Effects of alkaloids from Corydalis decumbens on contraction and electrophysiology of cardiac myocytes

The chloroform extract of Corydalis decumbens significantly increased the beating amplitude of cultured myocardial cell sheets. Chemical analysis led to the isolation of isoquinoline and protopine alkaloids. Of these isolated alkaloids, corlumidine and (+)-adlumidine increased the beating amplitude, but (+)-egenine decreased the beating rate and beating amplitude while protopine did not show any activity. We also studied the effects of (+)-egenine and corlumidine on contractile responses and Ca²⁺ currents in single bullfrog atrial cells using the voltage-clamp method. (+)-Egenine inhibited Ca²⁺ current by 68% of the control in single cell of bullfrog atrium, while corlumidine increased Ca²⁺ current to 60% at a concentration of 0.03 mM.     

Strategy for bone marrow transplantation in eculizumab-treated paroxysmal nocturnal hemoglobinuria

Although the recent introduction of eculizumab has had a significant impact on the management of paroxysmal nocturnal hemoglobinuria (PNH), bone marrow transplantation (BMT) remains the only therapeutic option for patients who develop severe aplasia in the clinical course of PNH. However, information regarding BMT for eculizumab-treated PNH patients is scarce, and two major points-the optimal duration of eculizumab therapy, and the optimal BMT conditioning regimen-remain unclear. Here, we describe the clinical course of a PNH patient who was successfully treated with unrelated reduced-intensity BMT. Eculizumab was discontinued 2?weeks prior to the initiation of the conditioning regimen, which consisted of fludarabine 180?mg/m(2), cyclophosphamide 100?mg/kg, rabbit anti-thymocyte globulin 2?mg/kg, and TBI 3?Gy. Complete donor chimerism was rapidly achieved in association with a rapid decrease in the proportion of PNH erythrocytes. The patient became transfusion-free immediately after BMT, and had no recurrence of hemolysis. The present case suggests that discontinuation of eculizumab before BMT and the use of a highly lymphoablative conditioning regimen may act as a successful treatment strategy in BMT for PNH. Further studies are warranted to evaluate the efficacy and safety of this treatment strategy.     

Difference in Left Ventricular Mass Index Between Hypertensive Patients With and Without Renal Artery Stenosis by Propensity Score Analysis

This study aimed to define the difference in cardiac hypertrophy between hypertensive patients with and without renal artery stenosis (RAS). When cardiac ultrasonographic examination was performed in 971 consecutive hypertensive outpatients, renal peak systolic velocity (PSV) was examined. Compared with patients without RAS, those with RAS (PSV ≥180 cm/s, 4.1%) were significantly older and included a higher proportion of male patients and had a higher left ventricular mass index (LVMI). A stratified analysis in the selected 120 patients showed that the LVMI was significantly higher in patients with RAS than in those without RAS for each confounding factor such as age and blood pressure. RAS was independently associated with a higher LVMI on propensity score analysis and multivariate analysis. Thus, the difference in LVMI between hypertensive patients with and without RAS was confirmed, irrespective of age and blood pressure, by stratified propensity score analysis and multivariate regression analysis.     

The impact of postoperative infliximab maintenance therapy on preventing the surgical recurrence of Crohn’s disease: a single-center paired case–control study

Purpose

Preventing a recurrence of Crohn’s disease is a problem that remains to be solved. We evaluated the impact of using infliximab as a postoperative therapy on preventing the surgical recurrence of Crohn’s disease.

Methods

We performed a pair-matched study comparing 100 patients who had received postoperative infliximab maintenance therapy with those who had not between 1995 and 2010. The patients were matched by gender, Vienna classification and age at the time of the operation. Crohn’s disease-related reoperation was evaluated as surgical recurrence.

Results

In the postoperative infliximab maintenance therapy group, infliximab was administrated within 8 weeks after the operation. The median follow-up period was 36 months in the postoperative infliximab maintenance therapy group and 51 months in the control group. Surgical recurrences were recognized in 37 patients (three in the postoperative infliximab maintenance therapy group and 34 in the control group). A univariate analysis by the Kaplan–Meier method identified a body mass index >18 at the time of the operation (HR 0.19, p = 0.01) and postoperative infliximab maintenance therapy (HR 0.22, p = 0.0022) as factors related to the reduction of surgical recurrence. The multivariate analysis revealed that postoperative infliximab maintenance therapy was the only significant factor preventing surgical recurrence.

Conclusion

Postoperative infliximab maintenance therapy for Crohn’s disease prevents surgical recurrence, at least within 3 years after the operation.     

Reoperative surgery in cholelithiasis

From 1965 to 1980, reoperations for residual or recurrent stones were performed on 78 out of 962 Japanese patients with cholelithiasis. The majority of patients who required reoperation had intrahepatic stones. Most of the causes of reoperation were residual stones due to incomplete removal or the non-detection of intrahepatic stones at the previous surgery. Very careful examination of the intrahepatic biliary trees should be done in patients with biliary tract diseases, because in many, the first operation was done during their youth. To remove the intrahepatic calculi completely, hepatic lobectomy should be considered as a final procedure. The causes of reoperation of common duct stones were residual in 60 per cent and recurrent in 40 per cent. Definitive surgery should be done at the first or at least the second operation to avoid irreversible hepatic disorders which have untoward effects on the prognosis. It is important not only to remove the stones but also to relieve the bile stasis in the biliary tract.     

Evaluation of extensive lymph node dissection for carcinoma of the stomach

We compared the results of curative resection for carcinoma of the stomach in 254 patients who underwent simple resection (SR) and 454 patients who underwent extensive regional lymph node dissection (ELD). The 5-year survival rates of the 2 procedures were significantly different in carcinoma involving the serosa of the stomach; it was 45% in the ELD group and 18% in the SR group (p<0.001). In patients with regional lymph node metastasis we obtained a 5-year survival rates of 39% and 18% by ELD and SR, respectively (p<0.001). The incidence of metastasis to the secondary lymph nodes, removable only by ELD, was higher in cases with carcinomatous invasion of the deeper layers of the gastric wall, and this may have been the reason why ELD proved to be more effective than SR. ELD is discussed in relation to the site of the primary carcinoma and the extent of lymph node metastasis.     

Hypotensive and hypertensive effects of acetaldehyde on blood pressure in rats

Intravenous injection of acetaldehyde produced hypotensive actions in pentobarbital-anaesthetised whole rats, but hypertensive actions in pithed rats. The hypotensive effects of acetaldehyde in whole rats were abolished by pre-treatment with yohimbine. In pithed rats, the hypertensive effects of acetaldehyde were significantly attenuated by prazosin and phentolamine, and in rats that had been pre-treated with reserpine. Our results suggest that the hypertensive actions of acetaldehyde in pithed rats are due to the release of catecholamines, which subsequently leads to vasoconstriction. In whole rats the hypotensive actions of acetaldehyde may be due to alpha2-adrenoceptor stimulation in the central nervous or peripheral system.