J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes: an 8-year follow-up of relatively lean Japanese individuals

AIMS

This study investigated the relationship between waist circumference and the subsequent incidence of Type 2 diabetes and the association with insulin resistance and pancreatic B-cell function in relatively lean Japanese individuals.

METHODS

The study participants were 3992 employees (2533 men and 1459 women, aged 35-55 years) of a metal-products factory in Japan. The incidence of diabetes was determined in annual medical examinations during an 8-year follow-up. We calculated age- and sex-adjusted hazard ratios (HRs) according to the sex-specific quintile of waist circumference at baseline. Differences in baseline insulin resistance [homeostatis model assessment (HOMA)-IR] and pancreatic B-cell function (HOMA-B) were compared between participants who developed diabetes and those who did not.

RESULTS

During the follow-up, 218 participants developed diabetes. Age- and sex-adjusted HRs across the quintiles of waist circumference were 1.78, 1.00 (reference), 1.59, 3.11 and 3.30, respectively (P for trend, < 0.0001). The HR for the lowest quintile was significantly higher than that for the second quintile. Among participants with waist circumference of the lowest quintile, HOMA-B was lower in those who developed diabetes than in those who did not [33.1 (24.1-45.0) vs. 54.3 (37.9-74.6) median (interquartile range), P < 0.0001], but HOMA-IR did not differ between these groups.

CONCLUSIONS

There was a J-shaped relationship between waist circumference and subsequent risk for Type 2 diabetes in relatively lean Japanese individuals; lower pancreatic B-cell function may also increase the risk of diabetes in very lean Japanese people. Diabet. Med. 26, 753-759 (2009).

Electrical properties of individual ZnO nanowires

The electrical properties of individual ZnO nanowires were investigated for two methods of fabricating nanowire-electrode junctions. The number of carriers in the nanowires was increased by electrostatically doping them by applying a gate voltage. The nanowires were chemically doped by introducing impurities during growth. The Ga-doped nanowires had a linear current-voltage relationship over a wide voltage region. The nanowire-electrode junctions were formed either by using lithography to form electrodes on the nanowire or by using an AFM probe to move a nanowire onto prepared electrodes. With both methods, electrodes made of Ga-doped ZnO were found to make better electrical contact with the nanowire than those made of Ti/Au.

Evaluation of early and midterm results of offpump coronary artery bypass in patients with left main disease

PURPOSE

This study evaluated the early and midterm results of offpump coronary artery bypass (OPCAB) for left main coronary artery (LMCA) stenosis.

METHODS

Patients treated between November 2001 and December 2006, during which isolated coronary artery bypass grafting (CABG) was performed without cardiopulmonary bypass in principle, were included. Isolated CABG was performed in 206 patients, of whom 62 (30.1%) had LMCA stenosis >50%.

RESULTS

The in-hospital mortality rate (LMCA stenosis > 50%, 1.6%; LMCA stenosis <or=50%, 0.7%, p = 0.512), the incidence of postoperative complications, and the midterm survival rate (LMCA stenosis succeeds50%, 86.7 +/- 5.2%/5 years, LMCA stenosis<or=50%, 89.6 +/- 3.8%/5 years, p = 0.21) did not significantly differ between the two groups. Conversion was significantly frequent in patients with LMCA stenosis >75% and severe stenosis >90% in the right coronary artery (RCA) trunk.

CONCLUSIONS

Patients with LMCA stenosis can undergo OPCAB safely and the midterm results are good. As conversion was significantly frequent in patients with severe LMCA and RCA trunk stenosis, adequate preparation for pump application is necessary.

Physicochemical, morphological and therapeutic evaluation of agarose hydrogel particles as a reservoir for basic fibroblast growth factor

Micron-sized agarose hydrogel particles were prepared using an emulsification/gelation method as a controlled release reservoir for basic fibroblast growth factor (bFGF). Mean particle size of agarose hydrogel particles decreased with an increase in stirring speed and also with an increasing temperature of the oil phase, as measured before cooling. Morphologies of agarose particles before and after dispersing into water were investigated by scanning electron microscopy (SEM) and cryogenic SEM, respectively. Freeze-dried agarose particles were spherical with rough surface. Porous polymer matrix structure was observed in the hydrogel particles by cryo-SEM. More than 99% of bFGF was encapsulated and the release from the agarose hydrogel particles was less than 3% during the incubation in phosphate buffered saline. bFGF molecules were not only adsorbed on the particle surface but also permeated and retained within the matrix. The therapeutic efficacy of bFGF retained in agarose hydrogel particles was significantly higher than that dissolved in saline. Agarose hydrogel particle seems to be a potential candidate for a bFGF reservoir.

Multicenter phase II study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity for the breast cancer patients (Kinki Multidisciplinary Breast Oncology Group: KMBOG-0605)

Abstract #4093

Background: We have learned from the questionnaire survey of description and hearing type that the onycholysis and skin toxicity occur in approximately 90% of patients(pts) treated with docetaxel (DTX) on hands and 65% on feet. Besides neurotoxicity and edema, these adverse events cause the worse quality of life (QOL) assessment because of the exposure, public noticed site. According to the report that the Elasto-Gel frozen glove (FG) was effective for the prevention of DTX-induced onycholysis and skin toxicity (Scotte F, JCO 23, 4424-29, 2005), we have planned to reanalyze the efficacy and safety of FG for Japanese breast cancer pts by the multicenter, prospective phase II study.&#x2028; Patients and Methods: Patients receiving DTX 75 mg/m2 alone or in combination chemotherapy more than 4 cycles were eligible for this case-control study. Each patient on case group wore an FG for a total of 90 minutes on the both hands. Her feet were not protected. The control data was obtained by the questionnaire survey from the pts who had not used FG during the chemotherapy. Onycholysis and skin toxicity were assessed at each cycle by National Cancer Institute Common Toxicity Criteria and documented by photography. This study had accomplished by multidisciplinary approach by nurses, pharmacists, and doctors. Wilcoxon matched-pairs rank test was used.&#x2028; Results: Between March 2006 and May 2007, 70 pts on case and 52 pts on control were evaluated. Median age were similar for each group, 52 [29-74 years] on case and 51 [25-73 years] on control. Onycholysis and skin toxicity were significantly lower in the FG-protected hands compared with the control hands (P = .0001). Onycholysis was grade (G) 0 in 41% v 8%, G1 in 54% v 74%, and G2 to 3 in 4.3% v 18% for the FG-protected hands and the control hands, respectively. For the feet, there was no difference in frequency between pts on case and on control. Skin toxicity was G0 in 76.6% v 44%, G1 in 13.6% v 42%, and G2 to 3 in 4.4% v 14% for the FG-protected hands and the control, respectively. 32 pts (46%) had experienced the deterioration of pigmentation on hands and/or feet, the FG had seemed not to be able to prevent these unfavorable events. Median time to nail and skin toxicity occurrence was not significantly different between the FG-protected and the control hands of feet, respectively. Although one pt (1.4%) experienced discomfort due to cold intolerance, there were no serious adverse events caused by FG.&#x2028; Conclusion: FG significantly reduces the nail and skin toxicity associated with DTX and is a safety tool on supportive care management. This should be provided in general practice widely to improve a patient's QOL.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4093.

[Surgical stratery for abdominal aortic aneurysm with coronary artery disease]

Coronary artery disease (CAD) and abdominal aortic aneurysm (AAA) frequently coexist. One-stage surgery of coronary artery bypass grafting (CABG) and AAA repair is recommended for the treatment of patients having a combination of severe CAD and large AAA. Fifty-three patients underwent simultaneous CABG and AAA repair. By operative methods, we classified them into 3 groups; on-pump CABG and AAA repair group (group A: n=13), AAA repair and off-pump CABG using partial sternotomy group (group B: n=23) and those using full sternotomy group (group C: n=16). It was evaluated which operative method was superior. Off-pump method was superior to on-pump method. A problem of simultaneous CABG and AAA repair was postoperative respiratory complication. This study suggests that the minimally invasive methods should be used for one-stage operation of CABG and AAA repair.

Silent venous thromboembolism before treatment in endometrial cancer and the risk factors

Venous thromboembolism (VTE) often occurs after surgery and can even occur before surgery in patients with gynaecological malignancies. We investigated the incidence of VTE before treatment of endometrial cancer and associated risk factors. Plasma D-dimer (DD) levels before initial treatment were examined in 171 consecutive patients with endometrial cancer. Venous ultrasound imaging (VUI) of the lower extremities was performed in patients with DD ⩾1.5 μg ml⁻¹, as the negative predictive value of DD for VTE is extremely high. For patients with deep vein thrombosis (DVT), pulmonary scintigraphy was performed to ascertain the presence of pulmonary thromboembolism (PTE). Risk factors for VTE were analysed using univariate and multivariate analyses for 171 patients. Of these, 37 patients (21.6%) showed DD ⩾1.5 μg ml⁻¹, 17 (9.9%) displayed DVT by VUI and 8 (4.7%) showed PTE on pulmonary scintigraphy. All patients with VTE were asymptomatic. Univariate analysis for various risk factors revealed older age, non-endometrioid histology and several variables of advanced disease as significantly associated with VTE before treatment. Obesity, smoking and diabetes mellitus were not risk factors. Multivariate analysis confirmed extrauterine spread and non-endometrioid histology as independently and significantly associated with risk of VTE. These data suggest that silent or subclinical VTE occurs before treatment in at least around 10% of patients with endometrial cancer. Risk factors for VTE before treatment might not be identical to those after starting treatment.

An insight into the general relationship between the three dimensional structures of enzymes and their electronic wave functions: Implication for the prediction of functional sites of enzymes

In this study, we explored the general relationship between the three-dimensional (3D) structures of enzymes and their electronic wave functions. Furthermore, we developed a method for the prediction of their functionally important sites. For this purpose, we first performed linear-scaling molecular orbital calculations for 112 nonredundant, non-homologous enzymes with known structure and function. In consequence, we showed that the canonical molecular orbitals (MOs) of the enzymes could be classified into three groups according to the degree of electron delocalization: highly localized orbitals (Group A), highly delocalized orbitals whose electrons are distributed over almost the whole molecule (Group B), and moderately delocalized orbitals (Group C). The MOs belonging to Group A are located near the HOMO-LUMO band gap, and thereby include the frontier orbitals of a given enzyme. We inferred that the MOs of Group B play a role in stabilizing the 3D structure of the enzyme, while those of Group C contribute to constructing the covalent bond framework of the enzyme. Next, we investigated whether the frontier orbitals of enzymes could be used for identifying their potential functional sites. As a result, we found that the frontier orbitals of the 112 enzymes have a high propensity to be colocalized with the known functional sites, especially when the enzymes are hydrated. Such a propensity is shown to be remarkable when Glu or Asp is a functional site residue. On the basis of these results, we finally propose a protocol for the prediction of functional sites of enzymes.

Antioxidative Role of Interleukin-6 in Septic Lung Injury in Mice

We have previously demonstrated the protective role of interleukin (IL)-6 against septic lung injury induced by lipopolysaccharide (LPS) using IL-6 knock-out (−/−) mice. This protection is mediated, at least partly, through the inhibition of the enhanced local expression of proinflammatory cytokines. In the present study, we addressed whether IL-6 regulates oxidative stress in the lung generated by LPS exposure using IL-6 (−/−) and corresponding wild type (WT) mice. Intraperitoneal LPS (1 mg/kg) challenge induced transcriptional expressions of inducible nitric oxide synthase and heme oxygenase −1 in the lung of mice with both genotypes. In the presence of LPS, these expressions were significantly greater in IL-6 (−/−) than in WT mice. Immunohistochemistry also showed that LPS induced a significant increase in 8-hydroxy-2′-deoxyguanosine formation in the lung as compared to vehicle. Furthermore, the formation was more intense in IL-6 (−/−) than in WT mice in the presence of LPS challenge. In the presence of LPS, lipid peroxidation in the lung was significantly greater in IL-6 (−/−) than in WT mice. These data suggest that the possible mechanisms in which endogenous IL-6 protects against septic lung injury induced by LPS involve, at least in part, its antioxidative properties.

Mass production of ZnO nanotetrapods by a flowing gas phase reaction method

We have developed a flowing gas phase reaction method for synthesizing ZnO nanotetrapods. The synthesis was carried out in a tube furnace under air pressure using air and nitrogen as reactive and carrying gases. The zinc precursor was provided by carbothermal reduction of ZnO powder. The source material transformation efficiency is higher than 90%. ZnO nanotetrapods were nucleated and grown in the gas phase via a vapor-solid mechanism. The reaction occurred at a temperature controlled to 1050-1200 °C and gas flow rate controlled to 0.7-2 L/min. The high flow rate suppressed the diffusion of growth precursors and productions towards the tube wall, and localized them into a gas phase pipe. The harvested ZnO nanotetrapods were carried by the flowing gas and collected outside of the furnace. The sizes of the nanotetrapods range from several hundred nanometers to more than 10 µm with leg diameters of 30-200 nm. The flowing gas phase reaction method provides a relatively uniformity environment for nanotetrapod growth and simplifies the product collection procedure compared with other techniques. This technique is simple and inexpensive, which is promising for realizing continuous mass production of ZnO nanotetrapods on a factory scale.

Size effects of nanomaterials on lung inflammation and coagulatory disturbance

Effects of nano-sized materials (nanomaterials) on subjects with predisposing inflammatory disorders have not been well elucidated. This study examined the effects of pulmonary exposure to TiO2 nanomaterials on lung inflammation induced by lipopolysaccharide (LPS) and consequent systemic inflammation with coagulatory disturbance in mice, in particular regarding their size-dependency. Also, gene expression pattern in the lung was compared among the experimental groups using cDNA microarray analysis. ICR male mice were divided into 8 experimental groups that intratracheally received vehicle, three sizes (15, 50, 100 nm) of TiO2 nanomaterials (8 mg/kg), LPS (2.5 mg/kg), or LPS plus nanomaterials. Twenty four h after the treatment, these nanomaterials exacerbated the lung inflammation and vascular permeability elicited by LPS, with an overall trend of amplified lung expressions of cytokines such as interleukin (IL)-1beta, macrophage chemoattractant protein (MCP)-1, and keratinocyte chemoattractant (KC). LPS plus nanomaterials, especially of a size less than 50 nm, elevated circulatory levels of fibrinogen, IL-1beta, MCP-1, and KC, and von Willebrand factor as compared with LPS alone. The enhancement tended overall to be greater with the smaller nanomaterials than with the larger ones. cDNA microarray analyses revealed that there was no difference in gene expression pattern between the LPS group and the LPS + nanomaterial. These results suggest that nanomaterials exacerbate lung inflammation related to LPS with systemic inflammation and coagulatory disturbance, and that the exacerbation is more prominent with smaller nanomaterials than with larger ones.

Pulmonary exposure to carbon black nanoparticles increases the number of antigen-presenting cells in murine lung

Particulate matters can enhance antigen-related airway inflammation and immunoglobulin production. The present study was designed to determine the effects of different sizes of nanoparticles on the antigen-presenting cells (APC) in the lung. ICR mice were exposed to vehicle, carbon black (CB) nanoparticles (14 nm or 56 nm), ovalbumin (OVA), or OVA + nanoparticles intratracheally. The expression of major histocompatibility complex (MHC) class II, costimulatory molecules (CD80, CD86, CD11c), and DEC205 (dendritic cell marker), F4/80 (macrophage marker), and CD19 (B-cell marker) in the lung cells was measured by flow cytometry. 14 nm nanoparticles, but not 56 nm nanoparticles, increased the number of the total lung cells. Combination of OVA and 14 nm or 56 nm nanoparticles increased the total lung cells. The expression of MHC class II and/or costimulatory molecules and the number of APC in the lung were increased by 14 nm nanoparticles in the presence or absence of OVA. The increases were more prominent with combination of OVA and 14 nm nanoparticles. 56 nm nanoparticles did not show any significant effects. 14 nm CB nanoparticles can increase the expression of MHC class II and costimulatory molecules and the number of APC in the lung, especially in the presence of antigen, which can result in subsequent antigen-related airway inflammation and immunoglobulin production.

Effects of nanoparticles on lung physiology in the presence or absence of antigen

Ambient particulate matter (PM) exacerbates allergic airway diseases. Our previous study showed that diesel exhaust particles, the main constituents in urban PM, enhance airway hyperresponsivness in mice. In addition, health effects of PM with a diameter of less than 100 nm, called nanoparticles, have been reported, and we have also demonstrated that carbon nanoparticles exacerbate antigen-related airway inflammation. The present study investigates the effects of pulmonary exposure to two sizes of carbon nanoparticles on lung physiology and lung expression of Muc5ac in the presence or absence of antigen in mice. Nanoparticles alone or ovalbumin (OVA) alone moderately enhanced cholinergic airway reactivity, as assessed by total respiratory system resistance (R) and Newtonian resistance (Rn). In the nanoparticle + OVA groups, all the parameters for lung responsiveness, such as R, compliance, elastance, Rn, tissue damping, and tissue elastance, were worse than those in the vehicle group, the corresponding nanoparticle groups or the OVA group. The lung mRNA level for Muc5ac was significantly higher in the OVA group than in the vehicle group, and further increased in the nanoparticle + OVA groups than in the OVA or the nanoparticle groups. These data suggest that carbon nanoparticles can enhance lung hyperresponsiveness, especially in the presence of antigen. The effects may be mediated, at least partly, through the enhanced lung expression of Muc5ac.

Optical and electrophysiological recordings of corticospinal synaptic activity and its developmental change in in vitro rat slice co-cultures

Electrophysiological recordings and optical imaging with a fast voltage-sensitive dye (di-4-ANNEPS) were used to directly examine the spatiotemporal properties of in vitro corticospinal synapses formed in co-cultures of cerebral cortex and spinal cord slices. Whole cell recordings from spinal cord cells showed both monosynaptic and polysynaptic excitatory postsynaptic currents (EPSCs) in response to stimulation of corticospinal axons. Monosynaptic EPSCs and excitatory postsynaptic potentials (EPSPs) were isolated in artificial cerebrospinal fluid containing high concentrations of divalent cations. Optical imaging and extracellular recordings were done simultaneously. Both EPSPs and optically recorded excitatory postsynaptic potentials (optEPSPs) lasted 300-500 ms and were almost always positive. The major component of these long-lasting potentials was blocked by ifenprodil, a specific antagonist of the NR2B subunit-containing N-methyl-d-aspartate receptor (NMDAR). The spatial distribution of corticospinal optEPSPs paralleled that of the corticospinal field excitatory postsynaptic potentials (fEPSPs), suggesting that positive fEPSP amplitude is a reliable indicator of the distribution of corticospinal synapses. Corticospinal optEPSPs spread into the ventrolateral region by 6-7 days in vitro (DIV), but were restricted to the dorsomedial area by 11-13 DIV, suggesting synapses were eliminated from the ventrolateral side of the spinal cord. After the recordings were complete, corticospinal fibers were often anterogradely labeled with biocytin to assess the relation between presynaptic fiber distribution and the optical signals (optically-recorded presynaptic fiber volley (opt-prevolley) and optEPSP). The distributions of the opt-prevolleys and optEPSPs correlated well with the distribution of presynaptic fibers, suggesting the opt-prevolley reflects corticospinal fiber activity and that the fibers made synapses relatively evenly along their axons. The NR2B-mediated component of the corticospinal synaptic response declined during the interval between 6 and 7 DIV and 11-13 DIV, suggesting that a shift in the NMDAR subtype from NR2B to something else (perhaps NR2A) may be involved in regulating developmental plasticity in the rat spinal cord and the process of corticospinal synapse elimination.

High incidence of silent venous thromboembolism before treatment in ovarian cancer

Venous thromboembolism (VTE) such as deep-vein thrombosis (DVT) and pulmonary thromboembolism (PTE) often occurs after surgery and rarely occurs even before surgery in patients with ovarian cancer. It is well known that levels of plasma D-dimer (DD) before treatment in most ovarian cancer patients are increased. This study therefore examined whether increased levels of DD are associated with presence of VTE before treatment of ovarian cancer. Between November 2004 and March 2007, DD levels prior to initial treatment were measured in 72 consecutive patients with presumed epithelial ovarian cancer (final diagnosis: epithelial ovarian cancer, n=60; and epithelial ovarian borderline malignancy, n=12). Venous ultrasound imaging (VUI) of the lower extremity was conducted for all patients except for two patients in whom DVT was detected by pelvic computed tomography (CT). When DVT was found, pulmonary scintigraphy was subsequently performed to ascertain presence of PTE. D-dimer levels were above the cut-off value (0.5 μg ml⁻¹) in 65 of 72 patients (90.2%). Venous ultrasound imaging or CT revealed DVT in 18 of 72 patients (25.0%) and pulmonary scintigraphy found PTE in 8 patients (11.1%). All patients with VTE were asymptomatic when VTE was found. D-dimer levels were associated with incidence of VTE (0–1.4 μg ml⁻¹; 0 of 26 (0%), 1.5–7.4 μg ml⁻¹; 9 of 30 (30%) and ⩾7.5 μg ml⁻¹; 9 of 16 (56.3%), P for trend=0.0003). However, even if 1.5 μg ml⁻¹ was used as a cut-off value, this had low specificity and positive predictive value (47.2, 38.3%), though it had high sensitivity and negative predictive value (100, 100%). Therefore, ovarian cancer patients with DD level ⩾1.5 μg ml⁻¹ should be examined using VUI to detect silent DVT. Patients with VTE underwent preventive managements including anticoagulant therapy before initial treatment, chemotherapy or surgery, and after surgery. There was no clinical onset of postoperative VTE in all 72 patients. Measurement of DD levels and subsequent ultrasonography revealed that silent or subclinical VTE frequently occurs before surgery in ovarian cancer. The usefulness of preoperative assessment of VTE needs further confirmation in randomised controlled trials.

Analysis of pharmacological effect and molecular mechanisms of a traditional herbal medicine by global gene expression analysis: an exploratory study

BACKGROUND AND OBJECTIVES

Although traditional herbal medicines have been used for more than 2000 years, there are few studies on their molecular mechanisms of action. We examined the pharmacological effect and mechanism of action of a traditional herbal medicine (Kososan) with global gene expression analysis using a DNA chip.

METHODS

Fourteen healthy subjects were given the herbal medicine (Kososan) for 2 weeks and interviewed. Peripheral blood was collected before and after 2-week medication. Based on the outcomes of the interview, the subjects were divided into responders and non-responders. We analysed the blood samples from responder and non-responder groups, respectively, using a DNA chip.

RESULTS

In the Kososan responder group, 70 genes were over-expressed (2-fold or more), and their over-expression was normalized by Kososan (0.5-fold or less), whereas 24 genes were under-expressed (0.5-fold or less), and the under-expression was normalized by Kososan (2-fold or more).

CONCLUSION

This exploratory study suggests that gene expression profiling is a possible approach for studying the effects of complex herbal remedies. Some of the genes studied seem to have functions related to the pharmacological effects of Kososan, which have been known for a long time.

Branched-chain amino acids supplementation attenuates the accumulation of blood lactate dehydrogenase during distance running

AIM

We investigated the effect of branched-chain amino acids (BCAA) supplementation on tissue damage during distance running.

METHODS

Eight male distance runners (mean +/- standard deviation; age: 20.4+/-1.2 years, body weight: 58.4+/-4.2 kg) participated in a double blinded cross over designed study conducted during training camp. During each intervention period, the subjects were asked to participate in a 25-km run, and the blood BCAA and lactate dehydrogenase (LDH) level, an index of tissue damage, were measured pre- and post-run. Either a drink containing BCAA (0.4% BCAA in a 4% carbohydrate solution) or an iso-calorie placebo drink was provided to the subjects 5 times during the run without any restriction in the volume.

RESULTS

The total volume of the drink consumed by the subjects did not differ substantially between the trials: 591+/-188 (2.36 g BCAA) vs 516+/-169 mL in BCAA and placebo trial, respectively. During the run, the blood BCAA concentration was maintained in the BCAA trial. However, the blood BCAA concentration level tended to decrease in the placebo trial (P<0.1). The extent of the blood LDH increase in the BCAA trial was significantly less than that of the placebo trail (48% vs 58%, P<0.05).

CONCLUSION

Maintaining the blood BCAA level throughout a long distance run contributes to a reduction in the LDH release and, therefore, the effect of BCAA supplementation is suggested to reduce the degree of muscle damage.

Extensor digitorum longus tenosynovitis caused by talar head impingement in an ultramarathon runner: a case report

Stenosing tenosynovitis of the extensor digitorum longus tendon is an injury related to ultramarathon running. A 32-year-old male ultramarathon runner developed chronic tenosynovitis of the ankle dorsiflexors. He was diagnosed with extensor digitorum longus tenosynovitis caused by talar head impingement associated with exostosis. He failed to respond to non-operative management and decided to undergo tenosynovectomy of the extensor digitorum longus tendon. The pain was relieved without functional disturbance of the foot and ankle, and the patient returned to running 3 weeks postoperatively. At the 2-year follow-up, he was participating fully in ultramarathons.

Pitfalls of Skeletonized Internal Thoracic Artery:

BACKGROUND AND AIM OF THE STUDY

Skeletonization of the internal thoracic artery (ITA) has several advantages: sequential bypass grafting can be easily performed, and a graft of increased length can make the distal coronary artery accessible. However, kinking of the grafts has been observed on postoperative angiograms in a few cases. We investigated whether there were significant differences in the frequency of graft kinking and stenosis degree at the kink site between pedicled and skeletonized grafts.

METHODS

Postoperative angiography was performed for all cases. In pedicled (n = 65) and skeletonized (n = 129) groups, the results of postoperative graft angiography were analyzed to investigate the presence of graft kinking and stenosis degree at the kink site.

RESULTS

Kinking was observed in 4 (5.9%) and 9 (3.9%) arteries in the pedicled and skeletonized groups, respectively (p = 0.341). The stenosis degree at the kink site (mean +/- SD) was significantly higher in the skeletonized group (47.2 +/- 16.8%) than in the pedicled group (23.5 +/- 13.7%), (p = 0.032). In four patients in whom early postoperative angiography showed a kink with more than 50% stenosis, late-term angiography was performed. All four cases showed regression of the stenosis degree at the kink site.

CONCLUSIONS

When the ITA had a kink, the stenosis degree at the kink site was significantly higher in the skeletonized group than in the pedicled group. Late angiography often reveals regression of stenosis at the kink site. Immediate intervention need not always be performed if the patient has no angina caused by a stenotic lesion at the kink site.

Genes involved in oxidative phosphorylation are coordinately upregulated with fasting hyperglycaemia in livers of patients with type 2 diabetes

AIMS/HYPOTHESIS

Mitochondrial oxidative phosphorylation (OXPHOS) plays an important role in the pathophysiology of type 2 diabetes. Genes involved in OXPHOS have been reported to be down-regulated in skeletal muscle from patients with type 2 diabetes; however, hepatic regulation is unknown.

MATERIALS AND METHODS

We analysed expression of genes involved in OXPHOS from the livers of 14 patients with type 2 diabetes and 14 subjects with NGT using serial analysis of gene expression (SAGE) and DNA chip analysis. We evaluated the correlation between expression levels of genes involved in OXPHOS and the clinical parameters of individuals with type 2 diabetes and NGT.

RESULTS

Both gene analyses showed that genes involved in OXPHOS were significantly upregulated in the type 2 diabetic liver. In the SAGE analysis, tag count comparisons of mitochondrial transcripts showed that ribosomal RNAs (rRNA) were 3.5-fold over-expressed, and mRNAs were 1.2-fold over-expressed in the type 2 diabetes library. DNA chip analysis revealed that expression of genes involved in OXPHOS, which correlated with several nuclear factors, including estrogen-related receptor-alpha or peroxisome proliferator-activated receptor-gamma, was a predictor of fasting plasma glucose levels, independently of age, BMI, insulin resistance and fasting insulin levels (p = 0.04). Surprisingly, genes involved in OXPHOS did not correlate with peroxisome proliferator-activated receptor-gamma coactivator-1alpha or nuclear respiratory factor 1.

CONCLUSIONS/INTERPRETATION

Our results indicate that upregulation of genes involved in OXPHOS in the liver, which are regulated by different mechanisms from genes in the skeletal muscle, is associated with fasting hyperglycaemia in patients with type 2 diabetes.

Late-term regression of stenosis at the kink site in the internal thoracic artery in two cases

A kink in the internal thoracic artery (ITA) is a rare postoperative complication after coronary artery bypass surgery. The kink can be accompanied by significant stenosis and has been observed after the ITAs are harvested by the skeletonization method. In this report, we present two cases in which early postoperative angiography showed the kink accompanied by significant stenosis, and late angiography revealed regression of stenosis at the kink site. Immediate intervention is not always necessary even when the kink, accompanied by significant stenosis was observed on early postoperative angiography.

A case complicated with Horner's syndrome after off-pump coronary artery bypass

In the present report, a case complicated with Horner's syndrome after off-pump coronary artery bypass (OPCAB) was presented. This case showed ptosis and miosis in the left eye promptly after OPCAB. No abnormal neurological findings other than Horner's syndrome were observed in postoperative examinations including head magnetic resonance imaging (MRI), and this case was thought to have Horner's syndrome as a complication after cardiac surgery through median sternotomy.