Training of cardiovascular surgery

Among all the other fields in medicine where safety and good quality are always expected, cardiovascular surgery is the one field where you are expected the most. Therefore cardiovascular surgeons should have an ability to deal adequately with a severe relationship between patients and surgeons. A long-term education after several years of basic surgery training is mandatory to be an authorized high quality cardiovascular surgeon. However, basic surgery is a synonym of general surgery in the present system. In order to authorize general surgeons as well, basic surgery and general surgery should be separated. To avoid the world of cardiovascular surgery becoming the aging society, a long-term training of cardiovascular surgery should begin as early as possible after efficient short-term training of basic surgery. Meanwhile high income should be guaranteed for high risk/volume work.     

3beta-hydroxy-delta5 -C27-steroid dehydrogenase deficiency: diagnosis and treatment

The aim of this study was to evaluate the effects of bile acid treatment and to obtain further information about the pathway of bile acid biosynthesis in a patient with 3beta-hydroxy-delta5-C27-steroid dehydrogenase/isomerase (3beta-HSD) deficiency by gas chromatography-mass spectrometry. Results showed that at 2 months of age, 3beta-hydroxy-5-cholen-24-oic acid (3.0 micromol/mmol Cr, 7.9%) was detected in the urine in essentially the same relative amount as 3beta,7alpha-dihydroxy- and 3beta,7alpha,12alpha-trihydroxy-5-cholen-24-oic acids (3.7 micromol/mmol Cr, 9.8%) during ursodeoxycholic acid treatment combined with prednisolone. As a result, diagnosis was delayed until 18 months of age. One month later with substitution of chenodeoxycholic acid treatment, urinary 3beta,7alpha-dihydroxy- and 3beta,7alpha,12alpha-trihydroxy-5-cholen-24-oic acids decreased significantly, and subsequent improvement of liver dysfunction was accelerated. Chenodeoxycholic acid treatment is useful in 3beta-HSD deficiency. However, in the diagnosis of this disease in early life, it should be noted that the acidic pathway may be the major route for bile acid biosynthesis in the neonatal period. Diagnosis of 3beta-HSD deficiency may have been delayed by administration of ursodeoxycholic acid, resulting in prolonged diagnostic investigation in this child with cholestasis. Further, use of prednisolone may have been contraindicated.     

Detection of the four sequence variations of MDR1 gene using TaqMan MGB probe based real-time PCR and haplotype analysis in healthy Japanese subjects

OBJECTIVES: P-glycoprotein (P-gp) is significant from the viewpoint of pharmacokinetics/pharmacodynamics (PK/PD). MDR1 gene encodes P-gp and has a wide variety of SNPs. As the SNPs may be one of the factors that induce pharmacogenetic individual difference, haplotype analysis is necessary to evaluate the PK/PD. DESIGN AND METHODS: The SNPs of the detected MDR1 were -129T>C, 325G>A, 2677G>T/A, and 3435C>T. For the analysis of linkage disequilibrium (LD) and haplotype analysis, and for the reconstruction of the haplotype pair, ARLEQUIN and PHASE were employed. RESULTS: The result of the chi(2) test detected significant LD between -129 and 2677, -129 and 3435, and 2677 and 3435. There were 9 haplotypes: T-G-C, T-T-C, C-T-C, T-A-C, C-A-C, T-G-T, T-T-T, C-G-T, and C-T-T. CONCLUSIONS: LD was found among the positions -129, 2677 and 3435. As a result, 9 haplotypes exists in the Japanese population. These results suggest that it would be necessary to give consideration to haplotype for the purpose of evaluating the PK/PD of the drugs transported by P-gp.     

The inhibitory effect of herbal medicine -Dai Kenchu To (DKT)- on the colonic motility in rats in vitro

Dai-Kenchu-To (DKT) is a herbal medicine and is currently used as the treatment of paralytic ileus in Japan. We investigated the mechanism of beneficial effects of DKT in vitro. DKT-extract powder (DKT-EP; 30-300 microg/ml) caused a significant inhibition on carbachol (CCH: 10(-6))-induced contraction in a concentration dependent manner of the rat distal colon. DKT-EP (100 microg/ml) consists of 20 microg/ml of Zanthoxylum Fruit, 30 microg/ml of Ginseng Root and 50 microg/ml of Ginger Rhizome. Although each of them had no effect on CCH-induced muscle contraction, the combination of three ingredients caused a significant inhibition on CCH-induced contraction.     

SW-163A and B, novel immunosuppressants produced by Streptomyces sp

SW-163A and B, novel immunosuppressants, were isolated from the culture broth of Streptomyces sp. SNA15896. The molecular formulas of SW-163A and B were determined as C34H42N2O12 and C33H40N2O12 based on the HRFAB-MS analysis, respectively. Both compounds were elucidated to be a large ring ester structure through spectroscopic analyses including various NMR measurements. SW-163A and B showed immunosuppressive and antimicrobial activities in vitro.     

Effects of imidapril and captopril on streptozotocin-induced diabetic nephropathy in mice

We investigated whether the prevention of the development of diabetic nephropathy by angiotensin-converting enzyme inhibitors is associated with decreases in renal angiotensin-converting enzyme activity and/or blood pressure in diabetic mice. C57Bl/6 mice were injected with streptozotocin (200 mg/kg, i.v.) and randomized to receive either imidapril (1 and 5 mg/kg) or captopril (10 and 50 mg/kg) or vehicle by gavage for 28 days. Each assay was performed on 8-10 mice from each treatment. At 28 days after the start of drug treatment, imidapril and captopril significantly reduced blood pressure of the diabetic mice, and this effect of captopril was stronger than that of imidapril. On the other hand, inhibition of renal angiotensin-converting enzyme activity by imidapril was stronger than that by captopril. Imidapril and captopril dose-dependently inhibited urinary albumin excretion to similar extents, but they failed to inhibit the renal hypertrophy and elevation of creatinine clearance. Total renal angiotensin-converting enzyme activity was significantly reduced in diabetic mice, but immunohistochemical localization of angiotensin-converting enzyme was intensive in the vasculature and glomeruli of the diabetic kidney. In conclusion, both effects on blood pressure and angiotensin-converting enzyme activity may be involved in the prevention of development of diabetic nephropathy by imidapril and captopril in streptozotocin-induced diabetic mice. The data suggest that the degrees of contribution of their effects on blood pressure and renal angiotensin-converting enzyme activity to the inhibition of urinary albumin excretion may be different between the two angiotensin-converting enzyme inhibitors.     

Minimally invasive hemiarthroplasty in femoral neck fractures. Randomized comparison between a mini-incision and an ordinary incision: preliminary results

Minimally invasive osteosynthesis is a well-recognized treatment; however, those of arthroplasty or hemiarthroplasty may rarely be performed. We reviewed the comparison of a mini-incision approach in hemiarthroplasty versus that of an ordinary approach in patients with femoral neck fractures. Two different operative procedures were compared. Thirty-two patients (group 1) had a mini-incision in hemiarthroplasty. Thirty-two patients (group 2) were treated with the conventional approach. The postoperative treatment course was the same for both groups. The mean length of follow-up was 25 months. The results were excellent or good in 86% of the patients (50 of 64) and were equally good for both procedures. However, the full weight bearing term was significantly shortened for patients treated by the mini-incision procedure. Good and excellent results can be expected from either the mini-incision or the ordinary approach in hemiarthroplasty. Only full weight bearing term was significantly short following the mini-incision. This approach results in less dissection and facilitates rapid patient recovery and possibility earlier discharge from the hospital.