Enhancement of Cornified Envelope-Related Gene and Protein Expression by Carba Cyclic Phosphatidic Acid in Normal Human Epidermal Keratinocytes.

The aim of this study was to examine the effects of carba cyclic phosphatidic acid (ccPA) on cornified envelope (CE) formation and keratinocyte differentiation. ccPA-treated keratinocytes showed higher mRNA and protein levels of differentiation markers and CE components than untreated cells. These results suggest that ccPA could serve as therapeutic targets for treating skin barrier dysfunction because of their roles in upregulating genes and proteins associated with CE formation and keratinocyte differentiation.

Formation of charge-transfer complexes in ionic crystals composed of 1,3-bis(dicyanomethylidene)indan anion and viologens bearing alkyl chains.

The relationship between charge-transfer (CT) properties and the molecular arrangement formed from π-electronic ion pairs remains unclear because of the limited variety of π-electron anions. This study addressed this issue by synthesising a series of ion pair assemblies composed of viologen dications with diverse alkyl chains as π-electron cations and 1,3-bis(dicyanomethilidene)indan anion (CMI-) as a stable π-electron anion. We obtained seven ionic crystals and identified their assembled structures using single-crystal X-ray analysis. These structures are categorized into three types: "columnar", "slipped columnar" and "independent". The CT properties were characterised using UV-Vis absorption spectroscopy, which revealed that the CT absorption bands were dependent on the alkyl chain length. This intriguing variation in the CT transitions can be explained by the differences in the type of assembled structure.

[Investigation of atherosclerosis using carotid ultrasonography].

Carotid ultrasonography is useful for patients in the early stage of atherosclerosis or with manifest vascular disease. We can assess the intima-media thickness (IMT), stenosis, and also elasticity of the carotid artery noninvasively. IMT is well-known as a strong predictor of future vascular events and a surrogate marker of atherosclerosis. We examined 353 consecutive subjects (coronary artery disease: n=92, cerebral vascular disease: n=62, peripheral arterial disease: n=104), regarding whether the accumulation of vascular diseases affects the IMT. The maximum IMT of the common carotid artery expanded with increasing numbers of vascular diseases (no vascular disease, 1.10 +/- 0.51; one vascular disease, 1.38 +/- 0.63; two vascular diseases, 1.69 +/- 0.65; three vascular diseases, 2.01 +/- 0.67 mm; p < 0.01, no vs. one vascular disease, one vs. two vascular diseases). The accumulation of vascular diseases, independent of the types of vascular lesion, accelerated carotid atherosclerosis. The stiffness parameter beta of the carotid artery was related to the brachial-to-ankle pulse wave velocity(baPWV) (n=38, r = 0.81, p < 0.0001). Stiffness parameter beta (10.95 +/- 2.8) and baPWV (1,549 +/- 179 cm/s) in the metabolic syndrome (MetS) group (n=18) was higher than in the preliminary MetS (n=12, 8.82 +/- 1.69, 1417 +/- 148 cm/s) and control (n=8, 7.90 +/- 1.78, 1357 +/- 171 cm/s) groups. The mean IMT of the common carotid artery was not different between the MetS and preliminary MetS groups. Morphological and functional changes in atherosclerosis can be evaluated employing carotid ultrasonography.

[Clinical features of lung cancer HIV-infected patients].

Since HIV infection and opportunistic infections began to be treated by highly active antiretroviral therapy (HAART), the incidence of cancers, especially lung cancer increased. The clinical course of lung cancer in HIV infected patients is more aggressive, and little is known about its features or management. We retrospectively evaluated 6 cases of lung cancer with HIV infected patients in Tokyo Metropolitan Komagome Hospital. All patients were male and current smokers. Adenocarcinoma, squamous cell carcinoma and small cell carcinoma were observed in 3, 2 and 1, respectively. There were 2 cases each of clinical Stage I, IIIB, and IV were each 2 cases. The range of the CD4 cell count was 52-432/microL. HIV infection was confirmed concurrently with the diagnosis of lung cancer or complications in 5 of 6 patients. Some cases treated for both lung cancer and HIV, had a relatively good clinical course. We suggest that cancer treatment concurrently with HAART may be useful for similar cases. Further experience and study are necessary.

Malnutrition, renal dysfunction and left ventricular hypertrophy synergistically increase the long-term incidence of cardiovascular events.

Although malnutrition indicates an unfavorable prognosis in some clinical settings, the synergistic impact of nutritional state, renal dysfunction and left ventricular hypertrophy (LVH) on cardiovascular events is unknown. Among 338 patients aged 40-80 years who underwent echocardiographic evaluation between 2003 and 2005, 161 patients who were followed for >7 years were recruited. Malnutrition was defined as a geriatric nutritional risk index (GNRI) of ⩽96. The mean patient age was 63.5±9.2 years; the mean estimated glomerular filtration rate (eGFR) was 72.9±18.7 ml min(-1) per 1.73 m(2); the mean LV mass index was 114±33 g m(-)(2); and the mean GNRI was 100.4±6.0. Among the patients, 25% (n=40) had an eGFR of <60 ml min(-1) per 1.73 m(2), 29% (n=46) exhibited chronic kidney disease (CKD) and 37% (n=59) had LVH. During the follow-up period (median: 96 months), cardiovascular events were observed in 15 patients (9%). Kaplan-Meier curves showed a significantly higher incidence of cardiovascular events in patients with an eGFR of <60 ml min(-1) per 1.73 m(2) (log-rank P=0.007), a GNRI of ⩽96 (P=0.003) or LVH (P=0.010). In a Cox regression analysis, eGFR, LVH and GNRI were independent determinants of cardiovascular event incidence after adjusting for age, gender and the presence of hypertension and diabetes. Furthermore, the combination of LVH and lower GNRI was significantly associated with a higher rate of cardiovascular events not only in all patients but also in patients with CKD. In conclusion, malnutrition, low eGFR and LVH were independent determinants of cardiovascular event incidence; they synergistically increased rates of these events in the long term. The evaluation and management of LVH progression and the improvement of nutritional status are critical for preventing cardiovascular complications even in non-dialysis patients.

Effects of papaverine on carbachol- and high K+ -induced contraction in the bovine abomasum.

The effects of papaverine on carbachol (CCh) -and high K(+)- induced contraction in the bovine abomasum were investigated. Papaverine inhibited CCh (1 µM) -and KCl (65 mM) -induced contractions in a concentration-dependent manner. Forskolin or sodium nitroprusside inhibited CCh-induced contractions in a concentration-dependent manner in association with increases in the cAMP or cGMP contents, whereas papaverine increased cGMP contents only at 30 µM. Changes in the extracellular Ca(2+) from 1.5 mM to 7.5 mM reduced verapamil-induced relaxation in high K(+)-depolarized muscles, but papaverine-induced relaxation did not change. Furthermore, papaverine (30 µM) and NaCN (300 µM) decreased the creatine phosphate contents. These results suggest that the relaxing effects of papaverine on the bovine abomasum are mainly due to the inhibition of aerobic energy metabolism.

[Pituitary stalk metastasis from lung cancer, preceding diabetes insipidus--case report and clinical review of the literature].

A 59-year-old woman whose first clinical manifestations were polyuria and polydipsia was admitted to our hospital. Brain MRI showed multiple mass lesions and a thickened pituitary stalk. Chest CT showed hilar and mediastinal lymphadenopathy and a small nodule measuring about 1.5 cm in the apex of the right lung. Histopathological examination revealed adenocarcinoma of the lung, and primary lung cancer with diabetes insipidus secondary to pituitary stalk metastasis was diagnosed. She received systemic chemotherapy and whole-brain irradiation concurrent with intranasal desmopressin (DDAVP) treatment. Although the size of the tumor was reduced, her symptoms did not improve and the same dose of hormone replacement therapy was required. We present this rare case and review the twenty cases of metastatic pituitary lesions arising from lung cancer reported in the literature.

Aortic regurgitation caused by fibrous strand rupture in a fenestrated aortic valve.

Fibrous strand rupture in a fenestrated aortic valve can cause acute severe aortic regurgitation. We report the case of a 56-year-old woman with severe aortic regurgitation. Transesophageal echocardiography showed an abnormal fibrous strand echo on the prolapsed left coronary cusp (LCC). The operative finding revealed one ruptured fibrous strand attached to the LCC at the commissure between the left and noncoronary cusps. Pathologic examination of the aortic valve revealed myxomatous degeneration.

The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients.

Fetuin-A and osteoprotegerin (OPG) are arterial calcification regulators, which are related to cardiovascular survival in hemodialysis patients. We hypothesized that a balance of these calcification regulators might mediate the progression of left ventricular (LV) diastolic dysfunction in hemodialysis patients. We recruited 63 hemodialysis patients and measured their serum fetuin-A, OPG, arterial stiffness, aortic calcification and echocardiographic parameters, including the transmitral early diastolic velocity/tissue Doppler mitral annular early diastolic velocity ratio (E/E'), and analyzed the relationships between these variables. Fetuin-A levels were significantly and negatively correlated with the ankle-brachial pulse wave velocity (baPWV), aortic calcification score (AOCS), left atrial volume index (LAVI), LV mass index (LVMI) and E/E'. OPG levels and the ratio of OPG to fetuin-A levels were significantly and positively correlated with the baPWV, AOCS, LAVI and E/E'. A stepwise multiple regression analysis revealed that E/E' was independently correlated with fetuin-A levels (ß=-0.334, P=0.02), OPG levels (ß=0.367, P=0.01) and the ratio of OPG to fetuin-A (ß=0.295, P=0.04). Categorizing the patients according to their serum fetuin-A and OPG levels revealed that patients with low fetuin-A and high OPG levels had the highest LAVI, LVMI and E/E' values after adjusting for potential confounders. Serum fetuin-A levels negatively reflected, whereas OPG levels and the ratio of OPG to fetuin-A positively reflected an increase in vascular and ventricular stiffness, leading to the aggravation of diastolic dysfunction. Therefore, based on our results, the balance of the tissue calcification regulators fetuin-A and OPG could mediate the progression of LV diastolic dysfunction in hemodialysis patients.

Brugada syndrome case: difficult differentiation between a concealed form and tricyclic antidepressant-induced Brugada sign.

We describe a case of Brugada syndrome, in which recurrent syncope with convulsive seizures was induced after antidepressant treatment. The patient had been treated with five kinds of psychotropic drugs. The twelve-lead ECG after the syncope exhibited an RSR'-pattern in the precordial leads, however, a coved type ST-segment elevation was induced by a pilsicainide test. Although ventricular fibrillation was not induced in the electrophysiologic study, an ICD implantation was considered as the recommended therapy since Brugada syndrome unmasked by antidepressants could not be ruled out. The possible contribution of antidepressants to Brugada type ST-segment changes is discussed.

A long-term survival case of small cell lung cancer in an HIV-infected patient.

We report a case of small cell lung cancer in a patient with human immunodeficiency virus (HIV) infection. The patient was a 51-year-old man diagnosed 8 years previously as seropositive for HIV, who was admitted to our hospital for re-evaluation of antiretroviral medications due to multidrug resistance. Chest radiograph revealed an abnormal hilar shadow subsequently confirmed to be small cell lung cancer. He received chemotherapy concurrently with highly active antiretroviral therapy (HAART), and lived for 14 months after the diagnosis. The prognosis of lung cancer in HIV-seropositive patients is very poor, and adverse effects of chemotherapy occur more frequently than in other patients. However, the simultaneous antiretroviral agents and combination chemotherapy was successful. Such treatment may be effective despite an otherwise poor prognosis, including HIV infection.

A sistemática da distribuiçäo e prescriçäo de medicamentos em unidades básicas de saúde da regiäo sul de Londrina / The sistematic of the distribution and prescription's drug in the health basic unit of Londrina's south region

Após a observaçäo da realidade na Unidade Básica de Saúde Parque das Indústrias do Município de Londrina, os autores verificaram, em vários levantamentos realizados, a deficiência no controle e distribuiçäo de medicamentos, bem como a falta dos mesmos para usuários desta Unidade. Portanto, objetivou-se analisar a sistemática de distribuiçäo e prescriçäo de medicamentos desses serviços nas Unidades Básicas de Saúde da Regiäo Sul, além de propor um esquema de controle para tal distribuiçäo. Para atingir tal objetivo, foram levantados dados através da aplicaçäo de questionários para 17 médicos e dentistas, 25 auxiliares de enfermagem, além de 51 pacientes que foram submetidos a consultas médicas ou odontológicas nas citadasUnidades Básicas de Saúde (UBS). Com a mesma finalidade, também foram realizadas entrevistas com a chefia da divisäo de unidades ambulatoriais da Secretaria Municipal de Saúde e Centrofarma do Serviço de Saúde do Município