Indirectly probing Ca2+ handling alterations following myocardial infarction in a murine model using T1‐mapping manganese‐enhanced magnetic resonance imaging

Prolonged ischemia causes cellular necrosis and myocardial infarction (MI) via intracellular calcium (Ca²⁺) overload. Manganese‐enhanced MRI indirectly assesses Ca²⁺ influx movement in vivo as manganese (Mn²⁺) is a Ca²⁺ analog. To characterize myocardial Mn²⁺ efflux properties, T₁‐mapping manganese‐enhanced MRI studies were performed on adult male C57Bl/6 mice in which Ca²⁺ efflux was altered using pharmacological intervention agents or MI‐inducing surgery. Results showed that ( 1 ) Mn²⁺ efflux rate increased exponentially with increasing Mn²⁺ doses; ( 2 ) SEA0400 (a sodium–calcium exchanger inhibitor) decreased the rate of Mn²⁺ efflux; and ( 3 ) dobutamine (a positive inotropic agent) increased the Mn²⁺ efflux rate. A novel analysis technique also delineated regional features in the MI mice, which showed an increased Mn²⁺ efflux rate in the necrosed and peri‐infarcted tissue zones. The T₁‐mapping manganese‐enhanced MRI technique characterized alterations in myocardial Mn²⁺ efflux rates following both pharmacologic intervention and an acute MI. The Mn²⁺ efflux results were consistent with those in ex vivo studies showing an increased Ca²⁺ concentration under similar conditions. Thus, T₁‐mapping manganese‐enhanced MRI has the potential to indirectly identify and quantify intracellular Ca²⁺ handling in the peri‐infarcted tissue zones, which may reveal salvageable tissue in the post‐MI myocardium. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Trigeminal neuralgia in an elderly patient associated with a variant of persistent primitive trigeminal artery

An 86-year-old woman presented with a 10-year history of right paroxysmal facial pain. The trigger zone was the right maxilla. Magnetic resonance (MR) angiography and MR cisternography sourse images showed an aberrant artery originating from the right internal carotid artery anastomosed to the anterior inferior cerebellar artery territory (AICA) of the cerebellum, and it was closed at the root entry zone of trigeminal nerve. The patient underwent microvascular decompression (MVD), and her pain resolved after the operation. Most of the offending vessels that cause trigeminal neuralgia are the superior cerebellar artery (75-80%) and AICA. Although persistent primitive trigeminal artery (PTA) is the most common type of persistent carotid-basilar anastomosis, trigeminal neuralgia associated with PTA or a PTA variant is very rare, and particularly, a PTA variant is an uncommon, anomalous, intracranial vessel. It is necessary to inspect MR imaging scans carefully prior to MVD surgery because they are frequently associated with intracranial aneurysms. During surgery, we must be careful not to injure the perforating arteries from the PTA variant. MVD for trigeminal neuralgia in elderly patients is effective if the patients can have a tolerate general anesthesia. However, when we plan surgery for elderly patients, we must take care that it does not to lead to unexpected complications.     

Bone regeneration with self-assembling peptide nanofiber scaffolds in tissue engineering for osseointegration of dental implants

The aim of this study was to evaluate the correlation between the osseointegration of dental implants and tissue-engineered bone using a nanofiber scaffold, PuraMatrix (PM). The first molar and all premolars in the mandibular regions of dogs were extracted, and three bone defects were prepared with a trephine bur on both sides of the mandible after 4 weeks. The experimental groups were as follows: (1) PM, (2) PM and dog mesenchymal stem cells (dMSCs), (3) PM, dMSCs, and platelet-rich plasma, and (4) control (defect only). Implants were placed in the prepared areas 8 weeks later and were assessed by histologic and histomorphometric analyses (bone-to-implant contact [BIC]). The BICs for groups 1, 2, 3, and 4 were 40.77%, 50.35%, 55.64%, and 30.57%, respectively. The findings indicate that PM may be useful as a scaffold for bone regeneration around dental implants.     

Impaired cognition preceding cardiac surgery is related to cerebral ischemic lesions

Purpose  

Cognitive dysfunction is more frequent after cardiac surgery. However, the preoperative cognitive state is seldom assessed when the effects of cardiac surgery on cognition are investigated. Postoperative cognitive dysfunction may be associated with the preoperative cognitive state and the existence of cerebral ischemic lesions in patients who undergo cardiac surgery.     

Turbulent left-to-right shunt flow through the interatrial septum suggesting high left atrial pressure in patients with heart failure with preserved ejection fraction

Lutembacher’s syndrome is a combination of interatrial septal (IAS) defect or patent foramen ovale (PFO), associated with mitral stenosis. High left atrial (LA) pressure in mitral stenosis exaggerates left-to-right shunt in patients with interatrial communication. We present a case of heart failure with preserved ejection fraction. Echocardiography revealed normal left ventricular systolic function without mitral stenosis and turbulent left-to-right shunt through the IAS. The peak velocity of the shunt flow was 2.3 m/s and the estimated pressure gradient was 22 mmHg, indicating high LA pressure. The presence of turbulent left-to-right shunt through the IAS is helpful for detecting high LA pressure.     

Risk group stratification to predict recurrence after transurethral resection in Japanese patients with stage Ta and T1 bladder tumours: validation study on the European Association of Urology guidelines

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? EAU guidelines on non‐muscle‐invasive bladder tumours have been widely used for the prediction of recurrence after TUR. However, there are substantial differences in bladder cancer incidence and mortality rates between European countries and Japan. This study provides useful factors for predicting recurrence and validation of EAU guidelines on the risk group stratification to predict recurrence in Japanese patients with stage Ta and T1 bladder tumours.

OBJECTIVE

• ? To validate the European Association of Urology (EAU) guidelines on risk group stratification to predict recurrence in Japanese patients with stage Ta and T1 bladder tumours.

PATIENTS AND METHODS

• ? A cohort of 592 Japanese patients who were treated with transurethral resection (TUR) and histopathologically diagnosed with Ta and T1 urothelial carcinoma of the bladder were enrolled in this retrospective study.
• ? The primary endpoint of the present study was recurrence‐free survival, and the median follow‐up duration was 37 months in recurrence‐free survivors.

RESULTS

• ? Multivariate Cox proportional hazards regression analysis showed that the Eastern Cooperative Oncology Group performance status (ECOG PS), prior recurrence rate, number of tumours and T category were independent predictors of time to recurrence (P < 0.05). According to the EAU guidelines for predicting recurrence, the vast majority of Japanese patients were classified into intermediate risk.
• ? The intermediate‐risk patients were further divided into intermediate‐low‐risk and intermediate‐high‐risk subgroups based on the European Organization for Research and Treatment of Cancer risk table, and a significant difference in the recurrence‐free survival rates was found between these subgroups (P < 0.001).
• ? It was also found that patients with high risk combined with intermediate‐high risk had significantly poorer recurrence‐free survival rates than those with low risk combined with intermediate‐low risk (P < 0.001).

CONCLUSIONS

• ? This is the first report on the ECOG PS as a potentially useful predictor for bladder tumour recurrence.
• ? The risk group stratification of the EAU guidelines for recurrence might not be applicable to Japanese patients with Ta and T1 bladder tumours, but the subgroup classification of intermediate risk could be appropriate.

     

Panretinal photocoagulation with simultaneous cryoretinopexy or intravitreal bevacizumab for neovascular glaucoma

Background

To compare the therapeutic effects of panretinal photocoagulation (PRP) combined with intravitreal bevacizumab (IVB) and cryoretinopexy (CR-IVB) to that of PRP combined with IVB alone in eyes with neovascular glaucoma (NVG).

Design

Retrospective, consecutive, case-control study.

Methods

The medical records of 102 eyes of 96 patients with NVG due to proliferative diabetic retinopathy, central retinal vein occlusion, and ocular ischemic syndrome were reviewed. The mean age of the patients was 59.6?±?11.5 years, with a range of 34 to 84 years. Patients received either 1.25 mg/0.05 ml of IVB combined with 360° of cryotherapy of the peripheral retina (CR-IVB subgroup) or IVB alone (IVB alone subgroup) as adjunctive treatments to PRP. The patients were followed for at least 12 months. Fifty-four eyes of 49 patients had open-angle NVG; 30 of these eyes were treated by CR-IVB, and 24 eyes by IVB alone. Forty-eight eyes of 48 patients had angle-closure NVG; 22 of these eyes were treated by CR-IVB, and 26 eyes were by IVB alone. Failure was defined as a postoperative intraocular pressure (IOP) >21 mmHg for two consecutive follow-up visits, or the need of additional surgery such as trabeculectomy or diode laser cycloablation. The differences in the success rates between the CR-IVB and IVB alone subgroups for the eyes with open-angle and closed-angle NVG were compared.

Results

The success rate at 12 months in eyes with open-angle NVG was 80.0 % in the CR-IVB subgroup and 41.7 % in the IVB alone subgroup (P?=?0.0096). In eyes with angle-closure NVG, the success rate at 12 months was 22.7 % in the CR-IVB subgroup and 0 % in the IVB-alone subgroup (P?=?0.030).

Conclusion

The significantly better IOP control after PRP combined with cryotherapy and IVB than after PRP with IVB alone indicates that cryotherapy enhances the effectiveness of PRP for neovascular glaucoma for at least 1 year.     

Cyclosporine versus tacrolimus in patients with HCV infection after liver transplantation： Effects on virus replication and recurrent hepatitis

AIM: To determine the effects of the calcineurin inhibitors, cyclosporine and tacrolimus, on hepatitis C virus (HCV) replication and activity of recurrent hepatitis C in patients post liver transplantation. METHODS: The data of a cohort of 107 patients who received liver transplantation for HCV-associated liver cirrhosis between 1999 and 2003 in our center were retrospectively analyzed. The level of serum HCV-RNA and the activity of recurrent hepatitis were compared between 47 patients who received either cyclosporine or tacrolimus as the primary immunosuppressive agent and an otherwise similar immunosuppressive regimen which did not lead to biliary complications within the first 12 mo after transplantation. RESULTS: HCV-RNA increased within 3 mo after transplantation but the differences between the cyclosporine group and the tacrolimus group were insignificant (P=0.49 at 12 mo). In addition, recurrent hepatitis as determined by serum transaminases and histological grading of portal inflammation and fibrosis showed no significant difference after 12 mo (P=0.34). CONCLUSION: Cyclosporine or tacrolimus as a primary immunosuppressive agent does not influence the induction or severity of recurrent hepatitis in HCV-infected patients after liver transplantation.     

Phase I/II Trial of Docetaxel and Carboplatin as a First-Line Therapy in Patients with Stage IV Non-Small-Cell Lung Cancer

A phase I/II study was conducted to determine the maximum-tolerated dose, the safety and tolerability, and the clinical efficacy of carboplatin and docetaxel in combination in patients with stage IV non–small-cell lung cancer. Patients with measurable, previously untreated, good performance status, and stage IV non–small-cell lung cancer were eligible. Increasing doses of docetaxel were given in combination with a fixed dose of carboplatin except at level 5. Cycles were repeated every four weeks. Seventy-seven patients were registered. In phase I, 27 patients were entered at five different dose levels. A docetaxel dose of 60 mg/m² and carboplatin area under the concentration time curve 6 was recommended for phase II, and an additional 50 patients were entered at this level for a total of 56 patients. Grade 3/4 neutropenia was the most common adverse event and occurred in 70% of the patients. Two patients had febrile neutropenia. Fifty-six patients were assessable for response; 21 partial responses were observed for an overall response rate of 37.5%. The median time to tumor progression was 4.0 months (range, 1.0–21.0 months), and the median survival was 12.9 months (range, 0.4–51.3 months). The one-year survival rate was 46.4%. The combination of docetaxel 60 mg/m² and carboplatin area under the concentration time curve 6 is feasible and effective in patients with stage IV non–small-cell lung cancer.