Deep and superficial circumflex iliac arteries and their relationship to the ultrasound‐guided femoral nerve block procedure: A cadaver study

The in‐plane lateral to medial approach is a standard technique for ultrasound‐guided femoral nerve block (USG‐FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG‐FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG‐FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin‐fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG‐FNB using the in‐plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413–420, 2017. © 2017 Wiley Periodicals, Inc.     

A case of systemic sclerosis associated with gastric cancer.

We report the case of a 47-year-old woman who began to experience stiffness and Raynaud's phenomenon of her fingers and toes as well as easy fatigability approximately one year before initial evaluation. Histopathologic examination revealed dense fibrosis and perivascular lymphoid cell infiltration in the dermis. The patient's diagnosis was systemic sclerosis (SSc). Esophageal sclerosis was not revealed, but an early type IIb carcinoma of the gastric antrum was noted by endoscopic examination. Other recent reports have discussed the association of SSc with various malignant carcinomas. We also reviewed the literature for associations between SSc and gastric cancer in Japanese patients.     

A correlation between increases in suicide rates and increases in male unemployment rates in Mie prefecture, Japan

The number of suicides in Japan has increased from approximately 22,000 per year in 1988-1997 to over 30,000 per year since then. It has also increased in Mie prefecture during that period. In the present study, we investigated the correlation between annual suicide rates in Mie prefecture, Japan from 1996-2002 and the annual unemployment rate in Japan from 1996-2002 among males. Among the results, annual suicide rates in total correlated with the unemployment rate in Japan, but the relation was not statistically significant: r(7)=0.76, r(2)(7)=0.58, p=0.05 (y=3.54x+6.37); the rates in males, however, correlated significantly with the unemployment rate in Japan: r(7)=0.85, r(2)(7)=0.73, p=0.01 (y=5.72x+4.49). In addition, we found that annual suicide rates in total correlated significantly with the male unemployment rates. When a patient is unemployed and in a bad situation, the medical staff and the family should be aware of the correspondence between suicide rates and unemployment.     

Relationship between cardiomyocyte cell death and cardiac function during hypertensive cardiac remodelling in Dahl rats

The exact mechanisms responsible for the progression of heart failure remain unclear. We investigated the in vivo relationship between the incidence of apoptotic cell death and left ventricular function serially from the beginning of hypertension to decompensated heart failure in Dahl salt-sensitive rats. Dahl salt-resistant and Dahl salt-sensitive rats were fed on a high-salt diet from 6 weeks of age. Systolic blood pressure was recorded by the tail-cuff method every week. Cardiac function in vivo was evaluated by echocardiography and cardiac catheterization. Cardiomyocyte apoptosis was detected by the TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling) method. The gene expression of Bax, Bcl-2 and Bcl-xL was analysed by Northern blotting. The TUNEL method revealed that the incidence of cardiomyocyte apoptosis was significantly increased in the hearts of 18-week-old Dahl salt-sensitive rats (apoptotic index 1.3 +/- 0.1%). Northern blot analysis revealed that the Bcl-xL mRNA level increased gradually during the progression towards heart failure. In conclusion, these data suggest that cardiomyocyte apoptosis is a terminal event, and plays a role as an aggravating factor in the vicious cycle of heart failure.     

Clinical features of patients with HCC who are negative for both HBV and HCV markers

BACKGROUND/AIMS: The aim of this study is to clarify the clinical features of hepatocellular carcinoma that are negative for both hepatitis B surface antigen and anti-hepatitis C antibody. METHODOLOGY: Patients were classified according to viral markers: 45 patients (82%) had hepatitis B (B-HCC), 467 patients (82%) had hepatitis C (C-HCC), and 53 patients (9%) had neither hepatitis B nor hepatitis C (NBNC-HCC). Differences in clinical parameters among these three groups were analyzed. RESULTS: Patients with NBNC-HCC were older than B-HCC and C-HCC patients. The incidence of alcoholism in NBNC-HCC patients was higher than in C-HCC patients. Patients with NBNC-HCC had similar rates of positive antibody to hepatitis B core antigen as did patients with C-HCC. NBNC-HCC patients were further classified according to median age. The younger group showed a greater tendency towards alcoholism than did the aged group. Liver functioning in the younger group was worse than in the older group. The older group had larger tumors than the younger group. CONCLUSIONS: The livers of younger NBNC-HCC patients were more cirrhotic, possibly because of alcoholism. Older NBNC-HCC patients presented with larger tumors, possibly because they did not receive regular medical check-ups due to their relatively preserved liver function.     

Effect of intravenous administration of cibenzoline on left ventricular diastolic pressures in patients with hypertrophic cardiomyopathy: its relationship to transmitral Doppler flow profiles.

BACKGROUND: Cibenzoline is able to improve left ventricular (LV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM), but the exact mechanism remains to be determined. METHODS AND RESULTS: The present study was designed to elucidate the effect of intravenous administration of 1.4 mg/kg of cibenzoline on aortic and LV pressures, and transmitral Doppler flow pattern in 7 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 9 patients with hypertrophic nonobstructive cardiomyopathy (HNCM). Before and at the end of the administration, aortic and LV pressures, LV pressure gradient (LVPG) and transmitral Doppler velocity profiles were examined. After the administration of cibenzoline, LV minimal and end-diastolic pressures decreased from 9+/-4 mmHg to 1+/-5 mmHg (p=0.0049) and from 22+/-7 mmHg to 14+/-5 mmHg (p=0.0106) in patients with HOCM, and from 9+/-5 mmHg to 5+/-3 mmHg (p=0.0036) and from 20+/-6 mmHg to 14+/-3 mmHg (p=0.0033) in patients with HNCM. LVPG decreased in all patients with HOCM. E-wave velocity increased, A-wave velocity decreased, and thus the E/A ratio increased from 0.77+/-0.29 to 1.20+/-0.48 (p=0.0004). CONCLUSIONS: Reduction of LV diastolic pressures by intravenous administration of cibenzoline may be related to an improvement in the E/A ratio in patients with HCM.     

Reduced current density,partially rescued by mexiletine,and depolarizing shift in activation of SCN5A W374G channels as a cause of severe form of Brugada syndrome

Background

SCN5A-related Brugada syndrome (BrS) can be caused by multiple mechanisms including trafficking defects and altered channel gating properties. Most SCN5A mutations at pore region cause trafficking defects, and some of them can be rescued by mexiletine (MEX).

Objective

We recently encountered symptomatic siblings with BrS and sought to identify a responsible mutation and reveal its biophysical defects.

Methods

Target panel sequencing was performed. Wild-type (WT) or identified mutant SCN5A was transfected into tsA201 cells. After incubation of transfected cells with or without 0.1 mM MEX for 24–36 hr, whole-cell sodium currents (I_Na) were recorded using patch-clamp techniques.

Results

The proband was 29-year-old male who experienced cardiopulmonary arrest. Later, his 36-year-old sister, who had been suffering from recurrent episodes of syncope since 12 years, was diagnosed with BrS. An SCN5A W374G mutation, located at pore region of domain 1 (D1 pore), was identified in both. The peak density of W374G-I_Na was markedly reduced (WT: 521 ± 38 pA/pF, W374G: 60 ± 10 pA/pF, p < .01), and steady-state activation (SSA) was shifted to depolarizing potentials compared with WT-I_Na (V_1/2-WT: −39.1 ± 0.8 mV, W374G: −30.9 ± 1.1 mV, p < .01). Incubation of W374G-transfected cells with MEX (W374G-MEX) increased I_Na density, but it was still reduced compared with WT-I_Na (W374G-MEX: 174 ± 19 pA/pF, p < .01 versus W374G, p < .01 versus WT). The SSA of W374G-MEX-I_Na was comparable to W374G-I_Na (V_1/2-W374G-MEX: −31.6 ± 0.7 mV, P = NS).

Conclusions

Reduced current density, possibly due to a trafficking defect, and depolarizing shift in activation of SCN5A W374G are underlying biophysical defects in this severe form of BrS. Trafficking defects of SCN5A mutations at D1 pore may be commonly rescued by MEX.

     

Evaluation of transcatheter arterial embolization prior to percutaneous tumor ablation in patients with hepatocellular carcinoma: a randomized controlled trial.

BACKGROUND: Transcatheter arterial embolization (TAE) may reduce the risk of hepatocellular carcinoma (HCC) recurrence when performed before percutaneous tumor ablation (PTA), either percutaneous ethanol injection therapy (PEIT) or radiofrequency ablation (RFA). We conducted a randomized, controlled trial comparing the use of TAE combined with percutaneous ethanol injection therapy (TAE/PEIT) to the use of PEIT only to assess the effects on HCC recurrence and survival. We continued the study after the introduction of RFA and compared TAE combined with RFA (TAE/RFA) with RFA only. METHODS: Between March 1997 and April 2001, 42 HCC patients were enrolled who satisfied the following inclusion criteria: (1) uninodular HCC as determined by angiography under computed tomography, (2) arterial hypervascularity, and (3) no prior history of HCC treatment. Twenty-two patients were treated with TAE/PTA (PEIT, 12; RFA, 10) and 20 patients with PTA only (PEIT, 14; RFA, 6). RESULTS: There were four cases of local recurrence in the PTA-only group and none in the TAE/PTA group (P=0.043). The four patients with local recurrence were treated with PEIT. None of the patients treated with RFA showed local recurrence. The effect of TAE on overall recurrence was not significant (P=0.4179). In the multivariate analysis, prior TAE was not significant for survival (P=0.514). CONCLUSIONS: TAE has a limited use in suppressing local recurrence when performed before PEIT but not before RFA.     

Aldosterone-and-salt-induced cardiac fibrosis is independent from angiotensin II type 1a receptor signaling in mice.

Aldosterone infusion with high salt treatment induces cardiac fibrosis in rats. Aldosterone enhanced angiotensin II (Ang II) has been shown to induce proliferation and increase the expression of Ang II receptor mRNA and Ang II binding in vitro. To investigate the role of Ang II type 1a receptor (AT1aR) in aldosterone-and-salt (Ald-NaCl)-induced cardiac fibrosis, we subcutaneously infused aldosterone (0.15 microg/h) and 1% NaCl (Ald-NaCl) into AT1aR knockout mice (AT1aR-KO) or wild type mice (Wt). To examine the role of NaCl on cardiac fibrosis, we gave some of the aldosterone-treated AT1aR-KO tap water (Ald-H2O). Ald-NaCl treatment increased systolic blood pressure and induced cardiac hypertrophy in both strains, whereas there were no such changes in the mice without aldosterone. Severe cardiac fibrosis was seen in Ald-NaCl-treated AT1aR-KO and not in Ald-NaCl-treated Wt. In contrast, Ald-NaCl-treated Wt with co-administration of an active metabolite of olmesartan, the AT1aR antagonist (10 mg/kg/day) did not show cardiac fibrosis. Na+/H+ exchanger, and Na+-K+ ATPase alpha2 subunit mRNA were decreased in AT1aR-KO. Na+/Ca2) exchanger mRNA was lower in AT1aR-KO than Wt and was decreased by Ald-NaCl in both strains. Phosphorylation of epidermal growth factor receptor and extracellular signal-regulated kinase was increased by Ald-NaCl treatment in AT1aR-KO. Connective tissue growth factor (CTGF) and osteopontin mRNA were increased and accumulation of CTGF proteins was seen in the hearts of Ald-NaCl-treated AT1aR-KO. Ald-H2O-treated AT1aR-KO did not show any cardiac fibrosis. These results suggest that Ald-NaCl-induced cardiac fibrosis required both aldosterone and salt. Because cardiac fibrosis was exaggerated in Ald-NaCl-treated AT1aR-KO but was not seen in Wt treated with Ald-NaCl and olmesartan, AT1aR may not play a primary role in progression of cardiac fibrosis by Ald-NaCl, and gene disruption of AT1aR may have some implications in this model.     

Single-arm,open-label pilot intervention study to investigate an effect of oral 5-aminolevulinic acid plus sodium ferrous citrate on glucocorticoid reduction in patients with adult-onset Still disease: Study protocol for clinical trial (SPIRIT compliant)

Background:Glucocorticoids are an important class of medication for patients with adult-onset Still disease (AOSD), however, relapse following glucocorticoid reduction and adverse events due to long-term effects of glucocorticoid are still problematic. It is of course essential to minimize the risk of treatment. Immunosuppressive therapies such as methotrexate and biologics including tocilizumab are used in glucocorticoid-dependent patients with AOSD, but no second-line treatments for patients with glucocorticoid dependence have been established yet. Given that these drugs also have the potential to cause adverse events, alternative treatments are sought. Recently, elevated heme oxygenase-1 (HO-1) has been reported in the serum of patients with AOSD, suggesting that HO-1 activity contributes to AOSD pathogenesis and may represent a new therapeutic target for the treatment of AOSD. The amino acid 5-aminolevulinic acid (5-ALA) is a non-proteinogenic δ amino acid in human body. An addition of ferrous iron to 5-ALA enhances heme biosynthesis. The increase in heme in vivo induces HO-1 production, a heme-degrading enzyme. Elevated HO-1 has been suggested to contribute to the pathogenesis of AOSD, and administration of 5-ALA and ferrous iron may be a potential treatment for AOSD.Methods/design:This study is a single-arm, open-label pilot intervention study using clinical endpoints to investigate the effects of oral 5-ALA with sodium ferrous citrate on glucocorticoid reduction in patients with AOSD receiving glucocorticoid therapy.Discussion:This pilot intervention study will provide evidence regarding the effectiveness and safety of 5-ALA/sodium ferrous citrate as a potential new therapeutic agent for glucocorticoid-dependent patients with AOSD.Trial registration:This study was registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp) on January 14, 2020 as jRCTs071190042.