Pulmonary Intimal Sarcoma Treated by a Left Pneumonectomy with Pulmonary Arterioplasty Under Cardiopulmonary Bypass: Report of a Case

Intimal sarcoma of the pulmonary artery is a rare disease. This neoplasm was characterized by an aggressive extension to the lumen of the pulmonary artery, thus mimicking a pulmonary thromboembolism. We herein report a 44-year-old woman who was diagnosed as having primary intimal sarcoma of the left lung preoperatively by transbronchial biopsy. The tumor originated in the pulmonary artery in the left lung, extending to the main pulmonary trunk via the pulmonary arterial lumen, thus resulting in stenosis of the main pulmonary trunk. A complete resection of the tumor with the left pneumonectomy and the pulmonary arterioplasty was successfully performed under cardiopulmonary bypass with vacuum assisted venous drainage.     

Successful Video-Assisted Thoracic Surgery for Pulmonary Endometriosis: Report of a Case

Pulmonary endometriosis is a disease in which uterine endometrial cells with stromal components grow in the pulmonary parenchymal tissues or pleura. Surgical resection is considered an effective and radical treatment for pulmonary endometriosis to avoid the adverse effects of long-term hormone therapy in young women of childbearing years with a localized abnormal lesion. We report a case of pulmonary endometriosis with catamenial hemoptysis, an uncommon result of this disease, which was diagnosed histologically and treated successfully by video-assisted thoracic surgery.     

Improved quantity and in vivo function of islets isolated by reduced pressure-controlled injection of collagenase in a rat model

In islet transplantation, insufficient yield is a major obstacle to one-donor/one-recipient transplant. Collagenase, which is injected via a pancreatic duct to separate islets from acini, can so easily distribute into the islet core that it may result in disruption of islets. The purpose of this study was to evaluate the superiority of reduced pressure-controlled collagenase injection (RPCI) at 80 mmHg on islet isolation to injection at 180 mmHg by examining in vivo transplant experiments besides the yield and the glucose stimulation test in a rat model. Lewis rat pancreases were distended with collagenase solution at 80 mmHg pressure as the RPCI group (group 1) and at 180 mmHg (group 2), followed by isolation. The yield in group 1 (1100 +/- 160 islets with 2750 +/- 530 IEQ) was significantly higher than that in group 2 (900 +/- 130 islets with 1570 +/- 350 IEQ, p < 0.01) due to the significant difference of the number of islets sized >150 microm in diameter, although the purity was not significantly different between the two groups. Stimulation indices in the glucose stimulation tests were 2.88 +/- 1.12 in group 1 and 1.93 +/- 0.62 in group 2 (p < 0.05). The cure rate by transplantation of 100 islets to diabetic nude mice in group 1 (8/10) was significantly higher than that in group 2 (3/10, p < 0.05). In a syngenic transplant model of 90% of islets isolated from one donor, the cure rates were 100% and 67% in groups I and 2, respectively (NS). The area under the curve on the graph of IPGTT on postoperative day 28 in group I was significantly smaller than that in group 2 (p < 0.05). In conclusion, our data show that RPCI at 80 mmHg could contribute to consistently high islet yield and in vivo function in a rat model. It was suggested that the current human protocol should be reviewed from this viewpoint.     

Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between april 2003 and march 2004

Tendency of isolated bacteria from infections in abdominal surgery during the period from April 2005 to March 2006 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, 384 strains including 18 strains of Candida spp. were isolated from 161 (70.3%) of 229 patients with surgical infections. One hundred and ninty-five strains were isolated from primary infections, and 171 strains were isolated from postoperative infections. From primary infections, aerobic Gram-negative bacteria and aerobic Gram-positive bacteria were predominant, while aerobic Gram-positive bacteria were predominant from postoperative infections. The isolation rate of aerobic Gram-positive bacteria, such as Enterococcus spp. and Staphylococcus aureus were higher from both types of infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Pseudomonas aeruginosa, Klebsiella spp. in this order, and from postoperative infections, E. coli was the most predominantly isolated, followed by Klebsiella pneumoniae and P. aeruginosa. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both primary and postoperative infections. In this series, we noticed no vancomycin-resistant Gram-positive cocci, nor multidrug-resistant P. aeruginosa. But cefazolin-resistant E. coli producing extended spectrum fl-lactamase was seen in 5.0 per cents. We should be carefully followed up the facts that the increasing isolation rates of B. fragilis group and Bilophila wadsworthia which were resistant to both penicillins and cephems.     

Characterization of the Uptake Mechanism for a Novel Loop Diuretic,M17055, in Caco-2 Cells: Involvement of Organic Anion Transporting Polypeptide (OATP)-B

Purpose M17055 is under development as a novel loop diuretic for oral administration. To investigate the molecular mechanism of its gastrointestinal absorption, we initially aimed to clarify the mechanism of uptake of M17055 by Caco-2 cells, focusing on possible involvement of OATP-B (SLCO2B1), which is localized in the apical membranes of human intestinal epithelial cells.Materials and Methods The uptake of [¹⁴C]M17055 by Caco-2 cells cultured on multi-well dishes was measured after cultivation for 14 days. Uptake of [¹⁴C]M17055 by HEK293 cells stably expressing OATP-B (HEK293/OATP-B cells) was also examined.Results M17055 uptake by Caco-2 cells was saturable, and was inhibited by various organic anions, including other loop diuretics, and several bile acids. Uptake of M17055 by HEK293/OATP-B cells was much higher than that by mock cells. The inhibitory profiles of various organic anions and the estimated K _m values for M17055 uptake were similar in Caco-2 and HEK293/OATP-B cells. Moreover, the values of inhibition constants of several inhibitors for M17055 uptake were comparable in the two cell lines.Conclusion Our data suggest that OATP-B plays a major role in the uptake of the novel loop diuretic M17055 from apical membranes in Caco-2 cells.     

Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation: subdivision and comparison with ordinary hepatocellular carcinoma

The morphologic characteristics and biologic behavior of small liver cancers with hepatic and biliary differentiation, and their histogenesis, remain unclear. In this study, 35 cases of hepatocellular carcinoma (HCC) smaller than 3 cm in diameter with biliary differentiation were divided into 3 groups, group 1 [cytokeratin (CK) 19-negative/mucin-negative], group 2 (CK 19-positive/mucin-negative), and group 3 (CK 19-positive/mucin-positive). Sixty-one HCCs without biliary differentiation were used as controls. We compared the histologic features of these tumors and the postoperative outcomes. Three morphologic features of HCCs with biliary differentiation were respectively observed in 40% (14/35), 60% (21/35), and 42.9% (15/35) as follows: (1) cancer cells with intermediate morphology, (2) prominent inflammatory cell infiltrate, (3) desmoplastic stroma; neural cell adhesion molecule and c-kit expression were noted in 25.7%(9/35) and 8.6%(3/35), respectively. Extrahepatic tumor recurrence after surgery occurred in 0% (0/16) of group 1, 33.3% (3/9) of group 2, 40.0% (4/10) of group 3, and 8.2% (5/61) of the ordinary HCCs. The tumor-related survival of group 3 patients was worse than that of patients with ordinary HCCs, but there were no differences between the survival of group 1, or group 2 patients and those with ordinary HCCs. Our results suggest that the biliary differentiation does occur even in small HCC, and a mucin-producing cancer cells indicates aggressive tumor behavior. The combination of intermediate cancer cells, inflammatory cell infiltrate, and desmoplastic stroma is likely to be related to the biliary differentiation of HCC.     

Weight reduction can decrease circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in overweight middle-aged men

Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) has been reported to be associated with acute coronary syndrome, but its association with obesity has not been elucidated. In this study, we examined whether weight reduction would reduce the serum levels of sLOX-1 in a 12-week weight reduction intervention. Thirty-eight overweight middle-aged men were enrolled in the study, and 32 completed the intervention. The serum level of sLOX-1 was measured using a chemiluminescent enzyme-linked immunoassay. After the intervention program, body weight and the serum level of sLOX-1 decreased significantly (−7.5% ± 4.8% and −72.1% ± 35.9%, respectively). Changes in serum levels of sLOX-1 were positively correlated with changes in body weight (r = 0.54, P = .003), body mass index (r = 0.57, P = .001), body fat mass (r = 0.57, P = .002), total cholesterol (r = 0.41, P = .03), subcutaneous fat area (r = 0.50, P = .007), high-sensitivity C-reactive protein (r = 0.56, P = .002), leptin (r = 0.47, P = .01), and tumor necrosis factor-α (r = 0.32, P = .09); but no correlations were observed with fasting glycemic-related factors (blood glucose, hemoglobin A_1c, and insulin). Changes in body mass index and high-sensitivity C-reactive protein were selected as significant predictors of sLOX-1 changes by multiple regression analyses. These results suggest that LOX-1 induction may be related to adipocyte metabolism, inflammation, and immune response associated with obesity.     

STIM protein coupling in the activation of Orai channels

STIM proteins are sensors of endoplasmic reticulum (ER) luminal Ca²⁺ changes and rapidly translocate into near plasma membrane (PM) junctions to activate Ca²⁺ entry through the Orai family of highly Ca²⁺-selective “store-operated” channels (SOCs). Dissecting the STIM–Orai coupling process is restricted by the abstruse nature of the ER–PM junctional domain. To overcome this problem, we studied coupling by using STIM chimera and cytoplasmic C-terminal domains of STIM1 and STIM2 (S1ct and S2ct) and identifying a fundamental action of the powerful SOC modifier, 2-aminoethoxydiphenyl borate (2-APB), the mechanism of which has eluded recent scrutiny. We reveal that 2-APB induces profound, rapid, and direct interactions between S1ct or S2ct and Orai1, effecting full Ca²⁺ release-activated Ca²⁺ (CRAC) current activation. The short 235-505 S1ct coiled-coil region was sufficient for functional Orai1 coupling. YFP-tagged S1ct or S2ct fragments cleared from the cytosol seconds after 2-APB addition, binding avidly to Orai1-CFP with a rapid increase in FRET and transiently increasing CRAC current 200-fold above basal levels. Functional S1ct–Orai1 coupling occurred in STIM1/STIM2^−/− DT40 chicken B cells, indicating ct fragments operate independently of native STIM proteins. The 2-APB-induced S1ct–Orai1 and S2-ct–Orai1 complexes undergo rapid reorganization into discrete colocalized PM clusters, which remain stable for >100 s, well beyond CRAC activation and subsequent deactivation. In addition to defining 2-APB''s action, the locked STIMct–Orai complex provides a potentially useful probe to structurally examine coupling.     

Molecular Mechanism of the Additive Effects of Leukotriene Modifier in Asthmatic Patients Receiving Steroid Therapy

BackgroundThe addition of leukotriene modifier (LM) may be a useful approach for uncontrollable asthma despite treatment with inhaled corticosteroid (ICS), especially in asthmatics comorbid with allergic rhinitis (AR), although little is known about its molecular mechanism. We evaluated the additive effects of LM with ICS on pulmonary function and airway inflammation in asthmatics with or without AR.MethodsEighteen uncontrolled steroid-treated asthmatics, nine with and nine without AR, were enrolled. Spirometry, peak expiratory flow (PEF) measurements, and exhaled breath condensate sampling were performed before and 8 weeks after LM administration. The lowest PEF over the course of one week, expressed as a percentage of the highest PEF (Min%Max PEF), was used as an index of fluctuation of the airway caliber. Airway cytokine expression was analyzed with a protein array.ResultsA significant improvement in forced expiratory volume in one second as a percentage of the predicted value (%FEV₁) and Min%Max PEF was seen in the subgroup of asthma with AR. Although there was no significant difference in the baseline cytokine values between the groups, the exhaled RANTES level was significantly reduced by LM in the asthma with AR group. The changes in the RANTES level were significantly related to the changes in the %FEV1 and Min%Max PEF values.ConclusionsLM caused a greater improvement in pulmonary function and airway inflammation in asthmatics with AR. The RANTES-mediated pathway may be involved in the improvement of the airflow limitation and airway lability by LM additive therapy in asthmatics receiving steroid therapy.     

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.