Telmisartan treatment decreases visceral fat accumulation and improves serum levels of adiponectin and vascular inflammation markers in Japanese hypertensive patients.

Hypertension contributes to the occurrence and progression of cardiovascular diseases. The angiotensin II type 1 receptor blocker telmisartan is reported to activate the peroxisome proliferator-activated receptor gamma and improve insulin sensitivity. We investigated the effects of telmisartan treatment on visceral fat, serum adiponectin and vascular inflammation markers in Japanese hypertensive patients. This was an open-label, non-controlled study. Twenty-eight essential hypertensive patients (22 men and 6 women; age 60.6+/-1.9 years; body mass index [BMI] 25.5+/-0.6 kg/m(2)) participated. Fat area was assessed with computerized tomography. All the subjects were started on telmisartan 40 mg/day, which was increased to 80 mg/day to achieve the blood pressure target of less than 130/80 mmHg. We assessed the visceral and subcutaneous fat areas, serum adiponectin levels, and vascular inflammation markers at baseline and 24 weeks of telmisartan treatment. There were significant reductions in visceral fat area (from 103.1+/-7.9 to 93.3+/-8.4 cm(2), p<0.01) and pulse wave velocity (from 1,706+/-52 to 1,587+/-51 cm/s, p<0.01) at 24 weeks. In contrast, significant increases in serum high-density lipoprotein cholesterol (from 5.06+/-0.15 to 5.32+/-0.13 mmol/L, p<0.05) and adiponectin levels (from 8.27+/-0.76 to 9.13+/-0.81 microg/mL, p<0.05) were observed. Also, there were reductions in the interleukin-6 level (from 2.26+/-0.27 to 1.60+/-0.14 pg/mL, p<0.01). We also conducted these investigations in male subjects alone and similar findings were obtained for all of these parameters. In conclusion, telmisartan treatment was associated with an improvement of vascular inflammation, reductions in visceral fat and increases in serum adiponectin.     

Endoscopic Mucosal Resection (EMR) of Early Gastric Cancer

Abstract: We conducted this study to clarify the effectiveness of aspiration endoscopic mucosal resection (EMR) using a cap-fitted scope for early gastric cancer in the C and M regions of the stomach. EMR was performed in 111 early gastric cancer patients with 123 lesions in the C and M regions. The patients were divided into three groups. The EMR-1CS group consisted of patients who had undergone EMR with a one-channeled scope, the EMR-2CS group those who had received EMR in which a two-channeled scope was utilized. The EMRC group consisted of patients who had undergone aspiration EMR with a cap-fitted scope. The rate of complete resection improved to a statistically significant degree in the EMRC group in comparison with that in the EMR-1CS group. In type lie, a statistically significant improvement was achieved in the EMRC group in comparison with the EMR-2CS group. In the M region or in lesions 10 mm or less in diameter, the rate of complete resection improved in the EMRC group as compared with that in the EMR-2CS group. Our results suggest that EMRC is useful for lesions of early gastric cancer in the C and M regions.     

Aggregation of platelets in the mesenteric microcirculation of the rat induced by alpha-toxin (phospholipase C) of Clostridium perfringens.

We have investigated the effects of purified α-toxin (phospholipase C) of Clostridium perfringens (Yamakawa and Ohsaka, 1977) on the behavior of cellular components in the microcirculation, using cinematography on a microscopic level and electron microscopy. We demonstrated that after topical application of α-toxin to the mesentery of the rat, rolling of leucocytes along the vessel wall and sticking of leucocytes to the vessel wall occurred in venules but not in arterioles. Some of the leucocytes remained attached to the vessel wall. Thrombi were formed frequently in venules and capillaries, and at a later stage, in arterioles. With time, thrombi increased in number and size, leading eventually to stasis of the blood stream. Thrombi were also observed frequently in the mesenteric microcirculation when toxin was injected into the jugular vein of the rat. The experiments with adenosine pretreatment followed by topical application of α-toxin to the mesentery suggested that the formation of thrombi induced by this toxin does not involve the mediation of ADP. Electron-microscopic examination confirmed the formation of thrombi consisting solely of platelets. It was concluded that thrombosis must be involved as an early step in the pathogenesis of necrosis caused by α-toxin. The death of the animals injected intravenously with α-toxin may be due, at least in part, to thrombosis. It is possible that thrombosis induced by α-toxin may be one of the factors involved in the causation of toxemia often manifested in the late stage of gas gangrene.     

Double color-opponent receptive fields of carp bipolar cells

Bipolar cells with double color-opponent receptive fields were found in the carp retina. They were classified into two types depending on their response polarity. In the receptive field center, type I cells showed hyperpolarization to a long wavelength spot (R-) and depolarization to a short wavelength spot (G+), while in the surround they showed R+, G- responses. Type II cells showed responses of opposite polarities to those of type I cells, namely R+ G- in the center, and R- G+ in the surround. From their spectral sensitivity, R components were identified as coming from red-sensitive cones, and G components from green-sensitive cones. These bipolar cells are thought to be the origin of double color-opponent receptive fields of retinal ganglion cells.     

Standardization of habu (Trimeresurus flavoviridis) snake-venom toxoid.

Of the multiple toxic principles contained in the venom of the crotalid Habu (Trimeresurus flavoviridis), two hemorrhagic principles, HR1 and HR2, are known to play the most important role in envenomation. HR1 and HR2 were treated separately with formalin to make individual toxoids. The mixed toxoid composed of HR1- and HR2-toxoids was highly immunogenic for various animals and human beings. The potency of the mixed toxoid was determined relative to a reference toxoid, by titrating the circulating antitoxin in guinea-pigs, and was expressed in terms of guinea-pig immunizing units. It is of vital importance to determine whether or not the potency of toxoid preparations for human use can be expressed in guinea-pig immunizing units. Since the immune response of men and monkeys to HR1-toxoid was shown to be similar to each other, we studied the immune response of monkeys to the mixed toxoid, as a model system for that of humans. We demonstrated a linear relationship between the immune response of monkeys and the injected dose of the toxoid as expressed in guinea-pig immunizing units for HR1-antigen. The present findings enabled us to determine, in guinea-pigs, the potency of the toxoid preparations for human use relative to that of the reference toxoid.     

Vascular permeability increase by alpha-toxin (phospholipase C) of Clostridium perfringens.

T. Sugahara, T. Takahashi, S. Yamaya and A. Ohsaka. Vascular permeability increase by α-toxin (phospholipase C) of Clostridium perfringens. Toxicon15, 81–87, 1977.—Highly purified α-toxin increased the vascular permeability in guinea-pig skin. This vascular permeability-increasing activity reached a minimum value at around 70°C but heating at higher temperatures inactivated it to a lesser extent. The same anomaly in heat inactivation was observed with the phospholipase C activity possessed by the toxin. By subjecting the purified toxin to isoelectric focusing, four molecular forms were isolated, all of which were associated with both vascular permeability-increasing and enzymatic activities. These results clearly demonstrated the identity of the factor responsible for the vascular permeability-increasing activity with α-toxin.     

Successful coil embolization with assistance of coronary stenting in an adult patient with a huge coronary arterial-right atrial fistula

A 55 year-old man with huge coronary artery fistula to the right atrium is presented. The Qp/Qs ratio was 1.6. We failed to place simultaneously three interlocking detachable coils for closing the fistula, because the coils were washed out into the right atrium. We deployed the coronary stent at the distal portion of the coronary artery. This procedure enabled us to anchor 7 electrically or interlocking detachable coils and to interrupt the shunt flow. A Doppler flow wire was useful to reveal instantaneously the extent of flow reduction even when contrast angiography was not performed in each procedure.