Radial shock waves effectively introduced NF‐kappa B decoy into rat achilles tendon cells in vitro

The purpose of this study was to test if radial shock waves could enhance the introduction of nuclear factor‐kappa B (NF‐κB) decoy oligodeoxynucleotides, which is reported to markedly inhibit NF‐κB activation and suppress pro‐inflammatory cytokine gene expression, using rat Achilles tendon cells. In the presence of NF‐κB decoy labeled with or without fluorescein isothiocyanate (FITC) in culture media, radial shock waves were applied to the tendon cells in variable conditions and cultivated for 24 h. The transfection rate was assessed by counting FITC‐positive cells, and IL‐1–induced NF‐κB activation in the cells was assessed. Radial shock waves significantly enhanced introduction of NF‐κB decoy‐FITC into the tendon cells. IL‐1–induced NF‐κB activation was significantly inhibited by pretreatment of the cells with NF‐κB decoy combined with radial shock wave exposure. The present study demonstrated the effectiveness of radial shock waves on introduction of NF‐κB decoy into tendon cells. Radial shock wave treatment combined with local NF‐κB decoy administration could be a novel therapeutic strategy for chronic tendinopathy. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1078–1083, 2010     

Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic submucosal dissection of early colorectal neoplasia with carbon dioxide insufflation: a prospective study

Background  

The authors have reported that carbon dioxide (CO₂) insufflation is safe and effective for lengthy endoscopic submucosal dissection (ESD) with the patient under conscious sedation. However, CO₂ monitoring has not been assessed to clarify whether partial pressure of carbon dioxide (PCO₂) increases during this type of long procedure. This study aimed to monitor CO₂ before, during, and after ESD to investigate whether CO₂ insufflation is safe for patients receiving a lengthy ESD of early colorectal neoplasia under conscious sedation.     

Age and body mass index: significant predictive factors for successful laparoscopic antireflux surgery

Purpose

Laparoscopic antireflux surgery (LARS) is a feasible treatment for gastroesophageal reflux disease (GERD) patients, but it is unclear who will benefit from the surgery. This study investigated patients’ GERDspecific quality of life (GsQOL) and analyzed the factors leading to the performance of successful LARS.

Methods

Twenty-six (57.8%) of 45 consecutive patients who underwent LARS for GERD during the last decade were enrolled. All patients were evaluated by 24-h pH monitoring, esophageal manometry, esophagogastro-duodenoscopy and physical examinations. GsQOL was assessed by a visual analog scale, and the difference between the pre- and postoperative scores was defined as the visual analog scale improvement score (VASIS). The patients were classified into three groups based on the VASIS, and their clinical factors and surgical outcomes were compared.

Results

The high VASIS group patients (>70 VASIS; Excellent group) patients were significantly younger and obese in comparison to low the VASIS group (<30 VASIS; Poor group) consisting of older nonobese patients (P < 0.05). A multiple regression analysis revealed that age <60 years and body mass index (BMI) >25 kg/m² were significant factors that affected postoperative GsQOL. No other clinical or surgical factors had any influence on the postoperative GsQOL.

Conclusion

These results suggest that age and BMI can be predictive factors for the performance of successful LARS.     

Correlation between serum levels of free light chain and phenotype of plasma cells in bone marrow in primary AL amyloidosis

To investigate whether there is a correlation between subtypes of plasma cells in the bone marrow and the production of M-protein, flow cytometry and serum free light chain (FLC) analyses were carried out in 17 patients with primary systemic AL amyloidosis (mean age, 59.9?±?8.8 years) and controls with M-protein (MGUS controls, n?=?6) and without it (negative controls, n?=?9). The patients showed a significantly higher value in the serum predominant FLC:serum creatinine ratio (43.8?±?63.2) and CD38^?+?+?CD19^-CD56^?+? subpopulation (monoclonal plasma cells) (2.57?±?5.35%) than either the negative (p?<?0.0005 and p?<?0.001, respectively) or MGUS controls (p?<?0.05). With respect to maturation of plasma cells in the bone marrow, the intermediate (MPC-1^?+?CD45^-CD49e^-) and mature (MPC-1^?+?CD45^?+?CD49e^-) subtypes were significantly higher (49.2?±?23.2%, p?<?0.005) and lower (27.6?±?21.3%, p?<?0.005) in the patients than in the negative controls, respectively. The serum predominant FLC:serum creatinine ratio was elevated in parallel with an increase in CD38^?+?+?CD19^-CD56^?+? and MPC-1^?+?CD45^-CD49e^- cells and a decrease in mature subtypes (MPC-1^?+?CD45^?+?CD49e^- and MPC-1^?+?CD45^?+?CD49e^?+? cells), There was a significantly positive correlation between the serum predominant FLC:serum creatinine ratio and either CD38^?+?+?CD19^-CD56^?+? (r?=?0.510, p?<?0.05) or MPC-1^?+?CD45^-CD49e^- cells (r?=?0.481, p?<?0.05). In primary AL amyloidosis M-protein is probably produced by increased monoclonal plasma cells in the bone marrow, particularly by the intermediate subpopulation with a phenotype of MPC-1^?+?CD45^-CD49e^-.     

Effect of age and correlation between esophageal visceral chemosensitivity and mechanosensitivity in healthy Japanese subjects

Background

The aim of this study was to examine the impact of age on esophageal sensation, and to determine whether esophageal mechanosensitivity and chemosensitivity are correlated in healthy Japanese subjects.

Methods

To evaluate chemosensitivity, a catheter was inserted and placed 10 cm above the upper border of the lower esophageal sphincter (LES), which was determined with an esophageal manometric catheter. After saline had been infused into the esophagus at a rate of 10 mL/min for 2 min, 0.1 N hydrochloric acid, instead of saline–without the subjects’ knowledge–was infused for 10 min at the same rate. The acid perfusion sensitivity score (APSS) was assessed. To evaluate mechanosensitivity, a barostat test was performed, with a balloon being placed 10 cm above the upper border of the LES. The initial perception threshold (IPT), pain threshold (PT), and maximal pain were quantified.

Results

The APSS was significantly inversely correlated with age. IPT, PT, and mean maximal pain were significantly correlated with age. Body mass index, drinking, and smoking habits were not correlated with the esophageal perception threshold. The correlation of chemosensitivity and mechanosensitivity was also assessed, and the APSS was inversely correlated with IPT, PT, and maximal pain.

Conclusions

The thresholds of esophageal visceral chemosensitivity and mechanosensitivity in same individuals were significantly correlated and both of these thresholds were inversely correlated with age.     

Mitral valve repair for degenerative disease with leaflet prolapse: to improve long-term outcomes

Purpose  Residual mitral regurgitation (MR) is a risk factor of reoperation. Here we report the midterm results of mitral valve repair for degenerative disease with mitral valve prolapse and identify important factors for durable repair. Methods  From April 1999 to September 2007, 116 patients with leaflet prolapse (59 men; mean age 63 years) underwent mitral valve repair; they consisted of 19 anterior, 67 posterior, 23 bileaflet, and 7 isolated commissures. The mean clinical and echocardiographic follow-ups were at 4.1 ± 2.3 and 3.3 ± 2.4 years, respectively. Results  Altogether, 12 patients showed recurrent moderate or severe MR during the follow-up period; and 10 of the 12 patients (83.8%) had recurrent moderate or severe MR within 1.5 years. Causes of early MR recurrence were dehiscence of sutured segments and ineffectiveness of the artificial chords. The rates of freedom from reoperation at 3 and 7 years were 95.3% ± 2.0% and 91.0% ± 4.7%, respectively. The rates of freedom from recurrent moderate or severe MR at 3 and 7 years were 90.5% ± 2.9% and 83.8% ± 5.9%, respectively. Conclusions  The prevention of dehiscence of the sutured segment and reestablishment of coaptation using artifi- cial chords are imperative to maintain the durability of mitral valve repair for patients with degenerative disease. This study was presented at the 60th annual scientific meeting of the Japanese Association for Thoracic Surgery.     

Mechanisms underlying the impairment of ischemia-induced neovascularization in matrix metalloproteinase 2-deficient mice

Matrix metalloproteinases (MMPs) have been implicated in the process of neovascularization. However, the exact roles of individual MMPs in vessel formation are poorly understood. To study the putative role of MMP-2 in ischemia-induced neovascularization, a hindlimb ischemia model was applied to MMP-2(+/+) and MMP-2(-/-) mice. Serial laser Doppler blood-flow analysis revealed that the recovery of the ischemic/normal blood-flow ratio in MMP-2(-/-) young and old mice remained impaired throughout the follow-up period. At day 35, microangiography and anti-l-lectin immunohistochemical staining revealed lesser developed collateral vessels and capillary formation in both old and young MMP-2(-/-) mice compared with the age-matched MMP-2(+/+) mice. An aortic-ring culture assay showed a markedly impaired angiogenic response in MMP-2(-/-) mice, which was partially recovered by supplementation of the culture medium with recombinant MMP-2. Aorta-derived endothelial cells or bone marrow-derived endothelial progenitor cell (EPC)-like c-Kit(+) cells from MMP-2(-/-) showed marked impairment of invasive or/and proliferative abilities. At day 7, plasma and ischemic tissues of vascular endothelial growth factor protein were reduced in MMP-2(-/-). Flow cytometry showed that the numbers of EPC-like CD31(+)c-Kit(+) cells in peripheral blood markedly decreased in MMP-2-deficient mice. Transplantation of bone marrow-derived mononuclear cells from MMP-2(+/+) mice restored neovascularization in MMP-2(-/-) young mice. These data suggest that MMP-2 deficiency impairs ischemia-induced neovascularization through a reduction of endothelial cell and EPC invasive and/or proliferative activities and EPC mobilization.     

Primary aldosteronism and hypercortisolism due to bilateral functioning adrenocortical adenomas

A 50-year-old male patient with a 15-year history of hypertension was referred to our hospital for evaluation of bilateral adrenal tumors. No Cushingoid features were observed. Computed tomographic scan showed 10-mm masses in each adrenal gland. Preoperative endocrinological examinations revealed autonomous cortisol and aldosterone secretion in this patient. The results of a subsequent adrenal venous catheterization study were consistent with the presence of a left cortisol-producing tumor and a right aldosterone-producing tumor. A left partial adrenalectomy was performed initially, but cortisol and aldosterone over-secretion persisted. Accordingly, the patient underwent a right adrenalectomy. Pathological examination of the resected specimens, including immunohistochemical analysis, demonstrated that both adenomas possibly produced cortisol and aldosterone. This is an extremely rare case of bilateral adrenal tumors, in which the left adrenocortical tumor produced and secreted cortisol or both cortisol and aldosterone and the right one produced and secreted both aldosterone and cortisol, as confirmed by clinical findings and pathological studies using immunohistochemical analysis.