Automated carotid intima-media thickness and its link for prediction of SYNTAX score in Japanese coronary artery disease patients

AIM

The purpose of this study was to evaluate whether the automated carotid intima-media thickness (CIMT) identified by using automated software could predict the SYNTAX score for coronary artery disease (CAD) patients.

METHODS

Three-hundred-seventy consecutive patients (males 218; median age 69±11 years) who underwent carotid-ultrasound and coronary angiography were analyzed. Two experienced interventional cardiologists calculated the SYNTAX score from the carotid angiograms. After ultrasonographic examinations were performed, the plaque score (PS) was calculated and automated carotid IMT analysis was obtained by a fully automated algorithm. Correlation and stepwise logistic regression analysis were calculated and also the receiver operating characteristics (ROC) curve analysis was computed.

RESULTS

The mean SYNTAX score was 8.1±14.4; the PS was 7.1±14.4 and the mean CIMT was 0.86±0.23 mm (Normality rejected with a P-value of 0.001). A statistically significant correlation was found between the CIMT and SYNTAX score (r=0.323; P=0.0001) and between the PS and SYNTAX score (r=0.583; P=0.0001). The area under the ROC curve (Az) between CIMT and coronary artery disease was 0.648 (P=0.0001) and the CIMT of 1 mm or more was associated with the presence coronary artery disease with a specificity of 90.5%. Logistic regression analysis confirmed the association between CIMT and SYNTAX score (P=0.0002).

CONCLUSIONS

Results of our study using an automated algorithm showed a statistical significant association between CIMT and SYNTAX score and indicated that CIMT may be considered a reliable parameter for prediction of SYNTAX score in coronary artery disease patient population from Japan.

Single photon K(-2) and K(-1)K(-1) double core ionization in C(2)H(2n) (n=1-3), CO, and N(2) as a potential new tool for chemical analysis

We have observed single photon double K-shell photoionization in the C(2)H(2n) (n=1-3) hydrocarbon sequence and in N(2) and CO, using synchrotron radiation and electron coincidence spectroscopy. Our previous observations of the K(-2) process in these molecules are extended by the observations of a single photon double photoionization with one core hole created at each of the two neighboring atoms in the molecule (K(-1)K(-1) process). In the C(2)H(2n) sequence, the spectroscopy of K(-1)K(-1) states is much more sensitive to the bond length than conventional electron spectroscopy for chemical analysis spectroscopy based on single K-shell ionization. The cross section variation for single photon K(-1)K(-1) double core ionization in the C(2)H(2n) sequence and in the isoelectronic C(2)H(2n), N(2) and CO molecules validates a knock-out mechanism in which a primary ionized 1s photoelectron ejects another 1s electron of the neighbor atom. The specific Auger decay from such states is clearly observed in the CO case.

Unique demands of the femoral anatomy and pathology and the need for unique interventions

With the aging of the population the incidence of peripheral artery disease (PAD) is increasing, which is histologically characterized by fibrocalcific intimal plaques as well as underlying Mönckeberg's medial calcinosis as compared to coronary and carotid artery disease. Superficial femoral artery (SFA) is one of the longest and most dynamically active vessels in the body undergoing torsion, compression, flexion, and extension from leg motion, and is known to be more susceptible to atherosclerosis because of low shear stress or spiral flow, best appreciated in the long segment in its lesser curvature. Endovascular interventions are now considered the first-line strategy for the treatment of PAD patients presenting with claudication or critical limb ischemia, where physiologic stresses on the arterial wall, anatomic considerations, and lesion characteristics impact on their success. Stent fracture and malapposition, are a common phenomenon in PAD which are attributed to severe calcification and fibrosis along with greater motion of the lower extremity, that result in the dampening of the efficacy of stenting and balloon angioplasty. Better designs of self-expanding stents have resulted in either reduction in stent fracture rates or its elimination at least in the short-term follow-up studies, to date. Although drug-eluting stents (DES) have reduced restenosis rates in the coronary circulation, this benefit has not been consistently observed in PAD. However, recent clinical studies utilizing novel Zilver-PTX self-expanding stent (DES) have demonstrated favorable patency rate. Also, in patients with critical limb ischemia, better outcomes have been reported for below-the-knee utilization of DES. Nevertheless, drawbacks of stent technology remain and interests in the greater use of drug-coated balloons (DCB) for PAD have emerged. Randomized controlled trials have consistently shown superiority of DCB over uncoated balloons in reducing neointimal formation in patients with SFA disease. Moreover, there is a growing interest in atherectomy as an alternative treatment strategy for PAD, thus decreasing plaque burden with possibly avoidance of barotrauma. The results from registries support the effectiveness of the atherectomy devices; however, prospective randomized controlled trials are needed to confirm their benefit.

Gender difference in tooth autotransplantation with complete root formation: a retrospective survey

Gender-related risk factors in the survival of transplanted teeth with complete root formation have not yet been identified. The purpose of this study was to investigate gender differences in tooth autotransplantation at dental clinics. We asked participating dentists to provide information on transplantations they had undertaken from 1 January 1990 to 1931 December 2010. The data were screened to exclude patients who underwent more than one transplantation, smokers or those whose smoking habits were unknown, patients under 30 or who were 70 years old and over, cases where the transplanted teeth had incomplete root formation or multiple roots and those with fewer than 20 present teeth post-operation. We analysed 73 teeth of 73 males (mean age, 47.2 years) and 106 teeth of 106 females (mean age, 45.3 years) in this study. The cumulative survival rate and mean survival time were calculated using the Kaplan-Meier method. The cumulative survival rate for males was 88.3% at the 5-year mark, 64.8% at 10 years and 48.6% at 15 years; for females, it was 97.2% at the 5-year mark, 85.9% at 10 years and 85.9% at 15 years. A log-rank test indicated the difference between males and females to be significant (P = 0.011). There was also a significant difference in the main causes for the loss of transplanted teeth: males lost more transplanted teeth due to attachment loss than females (P < 0.05). These results indicate that males require more attention during the autotransplantation process, particularly at the stage of pre-operation evaluation and that of follow-up maintenance.

Effects of rain on energy metabolism while running in a cold environment

Environmental factors tend to influence the performance of individuals who exercise for extended periods. The present study aimed to determine energy metabolism while running in cold, wet conditions using a climatic chamber that can precisely simulate rainy conditions. 7 healthy men (age, 23.3±2.9 (SD) y; height, 168.6±7.5 cm; weight, 65.9±8.1 kg; V. O2max, 52.0±5.7 mL·kg - 1·min - 1) ran on a treadmill at 70% ˙VO2max intensity for 30 min in a climatic chamber at an ambient temperature of 5°C in the presence (RAIN) or absence (CON) of 40 mm/h of precipitation. Expired air, esophageal temperature, heart rate, mean skin temperature, rating of perceived exertion and blood samples were measured. Esophageal temperature and mean skin temperature were significantly lower (P<0.05) in RAIN than in CON all. Minute ventilation, oxygen consumption and levels of plasma lactate and norepinephrine were significantly higher (P<0.05) in RAIN than in CON. In conclusion, the higher oxygen consumption and plasma lactate in RAIN indicated that energy demand increases when running in cold conditions.

Activated natural killer T cells producing interferon-gamma elicit promoting activity to murine dendritic cell-based autoimmune hepatic inflammation

As natural killer (NK) T cells play an important role in the development of autoimmune diseases, they should have significant roles for the pathogenesis of autoimmune liver disease. Implication of the NK T cells in the generation of autoimmune-related hepatic inflammation was investigated using a novel mouse model. Immunization of mice with dendritic cells (DCs) loaded with hepatocyte-mimicking hepatocellular carcinoma cells (DC/Hepa1-6) induces cytotoxic T lymphocytes (CTL) capable of killing hepatocytes. Subsequent administration of interleukin (IL)-12, a potent interferon-gamma (IFN-γ) inducer, to the immunized mice generates autoimmune hepatic inflammation (AHI), as reported previously. Upon onset of the AHI response, the number of intrahepatic CD3(+) NK1 · 1(+) NK T cells increased markedly, along with a decrease in the number of splenic NK T cells, augmented expression of CXCR6 on intrahepatic NK T cells and CXCL16 in hepatic tissue, suggesting that NK T cells were recruited into the inflamed liver. The NK T cells were strongly positive for CD69 and produced IFN-γ, but not IL-4. AHI activity was attenuated markedly in CD1d(-/-) NK T cell-deficient mice, indicating that NK T cells play a pivotal role in the development of AHI. Mice treated with DC/Hepa1-6 and alpha-galactosylceramide, a potent NK T cell activator, also exhibited similar hepatic inflammation, in which activated NK T cells producing IFN-γ and CD8(+) T cells cytotoxic to hepatocytes were induced in liver-infiltrating mononuclear cells. Activated NK T cells producing IFN-γ potentiate DC-based AHI in the mouse model.

Analysis of adipose tissues and stromal vascular cells in a murine arthritis model

PURPOSE

Changes in body composition in rheumatoid arthritis (RA), including a reduction in skeletal muscle mass and the accumulation of visceral fat, have been identified, and the interaction between immune abnormality and metabolic disorders has received much attention. The effect of a high-fat (HF) diet and the role of adipose tissue in an arthritis model were investigated.

METHODS

The effect of an HF diet on the histopathology of joints in murine type II collagen-induced arthritis (CIA) was evaluated. The morphology and adipokine production of adipose tissues were analyzed, and macrophages in the stromal vascular fraction (SVF) were counted by flow cytometry. Serum adipokine levels were measured by ELISA.

RESULTS

Significant exacerbation of joint destruction and aggravated pathological conditions were observed in CIA mice that were fed an HF diet. However, the boundary length of adipose tissue tended to decrease and the levels of adipokines (leptin and adiponectin) were lowered by the induction of arthritis. In HF/CIA mice, nevertheless, the production of MCP-1 in adipose tissues and the accumulation of macrophages in the SVF were significantly higher than CON/CIA group. The serum leptin/adiponectin (L/A) ratio was positively correlated with the number of macrophages in the SVF and MCP-1 production by adipose tissue, particularly in the CIA group.

CONCLUSION

Functional alterations of adipose tissues could be originated from HF diet during developing arthritis. An abnormal activation of macrophages and an increased production of MCP-1 in adipose tissues might be both involved in joint destruction and inflammation.

Type I interferon induces CX3CL1 (fractalkine) and CCL5 (RANTES) production in human pulmonary vascular endothelial cells

Type I interferon (IFN) medications cause various adverse reactions, including vascular diseases. Although an association between chemokines and vascular diseases has also been reported, the relationship between type I IFN and chemokines in vascular endothelial cells (VEC) remains unclear. To provide clues to pathogenesis of the diseases, we analysed the effects of type I IFN on chemokine production in human VEC. Type I IFN induced higher CX3CL1 (fractalkine) mRNA expression and protein secretion in pulmonary arterial VEC than in umbilical vein VEC. Type I IFN also induced CCL5 [regulated upon activation normal T cell expressed and secreted (RANTES)] production in VEC, especially in lung micro-VEC. IFN-β induced much higher chemokine production than IFN-α, and Janus protein tyrosine kinase (JAK) inhibitor I prevented type I IFN-induced chemokine secretion. Type I IFN-induced chemokines may be involved in the pathophysiology of pulmonary vascular diseases, and the JAK inhibitor may serve as a therapeutic option for these diseases.

Age-related changes in the metabolism of neurotransmitters and the effect of scavengers: an in vivo microdialysis study

Brain microdialysis is a method to study the in vivo release and metabolism of neurotransmitters using freely-moving animals. We studied the changes in neurotransmitter metabolism from very young to the old rats (Sprague-Dawley). For brain microdialysis, a guide cannula, was implanted in the striatum (A +1.0, L +2.5, V -4.0). Extracellular content of neurotransmitters and their metabolites were detected with an electrochemical detector (ECD-100, EICOM Co.). The content was affected by KCl (100 mM), calcium-free Ringer and tetrodotoxin in a perfusion medium. Dopamine and its metabolites such as dihydroxyphenylacetic acid and homovanillic acid were significantly changed with age. The content of these metabolites were maximal around 2-3 months of age. In the case of serotonin metabolism, statisticaly no significant change was observed in the extracellular content of 5-hydroxyindoleacetic acid after sexual maturation (1.5 months of age). Potassium-induced dopamine release which is newly synthesized one, was maximum around 1.5 years of age and the content was about 50% lower in the old. The basal level of dopamine significantly decreased with age. Moreover, the inhibitory effect of pargyline, a monoamine oxidase inhibitor, was also decreased with age. On the basis of these results, it is suggested that the synaptic function shows postnatal development and reaches maximum at sexual maturation. Microdialysis could be a useful procedure for studying the in vivo metabolism of neurotransmitters.

Risk factors affecting third molar autotransplantation in males: a retrospective survey in dental clinics

The aim of this study was to investigate the risk factors affecting long-term prognosis of autotransplantation of third molars with complete root formation in males at dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. After data screening and elimination, participants of this study consisted of 183 teeth of 171 males ranging from 20 to 72 years of age (mean age, 44·8 years). The cumulative survival rate was 86·0% at the 5-year mark, 59·1% at 10 years and 28·0% at 15 years. The mean survival time was 134·5 months, as calculated by the Kaplan-Meier method. Single factor analysis using the log-rank test showed that the following factors had significant influence (P < 0·05) on survival of transplanted teeth: periodontal disease as the reason for recipient site tooth extraction, fewer than 25 present teeth and Eichner index Groups B1 to C. Cox regression analysis examined five factors: age, smoking habit, recipient site extraction caused by periodontal disease, fewer than 25 present teeth and Eichner index. This analysis showed that two of these factors were significant: fewer than 25 present teeth was 2·63 (95% CI, 1·03-6·69) and recipient site extraction caused by periodontal disease was 3·80 (95% CI, 1·61-9·01). The results of this study suggest that long-term survival of transplanted teeth in males is influenced not only by oral bacterium but also by occlusal status.