PrPc is temporospatially expressed in molar development of rats

Odontogenesis, tooth development, is derived from two tissue components: ectoderm and neural crest-derived mesenchyme. Cyto-differentiation of odontogenic cells during development involves time-dependent and sequential regulation of genetic programs. This study was conducted to detect molecules implicated in cyto-differentiation of developing molar germs of rats. Differential display-PCR revealed that PrP(c) was differentially expressed between cap/early bell-staged germs (maxillary 3rd molar germs) and root formation-staged germs (maxillary 2nd molar germs) at postnatal day 9. Both levels of PrP(c) mRNA and protein expression were higher in the root formation stage than the cap/early bell stage and increased in a time-dependent manner. Immunofluorescence revealed for the first time that PrP(c) was not localized in the enamel organ, but localized in dental follicular cells for the development of the periodontal ligament and cementum as well as odontoblasts, both of which are of neural crest origin. These results suggest that the physiological functions of the PrP(c) in tooth development may be implicated in the differentiation of neural crest-derived mesenchyme including the periodontal tissues for root formation rather than epithelial tissue.

Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida

STUDY DESIGN

Retrospective chart review.

OBJECTIVE

To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida.

SETTING

Japan.

METHODS

We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed.

RESULTS

A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs.

CONCLUSION

MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE.

Hemodynamic impact of changes in bifurcation geometry after single-stent cross-over technique assessed by intravascular ultrasound and fractional flow reserve

BACKGROUND

Angiographic stenosis of a sidebranch (SB) ostium is common after single-stent cross-over, but it is usually not hemodynamically significant. We evaluated the relationship between the mechanisms of SB stenosis and its hemodynamic significance.

METHODS AND RESULTS

We used preinterventional and post-interventional intravascular ultrasound (IVUS) of the main branch (MB) and the SB and post-intervention fractional flow reserve (FFR) of the SB to assess 40 nonleft main bifurcation lesions after a single stent cross-over. Although post-stenting angiographic diameter stenosis >50% was seen in 19 (48%) SB lesions, only 6 (15%) showed FFR < 0.80. Carina shift was seen in all but one lesion; and plaque shift superimposed on the carina shift was found in 18 (45%) lesions. The change in plaque area at the SB ostium positively correlated with preprocedural plaque burden at the carina of distal MB r = 0.341, P = 0.031). Plaque shift was more common in lesions with FFR < 0.80 vs. ≥0.80 (83% vs. 38%, P = 0.041); and FFR < 0.80 was more frequent in lesions with plaque shift superimposed on carina shift versus isolated carina shift (28% vs. 5%, P = 0.041).

CONCLUSIONS

Although carina shift was the main mechanism of SB lumen loss after a single stent cross-over technique, plaque shift superimposed on carina shift appeared to be necessary to cause a hemodynamically significant stenosis (FFR < 0.80). However, post-procedural IVUS assessment did not accurately predict the functional significance.

Clinical characteristics of patients with tuberculosis-destroyed lung

SETTING

Multicentre study.

OBJECTIVE

To define the clinical characteristics of patients with tuberculosis (TB) destroyed lung due to past TB.

DESIGN

We reviewed patients with TB-destroyed lung between May 2005 and June 2011.

RESULTS

A total of 595 patients from 21 hospitals were enrolled. The mean age was 65.63 ± 0.47 (mean ± standard error); 60.5% were male. The mean number of lobes involved was 2.59 ± 0.05. Pleural thickening was observed in 54.1% of the patients. Mean forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC, bronchodilator response and number of exacerbations per year were respectively 2.06 ± 0.03 l (61.26% ± 0.79), 1.16 ± 0.02 l (49.05% ± 0.84), 58.03% ± 0.70, 5.70% ± 0.34, and 0.40 ± 0.04. The number of lobes involved was significantly correlated with FVC and FEV(1), and with the number of exacerbations per year. Use of long-acting muscarinic antagonists or long-acting beta-2 agonists plus inhaled corticosteroids resulted in bronchodilatory effects. Multivariable regression analysis showed that age, initial FEV(1) (%) and number of exacerbations during follow-up were independent factors affecting change in FEV(1).

CONCLUSION

Decreased lung function with exacerbation, and progressive decline of FEV(1) were observed in patients with TB-destroyed lung.

Intravascular ultrasound assessment of drug-eluting stent coverage of the coronary ostium and effect on outcomes

When stenting an ostial or proximal coronary lesion, 1 fundamental decision is whether to extend the proximal end of the stent into the aorta (in the case of the left main [LM] or right coronary ostium) or into the polygon of confluence of the LM (in the case of the left anterior descending [LAD] ostium). Complete angiographic and intravascular ultrasound data and 9-month follow-up angiographic and clinical data were available from 459 patients with 138 ostial lesions (angiographic diameter stenosis within the ostium of ≥50%) or 321 nonostial lesions in which the proximal end of the stent ended at or near the coronary ostium. Strut protrusion was more frequent in the LM than in the right or LAD ostium (68% vs 59% vs 53%, p = 0.010). The length of strut protrusion was 3.4 ± 1.7 mm in the LM ostium, 1.7 ± 1.0 mm in the LAD ostium, and 2.4 ± 1.4 mm in the right ostium (p = 0.001). In contrast, incomplete stent coverage of the ostium was similar among the LM, LAD, and right coronary artery (23% vs 33% vs 28%, p = 0.084) with a residual uncovered segment plaque burden of 42 ± 11%. Ostial restenosis was similar between the lesions with versus without strut protrusion (3.2% vs 2.3%, p = 0.775) and between the lesions with incomplete versus complete stent coverage of the ostium (2.4% vs 3.0%, p = 0.100). Ostial restenosis was seen in only 2 of 61 lesions (3.3%) with acute malapposition. In conclusion, when treating an ostial or proximal coronary artery lesion with a drug-eluting stent, the decision of whether to protrude the proximal end of the stent or leave the ostium uncovered does not appear to be critical.

OCT analysis in patients with very late stent thrombosis

OBJECTIVES

We report optical coherence tomography (OCT) findings in 33 patients who presented with very late stent thrombosis (VLST) after either drug-eluting stent (DES) or bare-metal stent (BMS) implantation.

BACKGROUND

VLST is a potentially life-threatening complication, but the underlying mechanisms remain unclear.

METHODS

In 33 patients (27 DES- and 6 BMS-treated lesions) with definite VLST, OCT images were acquired before either thrombus aspiration or intravascular ultrasonography (IVUS) imaging.

RESULTS

The median duration from implantation was 61.5 months in the DES group and 109.1 months in the BMS group. In the overall cohort, combining DES and BMS, 94% showed intraluminal thrombi. VLST was associated with in-stent neointimal rupture in 23 patients (70%); 22 had thrombi near the site of neointimal rupture. Stent malapposition was observed in 14 (42%) lesions, but only 9 of them showed thrombi at the site of stent malapposition; moreover, 6 (18%) stented segments with malapposition also had neointimal rupture. Only 2 (6%) lesions had no evidence of neointimal rupture or malapposition. Stent fracture was detected in 3 DES-treated lesions, all with concomitant neointimal rupture. Compared with lesions without neointimal rupture, lesions with neointimal rupture showed a higher frequency of ST-segment elevation myocardial infarction (65% vs. 20%, respectively, p = 0.040) as well as a higher peak creatine kinase-myocardial band level (163.1 ng/ml vs. 15.7 ng/ml, respectively, p = 0.017).

CONCLUSIONS

OCT imaging indicated that advanced neoatherosclerosis with neointimal rupture and thrombosis was the most common mechanism of definite VLST and was associated with a high frequency of ST-segment elevation myocardial infarction.

Association of body mass index with major cardiovascular events and with mortality after percutaneous coronary intervention

BACKGROUND

Conflicting data exist regarding the relation between body mass index (BMI) and cardiovascular events and mortality after percutaneous coronary intervention.

METHODS AND RESULTS

We performed pooled analyses to evaluate the association between BMI (weight in kilograms divided by the square of the height in meters) and the risks of major cardiovascular events (defined as death from cardiovascular causes, nonfatal myocardial infarction, stent thrombosis, or stroke) and death among 23 181 patients from 11 prospective percutaneous coronary intervention studies. Overall, mean (±SD) BMI was 24.9±3.0. During follow-up (median, 2.1 years), 2381 patients had a major cardiovascular event, and 1004 patients died. After adjusting covariates, there was an inverse relationship between BMI and adverse outcomes. With a BMI of 22.5 to 24.9 as the reference category, the risk of major cardiovascular events was elevated among patients with a lower BMI (by a factor of 1.52 for a BMI <18.5; 1.05 for a BMI of 18.5-19.9; 1.03 for a BMI of 20.0-22.4); by contrast, the risk declined among patients with a higher BMI (by a factor of 0.97 for a BMI of 25.0-27.4; 0.97 for a BMI of 27.5-29.9; and 0.78 for a BMI of ≥30.0). In general, the hazard ratios for deaths were similar.

CONCLUSIONS

Among patients undergoing percutaneous coronary intervention, a low BMI was associated with increased risks of major cardiovascular events and death. However, there were no excess risks of these events associated with a high BMI.

Positive end-expiratory pressure aggravates left ventricular diastolic relaxation further in patients with pre-existing relaxation abnormality

BACKGROUND

Positive end-expiratory pressure (PEEP) has been known to adversely influence cardiac output. Even though left ventricular (LV) diastolic function significantly contributes to LV performance, the effects of PEEP on LV diastolic function remains controversial. We, therefore, aimed to examine the effects of PEEP on LV diastolic function by use of pulsed wave Doppler tissue imaging in patients with pre-existing LV relaxation abnormality.

METHODS

Seventeen patients with peak early diastolic velocity of lateral mitral annulus (E') <8.5 cm s(-1) among patients who underwent coronary artery bypass graft surgery were evaluated. Echocardiographic and haemodynamic variables were measured with 0, 5, and 10 cmH2O of PEEP. E' and deceleration time (DT) of peak early transmitral filling velocity (E) were used as echocardiographic indicators of LV diastolic function.

RESULTS

Mean arterial blood pressure decreased during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP. E' showed a gradual and significant decrease with an incremental increase in PEEP (6.9 ± 0.9, 5.8 ± 0.9, and 5.2 ± 1.2 cm s(-1) during 0, 5, and 10 cmH2O PEEP, respectively), and DT of E was prolonged during 10 cmH2O PEEP, compared with that during 0 cmH2O PEEP.

CONCLUSIONS

Increasing PEEP led to a progressive decline in LV relaxation in patients with pre-existing LV relaxation abnormality.