Cardiac Structure and Cardiorespiratory Fitness in Young Male Japanese Rugby Athletes

Limited data are available on athlete's heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes.

Impact of Exercise-Based Cardiac Rehabilitation on the Mid-Term Outcomes of Patients After Acute Myocardial Infarction Treated With Current Acute-Phase Management and Optimal Medical Therapy

BACKGROUND

Early reported beneficial effects of cardiac rehabilitation (CR) have recently been disputed. The present study aimed to investigate the clinical impact of CR on the mid-term outcomes of patients following ST-segment elevation myocardial infarction (STEMI) treated with currently available management.

METHODS

This study reviewed 145 consecutive patients who underwent primary coronary intervention and were discharged without any disability after STEMI during 2013-2015.

RESULTS

Among the patients, 66 (45.5%) completed an outpatient CR program (CR group) and 79 were their non-CR counterparts or patients who dropped out of the program (N-D group). There were no between-group differences in patient demographics and clinical profiles, including door-to-balloon times and prescriptions. A total of 27 patients developed major adverse cardiac and cerebrovascular events (MACCE) during follow-up. The MACCE-free survival rates were 88% and 76% in the CR and N-D groups, respectively (log-rank, p=0.04). Cox proportional analysis demonstrated that inclusion in the N-D group was a significant predictor of MACCEs (HR, 2.36; 95% CI, 1.07-5.74; p=0.03). In the CR group, peak oxygen consumption and ventilatory efficiency determined by cardiopulmonary exercise testing significantly improved after the program (p<0.01).

CONCLUSIONS

The impact of CR on the mid-term prognosis of patients with STEMI, even in the current myocardial infarction management era, was beneficial.

Prevalence and significance of sleep disordered breathing in adolescent athletes

Sudden cardiac death in a young athlete is a tragic event, and emerging data suggest that the leading finding associated with sudden cardiac death in athletes is autopsy-negative sudden unexplained death [1]. Sleep disordered breathing (SDB) can be arrhythmogenic and lead to sudden cardiac death [2, 3]. While obstructive sleep apnoea is generally prevalent in obese, inactive and/or aged subjects [4], little is known about its incidence in young athletes and highly active young people. Consequently, the impact of SDB on cardiovascular health of young athletes has not been fully elucidated. Athletes who participate in collision sports such as rugby and American football tend to exhibit risk factors for SDB such as large neck circumference and higher body mass index [5]. In this context, we investigated the prevalence and significance of SDB in young competitive athletes with a view to advancing the research conducted on athlete health.

Sleep disordered breathing (SDB) was more prevalent in adolescent athletes than expected, and several potential warning signs related to autonomic nerve activity appeared in SDB athletes. SDB screening may prevent associated downstream risks in the future.http://ow.ly/GQqK30nGm8r

Thrombus on the tricuspid valve in a patient with primary antiphospholipid syndrome after implantation of an inferior vena cave filter

A 62-year-old woman with a history of pulmonary embolism and primary antiphospholipid syndrome (PAPS) with positivity for lupus anticoagulant was admitted to hospital with shortness of breath. A filter had been implanted in her inferior vena cava (IVC) 5 years previously. Emergency echocardiography revealed a lobulated, mobile echogenic mass on the tricuspid valve, and on pulmonary perfusion scintigraphy several apparently new defects were noted. Fibrinolytic therapy improved her symptoms and the pulmonary perfusion, then intravenous heparinization was continued for a further week. Repeat echocardiography performed on the 7th day of the admission showed complete disappearance of the mass, which was retrospectively diagnosed as a thrombus based on its resolution with fibrinolytic and anticoagulant therapies.

Hysteroscopic selective salpingography

OBJECTIVE

To evaluate the effectiveness of hysteroscopic selective salpingography (HSS) as a method for diagnosing the tubal proximal occlusion shown by hysterosalpingography (HSG).

DESIGN

Prospective study.

SETTING

Outpatient Department of Obstetrics and Gynecology, Social Insurance Saitama Chuo Hospital, Urawa, Japan.

PATIENT(S)

A total of 572 infertile women underwent HSG. Forty-seven of 50 women with unilateral or bilateral proximal tubal occlusion demonstrated by HSG underwent HSS.

INTERVENTION(S)

Hysteroscopic selective salpingography was performed for the diagnosis of tubal occlusion in cases in which the proximal tubal occlusion was shown by HSG.

MAIN OUTCOME MEASURE(S)

Number of patients who underwent HSS and pregnancy rate after HSS.

RESULT(S)

Twenty-seven (79.4%) of 34 patients with unilateral occlusion diagnosed by HSG were shown to have normal patency by HSS. Of 12 women with bilaterally normal patent tubes confirmed by HSS, 8 (66.7%) achieved normal pregnancies within 1 year. Seven (53.8%) of 13 patients with bilateral occlusion found by HSG were shown to have normally patent tubes by HSS.

CONCLUSION

The simple method of HSS was clinically effective for evaluating the presence of proximal tubal occlusion.

Gestational choriocarcinoma whose responsible pregnancy was a complete hydatidiform mole identified by PCR analysis with new sequence tagged site primers

We report a case where the pregnancy responsible for a gestational choriocarcinoma was not the antecedent pregnancy or the second normal term delivery, but a complete hydatidiform mole that had advanced to clinically invasive mole. This responsible pregnancy was identified by polymerase chain reaction analysis (PCR). PCR analysis was performed by using five new sets of sequence-tagged site (STS) primers on four chromosomes (chr. 1, D1S225; chr. 3, D3S1744; chr. 12, D12S1090; chr. 18, D18S849 and D18S877). The constitution of alleles of choriocarcinoma was shown to be almost identical with that of the husband on every marker. The allele patterns of choriocarcinoma on D3S1744 and D12S1090 were not observed with DNA from the patient. The band pattern originating from molar DNA was also identical with those of the husband and choriocarcinomas on D18S849 and D1S225.

A study on the correlation between maturation and quality of human oocytes

The success ratio of live birth after human in vitro fertilization and embryo transfer program is still around 12% Per oocyte retrieval cycle. A large number of mature oocytes became degenerate and unable to develop after insemination or implantation. In order to determine this discrepancy, assessment of maturation process as well as cytoplasmic maturity of the oocyte was performed. Initiation and completion of maturation were dependent on steroid metabolism and cyclic AMP in the oocyte cytoplasm. Extracellular calcium is another determinant factor of oocyte maturation. Phosphorylation of 23.5kD and 29.5kD protein was observed in the cytoplasm during maturation. In addition to cAMP, nuclear maturation is regulated by protein tyrosine phosphorylation in the cytoplasm. An inhibitor of Na+/H+ antiport appears to be effective in the procedure of cryopreservation but has no relationship with oocyte maturation. Quality of the oocyte consists of nuclear and cytoplasmic maturation.

Effect of KN-62, a selective inhibitor of calmodulin-dependent kinase II, on mouse oocyte activation

PURPOSE

Our purpose was to determine the association of calmodulin-dependent protein kinase II (CaMKII) with oocyte activation and to explore the network of protein kinases during mammalian fertilization.

METHODS

Mouse M-II oocytes were collected after superovulation induced by PMSG-hCG injection. The oocytes were inseminated or artificially activated by Ca ionophore (A23187) or 12-O-tetradecanoyl phorbol 13-acetate (TPA). The effects of KN-62, a specific and selective inhibitor of calmodulin-dependent protein kinase II, on second polar body emission (2PBE), pronuclear formation (PF), and cortical granule exocytosis (CGE) during fertilization or after artificial oocyte activation were investigated.

RESULTS

KN-62 inhibited 2PBE and PF after sperm or Ca ionophore inducing activation. Additionally, PF was inhibited by KN-62 after TPA activation, whereas KN-62 did not inhibit CGE in any case. KN-04, an inactive form of KN-62, did not inhibit significantly 2PBE, CGE, or PF. When oocytes were exposed to KN-62 after Ca ionophore or TPA activation, no inhibitory effects on 2PBE or PF were observed.

CONCLUSIONS

The CaMKII activation that occurs after fertilization or artificial activation of mouse oocytes is presumably secondary to increases in the intracellular free calcium concentration. As determined by the use of inhibitor, CaMKII activity is associated with 2PBE and PF but not with CGE.

Egg activation induced by osmotic pressure change and the effects of amiloride on the cryopreservation of mouse oocytes

Activation of oocytes is caused by osmotic pressure change in some species. However, cryopreservation of oocytes occurs in the presence of osmotic pressure change induced by cryoprotectants. We investigated the effect of 5-(N,N,-dimethyl)-amiloride (NNDMA), a selective inhibitor of Na+/H+ exchange, on the cryopreservation and osmotic activation of mouse oocytes. The percentage (23.2%) of degenerate oocytes after cryopreservation in the presence of NNDMA was found to be lower than that (39.5%) of untreated oocytes. After thawing, the percentage (23.6%) of oocytes which could be fertilized following cryopreservation in the presence of NNDMA was significantly higher than that of untreated (18.0%) oocytes. These results suggest that amiloride increased the survival rate after thawing following cryopreservation. To investigate the effect of NNDMA on oocyte activation caused by the cryoprotectant, dimethyl sulphoxide (DMSO) was used to induce osmotic pressure change. NNDMA was found to inhibit cortical granule exocytosis, the second polar body emission and pronuclear formation which occurs upon activation due to osmotic pressure change. It also inhibited the increase in phosphorylation of many proteins including 33 and 45 kDa proteins, which occurs, during fertilization and chemical oocyte activation. In contrast, protein phosphorylation was not inhibited by W7, a calmodulin inhibitor. The actions of these inhibitors suggest that oocyte activation induced by osmotic pressure change involves a pathway mediated by Na+/H+ exchange which may be distinct from the Ca-calmodulin pathway. Amiloride may be a useful drug for increasing the rate of survival of cryopreserved oocytes.

The acceptability of prenatal diagnosis in Japan

Prenatal diagnosis has been performed more frequently in Japan recently, but is still less popular than in the United States or Europe. Legal arrangements, insufficient economic support, and insufficient medical information provided to future parents may explain this difference. The acceptability of prenatal diagnosis, based on the concept of the cost of side effects and elective abortion, was found to be similar when examined through decision analysis and direct survey. Amniocentesis was considered useful for more than half of couples in Japan when the incidence of chromosomal abnormality is more than 0.5% and proper information about the decision to undergo this examination is provided to the pregnant woman and her family.

Analysis of cytoplasmic factors in developmental cleavage of mouse embryo

One-cell embryos from certain mouse strains were found incapable of developing beyond the 2-cell stage in vitro (2-cell block), but a microinjection of EDTA effectively overcame this block. When 2-cell arrested embryos were fused with embryos that had developed to the late 2-cell stage in vivo, the fusants developed beyond the 2-cell stage. Microinjection of cytoplasm of in vivo 2-cell embryos into 1-cell embryos also obviated the 2-cell block. Analyses of 35S-labeled embryos by 2-dimensional polyacrylamide gel electrophoresis indicated changes in synthetic protein patterns possibly related to this block.

Cooperative inhibitory effect of follicular fluid and cAMP on hamster oocyte maturation

Porcine or human follicular fluid inhibited the spontaneous maturation of isolated hamster oocytes in vitro during the first 1.5 h of culture. Moreover, the presence of 50% follicular fluid combined with 100 microM dbcAMP cooperatively reduced the incidence of germinal vesicle breakdown. The addition of FSH also inhibited the resumption of meiosis, and the presence of LH did not overcome the inhibitory effects of follicular fluid and tended to impede isolated hamster oocyte maturation in vitro.

Microvasculature of preovulatory follicles: comparison of in situ and in vitro perfused rabbit ovaries following stimulation of ovulation

Perifollicular vasculature undergoes significant morphologic changes as ovulation approaches. These vascular changes were observed in in vitro perfused and in situ rabbit ovaries by means of scanning electron microscopy of microcorrosion casts. Casts were made in in situ unstimulated ovaries, in situ ovaries stimulated with human chorionic gonadotropin, in vitro perfused unstimulated ovaries, and in vitro perfused ovaries after an ovulation-inducing dose of human chorionic gonadotropin, prostaglandin F2 alpha, histamine, or norepinephrine. Dilated vessels, extravasation of resin from weakened vessels, and filling defects at the apex of the follicle were observed in in situ ovaries 9 to 12 hours after stimulation and in in vitro perfused ovaries 4 to 6 hours after human chorionic gonadotropin. In vitro perfused ovaries stimulated with prostaglandin F2 alpha or histamine demonstrated dilated capillaries with extravasation of the resin and filling defects at the apex of large follicles. Norepinephrine-stimulated ovaries showed incomplete filling of vessels, although some large follicles showed extravasation of resin. The occurrence of dilated vessels, extravasation of resin, and filling defects is indicative of preovulatory vascular changes in both in situ and in vitro perfused ovaries, regardless of the ovulatory stimulus.

Examination of the role of calcium in ovulation in the in vitro perfused rabbit ovary with use of ethyleneglycol-bis(beta-aminoethyl ether)-n,n'-tetraacetic acid and verapamil

The in vitro perfused rabbit ovary preparation was used to examine the role of calcium in the ovulatory process. Two groups of rabbits were studied. In the first group, verapamil hydrochloride (10(-4) mol/L), a calcium channel blocker, was used together with human chorionic gonadotropin (50 IU) in the perfusate. Verapamil had no apparent effect on human chorionic gonadotropin-induced ovulation. Verapamil treatment, however, significantly reduced the percentage of ovulated ova that were mature (68.8%) in comparison to ovulated ova from human chorionic gonadotropin-treated control ovaries (95.0%). In a second experimental group, ethyleneglycol-bis(beta-aminoethyl ether)-n,n'-tetraacetic acid (2.0 mmol/L), a calcium ion chelator, was included in the perfusate with gonadotropin. The ethyleneglycol-bis(beta-aminoethyl ether)-n,n'-tetraacetic acid significantly reduced ovulatory efficiency (16.7% +/- 9.43%) in comparison to that of controls exposed to human chorionic gonadotropin alone (79.5% +/- 11.1%). In addition, ovulation occurred at an earlier time in ovaries perfused with ethyleneglycol-bis(beta-aminoethyl ether)-n,n'-tetraacetic acid; however, only four ovulations occurred in these ovaries. These four ovulated ova were immature, probably reflecting the early time of ovulation. Furthermore, both verapamil and ethyleneglycol-bis(beta-aminoethyl ether)-n,n'-tetraacetic acid blocked ovarian smooth muscle contractions during ovarian perfusion. These data provide additional support for the concept that calcium dynamics influence the processes of ovulation and ovum maturation. Furthermore ovarian smooth muscle contractions do not appear to be essential for ovulation in this model.

The relationship between prostaglandins and histamine in the ovulatory process as determined with the in vitro perfused rabbit ovary

The process of follicle rupture has been described as an inflammatory reaction in which prostaglandins (PGs) and/or histamine may be involved. With an in vitro perfused rabbit ovary preparation, experiments were carried out for determination of whether a relationship exists among PGs, histamine, and ovulation. PGF2 alpha alone was capable of inducing ovulation when added to the perfusion fluid at 1, 10, and 100 ng/ ml. Effectiveness in achieving ovulation varied directly with the dosage; however, the ovulatory efficiency of PGF2 alpha-treated ovaries was lower than that of ovaries exposed to human chorionic gonadotropin (hCG, 100 IU). PGF2 alpha-induced ovulation could not be blocked by the H2 receptor antagonist, cimetidine. The PG synthesis inhibitor, indomethacin, did not prevent histamine-induced ovulation. Ovulation induced by hCG was partially blocked by the administration of indomethacin; however, the concomitant administration of cimetidine was not associated with further reduction in ovulation. In all but one experimental group, the majority of ovulated ova did not progress beyond the intact germinal vesicle stage unless the ovaries had been exposed to hCG. On the basis of these experiments, PGs and histamine do not appear to be interdependent in their effects on the ovulatory process in vitro.

Direct ovarian effect of clomiphene citrate in the rabbit

The effects of clomiphene citrate (CC) on ovulation and ovum maturation were studied using the isolated perfused rabbit ovary. CC (10(-5) M) added to the perfusate with human chorionic gonadotropin (50 IU) did not affect ovulatory efficiency, ovulation time, oocyte maturation, or degeneration of ovulated ova and follicular oocytes. During perfusion without human chorionic gonadotropin, the percentage of follicular oocytes with germinal vesicle breakdown was significantly increased in response to CC (10(-5) M or 10(-7) M); a greater percentage of follicular oocytes was degenerated. Estradiol (100 ng/ml) added to the perfusate reversed the effect of CC on degeneration of follicular oocytes. Of follicular oocytes from ovaries perfused with CC, 79.3% were degenerated; in contrast, 25% were degenerated in ovaries treated with CC plus estradiol. These data suggest that CC has a direct ovarian effect and that ovum degeneration associated with CC may be related to an antiestrogenic action.

Influence of calcium and magnesium deprivation on ovulation and ovum maturation in the perfused rabbit ovary

The role of calcium (Ca++) and magnesium (Mg++) in the ovulation process was studied using in vitro perfused rabbit ovaries. Ovaries were perfused with or without human chorionic gonadotropin (hCG) in Ca++/Mg++-free medium (M199) alone or combined with standard M199 to yield varying concentrations of Ca++ and/or Mg++. In all ovaries perfused with hCG, ovulatory efficiency was similar regardless of the concentration of Ca++ and/or Mg++. In ovaries perfused in Ca++/Mg++-free medium without hCG, ovulatory efficiency was similar to that in ovaries perfused with hCG. As Ca++/Mg++ levels were increased without hCG, ovulatory efficiency declined. Ovulation time was significantly accelerated in ovaries perfused in Ca++/Mg++-free medium with or without hCG. Most ovulated ova from ovaries perfused without hCG were immature. With hCG, degree of ovum maturity was directly related to ovulation time. Ovarian smooth muscle contractions were undetectable in 3 ovaries perfused in Ca++/Mg++-free M199 despite occurrence of ovulation. Smooth muscle contractions were recorded in 2 of 3 ovaries perfused in standard M199 with hCG. These results indicate: 1) Ca++/Mg++ exclusion results in rapid follicle rupture and immature ova; 2) oocyte maturation appears to be gonadotropin-dependent; 3) ovulation occurs in the absence of ovarian smooth muscle contractions during perfusion with Ca++/Mg++-free medium.

Gonadotropin-releasing hormone: effects on the in vitro perfused rabbit ovary

Gonadotropin-releasing hormone (GnRH) has been shown to inhibit ovulation in gonadotropin-primed hypophysectomized rats and steroid production in cultured rat granulosa cells. To determine if similar effects of GnRH can be observed in another species, the extracorporeal perfused rabbit ovary was utilized. Two groups of rabbit ovaries were exposed to GnRH in a pulsatile fashion at two dose levels (Group I, 2.56 X 10(-8) M; Group II, 2.56 X 10(-7) M). Contralateral ovaries were not perfused with GnRH. Human chorionic gonadotropin (hCG) was added to the perfusate of all ovaries 30 min after the onset of perfusion. Ovulation occurred in all ovaries exposed to hCG in the presence or absence of GnRH. Ovulatory efficiency was similar in both the experimental and control groups. No statistical difference could be determined in the time of ovulation, stage of maturity of oocytes, or percent of degeneration of ovulated or follicular oocytes. Progesterone production was not inhibited in the GnRH-treated ovaries. In contrast to observations in the rat, GnRH does not exhibit a direct inhibitory effect on ovulation or steroid production in the rabbit.

Effect of histamine and histamine blockers on the ovulatory process in the vitro perfused rabbit ovary

An increase in the content of histamine in the ovary following luteinizing hormone (LH) release and the inhibition of ovulation in the rabbit by antihistamines suggest that histamine may be involved in the ovulatory process. The effects of various doses of histamine and antihistamines on ovulation were investigated using the in vitro perfused rabbit ovary system. Histamine (100 ng/ml) added to the perfusate at hourly intervals induced ovulation, although at a rate below that observed following human chorionic gonadotropin (hCG) administration. Cimetidine (10 micrograms/ml), an H2 blocker, inhibited histamine-induced ovulation, while the H1 blocker, chlorpheniramine (66.7 micrograms/ml), failed to do so. Neither cimetidine nor chlorpheniramine was able to block ovulation following hCG (50 IU). In all experimental groups in which histamine was used to induce ovulation, both extruded ova and follicular oocytes remained in an immature stage and displayed little evidence of degeneration. In contrast, a high percentage of ova exposed to hCG were mature. Ovarian edema was increased in ovaries in which ovulation occurred, regardless of treatment. A linear correlation was noted between ovulatory efficiency and degree of ovarian edema. Histamine may be an intermediary in the mechanism of follicular rupture, but does not support ovum maturation. However, the inability of H1 and H2 antagonists to block hCG-induced ovulation raises questions regarding the role of histamine in the physiologic process of ovulation.

Ultrastructure and some biologic properties of human oocytes and granulosa cells cultured in vitro

Of follicular oocytes with germinal vesicles, 79% resumed meiosis within 48 hours in modified Ham's F-10 medium for oocyte culture, and 59% of them reached the second-metaphase stage of meiosis. An increase in cortical granules and tubular aggregates and a decrease in the Golgi apparatus were observed during the maturation process. Scanning electron microscopy of the oocyte surface revealed a decrease in number and length of microvilli. Nuclear DNA contents diminished to approximately one-half, but cytoplasmic protein contents measured by cytofluorometry were unchanged after culture in spite of these structural changes. Insemination with washed spermatozoa resulted in fertilization of 5 of 43 zona-intact cultured oocytes. After removal of the zona, 6 of 17 cultured oocytes showed polyspermic penetration, although immature oocytes were not fertilized even after removal of the zona. Cultured granulosa cells secreted progesterone spontaneously, and its amount was correlated with follicular size. Ultrastructurally, mitochondria with laminar cristae, enlarged nuclei, dispersed Golgi apparatus, smooth endoplasmic reticulum, lipid droplets in the ooplasm, and granular cytoplasmic protrusions were observed on the oocyte surface.