (0.6 mg/kg, s.c.) significantly increased the plasma concentration of corticosterone, an endogenous biomarker for anxiety, compared to vehicle. On the basis of these results, we conclude that veratrine induces anxiogenic-like behaviors in rats. The anxiogenic-like behaviors induced by veratrine (0.6 mg/kg, s.c.) were completely abolished by co-treatment with the typical benzodiazepine anxiolytic diazepam (1 mg/kg, s.c.), when assessed in the elevated-plus maze test. Similar results were obtained with co-treatment with riluzole (10 mg/kg, p.o.), which directly affects the glutamatergic system and has recently been suggested to have anxiolytic-like effects. In conclusion, this study provides evidence that systemically administered veratrine induces anxiogenic-like behaviors in rats. We propose the veratrine model as a novel pathological animal model to explore possible candidate drugs for anxiolytics.

Induction of galanin after chronic sertraline treatment in mouse ventral dentate gyrus.

A number of studies implicate neuroplasticity in the therapeutic mechanisms of antidepressants, specifically neuroplasticity in the dentate gyrus of the hippocampal formation. The dorsal hippocampal region in rodents is preferentially involved in spatial learning and memory, while the ventral hippocampal region plays a more important role in stress, emotion, and affective behaviors. These findings led us to investigate behavioral changes and gene expression changes in the ventral and dorsal dentate gyrus differentially after chronic treatment in mice with the antidepressant sertraline. Four-week treatment with sertraline significantly decreased immobility in the modified forced swim test, a behavioral test for assessing antidepressant-like effects in rodents. In the novelty-suppressed feeding test, performance of which is affected by functional changes in the dentate gyrus, sertraline treatment significantly decreased latency to feed. Next, we examined the expression of several neuroplasticity-related genes (those for Notch receptors, basic helix-loop-helix transcription factors and related factors, SoxC transcription factors, and glial-related genes) by real-time RT-PCR in the ventral and dorsal dentate gyrus of mice after the sertraline treatment. The gene encoding the neuropeptide galanin was significantly induced in only ventral dentate gyrus, not in dorsal dentate gyrus. These results suggest that sertraline-related galanin induction in ventral dentate gyrus may play an important role in therapeutic mechanisms for depression.