A prognostic role of mean 24-h pulse pressure level for cardiovascular events in type 2 diabetic subjects under 60 years of age

OBJECTIVE: To assess the prognostic role of ambulatory 24-h pulse pressure (PP) on various vascular events in relatively young type 2 diabetic subjects under 60 years of age. RESEARCH DESIGN AND METHODS: In this prospective study, 237 type 2 diabetic subjects without any history of vascular complications were analyzed. After excluding 9 dropout subjects, 228 subjects (mean age, 46 years; 69% men; mean follow-up period, 100 months) entered the study. RESULTS: Distribution of 24-h PP for all subjects showed left skewed data, indicating that there may be a diabetic subgroup that had a wide PP. Therefore, further analysis was performed by stratifying the diabetic subjects by quartile of 24-h PP. Outcomes for the widest quartile (n = 58; cut point = 53.3 mmHg) was then compared with those from the other narrower quartiles (n = 170). In the diabetic subjects with a wide PP, cardiovascular events occurred more frequently than those in the diabetic subjects with a narrow one (20.7 vs. 4.1%; P < 0.001), resulting in the significant difference in the cumulative incidence of cardiovascular events (P < 0.001, log-rank test), but not cerebrovascular events, between the two subgroups. The Cox model revealed that a wide 24-h PP at baseline independently predicted subsequent cardiovascular events but not cerebrovascular events. By contrast, only duration of diabetes was the risk factor for cerebrovascular events. CONCLUSIONS: This study showed that a wide 24-h PP is predictive for cardiovascular events in relatively young diabetic subjects.     

Hemostatic effects of fibrinogen gamma-chain dodecapeptide-conjugated polymerized albumin particles in vitro and in vivo

BACKGROUND: Prototypes of platelet (PLT) substitutes have been studied and the focus was on a dodecapeptide, HHLGGAKQAGDV (H12), which is a fibrinogen gamma-chain carboxy-terminal sequence (gamma 400-411) and exists only in the fibrinogen domain. STUDY DESIGN AND METHODS: H12 was conjugated to the surface of polymerized albumin particles (polyAlb) as biocompatible and biodegradable particles with a mean diameter of 260 +/- 60 nm, and the hemostatic ability of H12-conjugated polyAlb (H12-polyAlb) under flow conditions and thrombocytopenic rats have been studied. RESULTS: H12-polyAlb enhanced the in vitro thrombus formation of activated PLTs on a collagen-immobilized plate when exposed to the flowing thrombocytopenic imitation blood. Furthermore, the analysis of the tail bleeding time of rats that were made thrombocytopenic by busulfan injection showed that H12-polyAlb had a hemostatic effect. Based on the bleeding time and the amount injected, the hemostatic capacity of 20 H12-polyAlb was estimated to correspond to that of one PLT. CONCLUSION: These results were important first steps toward the development of PLT substitutes and indicated that H12-polyAlb may be a suitable candidate for an alternative to human PLT concentrates transfused into thrombocytopenic patients in the future.     

Radical prostatectomy for localized prostate cancer

With widespread use of PSA screening, radical prostatectomy has gained popularity among Japanese urologists over the last decade. Recent understanding of pelvic anatomy and improvement in surgical technique have substantially reduced its morbidity. Early recovery of urinary continence is possible and improvement of sexual function after surgery may be enhanced by use of sildenafil and nerve reconstructive surgery. As prostate cancer is increasingly diagnosed at early stages and therefore with more favorable survival outcomes, the basis on which patients select primary therapy has shifted toward considerations of health-related quality of life. Accordingly, QOL assessment has become an important form of outcomes based research that may weigh heavily on the treatment selection by patients.     

Bilateral congenital multicystic dysplasia of the kidney

The clinical and pathological features of congenital multicystic dysplasia of the kidney are reviewed and we report of a patient with bilateral dysplasia who lived longer than do most such patients. When multicystic disease of the kidney is bilateral, it is commonly confused with polycystic disease. Despite the fatal prognosis, differentiation is essential for appropriate genetic counselling since multicystic disease is not a familial occurrence.     

Myocardial protection by lidocaine hydrochloride in aorto-coronary bypass surgery

Myocardial protective effect of lidocaine hydrochloride on the ischemic myocardium was evaluated by serum (MB-CK) and cardiac function in 48 patients; 24 patients in control (C) and 24 patients in lidocainetreated group (L), who underwent aorto-coronary bypass surgery. Lidocaine hydrochloride, 1 mg/min was administered by continuous drip infusion from initiation of anesthesia, and throughout the operation and postoperative period for 24 hours. There were no significant differences between two groups with regard to duration of cardioplegia and cardiopulmonary bypass, hypothermic level and the number of grafts implanted. Serum MB-CK at 18–24 hours following cardioplegia was 39.5±15.2 I.U. (C) and 14.2±4.0 I.U. (L), (p<0.05). Cardiac index and stroke volume index were significantly increased in the lidocaine-treated group at 24 hours following aortocoronary bypass surgery, as compared to the control group. Lidocaine thus appears to be beneficial in aorto-coronary bypass surgery to prevent ischemic changes in the myocardium. The gist of this paper was read at the 82nd Meeting of the Japanese Surgical Society, April, 1981.     

Synaptic structures and quantification of catecholaminergic axons in the nucleus tractus solitarius of the rat: Possible modulatory roles of catecholamines in baroreceptor reflexes

The synaptic organization in the nucleus tractus solitarius (NTS) of the rat at the level of the obex was examined by fluorescence and electron microscopy in 5 groups of animals: (1) normal control, (2) intraventricular injection of 5-OHDA, (3) intraventricular injection of 6-OHDA, (4) intracranial denervation of the IXth and Xth cranial nerves, and (5) intraventricular injection of 5-OHDA 48 h after intracranial denervation of the IXth and Xth cranial nerves.A dense network of catecholaminergic nerves was observed in the NTS and several catecholaminergic neurons were seen to be scattered in the lateral portion of the NTS. Nerve cells in the NTS were small in size (15–20 μm in diameter). In addition to ordinary axodendritic and axo-somatic synapses, serial synapses were occasionally encountered. The first presynaptic site in some of the serial synapses was identified as catecholaminergic by 6-OHDA treatment.After treatment with 5-OHDA, 2.4% of axon varicosities were identified as catecholaminergic by small dense-cored vesicles. After administration of 6-OHDA, 5.19% of dense degenerated axon varicosities were counted. After intracranial deafferentation of the IXth and Xth cranial nerves, 5.3% of dense degenerated axon varicosities were found. The total number of axon varicosities in 6800 sq.μm area was decreased by 9% after the injection of 6-OHDA and 11% after deafferentation of the IXth and Xth cranial nerves.At least 3 types of axons could be identified: (1) catecholaminergic axons with small dense-cored vesicles after 5-OHDA administration, (2) afferent axons from the IXth and Xth cranial nerves with small clear vesicles, and (3) axons with small clear vesicles probably originated from the supramedullary nucleus.The results of the present study suggest that catecholamines modulate reflex blood pressure regulation within the NTS of the rat.     

Clinical studies of intrarectal administration of 5-FU emulsion as an adjunct to surgical treatment for rectal cancer

Preoperative intrarectal administration of 5-FU emulsion was attempted as an adjuvant chemotherapy to surgery for rectal cancer. The drug concentrations of resected specimens were determined and histological examinations of them were carried out in order to evaluate the effect of anticancer drugs on the metastatic lymph nodes as well as on the primary tumors. 5-FU levels both in the regional lymph nodes and primary tumors of 18 patients with rectal cancer, who were given with the 5-FU emulsion (emulsion group) or 5-FU suppository (suppository group) intrarectally two hours before surgery, was found to be much higher in emulsion group than in suppository group. 46 patients with rectal cancer were treated preoperatively with intrarectal administration of 5-FU emulsion (25 cases) or 5-FU suppositories (21 cases) for a period of 10 days before surgery, and the histological effect of this regimen on the metastatic lesion in the lymph nodes, as well as in the primary tumor was examined. No detectable difference was found in the primary lesions between the emulsion group and the suppository group. In the metastatic lesions, however, the rate of effectiveness was higher in the emulsion group than in the suppository (68 percent versus 33 percent).     

Circular dichroism of soybean trypsin inhibitor and its derivatives

Circular dichroism (CD) of soybean trypsin inhibitor (STI, the ?KUNITZ inhibitor”?)and some of its derivatives was studied in the spectral region of 185 to 320 mμ. Acetylation and succinylation, as well as denaturation with 6 M guanidine hydrochloride resulted in small changes in the CD spectra. In strongly acid solutions at pH 1.8 to 2.0 was observed a decrease of the amplitude of the positive COTTON effect at 226 mμ and a shift of this band to 230 mμ. Remarkable changes were observed in the CD spectra after cleavage of the disulfide bonds of STI either by reduction or sulfitolysis. The positive band at 226 mμ thereby disappeared, the negative bands around 240–300 mμ were modified and the amplitude of the strong negative COTTON effect at 200 mμ was diminished by the cleavage of the disulfide bonds. Reconstitution of the disulfide bonds lead to CD patterns resembling those of the native protein. The antitryptic activity of all chemically modified samples was significantly lowered.