Evaluation of the mitral valve leaflet morphology after mitral valve reconstruction with a concept "coaptation length index"

BACKGROUND: In clinical settings, information on morphology of mitral valve leaflet after mitral valve reconstruction is limited. METHODS: Between January 1996 and June 2000, 36 underwent mitral valve repair for mitral regurgitation (MR). The etiology of mitral insufficiency was prolapse, dilated annulus, and ischemic. Ring annuloplasty was performed in all cases. Mitral valve short-axis dimension (MVd), vertical distance between annular line and closing point (Vd), coaptation length (CL), coaptation length index (CL/MVd) were measured by the two-dimensional transesophageal echocardiography for the present 11 cases. RESULTS: In 11 cases, residual MR, using a scale from 0 to 4, was 0 in 5 patients, 1 in 4 patients, 2 in 2 patients whose etiology of regurgitation was cardiomyopathy. MVd and Vd decreased significantly (38.7 +/- 6.2 to 27.0 +/- 5.6 mm, 10.1 +/- 7.7 to 6.5 +/- 4.6 mm, respectively). CL and CLI increased significantly (6.4 +/- 2.4 to 11.6 +/- 4.6 mm, 0.16 +/- 0.06 to 0.44 +/- 0.21, respectively). Among those index, only CLI have a statistically significant negative correlation with the degree of residual MR. CONCLUSION: The mitral valve ring annuloplasty produce the morphologic change of mitral apparatus, especially the increase of CLI, which may be one of the main factors in regulation of regurgitation.     

Successful salvage therapy of continuous low-dose irinotecan for a patient with relapsed and refractory diffuse large B-cell lymphoma

A 46-year-old man with relapsed and refractory diffuse large B-cell lymphoma after salvage therapy (EPOCH and ESHAP regimens) was treated with continuous low-dose CPT-11 (irinotecan hydrochloride) at 30 mg/day (20 mg/m2/day) for three consecutive days every week. The patient's general condition and both LDH and CRP, tumor related markers, improved dramatically. Complete remission was achieved after a 10-week cycle of therapy without severe adverse effects. Unfortunately, the lymphoma relapsed after allogeneic hematopoietic stem cell transplantation, low-dose CPT-11 therapy was used again to palliate tumor symptoms for 12 months. This therapy may be a useful salvage and palliative chemotherapy for relapsed and refractory lymphoma.     

The Changes in Pulmonary Capillary Blood Flow and Anatomical Dead Space During Pulmonary Resection Under One-Lung Ventilation

Pulmonary capillary blood flow (PCBF), anatomical dead space (VDaw) and Spo₂ were measured and recorded continuously using NICO^TM (Novametrix Medical Systems Inc, USA) in 2 cases during pulmonary resection under one-lung ventilation (OLV). A pulmonary artery catheter was inserted and continuous CO (CCO) was also measured in case 2. In both cases PCBF decreased by half when one lung was blocked. CCO was unchanged before and after one lung blockade in case 2. During OLV, Spo₂, which had initially decreased, gradually increased along with a very slow increase in PCBF. The decreased PCBF obtained with NICO^TM represents the pulmonary blood flow of the ventilated (non-blocked) lung. The gradual increase in PCBF with NICO^TM during OLV may express the compensatory effects of hypoxic pulmonary vasoconstriction. By measuring VDaw before, during and after one-lung ventilation, we were able to calculate the bronchial volume of the non-ventilated lung and that of the resected lung.     

The threshold cadmium level that causes a substantial increase in beta2-microglobulin in urine of general populations

Cadmium (Cd) is a toxic element ubiquitous in the environment, and general populations have been exposed to this element primarily via foods. Thus, the critical level of non-occupational Cd exposure to cause any health effects among general populations is of public health as well as toxicological concern. The objectives of the present study were to examine the quantitative relationship between cadmium (Cd-U) and beta2-microglobulin in urine (beta2-MG-U) as a marker of exposure to Cd and as a marker of renal tubular dysfunction, respectively, and to identify a threshold Cd-U, if present, in causing a substantial increase in beta2-MG-U. Thus, paired data on geometric mean (GM) Cd-Ucr (i.e., Cd-U as corrected for creatinine [cr] concentration) and GM beta2-MG-Ucr (beta2-MG-U as corrected for cr) of residents in polluted as well as nonpolluted areas in Japan were retrieved in international and domestic sources. In practice, 245 cases of the data pairs were obtained in 51 articles published since 1975. Statistical analysis on ordinary scales disclosed that beta2-MG-Ucr increased markedly when Cd-Ucr exceeded a certain level. The relation between the two parameters after double-logarithmic conversion was in a shape of the letter J or a stick for ice hockey. Analysis for Cd-Ucr at the flexion point gave Cd-Ucr of 4 (on double logarithmic scales) or 7 microg/g cr (on ordinary scales). Cd-Ucr levels that correspond to a beta2-MG-Ucr of 1,000 microg/g cr were estimated to be 8-9 microg/g cr, by ordinary and logarithmic assumption as well as by the 3rd degree regression analysis. Thus, it is concluded that there is a threshold Cd-Ucr level that leads to a substantial increase in beta2-MG-Ucr, and that the threshold level is greater than 4 microg/g cr.     

Radical external beam radiotherapy for clinically localized prostate cancer in Japan: changing trends in the patterns of care process survey between 1996-1998 and 1999-2001

BACKGROUND: This report presents results of a study delineating changing trends in radical external beam radiotherapy usage for prostate cancer between the 1996-1998 and 1999-2001 Patterns of Care Study (PCS) survey periods in Japan. MATERIALS AND METHODS: Out of the 694 patients comprising the 1996-1998 and 1999-2001 PCS surveys, the current study analyzed data for 444 patients with clinically localized prostate cancer treated with external beam radiotherapy (1996-1998 PCS: 161 patients; 1999-2001 PCS: 283 patients). RESULTS: Significantly higher percentages of patients had earlier T stages (T1-T2: 48.2%) and well-differentiated tumors (23.6%) between 1999 and 2001 than between 1996 and 1998 (T1-T2: 34.6%, well-differentiated tumors: 15.1%). Although only 5.9% of patients were treated with radiotherapy by their own choice during 1996-1998, a larger proportion (26.5%) chose this treatment during 1999-2001. The median radiation dose was 65.0 Gy during 1996-1998, increasing to 68.4 Gy during 1999-2001. Moreover, the incidence of total treatment doses of > or = 70 Gy was higher during 1999-2001 (38.0%) than during 1996-1998 (17.5%). On the other hand, the percentage of patients receiving conformal therapy during 1996-1998 (49.1%) was almost the same as during 1999-2001 (50.2%). The median numbers of full-time equivalent (FTE) radiation oncologists increased in academic institutions (1.8 in 1996-1998; 2.4 in 1999-2001), while those in non-academic institutions remained low (0.5 in 1996-1998; 0.45 in 1999-2001). CONCLUSION: In Japan, fewer prostate cancer patients treated with radical external beam radiotherapy had advanced diseases. Increasing percentages of patients chose radiotherapy and received increased radiation doses, which might reflect the growing acceptance of radical external beam radiotherapy as a first-line treatment for prostate cancer in Japan.     

Effects of vitamin K2 in hemodialysis patients with low serum parathyroid hormone levels

In patients with adynamic bone disease, the bone contains few osteoblasts or osteoclasts and bone turnover is slow, so the risk of fracture is increased. The decrease of bone remodeling may also decrease the capacity of bone to buffer calcium, leading to an increase of the calcium x phosphate product and an increased risk of arterial calcification. Such findings emphasize that an effective treatment for adynamic bone disease is required. The present study investigated the influence of vitamin K2 (menatetrenone) on hemodialysis patients with low serum parathyroid hormone levels by using bone metabolism markers. The subjects were 32 hemodialysis patients (19 men and 13 women) aged from 27 to 76 years with an intact parathyroid hormone (PTH) level of less than 65 pg/ml and an intact osteocalcin level below 20 ng/ml. All patients received oral menatetrenone therapy (45 mg/day) for 12 months. To obtain control data on bone metabolism markers in hemodialysis patients with normal bone turnover, we selected 50 patients who had intact PTH levels within the range that maintains relatively normal bone turnover, that is, from 120 to 250 pg/ml. The baseline levels of all bone metabolism markers were significantly lower in our patients than in the normal PTH control group. There was a significant increase of gamma-carboxyglutamate (Gla) osteocalcin, bone alkaline phosphatase (B-ALP), tartrate-resistant acid phosphatase (TRACP), and cross-linked N-terminal telopeptide of type 1 collagen (NTx) levels after vitamin K2 administration. Type 1 procollagen carboxyterminal propeptide (P1CP) and intact osteocalcin both showed a significant increase after 12 months of treatment. Although there was no significant change of the alkaline phosphatase (ALP) level during the 12 months before the start of vitamin K2 therapy, there was a significant increase of alkaline phosphatase after vitamin K2 administration. Adjusted calcium, serum phosphate, and intact PTH showed no significant changes throughout the study. These changes of bone metabolism markers suggested that vitamin K2 therapy can improve bone remodeling in hemodialysis patients with low serum PTH levels.     

Effect of shift work on mental state of factory workers

This paper examines the effects of shift work on the mental state of factory workers. As an indicator of the workers' mental condition, the authors used a scoring system (referred to below as the 'depression tendency score') based on the SRQ-D investigative report. The depression tendency score of the men was higher among the shift worker group than among the regular day worker group (p < 0.01). The depression tendency score of the male back-to-back shift workers was higher than that of the male regular day workers among skilled workers (p < 0.05). Among the women, no notable difference in depression tendency score was observed between the regular day worker group and the shift worker group. However, the depression tendency score of the female two-shift workers was higher than that of the female regular day workers among skilled workers (p < 0.05). We conclude that the mental health of men is easily affected by back-to-back shift work and that of women is affected by two-shift work because of the difference in modern societal/home role between man and woman.     

Paclitaxel prevents loss of pulmonary endothelial barrier integrity during cold preservation

BACKGROUND: Cold preservation is the most practical method to maintain the viability of isolated lungs. However, rapid cooling may affect pulmonary endothelial function. We examined the effects of microtubule stabilization with paclitaxel on pulmonary endothelial barrier integrity under cold temperature. METHODS: Human pulmonary arterial endothelial cells were incubated at 4 degrees C for 2 hr in the presence or absence of paclitaxel (2.5 micromol/L). Microtubules was visualized using immunocytochemical techniques. Ultrasonic attenuation was measured with scanning acoustic microscopy. Endothelial barrier integrity was measured as transendothelial electric resistance. In addition, we examined graft function in a rat lung transplantation model, in which the donor lung had been preserved in the presence of paclitaxel (2.5 micromol/L) at 4 degrees C for 12 hr. RESULTS: Low temperature caused a reversible microtubule disassembly, but the structure of microtubules was preserved by paclitaxel. Paclitaxel prevented the cooling-induced decrease in ultrasonic attenuation and transendothelial electric resistance. In a rat transplantation model, we found that preservation with paclitaxel successfully improved the oxygenation performance of the donor lung, which demonstrated only mild congestion and less significant interstitial edema without fluid accumulation in the alveolar spaces. CONCLUSIONS: Our results indicate that microtubule stabilization with paclitaxel may be beneficial to prevent the loss of the endothelial barrier during cold preservation. We conclude that the use of paclitaxel in organ preservation solutions is useful in protecting pulmonary endothelial barrier integrity during cold preservation, thereby reducing the occurrence of early graft failure.