Brain natriuretic peptide as a novel cardiac hormone in humans. Evidence for an exquisite dual natriuretic peptide system, atrial natriuretic peptide and brain natriuretic peptide.

Using a specific radioimmunoassay for human brain natriuretic peptide (hBNP) with a monoclonal antibody, we have investigated its synthesis, secretion, and clearance in comparison with those of atrial natriuretic peptide (ANP) in normal subjects and patients with congestive heart failure (CHF). Mean BNP-like immunoreactivity (-LI) levels in normal atrium and ventricle were 250 and 18 pmol/g, respectively. The plasma BNP-LI level in normal subjects was 0.90 +/- 0.07 fmol/ml, which was 16% of the ANP-LI level. In contrast, the plasma BNP-LI level markedly increased in patients with CHF in proportion to its severity, and surpassed the ANP-LI level in severe cases. There was a significant step-up of the plasma BNP-LI level in the coronary sinus (CS) compared with that in the aortic root (Ao) and the difference between these BNP-LI levels, delta(CS-Ao)BNP, also increased with the severity of CHF. In addition, the step-up of the BNP-LI level in the anterior interventricular vein [delta(AIV-Ao)BNP] was comparable to delta(CS-Ao)BNP, indicating that BNP is secreted mainly from the ventricle. Predominant BNP synthesis in the ventricle was also confirmed by Northern blot analysis. Catheterization and pharmacokinetic studies revealed that hBNP is cleared from the circulation more slowly than alpha-hANP; this was in part attributed to lower (about 7%) binding affinity of hBNP to clearance receptors than that of alpha-hANP. A predominant molecular form of BNP-LI in the heart and plasma was a 3-kD form corresponding to hBNP. These results indicate that BNP is a novel cardiac hormone secreted predominantly from the ventricle, and that the synthesis, secretion and clearance of BNP differ from those of ANP, suggesting discrete physiological and pathophysiological roles of BNP in a dual natriuretic peptide system.     

Expression of transcription factor in Barrett's esophagus

Barrett's esophagus is the result of chronic injury which is usually caused by gastroesophageal reflux. NF-kappaB is expressed in the reflux esophagitis. Specialized columnar epithelium (SCE) is characteristic of Barrett's esophagus and has a malignant predisposition. SCE expresses Cdx1 and Cdx2. Adenocarcinoma in Barrett's esophagus is believed to develop through the metaplasia-dysplasia-carcinoma sequence. P53, beta-catenin, PPARgamma, and estrogen receptor beta are closely related to the development of esophageal carcinogenesis.     

Kampo Medicines for Mite Antigen-Induced Allergic Dermatitis in NC/Nga Mice

We have established an allergic dermatitis model in NC/Nga miceby repeated local exposure of mite antigen for analyzing atopicdermatitis. We examined how four Kampo medicines, Juzen-taiho-to,Hochu-ekki-to, Shofu-san and Oren-gedoku-to, on the dermatitismodel to obtain basic information on their usefulness for treatingatopic dermatitis. Mite antigen (Dermatophagoides farinae crudeextract) solution at a concentration of 10 mg/ml was paintedon the ear of NC/Nga mice after tape stripping. The procedurewas repeated five times, at 7 day intervals. An apparent biphasicear swelling was caused after the fourth and fifth antigen exposureswith elevated serum IgE levels and accumulation of inflammatorycells. In the cervical lymph nodes and ear lobes, the five proceduresof antigen exposure induced interleukin-4 mRNA expression butreduced interferon- mRNA expression. Oral administration ofall four Kampo medicines inhibited the formation of ear swellingand inflammatory cell accumulation. Juzen-taiho-to and Hochu-ekki-toapparently prevented the elevation of serum IgE level. Furthermore,the four Kampo medicines showed a tendency to prevent not onlythe increase in interleukin-4 mRNA expression but also the decreasein interferon- mRNA expression. The present results indicatethat Juzen-taiho-to, Hochu-ekki-to, Shofu-san and Oren-gedoku-tomay correct the Th1/Th2 balance skewed to Th2, and this activityhelps inhibit dermatitis in NC/Nga mice. The ability of theKampo medicines to correct the Th1/Th2 balance seems to underlietheir effectiveness in treating of atopic dermatitis.     

Disruption of blood flow in the outflow graft is a valuable marker for detecting suction events in patients with continuous-flow left ventricular assist devices

Journal of Echocardiography -     

The Hanger Reflex: An Inexpensive and Non-invasive Therapeutic Modality for Dystonia and Neurological Disorders

The hanger reflex is a phenomenon characterized by the involuntary rotation of the head when a wire hanger is worn around the head such that a force is applied to the frontal temporal area by the longer side of the hanger. The application of a shearing force on the skin is thought to be the cause of this phenomenon. Attempts have been made to treat cervical dystonia using equipment designed to induce the hanger reflex. This reflex may have implications in the treatment of headaches, cervical pain, and adhesive capsulitis. The hanger reflex is seen not only in the head region but is also in other parts of the body. Thus, it could be used in the treatment of systemic dystonias. The hanger reflex may help develop inexpensive and non-invasive treatment for dystonia or other neurological diseases and is expected to be the focus of research in the future.     

Authors’ Reply: Relevance of Level IIb Neck Dissection in Patients with Head and Neck Squamous Cell Carcinomas

World Journal of Surgery -     

Left ventricular apical pseudoaneurysm with aortic prosthetic valve endocarditis

We report an 83-year-old man with a mycotic left ventricular apical pseudoaneurysm and aortic prosthetic valve endocarditis caused by Enterococcus spp. Mycotic left ventricular pseudoaneurysm is very rare and is associated with a high risk of rupture. Here, we report the clinical presentation, diagnosis, prognosis, and treatment of a case of mycotic left ventricular pseudoaneurysm to raise awareness regarding this unusual and potentially fatal complication.