Effects of age on hemodynamic changes after transcatheter closure of atrial septal defect: importance of ventricular diastolic function

Some older patients develop symptoms of clinical heart failure after closure of an atrial septal defect (ASD). The present study tested the hypothesis that baseline hemodynamics and hemodynamic changes induced by transcatheter ASD closure are different between younger and older patients due to age-related differences in left ventricular (LV) diastolic dysfunction. Forty-three consecutive patients (27.7 ± 16.3 years of age, range 5–63, median 25) who underwent device closure for ASD were divided into younger (age ≤25, n = 24, 15.1 ± 1.2 years) and older (> 25 years, n = 19, 43.7 ± 2.2 years) groups. Echocardiographic evaluations were performed 1 day before and 2 days after ASD closure. Before ASD repair, early diastolic mitral annular velocity (e′) on lateral, an index of ventricular relaxation, showed an age-related decrease. After closure, e′ decreased by similar amount in both groups (p < 0.05). In addition, E/e′, an index of LV filling pressure, was relatively unchanged in the younger group (from 5.4 to 5.9) but significantly increased (p < 0.05) in the older group (from 6.3 to 8.1) over similar increase of normalized LV diastolic dimension. In older patients, ASD closure resulted in further deterioration of baseline impairment in LV relaxation and the increased LV stiffness caused a more marked rise in LV filling pressure, compared to the younger group. Thus, ASD should be closed at a younger age before the development of age-related LV diastolic dysfunction.     

Potential benefits of early continuous positive pressure ventilation in patients with rapidly progressive interstitial pneumonia

Background and objective: Rapidly progressive interstitial pneumonia (RPIP), including acute exacerbations of interstitial pneumonia, is associated with high rates of mortality. The present study was performed to examine the effects of respiratory management using non‐invasive ventilation (NIV) in patients with RPIP and to assess the prognostic factors for survival. Methods: BiPAP Vision was used for NIV. Clinical data and information on NIV were retrospectively obtained from patient records. Survival at 30 days was evaluated, and biomarkers were measured after initiation of NIV. Results: Thirty‐eight patients who had been admitted with RPIP and treated by NIV were included in the study. The ratio of PaO₂ to fraction of inspired oxygen at initiation of NIV was higher in survivors than in non‐survivors (P = 0.0054). The mean duration to initiation of NIV after admission was significantly shorter in survivors than in non‐survivors (P = 0.0006). Serum Krebs von den Lungen‐6 (KL‐6) and LDH levels at the start of NIV were higher in non‐survivors than in survivors (KL‐6, P = 0.022; LDH, P = 0.044). Bivariate logistic regression analysis showed that early intervention with NIV was a significant predictor of survival at 30 days. In addition, the ratio of PaO₂ to fraction of inspired oxygen and both LDH and KL‐6 levels at initiation of NIV were significant predictors of survival. Conclusions: Early intervention with NIV, mainly continuous positive pressure ventilation, is beneficial for the management of patients with RPIP. A randomized controlled study in a large population is needed to confirm the value of early NIV.     

Lung metastasis from an ovarian granulosa cell tumor 36 years after the initial diagnosis: report of a case

This report presents the case of a late relapse of an ovarian granulosa cell tumor (GCT) that metastasized to the lung 36 years after the initial diagnosis. A 72-year-old female demonstrated multiple nodules with extrapleural signs on chest computed tomography. Positron emission tomography with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG-PET) showed that the nodules had no FDG avidity. The nodules, which appeared as polypoid lesions of the visceral pleura on thoracoscopy, were resected and diagnosed as pulmonary metastases from the GCT. This case report indicates that thorough thoracoscopic exploration of the pleural cavity is essential when intrathoracic nodules are seen on postoperative imaging examinations in GCT patients, even when the [¹⁸F]FDG-PET results are negative.     

Wound blotting: A convenient biochemical assessment tool for protein components in exudate of chronic wounds

Because wound exudate includes secreted proteins that affect wound healing, its biochemical analysis is useful for objective assessment of chronic wounds. Wound blotting allows for collection of fresh exudate by attaching a nitrocellulose membrane onto the wound surface. To determine its applicability for several analysis methods and its executability in clinical wound assessment, this study comprised an animal experiment and clinical case reports. In the animal experiment, full‐thickness wounds were created on the dorsal skin of mice, and exudate samples were collected daily by a conventional method and by wound blotting. Extremely small but adequate volumes of exudate were collected by wound blotting for subsequent analysis in the animal experiments. Immunostaining showed the concentration and distribution of tumor necrosis factor (TNF) α. The activity of alkaline phosphatase was visualized by reaction with chemiluminescent substrate. The TNF distribution analysis indicated three different patterns: wound edge distribution, wound bed distribution, and a mostly negative pattern in both the animal and clinical studies, suggesting association between the TNF distribution pattern and wound healing. Our results indicate that wound blotting is a convenient method for biochemical analysis of exudate and a candidate tool with which to predict the healing/deterioration of chronic ulcers.     

Isoform transition from four-repeat to three-repeat tau underlies dendrosomatic and regional progression of neurofibrillary pathology

Regional progression of neurofibrillary tangles (NFTs) around the hippocampus was traced on thick sections double immunofluorolabeled with RD3 and RD4 antibodies, specific for three- and four-repeat tau, respectively. As reported, the cubic density of all tau-positive neurons was predominant in the entorhinal cortex and cornu ammonis (CA)1, and decreased progressively to the CA2–4 subregions. Among the three isoform profiles (RD3+/4?, RD3+/4+, and RD3?/4+), this regional gradient was replicated with RD3+/4? and RD3+/4+ neurons, while RD3?/4+ neurons exhibited the reverse gradient. Comparison of the subregion pairs confirmed a consistent profile shift along this gradient in every case regardless of the abundance of NFTs. To clarify the underlying mechanism of this regional profile shift, intraneuronal intensity of RD3 and RD4 immunoreactivity (IR) was quantified. Although their intensities were both lower in dendrites than in the soma, this gradient was steeper with RD4, leaving RD3 IR in dendrites. Dendritic arborization was abundant in RD3?/4+ pretangles, attenuated in RD3+/4+ neurons, and further attenuated in RD3+/4? ghost tangles. These findings suggest that dendritic RD4 IR retracts first, leaving RD3 IR in the dendrites. Taken together, this dendrite-oriented retraction initiates the gradual shift from RD3?/4+ pretangle neurons to RD3+/4? ghost tangles by way of RD3+/4+ NFTs. This intraneuronal profile shift may be a basis for the regional gradation featured by the similar profile shift during progression of NFT pathology.     

A peritoneal marker for optimal timing of ventriculo-peritoneal shunt revision in early childhood

Abstract

The ventriculo-peritoneal shunt placed in a neonate or infant needs revision to lengthen the peritoneal tube at certain times during childhood. The critical time for this revision is not exactly the same between individuals. Furthermore, the level of peritoneal insertion of the shunt tube is often unclear on x-ray films. To plan for and determine the optimal timing of revision, we applied a titanium clip on the peritoneal suture line in three infants as a marker of peritoneal insertion level. During the 31- to 37-month follow-up period, abdominal x-ray clearly demonstrated the peritoneal insertion level in all three patients, allowing accurate determination of the length of the intraperitoneal portion OP) of the shunt tube. The rate of shortening of the length of IP was 20 to 27% of the increase in body height (BH). This technique allows accurate determination of the length of IP and also optimal timing for revision. [Neural Res 1998; 20: 526-528]