Acute myocardial infarction due to traumatic coronary artery dissection: conflicts with thrombotic and bleeding pathologies.

Traumatic coronary artery dissection is a rare and challenging condition, requiring treatments for both thrombus and haemorrhage. We present a unique case of traumatic coronary artery dissection in which intra-aortic balloon pumping without heparin usage was useful in the acute traumatic phase of haemorrhagic shock with a contraindication to anti-thrombotic therapy.

Torsade de pointes in an older patient with Takotsubo cardiomyopathy caused by licorice-induced pseudoaldosteronism: A case report.

Takotsubo cardiomyopathy (TCM) causes QT interval prolongation, potentially leading to a fatal arrhythmia. We report the first case of TCM associated with licorice-induced pseudoaldosteronism causing fatal arrhythmia in an older patient on polypharmacy including yokukansan (TJ-54) and galantamine. Polypharmacy should be resolved to prevent unexpected adverse events in older patients.

Suppressive effect of nobiletin, a citrus polymethoxyflavonoid that downregulates thioredoxin-interacting protein expression, on tunicamycin-induced apoptosis in SK-N-SH human neuroblastoma cells.

Increased expression of thioredoxin-interacting protein (TXNIP) has recently been proved to be a crucial event for irremediable endoplasmic reticulum (ER) stress resulting in the programmed cell death (apoptosis) of pancreatic ß-cells. The present study demonstrated that treatment with 1-10 µg/ml tunicamycin, a potent revulsant of ER stress, drastically induced TXNIP expression accompanied by the generation of cleaved caspase-3 as an indicator of apoptosis in SK-N-SH human neuroblastoma cells. This result substantiated that TXNIP is also involved in neurodegeneration triggered by ER stress. Moreover, we evaluated the effects of nobiletin, a citrus polymethoxyflavonoid, on tunicamycin-induced apoptosis and TXNIP expression in SK-N-SH cells, because we reported previously that this flavonoid might be able to reduce TXNIP expression. Co-treatment of SK-N-SH cells with 100 µM nobiletin and 1 µg/ml tunicamycin for 24h strongly suppressed apoptosis and increased TXNIP expression induced by 1 µg/ml tunicamycin treatment alone. In addition, we proved that the ability of 100 µM nobiletin treatment to reduce TXNIP expression is exerted from 3h after the onset of treatment. Therefore, the protective and ameliorative effects of nobiletin on neuronal degeneration and impaired memory, which several studies using animal models have demonstrated, might arise in part from nobiletin's ability to repress TXNIP expression.

Comparison of constitutive gene expression levels of hepatic cholesterol biosynthetic enzymes between Wistar-Kyoto and stroke-prone spontaneously hypertensive rats.

Serum total cholesterol amounts in the stroke-prone hypertensive rat (SHRSP) strain are lower than in the normotensive control strain, Wistar-Kyoto (WKY) rat. To understand the strain difference, constitutive gene expression levels of hepatic cholesterol biosynthetic enzymes in male 8-week-old SHRSP and WKY rats were comparatively examined by DNA microarray and real-time reverse transcription-polymerase chain reaction (RT-PCR) analyses. Of 22 cholesterol biosynthetic enzyme genes, expression levels of 8 genes, Pmvk, Idi1, Fdps, Fdft1, Sqle, Lss, Sc4mol, and Hsd17b7, in SHRSP were less than 50% those of the WKY rats; especially, the expression level of Sqle gene, encoding squalene epoxidase, a rate-limiting enzyme in cholesterol biosynthesis pathway, was about 20%. The gene expression level of sterol regulatory element-binding protein-2 (SREBP-2), which functions as a transcription factor upregulating gene expression of cholesterol biosynthetic enzymes, in SHRSP was about 70% of that in WKY rats. These results demonstrate the possibility that the lower serum total cholesterol level in SHRSP is defined by lower gene expression of most hepatic cholesterol biosynthetic enzymes. In particular, decreased gene expression level of Sqle gene might be the most essential factor. Moreover, the broad range of lowered rates of these genes in SHRSP suggests that the abnormal function and/or expression not only of SREBP-2 but also of one or more other transcription factors for those gene expressions exist in SHRSP.

Characteristics of nobiletin-mediated alteration of gene expression in cultured cell lines.

Nobiletin, a polymethoxylated flavonoid that is highly contained in the peels of citrus fruits, exerts a wide variety of beneficial effects, including anti-proliferative effects in cancer cells, repressive effects in hyperlipidemia and hyperglycemia, and ameliorative effects in dementia at in vitro and in vivo levels. In the present study, to further understand the mechanisms of these actions of nobiletin, the nobiletin-mediated alterations of gene expression in three organ-derived cell lines - 3Y1 rat fibroblasts, HuH-7 human hepatocarcinoma cells, and SK-N-SH human neuroblastoma cells - were first examined with DNA microarrays. In all three cell lines, treatments with nobiletin (100 µM) for 24 h resulted in more than 200% increases in the expression levels of five genes, including the endoplasmic reticulum stress-responsive genes Ddit3, Trib3, and Asns, and in less than 50% decreases in the expression levels of seven genes, including the cell cycle-regulating genes Ccna2, Ccne2, and E2f8 and the oxidative stress-promoting gene Txnip. It was also confirmed that in each nobiletin-treated cell line, the levels of the DDIT3 (DNA-damage-inducible transcript 3, also known as CHOP and GADD153) and ASNS (asparagine synthetase) proteins were increased, while the level of the TXNIP (thioredoxin-interacting protein, also known as VDUP1 and TBP-2) protein was decreased. All these findings suggest that nobiletin exerts a wide variety of biological effects, at least partly, through induction of endoplasmic reticulum stress and suppressions of oxidative stress and cell proliferation.

Proportions of malocclusions in Japanese female adolescents over the last 40 years.

PURPOSE: To assess the prevalence of malocclusion in schoolgirls at a private high school and whether it has increased or not over 40 years by comparison with previous surveys on early and middle adolescence in Japan. MATERIALS AND METHODS: Conventional dental examination including evaluation of occlusion was performed in 2,378 schoolgirls who were enrolled in the seventh and the tenth grade between the years 2004 and 2006. The presence of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and crowding of teeth was recorded by visual inspection. The prevalences of various types of malocclusion were compared between the two grade groups and with data from the previous surveys. RESULTS: The proportions of malocclusions in the tenth grade (55.7%) and seventh grade (55.3%) were found to be similar. The prevalences of maxillary protrusion, anterior crossbite, edge-to-edge incisor relationship, open bite, deep bite and tooth crowding in the seventh grade students were 9.4%, 0.6%, 4.1%, 0.6%, 8.4% and 19.1%, respectively. The corresponding values in tenth grade students were almost the same except for deep bite, which was significantly lower than that in the seventh grade. Comparison with previous surveys indicated that the proportions of malocclusions taken as a whole had not changed over 40 years, whereas anterior crossbite, edge-to-edge incisor relationship, open bite and tooth crowding had decreased significantly within the last 20 years. CONCLUSION: Significant changes in the proportions of malocclusions as a whole in adolescents were not found over the last four decades.

Hepatic expression of spermatogenic genes and their transiently remarkable downregulations in Wistar-Kyoto rats in response to lead-nitrate administration: strain-difference in the gene expression patterns.

Administration of lead ion (Pb) to rats and mice affects hepatic functions such as the induction of hepatic cell proliferation and upregulation of cholesterol biosynthesis. To identify the genes for which expression changes in response to Pb-administration, we analyzed hepatic gene expression patterns in stroke-prone spontaneously hypertensive rat (SHRSP), its normotensive control, Wistar-Kyoto rat (WKY), and Spraque-Dawley (SD) rat strains, 3, 6, and 12 hr later after single i.v. injection of lead nitrate (LN) at a dose of 100 µmol using a DNA microarray technique. The data analysis demonstrated that the expression of a great number of genes was transiently and remarkably downregulated 3 hr after LN-injection, and then recovered to control levels only in LN-injected WKY. These normal hepatic expression levels in WKY and SHRSP were much higher than those in SD rats. Furthermore, most of these genes were ones thought to be expressed specifically in the spermatids and/or testes; i.e. genes encoding protamin 1, transition protein 1, and transition protein 2. These findings suggest that the regulation system common to expression of all of these genes could be a target site of Pb-toxic action, at least, in the liver of WKY, and that this system might be similar to the system essential for spermatogenesis, especially spermiogenesis, in the testis. In addition, it appears that clarifying the cause of the difference between the systems of WKY and SHRSP might aid in identifying the pathologic genes in SHRSP. Finally, it will be an important to clarify how the products of the genes related to spermatogenesis, including spermiogenesis, are functional in the livers of WKY and SHRSP.

[Effect of ISO15189 accreditation in Clinical Laboratory Center of Toyama University Hospital].

Quality, cost, risk, and knowledge control are essential in clinical laboratory management. In addition, a benchmark set by a third party is important. However, it is very difficult to develop these systems without a guideline and an authoritative body to set the benchmark. ISO15189 issued in 2003 is an international standard of "medical laboratories--particular requirements for quality and competence". This international standard is superior as a guideline. ISO15189 specifies quality and competence particular to medical laboratories. Also, it can be used by medical laboratories to develop their quality management systems and assess their own competence, and by accreditation bodies to confirm or recognize the competence of medical laboratories. In Japan, the Japan Accreditation Board for Conformity Assessment (JAB) is an accreditation body of ISO15189. We were awarded ISO15189 accreditation on July 31, 2008. In this report, we summarize the preparations for ISO15189 accreditation and the effects on our laboratory.

[Evaluation of a discharge support process at our hospital--an analysis of problems at the time of discharge in the sub-acute ward].

It has been anticipated that an elderly population of Japan will be 28,730,000 in the year 2010. With that in mind, the structure of disease will be greatly changed and asked of patient to be a self reliant as much as possible at home and the daily local living. A discharge support of the long-term inpatient is one of the important issues in our hospital. In handling of the troublesome discharged patients who were transferred to the sub-acute ward, we clarified some of the discharge support problems. In doing so, we need a systematic patient discharge support and a general educational system for the patient and family as well as care nursing staff.