The white blood cell count is an independent predictor of no-reflow and mortality following acute myocardial infarction in the coronary interventional era

BACKGROUND: In the era before the use of coronary reperfusion therapy, an elevated white blood cell (WBC) count was associated with a higher risk of adverse events following acute myocardial infarction (AMI). However, the relationship between WBC count and prognosis after AMI has not been investigated since coronary intervention was introduced. AIM: To evaluate whether a high WBC count within 48 hours of the onset of AMI predicts future adverse events in patients undergoing percutaneous coronary intervention (PCI). METHOD: We evaluated 1,016 patients who underwent PCI in the acute phase of MI using the Japanese Acute Coronary Syndrome Study (JACSS) database. RESULTS. WBC count was significantly associated with smoking, sudden onset AMI, and the no-reflow phenomenon during PCI, as were age, peak creatine kinase level, and Killip class. An elevated WBC count was significantly associated with higher risk of in-hospital mortality. Patients in the highest quartile of WBC count were about three times more likely to have a poor prognosis after AMI compared to those in the lowest quartile. CONCLUSIONS: The WBC count is of great significance for stratifying patient risk and can be used as a universal marker for predicting future adverse events following any treatment for AMI.     

The association of hemoglobin A1c and high risk plaque and plaque extent assessed by coronary computed tomography angiography

The objective of this study was to investigate the relationship of Hemoglobin A1c (HbA1c) and plaque characteristics including high risk plaque and plaque extent. We retrospectively examined 1079 consecutive coronary computed tomography (CT) angiography scans and the HbA1c results. We divided the patients into four groups by the HbA1c status: non-diabetic, ≤6.0; borderline, 6.1–6.4; diabetic low, 6.5–7.1; diabetic high, >7.1. We determined segment involvement score >4 as extensive disease. High risk plaque was defined as two feature positive (FP) plaque which consists of positive remodeling (remodeling index >1.1) and low attenuation (<30 HU). Univariate and multivariate analysis including conventional cardiovascular risk factors, symptoms and medication was performed. Univariate analysis showed that diabetic patients as well as borderline patients were significantly related with 2FP plaque and extensive disease. Although the relationship of borderline patients and 2FP plaque was marginal in multivariate analysis [odds ratio (OR) 1.53, 95 % confidence interval (CI) 0.95–2.40, p = 0.07], the elevation of HbA1c was strongly associated with 2FP plaque (diabetic low, OR 2.19, 95 % CI 1.37–3.45, p < 0.005; diabetic high, OR 4.14, 95 % CI 2.57–6.67, p < 0.0005). The association of HbA1c elevation and extensive disease was quite similar between borderline and diabetic patients (borderline, OR 1.96, 95 % CI 1.29–2.95, p < 0.005; diabetic low, OR 1.94, 95 % CI 1.25–3.01, p < 0.005; diabetic high, OR 2.19, 95 % CI 1.39–3.43, p < 0.005). Patients with elevated HbA1c of >6.0 are potentially at risk for future cardiovascular events due to increased high risk plaque and extensive disease, even below the diabetic level of 6.5. Coronary CT could be used for risk stratification of these patients.     

Plasma and Gastric Mucosal Endothelin-1 Concentrations in Patients with Peptic Ulcer

Peptic ulcer in the human stomach causeslocalized destruction of the gastric wall, which may beassociated with focal vascular insufficiency.Endothelin-1, an extremely potent vasoconstrictorpeptide, modulates regional blood flow in thevasculature of stomach, suggesting a role forendothelin-1 in peptic ulcer. We examined therelationship among endogenous plasma and mucosalendothelin-1 concentrations and the severity and area of ulcer in 19patients with gastric ulcers and eight healthy adults.Endothelin-1 concentrations were measured by enzymeimmunoassay in plasma and gastric mucosal specimens from ulcer margins, corpus, and antrum. The severityand area of ulcer were assessed endoscopically. Plasmaendothelin-1 concentrations in active (P < 0.01compared with normal) and healing (P < 0.05) stagesof ulcer were significantly greater than those innormal subjects. Plasma endothelin-1 concentrations, butnot mucosal endothelin-1 concentrations in the ulcermargin, were significantly associated with the severity of the ulcer. There was a significantpositive correlation between plasma endothelin-1concentration and area of ulcer (r = 0.70, P < 0.01).In conclusion, locally increased endothelin-1 may be an important mediator contributing to thepathogenesis of peptic ulcer.     

Quality of life following high‐intensity focused ultrasound for the treatment of localized prostate cancer: A prospective study

Objectives: To report our health‐related quality of life (QOL) and functional outcomes following high‐intensity focused ultrasound (HIFU) for localized prostate cancer. Methods: Data from prostate cancer patients undergoing HIFU at our institution between January 1999 and April 2007 were collected in our prospective database. Standard preoperative and surgical parameters, as well as baseline urinary function, QOL and sexual assessment were included. The Japanese version of the Functional Assessment of Cancer Therapy‐general (FACT‐G), the FACT‐prostate (P) and the International Index of Erectile Function‐5 (IIEF‐5) were used for the functional assessment. These self‐administered questionnaires were collected preoperatively and again at 6, 12 and 24 months postoperatively. Results: A total of 326 patients were included in the analysis. Maximum flow rate and residual urine volume were significantly impaired at 6 months (P = 0.010) after HIFU, even if they returned to baseline values at 12 or 24 months after HIFU. The total FACT‐G score significantly improved at 24 months (P = 0.027) after HIFU. At 6, 12 and 24 months after HIFU, 52%, 63% and 78%, respectively, of the patients, not receiving neoadjuvant hormonal therapy, were potent. Conclusions: In our experience, functional and QOL outcomes after HIFU therapy for localized prostate cancer are better than those after other treatment modalities.     

Detection of acute subdural hemorrhage using intraoperative MR imaging during glioma surgery: a case report

Intraoperative MRI (iMR) and neuronavigation have substantially changed the principles of surgery for brain tumors. iMR provides updated information on anatomical data and unanticipated brain events, thereby allowing safer and more accurate surgery. We herein report a case of unanticipated intracranial hemorrhage in an iMR imaging suite. The patient was a 53-year-old man with a chief complaint of generalized convulsion. MRI showed a lesion in the right temporal lobe about 6.0 cm in diameter. The tumor was resected using an iMR system and neuronavigation. The first iMR images showed a residual tumor in the medial temporal lobe. No brain events were detected at this time. We obtained updated navigation data and performed additional resection. After completion of the planned tumor resection, additional iMR images were taken. The second iMR images confirmed that the tumor had been completely removed, but they also revealed a contra-lateral subdural hemorrhage. After expedited closure of the original incision, left unilateral craniotomy was performed and the hematoma was evacuated. Fortunately, the patient had no new neurological deficits. The use of iMR imaging allowed the complete removal of the tumor and facilitated prompt and effective identification of an unanticipated life-threatening complication.     

Cerivastatin induces type-I fiber-, not type-II fiber-, predominant muscular toxicity in the young male F344 rats

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are associated with adverse skeletal muscle toxicity, but the underlying mechanism remains unclear. To investigate the pathological mechanism of statin-induced myotoxicity, cerivastatin (20 ppm; corresponding to 2 mg/kg/day) was dietarily administered to young male F344 rats for 10 days, and time-course clinical observations, measurement of plasma creatine kinase activity, and light and electron microscopy of type I fiber-predominant skeletal muscle (soleus) or type II fiber-predominant skeletal muscles (extensor digitorum longus and tibialis anterior), were performed. Clinical symptoms including weakness of hind limbs, staggering gait and body weight loss, accompanied by marked plasma creatinine kinase elevation in rats fed cerivastatin at around Day 6 to 8. Interestingly, microscopic examination revealed that cerivastatin-induced muscle damages characterized by hypercontraction (opaque) and necrosis of the fibers were of particular abundance in the soleus muscle at Day 8, whereas these histological lesions in the extensor digitorum longus and tibialis anterior were negligible, even at Day 9. Prior to manifestation of muscle damage, swollen mitochondria and autophagic vacuoles in the soleus were observed as the earliest ultra structural changes at Day 6; then activated lysosomes, disarray of myofibril and dilated sarcoplasmic reticulum vesicles became ubiquitous at Day 8. These results demonstrate that cerivastatin induces type I fiber-predominant muscles injury, which is associated with mitochondrial damage, in young male F344 rats. Since the rat exhibiting type I fiber-targeted injury is a unique animal model for statin-induced myotoxicity, it will be useful for gaining insight into mechanisms of statin-induced myotoxicity.