Clonogenic Patterns of Human Pulmonary Adenocarcinoma Cell Lines (PC-9, PC-13 and PC-14) and How They Influence the Results of Test for Chemosensitivity to Cisplatin in the Human Tumor Clonogenic Assay

The clonogenic patterns of three human pulmonary adenocarcinomacell lines (PC-9, PC-13 and PC-l4) were studied by human tumorclonogenic assay (HTCA), and factors which could influence theresults of tests for the chemosensitivity of these tumor cellsto cisplatin in HTCA were determined. The results showed thateach tumor cell line had a characteristic clonogenic pattern.The time intervals for the cells to grow to the plateau phasevaried from 9 to 16 days, depending on the cell line and numberof cells plated. The number of cells plated could substantiallyinfluence the results of chemosensitivity tests. The percentageof surviving colonies increased markedly if too many cells (usually5 x 10⁴ or more/plate) were plated. For continuous exposure,the results of chemosensitivity tests were rather stable after7 days of incubation in each cell line, especially when fewerthan 2 x 10⁴ cells/plate were plated. For 1-hour exposure, theincubation periods for the results to become stable varied from7 to 16 days depending on the cell type, number of cells platedand drug concentration. It was stressed that for the correctevaluation of the chemosensitivity of cultured cell lines inHTCA, the clonogenic pattern of each tumor cell line shouldbe checked in detail before further experiments are conducted.The higher the concentration and the longer the exposure time,the more strongly cis-diamminedichloroplatinum (CDDP) suppressedthe colony growth in each of the three cell lines in HTCA, andit was recommended that CDDP should be used clinically in sucha way as to maintain a high serum level of the active form ofCDDP for a long time.     

Predicting optimal continuous positive airway pressure in Japanese patients with obstructive sleep apnoea syndrome

Background and objective: Several algorithms that predict the optimal CPAP have been developed for Caucasian patients with OSA syndrome, but these algorithms do not allow for racial differences in craniofacial anatomy. We investigated whether an equation that included data on craniofacial structure, physique and severity of OSA could more accurately predict the optimal CPAP for Japanese patients with OSA syndrome. Methods: In 170 Japanese patients with OSA syndrome, the optimal CPAP was determined by manual titration during polysomnography. An equation predicting the optimal pressure was derived from anthropometric, polysomnographic and cephalometric data. This equation was validated in another 110 Japanese patients with OSA syndrome. Results: Stepwise multiple regression analysis identified AHI, BMI, mean SaO₂ and a cephalometric parameter: the angle between a line from point B to the menton (Me) and a line from Me to the hyoid bone (H) (BMeH), as independent predictors of optimal CPAP. The following equation was constructed to predict the optimal CPAP: 27.78 + (0.041 × BMeH) + (0.141 × BMI) + (0.040 × AHI) ? (0.312 × mean SaO₂). This equation accounted for 47% of the variance in optimal pressure (R² = 0.47, P < 0.0001). The measured optimal pressure and the pressure calculated using this equation were very similar in the other 110 patients with OSA syndrome (9.5 ± 3.0 and 9.2 ± 2.1 cmH₂O, respectively). Conclusion: Optimal CPAP was more accurately predicted by combining a cephalometric parameter with BMI and polysomnographic data in Japanese patients with OSA, suggesting that craniofacial structure may be important in the pathogenesis of OSA syndrome among Asians.     

Reentrant Ventricular Outflow Tract Tachycardia Arising from Focal Scar Detected by Delayed Enhancement Magnetic Resonance Imaging

A 58‐year‐old man was referred to our emergency room with hemodynamically unstable sustained ventricular tachycardia (VT). The morphology of the VT exhibited a left bundle branch block and inferior axis deviation. He had no past history of cardiovascular disease. Echocardiography, cardiac catheterization, cardiac biopsy, gallium scintigram, myocardial scintigram, T1,T2‐weighted magnetic resonance imaging (MRI), and gadolinium‐enhanced cine MRI did not detect any structural heart disease or abnormal cardiac function. However, delayed‐enhancement MRI (DE‐MRI) detected a focal intramural scar within the septal ventricular outflow tract. An electrophysiological study revealed a sustained VT with several morphologies and the entrainment phenomenon. Radiofrequency catheter ablation to the site corresponding to the focal scar detected by DE‐MRI successfully eliminated the VT. (PACE 2012;35:e349–e352)     

Optimal Target Site for Slow AV Nodal Pathway Ablation

INTRODUCTION: Although a variety of ablation techniques have been developed in the treatment of atrioventricular nodal reentrant tachycardia (AVNRT), there have been few reports discussing the location of the optimal target site. Based on our early experiences, we hypothesized that radiofrequency (RF) current applied around the upper margin of the coronary sinus ostium (UCSO) results in the most effective and safe treatment of AVNRT. METHODS AND RESULTS: To confirm our hypothesis, the efficacy of RF currents applied around the UCSO guided by local electrograms in 59 patients (group B: predetermined focal mapping approach) were compared with the outcomes in 60 other patients previously treated with the standard electrogram-guided mapping method starting around the lower margin of the coronary sinus ostium (group A). The precise location of ablation catheters at successful sites (S) was also evaluated. All the patients were successfully treated without complications. Significantly fewer RF pulses and lower energies were needed in group B patients (mean RF applications: 4.3 vs 1.4 applications, mean total energy delivered: 4,699 vs 2,236 J in groups A and B, respectively, P < 0.01). Detailed analyses of the anatomical locations of S using CS venography in group B patients who received only a single RF application (46 patients) revealed that the distance between His and S varied according to the length of Koch's triangle, while that between S and UCSO was relatively constant. In 85 % of these 46 patients, S was located within 5 mm above and below the level of the UCSO. CONCLUSION: RF applications around the UCSO guided by local electrograms yielded excellent outcomes in AVNRT patients with wide varieties in the size of Koch's triangle. The optimal target site was located within 5 mm above and below the level of UCSO along the tricuspid annulus.     

High‐dose unfractionated heparin therapy in a pregnant patient with antiphospholipid syndrome: a case report

A case of a 37‐year‐old pregnant patient with antiphospholipid syndrome (APS), who has a medical history of both thrombosis and recurrent fetal loss, is presented. She was treated with predonisolone and fixed‐dose unfractionated heparin (UFH) infusion, followed by plasmaphereses and fixed‐dose low‐molecular‐weight heparin infusion during her fourth pregnancy. Unfortunately, this treatment did not have beneficial effects, resulting in intrauterine growth restriction and finally neonatal death. Continuous intravenous UFH infusion and low‐dose aspirin were administrated under the monitoring of the activated partial thromboplastin time to achieve a target level of 120 s during her fifth pregnancy. A healthy baby weighing 1818 g at birth was delivered by Cesarean section at the 34th week of pregnancy. High‐dose UFH infusion may be considered to be one of the preferable options to manage pregnant patients with refractory APS.     

Ultra-high-molecular-weight Polyethylene (UHMWPE) Wing Method for Strong Cranioplasty

We developed a new cranioplasty method that utilizes artificial bone made of ultra-high-molecular-weight polyethylene, with a wedge-shaped edge (UHMWPE Wing). This study shows the methods and data of case series and finite element analyses with the UHMWPE Wing. A circumferential wing was preoperatively designed for a custom-made artificial bone made of UHMWPE to achieve high fixed power and to minimize the usage of cranial implants. Here, we present 4 years of follow-up data and finite element analyses for patients treated with the UHMWPE Wing between February 2015 and February 2019. Eighteen consecutive patients underwent cranioplasty using our UHMWPE Wing design. There were no postoperative adverse events in 17 of the patients for at least 18 months. One case of hydrocephalus experienced screw loosening and graft uplift due to shunt malfunction. Placement of a ventriculo-peritoneal shunt immediately returned the artificial bone to normal position. Finite element analyses revealed that a model using the UHMWPE Wing had the highest withstand load and lowest deformation. This is the first report on the UHMWPE Wing method. This method may enable clinicians to minimize dead space and achieve high strength in cranioplasty.