Gluconeogenesis in the extraembryonic yolk syncytial layer of the zebrafish embryo

Yolk-consuming (lecithotrophic) embryos of oviparous animals, such as those of fish, need to make do with the maternally derived yolk. However, in many cases, yolk possesses little carbohydrates and sugars, including glucose, the essential monosaccharide. Interestingly, increases in the glucose content were found in embryos of some teleost fishes; however, the origin of this glucose has been unknown. Unveiling new metabolic strategies in fish embryos has a potential for better aquaculture technologies. In the present study, using zebrafish, we assessed how these embryos obtain the glucose. We employed stable isotope (13C)-labeled substrates and injected them to the zebrafish embryos. Our liquid chromatography-mass spectrometry-based isotope tracking revealed that among all tested substrate, glutamate was most actively metabolized to produce glucose in the zebrafish embryos. Expression analysis for gluconeogenic genes found that many of these were expressed in the yolk syncytial layer (YSL), an extraembryonic tissue found in teleost fishes. Generation 0 (G0) knockout of pck2, a gene encoding the key enzyme for gluconeogenesis from Krebs cycle intermediates, reduced gluconeogenesis from glutamate, suggesting that this gene is responsible for gluconeogenesis from glutamate in the zebrafish embryos. These results showed that teleost YSL undergoes gluconeogenesis, likely contributing to the glucose supplementation to the embryos with limited glucose source. Since many other animal lineages lack YSL, further comparative analysis will be interesting.

Single-polyp metabolomics for coral health assessment

Coral reef ecosystems supported by environmentally sensitive reef-building corals face serious threats from human activities. Our understanding of these reef threats is hampered by the lack of sufficiently sensitive coral environmental impact assessment systems. In this study, we established a platform for metabolomic analysis at the single-coral-polyp level using state-of-the-art mass spectrometry (probe electrospray ionization/tandem mass spectrometry; PESI/MS/MS) capable of fine-scale analysis. We analyzed the impact of the organic UV filter, benzophenone (BP), which has a negative impact on corals. We also analyzed ammonium and nitrate samples, which affect the environmental sensitivity of coral-zooxanthella (Symbiodiniaceae) holobionts, to provide new insights into coral biology with a focus on metabolites. The method established in this study breaks new ground by combining PESI/MS/MS with a technique for coral polyps that can control the presence or absence of zooxanthellae in corals, enabling functions of zooxanthellae to be assessed on a polyp-by-polyp basis for the first time. This system will clarify biological mechanisms of corals and will become an important model system for environmental impact assessment using marine organisms.

Metagenomic analysis of the microbial communities and associated network of nitrogen metabolism genes in the Ryukyu limestone aquifer

While microbial biogeochemical activities such as those involving denitrification and sulfate reduction have been considered to play important roles in material cycling in various aquatic ecosystems, our current understanding of the microbial community in groundwater ecosystems is remarkably insufficient. To assess the groundwater in the Ryukyu limestone aquifer of Okinawa Island, which is located in the southernmost region of Japan, we performed metagenomic analysis on the microbial communities at the three sites and screened for functional genes associated with nitrogen metabolism. 16S rRNA amplicon analysis showed that bacteria accounted for 94-98% of the microbial communities, which included archaea at all three sites. The bacterial communities associated with nitrogen metabolism shifted by month at each site, indicating that this metabolism was accomplished by the bacterial community as a whole. Interestingly, site 3 contained much higher levels of the denitrification genes such as narG and napA than the other two sites. This site was thought to have undergone denitrification that was driven by high quantities of dissolved organic carbon (DOC). In contrast, site 2 was characterized by a high nitrate-nitrogen (NO3-N) content and a low amount of DOC, and this site yielded a moderate amount of denitrification genes. Site 1 showed markedly low amounts of all nitrogen metabolism genes. Overall, nitrogen metabolism in the Ryukyu limestone aquifer was found to change based on environmental factors.

Mechanism of denitrification in subsurface-dammed Ryukyu limestone aquifer, southern Okinawa Island, Japan

Denitrification crucially regulates the attenuation of groundwater nitrate and is unlikely to occur in a fast-flowing aquifer such as the Ryukyu limestone aquifer in southern Okinawa Island, Japan. However, evidences of denitrification have been observed in several wells within this region. This study analyzed environmental isotopes (δ15NNO3 and ẟ18ONO3) to derive the rationale for denitrification at this site. Additionally, the presence of two subsurface dams in the study area may influence the processes involved in nitrate attenuation. Herein, we analyzed 150 groundwater samples collected spatially and seasonally to characterize the variations in the groundwater chemistry and stable isotopes during denitrification. The values of δ15NNO3 and δ18ONO3 displayed a progressive trend up to +59.7 ‰ and + 21 ‰, respectively, whereas the concentrations of NO3--N decreased to 0.1 mg L-1. In several wells, the enrichment factors of δ15NNO3 ranged from -6.6 to -2.1, indicating rapid denitrification, and the δ15NNO3 to δ18ONO3 ratios varied from 1.3:1 to 2:1, confirming the occurrence of denitrification. Denitrification intensively proceeds under conditions of depleted dissolved oxygen concentrations (<2 mg L-1), sluggish groundwater flow with longer residence times, high concentrations of dissolved organic carbon (>1.2 mg L-1), and low groundwater levels during the dry season with precipitation rates of <100 mm per month (Jun-Sep). SF6 analysis indicated the exclusive occurrence of denitrification in specific wells with groundwater residence times exceeding 30 years. These wells are located in close proximity to the major NE-SW fault system in the Komesu area, where the hydraulic gradient was below 0.005. Detailed geological and lithological investigations based on borehole data revealed that subsurface dams did not cause denitrification while the major NE-SW fault system uplifted the impermeable basement rock of the Shimajiri Group, creating a lithological gap at an equivalent depth that ultimately formed a sluggish groundwater area, promoting denitrification.

Characterization of recombinant photoconverting green fluorescent Akanes

Akanes are fluorescent proteins that have several fluorescence maxima. In this report, Akane1 and Akane3 from Scleronephthya gracillima were selected, successfully overexpressed in Escherichia coli and purified by affinity chromatography. Fluorescence spectra of the recombinant Akanes matured in darkness, or ambient light were found to have several fluorescence peaks. SDS-PAGE analysis revealed that Akanes matured in ambient light have two fragments. MS/MS analysis of Akanes digested with trypsin showed that the cleavage site is the same as observed for the photoconvertible fluorescent protein Kaede. The differences between the calculated masses from the amino acid sequence of Akane1 and the measured masses of Akane1 fragments obtained under ambient light coincided with those of Kaede. In contrast, a mass difference between the measured N-terminal Akane3 fragment and the calculated mass indicated that Akane3 is modified in the N-terminal region. These results indicate that numerous peaks in the fluorescent spectra of Akanes partly arise from isoproteins of Akanes and photoconversion. Photoconversion of Akane1 caused a fluorescence change from green to red, which was also observed for Akane3; however, the fluorescent intensity decreased dramatically when compared with that of Akane3.

Visualisation of Phosphate in Subcalicoblastic Extracellular Calcifying Medium and on a Skeleton of Coral by Using a Novel Probe, Fluorescein-4-Isothiocyanate-Labelled Alendronic Acid

The overload of nutrients of anthropogenic origin, including phosphate, onto coastal waters has been reported to have detrimental effects on corals. However, to the best of our knowledge, the phosphate concentration threshold for inhibiting coral calcification is unclear owing to a lack of information on the molecular mechanisms involved in the inhibitory effect of phosphate. Therefore, in this study, we prepared a new phosphate analogue, fluorescein-4-isothiocyanate (FITC)-labelled alendronic acid (FITC-AA), from commercially available reagents and used it as a novel probe to demonstrate its transfer pathway from ambient seawater into Acropora digitifera. When the juveniles at 1 d post-settlement were treated with FITC-AA in a laboratory tank, this phosphate analogue was found in the subcalicoblastic extracellular calcifying medium (SCM) and was absorbed on the basal plate in the juveniles within a few minutes. When the juveniles bear zooxanthellae at 3 months post-settlement, FITC-AA was observed on the corallite walls within a few minutes after adding ambient seawater. We concluded that FITC-AA in ambient seawater was transferred via a paracellular pathway to SCM and then absorbed on the coral CaCO₃ skeletons because FITC-AA with a high polarity group cannot permeate through cell membranes.

Phosphate bound to calcareous sediments hampers skeletal development of juvenile coral

To test the hypothesis that terrestrial runoff affects the functions of calcareous sediments in coral reefs and hampers the development of corals, we analysed calcareous sediments with different levels of bound phosphate, collected from reef areas of Okinawajima, Japan. We confirmed that phosphate bound to calcareous sediments was readily released into ambient seawater, resulting in much higher concentrations of phosphorous in seawater from heavily polluted areas (4.3-19.0 µM as compared with less than 0.096 µM in natural ambient seawater). Additionally, we examined the effect of phosphate released from calcareous sediments on the development of Acropora digitifera coral juveniles. We found that high phosphate concentrations in seawater clearly inhibit the skeletal formation of coral juveniles. Our results demonstrate that calcareous sediments in reef areas play a crucial role in mediating the impact of terrestrial runoff on corals by storing and releasing phosphate in seawater.

Morphological study of fibrous aragonite in the skeletal framework of a stony coral

The overall calcareous skeletons, including a low-crystalline core and surrounding fibrous crystals, of juvenile stony corals were characterized to clarify the entire calcic architecture and the contribution of abiotic processes.

Negative impact of ultra-thin strut on neointimal coverage condition within one year after implantation as compared to thin sturt in biogradable-polymer sirorimus eluting stents

Background

BIOSCIENCE randomized trial which compared biodegradable-polymer sirolimus-eluting stents with ultra-thin (60μm) strut (ultra-thin BP-SES) and durable-polymer everolimus-eluting stents with thin (81μm) strut (thin DP-EES) have reported that definite stent thrombosis within 1 year had more frequently occurred in ultra-thin BP-SES (0.9%) than in thin DP-EES group (0.4%) although it was not statistically significant. It suggests that neointimal coverage after stent implantation within 1 year might be different between ultra-thin BP-SES and thin DP-EES. Recently, two types of biogradable-polymer sirorimus eluting stents, thin (80μm) strut type (thin BP-SES) and ultra-thin (60μm) strut type (ultra-thin BP-SES), can be available in clinical settings.

Purpose

We compared neointimal coverage conditions between ultra-thin BP-SES and thin BP-SES by optical coherence tomography (OCT).

Methods

Consecutive Forty-six patients who underwent 21 ultra-thin BP-SESs or 25 thin BP-SESs implantation were enrolled. We compared incidences of acute coronary syndrome, type B2/C lesion, atherectomy device use, stent size, stent length, maximum inflation pressure, and 8-month follow-up OCT parameters including proportions of uncovered struts (%Uncovered), malapposed struts, (%Mallaposed) and mean neointimal hyperplasia thickness (mean NHT) between the two groups.

Results

%Uncovered and %malapposed were significantly higher and mean NHT was significantly lower in ultra-thin BP-SES than in thin BP-SES (Table). The other parameters were similar between the two groups.

Conclusion

Ultra-thin BP-SES showed worse neointimal coverage as compared to thin BP-SES within 1 year after stent implantation, which may increase stent thrombosis.

Funding Acknowledgement

Type of funding source: None

Real-world clinical impact of external elastic lamina-based stent sizing criteria using optical coherence tomography

Introduction

ILUMIEN III trial has reported that non-inferiority of optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) to intravascular ultrasound-guided PCI for postprocedural minimum stent area. In the trial, external elastic lamina (EEL)-based stent sizing criteria was introduced, however OCT has limitations including incomplete visualization of EEL in severale lesions.

Purpose

The aim of the study is to investigate real-world clinical impact of EEL-based stent sizing criteria.

Methods

The study included consecutive patients who underwent OCT-guided percutaneous coronary intervention (PCI) for de novo lesions in our institution between September 2016 and April 2018. EEL visibility, mean EEL diameter, mean lumen diameter and plaque morphology were assessed at proximal and distal references. The plaque morphology at references was categorized according to its most prevalent component as follows: normal, fibrous plaque, lipid plaque, and calcified plaque. Both references were divided into 3 groups according to visibility of EEL.

Results

Among 205 lesions, 31 lesions had artifacts at references (16 proximal and 17 distal references). EEL visibility was summarized in a table. Out of 174 lesions with both analyzable references, 111 lesions (63.8%) had &gt;180-degree EEL visibility at both references. Proportion of plaque morphology were significantly different among 3 groups at proximal and distal references as shown in a figure.

Conclusions

EEL-based stent sizing criteria was usable for 63.8% of all the lesions. Vessel size and plaque morphology were significantly associated with EEL visibility.

Proportion of plaque morphology

Funding Acknowledgement

Type of funding source: None

Difference of myocardial injury, inflammation and early recurrence after pulmonary vein isolation among laser balloon ablation, radiofrequency catheter ablation and cryoballoon ablation

Background

Pulmonary vein isolation (PVI) has become well-established as the main therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF) and various isolation methods including radiofrequency ablation (RFA), cryoballoon ablation (CBA) and laser balloon ablation (LBA) were available. Pathological findings in each ablation methods such as myocardial injury and inflammation are thought to be different. High sensitive cardiac troponin I (hs-TnI), subunit of cardiac troponin complex, is a sensitive and specific marker of myocardium injury. High-sensitive C-reactive protein (hs-CRP) is a biomarker of inflammation and is elevated following cardiomyocyte necrosis. Relationship between myocardial injury and inflammation after ablation using RFA, CBA and LBA and early recurrence of atrial fibrillation (ERAF) remains unclear.

Methods

We enrolled consecutive PAF patients from Osaka Rosai Atrial Fibrillation (ORAF) registry who underwent PVI from January 2019 to October 2019. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters including left ventricular dimensions, left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between RFA, CBA and LBA groups. We investigated the difference of relationship between myocardial injury marker (hs-TnI), inflammation markers (white blood cell change (DWBC) from post to pre PVI, neutrophil-to-lymphocyte ratio change (DNLR) from after to before PVI and hs-CRP) at 36–48 hours after PVI and ERAF (&lt;3 months after PVI) between each group.

Results

We enrolled 187 consecutive PAF patients who underwent PVI. RFA, CBA and LBA groups comprised 108, 57 and 22 patients, respectively. There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters between each group. Serum hs-TnI in RFA group and LBA group were significantly lower than in CBA group (2.643 ng/ml vs 5.240ng/ml, 1.344 ng/ml vs 5.240 ng/ml, p&lt;0.001, p=0.002, respectively, Figure). DWBC was significantly higher in LBA group than CBA group (1157.3/μl vs 418.4/μl, p=0.045). DNLR did not differ between each group. Hs-CRP in RFA group and LBA group were significantly higher than in CBA group (1.881 mg/dl vs 1.186 mg/dl, 2.173 mg/dl vs 1.186 mg/dl, p=0.010, p=0.003, respectively, Figure). Incidence of ERAF was significantly higher in LBA group than RFA group (36.4% vs 16.7%, p=0.035). Incidence of ERAF tended to be higher in LBA group than CBA group (36.4% vs 19.3%, p=0.112).

Conclusion

LBA may cause less myocardial injury than RFA and CBA, on the contrary LBA may cause more inflammation than CBA. Incidence of ERAF in LBA was highest between each procedure.

Inflammation markers and ERAF

Funding Acknowledgement

Type of funding source: None

Outcome of contact force-guided radiofrequency catheter ablation or second generation cryoballoon ablation for paroxysmal atrial fibrillation: propensity score matched analysis

Background

Little has been reported on the outcome of contact force (CF)-guided radiofrequency catheter ablation (RFCA) and second generation cryoballoon ablation (CBA).

Purpose

The purpose of this study was to compare the outcome of CF-guided RFCA and second generation CBA for paroxysmal atrial fibrillation (PAF).

Methods

We enrolled the consecutive 364 patients with PAF who underwent initial ablation between September 2014 and July 2018 in our hospital. We compared the late recurrence of atrial tachyarrhythmia more than three months after ablation between RFCA group and CBA group. All RFCA procedures were performed using CF-sensing catheter and all CBA procedures were performed using second generation CB.

Results

There were significant differences in background characteristics: chronic kidney disease, serum brain natriuretic peptide level, and left ventricular ejection fraction. After propensity score matched analysis (Table), atrial tachyarrhythmia free survival was significantly higher in CBA group than in RFCA group (Figure).

Conclusions

Second generation CBA showed a significantly lower late recurrence rate compared to CF-guided RFCA.

Kaplan-Meier Curve

Funding Acknowledgement

Type of funding source: None

Clinical characteristics and outcomes after pulmonary vein isolation in atrial fibrillation patients with complete right bundle branch block

Background

Complete right bundle branch block (CRBBB) is one of the most frequent alterations of the electrocardiogram (ECG). Several studies have shown that CRBBB was a risk factor for cardiovascular diseases and the appearance of CRBBB in patients hospitalized for exacerbated heart failure (HF) was associated with a worse prognosis. Various alternations of ECG such as early repolarization pattern and intraventricular conduction disturbance were associated with high recurrence ratio of atrial fibrillation (AF) after pulmonary vein isolation (PVI). However clinical outcome after PVI in patients with CRBBB remains unclear.

Methods

We enrolled consecutive AF patients who underwent PVI from September 2014 to November 2018 rom Osaka Rosai Atrial Fibrillation (ORAF) registry. We excluded patients with other wide QRS (left bundle branch block, ventricular pacing and unclassified intraventricular conduction disturbance) and divided into 2 groups; CRBBB (QRS duration ≥120msec) group and no-CRBBB (QRS duration &lt;120) group. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, paroxysmal AF (PAF), renal function, plasma brain natriuretic peptide (BNP) level and echocardiographic parameters including left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between the 2 groups. We also compared the incidence of late recurrence of AF/atrial tachycardia (AT) between the 2 groups. We investigated whether CRBBB was an independent predictor of late recurrence of AF/AT after PVI by multivariate Cox analysis.

Results

We enrolled 736 consecutive AF patients who underwent PVI. CRBBB patients comprised 55 patients (7.5%). There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, PAF, renal function, plasma BNP level and echocardiographic parameters (LVDd, LVDs, LVEF and LAD) between the 2 groups. Incidence of AF/AT recurrence after PVI was significantly higher in CRBBB group than no-CRBBB group (Figure). CRBBB was an independently and significantly associated with late recurrence of AF/AT after PVI by multivariate Cox analysis (hazard ratio: 1.923, 95% CI: 1.190–2.961, p=0.009) in addition to female (p&lt;0.001), no-PAF (p=0.005) and left atrial diameter (p=0.042).

Conclusion

CRBBB may be a strong predictor of AF/AT late recurrence after PVI.

AF/Ar recurrence after PVI

Funding Acknowledgement

Type of funding source: None

Ablation index guide pulmonary vein isolation can reduce early recurrence of atrial fibrillation: a propensity score-matched analysis

Background

Ablation index (AI) is a novel marker of ablation lesion quality for radiofrequency ablation (RFA). It has been reported that AI guided pulmonary vein isolation (PVI) reduced pulmonary vein reconnection and late recurrence of atrial fibrillation (AF). However, little is known about the impact of AI guided PVI on early recurrence of AF (ERAF).

Purpose

The aim of this study is to clarify whether AI guided PVI can reduce ERAF.

Methods

From September 2014 to August 2019, consecutive AF patients who underwent 1st session PVI were enrolled. We compared prevalence of ERAF between AI guided PVI group (AI group) and conventional contact force guided PVI group (CF group) using propensity score-matched analysis, which adjusted patient backgrounds (age, sex, and body mass index (BMI)), type of AF, the history of heart failure, hypertension, diabetes and stroke, laboratory findings including estimated glomerular filtration rate (eGFR) and b-type natriuretic peptide (BNP), and echocardiographic parameters including left ventricular ejection fraction (LVEF) and left atrial diameter.

Results

Total 711 patients were enrolled. AI group comprised 233 patients and CF group comprised 233 patients. Prevalence of ERAF were significantly lower in AI group than in CF group significantly (21.5% vs 36.1%, p=0.001, Table).

Conclusions

AI guided PVI can reduce ERAF as compared to conventional method.

Funding Acknowledgement

Type of funding source: None

Leishmanicidal phenolic compounds derived from Dalbergia cultrata

Leishmaniasis is a protozoan tropical infection that is estimated to be more than 0.3 million new cases occur annually worldwide. A novel phenolic compound, cultratin A (1), was isolated as a leishmanicidal constituent from the timber of Dalbergia cultrata, along with three known neoflavanoids (2, 3, 4), two benzofurans (5, 6), and two phenolic compounds (7, 8). Their structures were determined using spectral methods. Among them, a new compound (1) and 4-(S)-methoxydalbergione (2) showed effective leishmanicidal activities (IC₅₀: 2.0 and 2.6 μM, respectively), while compound 8 showed moderate activity (IC₅₀: 11 μM). The cytotoxicity of compounds 1 and 2 was also weaker than that of the other compounds.

Trivalent Iron Is Responsible for the Yellow Color Development in the Nacre of Akoya Pearl Oyster Shells

The gold and cream colors of cultured Akoya pearls, as well as natural yellow nacre of pearl oyster shells, are thought to arise from intrinsic yellow pigments. While the isolation of the yellow pigments has been attempted using a large amount of gold pearls, the substance concerned is still unknown. We report here on the purification and characterization of yellow pigments from the nacre of Akoya pearl oyster shells. Two yellow components, YC1 and YC2, were isolated from the HCl-methanol (HCl-MeOH) extract from nacreous organic matrices obtained by decalcification of the shells with ethylenediaminetetraacetic acid (EDTA). Energy-dispersive X-ray and infrared spectroscopy analyses suggested that YC1 and YC2 precipitated under basic conditions are composed of Fe-containing inorganic and polyamide-containing organic compounds, respectively. YC1 solubilized under acidic conditions exhibited positive reactions to KSCN and K₄[Fe(CN)₆] reagents, showing the same ultraviolet-visible absorption spectrum as those of Fe(III)-containing compounds. In addition, X-ray absorption fine structure analysis supported the compound in the form of Fe(III). The total amount of Fe was approximately 2.6 times higher in the yellow than white nacre, and most Fe was fractionated into the EDTA-decalcifying and HCl-MeOH extracts. These results suggest that Fe(III) coordinated to EDTA-soluble and insoluble matrix compounds are mainly associated with yellow color development not only in the Akoya pearl oyster shells but also in the cultured Akoya pearls.

P2691Excimer laser coronary angioplasty can achieve favorable clinical outocomes for in-stent restenosis lesion with neoatherosclerosis

Background

Recent reports revealed that residual area stenosis (% AS) ≤30% after lesion preparation is a suitable predictor for target lesion revascularization (TLR) after drug-coated balloon (DCB) treatment for in-stent restenosis (ISR). Excimer laser coronary angioplasty (ELCA) can obtain larger lumen area and may be more useful for lesion preparation than plain old ballooning (POBA). On the other hands, it has been reported that in-stent neoatherosclerosis (NA) is major cause of restenosis. It is unclear the correlation between NA of ISR and the effect of ELCA. Thus, we compared the influence of NA which was evaluated by optical coherence tomography (OCT) on % AS for ISR treatment between ELCA and DCB (ELCA) group and POBA and DCB (non-ELCA) group and their clinical outcome.

Methods

We enrolled 58 consecutive ISR lesions which were treated by OCT guidance between July 2014 and July 2018 in our hospital. The lesions were divided into NA and non-NA lesions according to OCT findings. In each lesion, we compared post procedural % AS and % AS change which was calculated by the difference between pre and post procedural % AS between ELCA and non-ELCA groups. In addition, we compared 8-month major advance cardiac events (MACE) defined by composite of binary restenosis and target lesion revascularization (TLR) between ELCA and non-ELCA group in NA lesions.

Results

There were 19 NA (33.3%) and 39 non-NA lesions. In NA lesions, ELCA group can obtain significantly lower % AS (p=0.02) and significantly larger % AS change (p<0.01) than non-ELCA group, but in non-NA lesions, % AS and %AS change were similar between ELCA and non-ELCA groups (table). In 8-month clinical outcome, non-ELCA group experienced MACE twice as much as ELCA group did. (31% vs 17%)

Results of %AS NA lesions (n=19) P value non-NA lesions (n=39) P value ELCA group (n=6) non-ELCA group (n=13) ELCA group (n=17) non-ELCA group (n=22) Post %AS (%) 2±21 26±25 0.02 7±29 23±19 0.07 %AS change (%) 71±15 38±19 <0.01 56±29 44±17 0.11

Conclusion

Although neoatherosclerosis is correlated with refractory restenosis, ELCA can improve residual area stenosis in neoatherosclerosis lesions and can achieve better clinical outcomes for in-stent neoatherosclerosis.

P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis

Background

New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up.

Purpose

In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES.

Methods

We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them.

Results

BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group.

Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01

Conclusion

The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.

103Maximum calcium thickness is a useful predictor for under expansion after post dilatation in calcified lesions: optical coherence tomographic study

Background

Several reports have revealed that stent under expansion is associated with target lesion failure and calcified lesions usually induced inadequate stent expansion. Contemporary debulking devices such as rotational/orbital atherectomy can modify severe calcified lesions before stenting. However, it is uclear which calcium parameter is most useful predictor for stent expansion in the calcified lesions. Thus, we investigated useful calcium parameters correlating with stent expansion in the calcified lesions.

Methods

We enrolled 43 consecutive calcified lesions (43 patients) who underwent optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) between September 2016 and January 2019. We evaluated the lesions treated with post dilatation by non-compliant balloon due to stent under expansion after stenting. Exclusion criteria included acute coronary syndrome, in-stent restenosis and lesions without any calcium or treated with rotational atherectomy. If there were several calcium lesions in one patient, we selected maximum calcium angle lesion. Stent expansion defined as post-PCI lumen area divided by the values predicted by the manufactures compliance charts. We compared mean reference area, pre lesion area stenosis, calcium parameters including calcium arc, maximum thickness, area and longitudinal length in pre-PCI OCT evaluations with post-PCI stent expansion at that site.

Results

Maximum calcium thickness showed significant correlation with stent expansion, while the others did not show a significant correlation with stent expansion (table). The optimal thresholds of maximum calcium thickness for the prediction of acceptable stent expansion defined by 80% of the values predicted by the manufactures compliance charts was 870mm (area under curve (AUC): 0.65) (figure).

Results of OCT parameters Univariate analysis P value Mean reference area 0.41 Pre % area stenosis 0.16 Calcium parameters   Calcium arc 0.37   Calcium maximum thickness 0.04   Calcium area 0.20   Calcium longitudinal length 0.43

Conclusion

A maximum calcium thickness<870mm is a useful predictor for acceptable stent expansion after post dilatation in calcified lesions.

P3393Comparison of intermediate-term vascular response to new-generation biodegradable polymer and durable polymer-based drug-eluting stents: optical coherence tomographic study

Background

Over the last decade, drug-eluting stents (DES) have undergone substantial modifications with thinner struts and more biocompatible durable polymer (DP) or biodegradable polymer (BP). In DP-based DES, after drug elusion has been completed, DP remnants may trigger of local inflammatory vascular reactions and promote delayed healing, leading to accelerated neoatherosclerosis (NA). Thus, BPs have been developed to reduce the above-mentioned risks. Recently, poor strut coverage and in-stent NA are increasingly recognized the cause of late stent failure, but it is unclear whether BPs can reduce the incidence of NA and the poor stent coverage as compared to DPs.

Objectives

The purpose of this study was to compare the incidence of NA and the stent coverage using optical coherence tomography (OCT) between the DPs and the BPs.

Methods

Between July 2016 and April 2018, 127 consecutive patients with new-generation DES who underwent 8-month follow up OCT imaging were enrolled. Patients were divided into the two groups: DP group who had the new-generation durable polymer everolimus-eluting and zotarolimus-eluting stents and BP group who had the new-generation biodegradable polymer sirolimus-eluting and everolimus-eluting stents. We compared patient characteristics including hypertension, dyslipidemia and diabetes mellitus and 8-month follow up OCT findings including NA, uncovered struts and malapposed struts between the two groups.

Results

The DP group comprised 64 patients (50.4%. The incidence of NA, uncovered struts and malapposed struts were similar between the two groups (DPs vs BPs, 1.56% vs 7.94%, P=0.11; 7.80% vs 5.88%, P=0.16 and 2.76% vs 2.01%, P=0.43, respectively) (table). The other parameters were also similar between the two groups.

Table 1 DP group (n=64) BP group (n=63) P value Hypertension 44 (68.8%) 50 (79.4%) 0.2251 Dyslipidemia 39 (60.9%) 37 (58.7%) 0.8573 Diabetes mellitus 25 (39.1%) 30 (47.6%) 0.3731 8 month OCT follow up findings   Neoatherosclerosis 1 (1.6%) 5 (7.9%) 0.1147   Uncovered struts 7.8% (2.8–20.4) 5.9% (0.7–16.7) 0.1616   Malapposed struts 0.2% (0–2.8) 0% (0–2.8) 0.4392

Conclusions

The new-generation DP based-DES may have similar effects on vascular response compared to the new-generation BP-based DES during 8-month follow-up period.

P2689Irregular protrusion area is associated with incidence of cardiac events after implantation of new generation drug-eluting stents - optical coherence tomography study

Background

Several studies using optical coherence tomography (OCT) have shown that the prevalence of irregular protrusion was associated with the incidence of adverse cardiac events. However, the correlation between cardiac events and protrusion area is not well investigated.

Method

One hundred twenty-nine consecutive patients with 138 clesions with 2nd and 3rd generation drug-eluting stents (DES) which had pre-stenting and post-stenting OCT imaging between April 2016 and April 2018 were evaluated. We compared baseline characteristics, procedure findings and OCT findings including minimum stent area, protrusion type and maximum protrusion area between target lesion revascularization (TLR) group and non-TLR group.

Results

TLR occurred in 12 (9.3%) in 129 patients. The baseline characteristics and procedure findings were similar between TLR group and non-TLR group. Univariate analysis revealed that maximum irregular protrusion area was significantly larger (0.51 [0.00–0.63] vs 0.00 [0.00–0.27], p=0.036) in TLR group than non-TLR group. Receiver operating characteristic curve analysis revealed that the suitable cutoff value of maximum irregular protrusion area were 0.43mm2 for TLR. In multivariate analysis using the parameters with p value<0.10 determined by univariate analysis, maximum irregular protrusion (≥0.43mm2) and minimum stent area (MSA) were independently correlated with TLR (table).

Odd's ratio (95% CI) P value Major irregular protrusion (≥0.43mm2) 17.3 (3.63–82.6) <0.001 MSA 2.13 (1.15–3.93) 0.002

Conclusion

Major irregular protrusion (>0.43mm2) in post-stenting OCT findings may be a powerful predictor of TLR in the patients with new generation DES.

P1914Relationship between myocardial injury, inflammation and early, late recurrence after pulmonary vein isolation may be different between radiofrequency catheter ablation and cryoballoon ablation

Background

High sensitive cardiac troponin I (hs-TnI), subunit of cardiac troponin complex, is a sensitive and specific marker of myocardium injury as troponin T. Several studies showed hs-TnI was associated with worse cardiovascular outcomes but relationship between serum hs-TnI level in patients with atrial fibrillation (AF) after pulmonary vein isolation (PVI) and AF recurrence remains unclear.

Methods

We enrolled 444 consecutive AF patients who underwent PVI from May 2017 to September 2018. We investigated the difference of relationship between serum hs-TnI, inflammation markers at 48 hours after PVI and early or late recurrence of AF (ERAF, <3 months and LRAF, during 1 year after PVI in patients with AF) between radiofrequency ablation (RFA) group and cryoballoon ablation (CBA) group.

Results

RFA and CBA were performed in 328 and 116 patients, respectively. There were no significant differences in patient characteristics between RFA group and CBA group. Serum hs-TnI in RFA group was significantly lower than in CBA group (1.93 ng/ml±3.28 vs 5.08 ng/ml±4.29, p<0.001), while hs-CRP was significantly higher in RFA group than CB group (1.97±2.38 mg/dl vs 1.10±0.84 mg/dl, p<0.001). The incidence of ERAF was similar between the two groups (RFA group: 26.8% and CBA group: 21.6%, p=0.262). There was no significant difference of hs-TnI and hs-CRP between patients with ERAF and without ERAF (table). In 213 patients who were followed during 1 year (PVIs were performed from May 2017 to January 2018, RFA 149 and CBA 64 patients), there was no significant association between hs-TnI, hs-CRP and incidence of LRAF (table).

TnI and CRP between RFA and CBA RFA (n=328) CBA (n=116) P value hs-TnI 1.93±3.28 5.08±4.29 <0.001 hs-CRP 1.97±2.38 1.10±0.84 <0.001 3 months follow-up RFA (n=328) CBA (n=116) ERAF (+) ERAF (−) P value ERAF (+) ERAF (−) P value hs-TnI 1.68±1.90 2.02±3.66 0.410 5.03±3.17 5.10±4.56 0.943 hs-CRP 2.23±2.65 1.88±2.27 0.238 1.01±0.84 1.13±0.85 0.524 1 year follow-up RFA (n=149) CBA (n=64) LRAF (+) LRAF (−) P value LRAF (+) LRAF(−) P value hs-TnI 1.61±1.77 1.87±2.69 0.570 4.71±2.14 5.60±5.69 0.664 hs-CRP 2.18±2.24 1.92±2.24 0.550 1.12±0.64 1.12±0.98 0.991

Conclusion

CBA may cause more myocardial injury than RFA, on the contrary RFA may cause more inflammation than CBA. These markers did not affect ERAF and LRAF after PVI.

P1736A novel calcium parameter, calcium ratio, can predict minimum lumen area in calcified lesions: optical coherence tomographic study

Background

Several reports have revealed that minimum lumen area (MLA) is associated with target lesion failure even with newer-generation drug-eluting stents, and calcified lesions usually induced inadequate lumen area because of stent under expansion. Contemporary debulking devices such as rotational/orbital atherectomy can modify severe calcified lesions before stenting. However, there are no optimal criteria to indicate necessity for calcium modification to obtain adequate acute gain. Therefore, we investigated useful calcium parameters correlating with MLA in the calcified lesions after stenting.

Methods

We enrolled 71 consecutive calcified lesions (71 patients) who underwent optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) between September 2016 and January 2019. Exclusion criteria included acute coronary syndrome, in-stent restenosis and lesions without any calcium or treated with rotational atherectomy. If there were several calcium lesions in one patient, we selected maximum calcium angle lesion. We compared mean reference area, pre lumen area and various calcium parameters including calcium arc, maximum thickness, depth, area, longitudinal length and calcium ratio that was maximum calcium thickness divided by nearest reference diameter in disease-free segments as much as possible in pre-PCI OCT evaluation with post-PCI lumen area at that site by simple and multiple regression analysis.

Results

Calcium ratio was an independent predictor for post-PCI lumen area in addition to mean reference area, while the others were not associated with post-PCI lumen area (table).

Results of OCT parameters Univariate analysis Multivariate analysis P value P value β Mean reference area <0.01 <0.01 0.69 Pre lumen area <0.01 0.08 0.15 Cacium arc <0.01 0.58 −0.06 Calcium maximum thickness 0.62 Calcium ratio <0.01 0.01 −0.21 Calcium area 0.02 0.64 0.05 Calcium longitudinal length 0.60 Calcium depth 0.09

Conclusion

The novel calcium measurement, calcium ratio, may be a useful predictor for post-PCI lumen area for calcified lesions.

Phosphate Enrichment Hampers Development of Juvenile Acropora digitifera Coral by Inhibiting Skeleton Formation

Coral reef degradation due to various local stresses, such as nutrient enrichment and terrestrial run-off into coastal waters, is an increasing global concern. Inorganic phosphates have been considered to possibly inhibit skeleton formation in corals. Despite many studies available on the effects of nutrients on corals, a clear consensus on how nutrients exert deteriorative effects on corals has not been established satisfactorily. In this study, we examined the effects of phosphates and nitrates on in vitro aragonite CaCO₃ formation by using biogenic polyamines and in vivo aragonite formation in the skeleton of juvenile Acropora digitifera corals. We showed that the phosphates at similar concentrations clearly inhibited both in vitro and in vivo CaCO₃ formation. In contrast, nitrates inhibited neither in vitro aragonite CaCO₃ formation nor in vivo aragonite formation in juvenile coral skeleton. Furthermore, our findings showed that inhibition of coral skeleton formation was due to absorption of phosphate on the skeleton, which inorganically inhibited normal development of juvenile coral skeleton.

Effects of moderate thermal anomalies on Acropora corals around Sesoko Island, Okinawa

Over the past several decades, coral reef ecosystems have experienced recurring bleaching events. These events were predominantly caused by thermal anomalies, which vary widely in terms of severity and spatio-temporal distribution. Acropora corals, highly prominent contributors to the structural complexity of Pacific coral reefs, are sensitive to thermal stress. Response of Acropora corals to extremely high temperature has been well documented. However, studies on the effects of moderately high temperature on Acropora corals are limited. In the summer of 2016, a moderate coral bleaching event due to moderately high temperature was observed around Sesoko Island, Okinawa, Japan. The objective of this study was to examine thermal tolerance patterns of Acropora corals, across reefs with low to moderate thermal exposure (degree heating weeks ~2-5°C week). Field surveys on permanent plots were conducted from October 2015 to April 2017 to compare the population dynamics of adult Acropora corals 6 months before and after the bleaching events around Sesoko Island. Variability in thermal stress response was driven primarily by the degree of thermal stress. Wave action and turbidity may have mediated the thermal stress. Tabular and digitate coral morphologies were the most tolerant and susceptible to thermal stress, respectively. Growth inhibition after bleaching was more pronounced in the larger digitate and corymbose coral morphologies. This study indicates that Acropora populations around Sesoko Island can tolerate short-term, moderate thermal challenges.

Changes in free amino acid concentrations and associated gene expression profiles in the abdominal muscle of kuruma shrimp Marsupenaeus japonicus acclimated at different salinities

Shrimps inhabiting the coastal water can survive in a wide range of salinity. However, the molecular mechanisms involved in their acclimation to different environmental salinities have remained largely unknown. In the present study, we acclimated kuruma shrimp Marsupenaeus japonicus at 1.7 %, 3.4 % and 4.0 % salinities. After acclimating for 6, 12, 24 and 72 h, we determined free amino acid concentrations in their abdominal muscle, and performed RNA-seq analysis on this muscle. The concentrations of free amino acids were clearly altered depending on salinity after acclimating for 24 h. Glutamine and alanine concentrations were markedly increased following the increase of salinity. In association with such changes, many genes related to amino acid metabolism changed their expression levels. In particular, the increase of the expression level of the gene encoding glutamate-ammonia ligase which functions in the glutamine metabolism appeared to be relevant to the increased glutamine concentration at high salinity. Furthermore, the alanine concentration increased at high salinity was likely to be associated with the decrease in the expression levels of the alanine-glyoxylate transaminase gene. Thus, there is a possibility that changes in the concentration of free amino acids for osmoregulation in kuruma shrimp are regulated by changes in the expression levels of genes related to amino acid metabolism.

Biogenic polyamines capture CO2 and accelerate extracellular bacterial CaCO3 formation

Bacteria, including cyanobacteria, as well as some fungi, are known to deposit calcium carbonate (CaCO(3)) extracellularly in calcium-containing artificial medium. Despite extensive investigation, the mechanisms involved in extracellular formation of CaCO(3) by bacteria have remained unclear. The ability of synthetic amines to remove carbon dioxide (CO(2)) from natural gas led us to examine the role of biogenic polyamines in CaCO(3) deposition by bacteria. Here, we demonstrated that biogenic polyamines such as putrescine, spermidine, and spermine were able to react with atmospheric CO(2) and the resultant carbamate anion was characterized by using nuclear magnetic resonance (NMR) analysis. Biogenic polyamines accelerated the formation of CaCO(3), and we artificially synthesized the dumbbell-shaped calcites, which had the same form as observed with bacterial CaCO3 precipitates, under nonbacterial conditions by using polyamines. The reaction rate of calcification increased with temperature with an optimum of around 40 °C. Our observation suggests a novel scheme for CO(2) dissipation that could be a potential tool in reducing atmospheric CO(2) levels and, therefore, global warming.

Variations in the structure and transcription of the mitochondrial atp and cox genes in wild Solanum species that induce male sterility in eggplant (S. melongena)

In order to determine the molecular basis of cytoplasmic male sterility (CMS) in alloplasmic lines of eggplant, the genomic structures and transcription patterns of mitochondrial ATP synthase subunit (atp) and cytochrome oxidase subunit (cox) genes were studied for wild and cultivated eggplants. Alloplasmic eggplant lines with cytoplasms of wild Solanum species showing either anther indehiscent type of CMS or non-pollen production type of CMS were studied with the cultivated eggplant Solanum melongena, used as a control. Southern hybridization of the mitochondrial genes indicated the difference between the two types of CMS and showed complete identity within each type. The cytoplasmic patterns of all wild species differed from that of the cultivated eggplant. Thus, the cytoplasm of the six wild eggplants and the one cultivated eggplant was classified into three groups. Male sterile plants of both types of CMS showed novel transcription patterns of atp1, whereas a different transcription pattern of cox2 was observed only in the anther indehiscent type. Based on these differences, we determined the DNA sequences of about a 4 kbp segment in the atp1 region. Although the coding and 3' flanking regions were almost identical among the cytoplasms, the 5' flanking region was completely different and novel open reading frames (orfs) were found for each of the CMS types and the cultivated eggplant. The cytoplasm of Solanum kurzii inducing the anther indehiscent type CMS had orf312, and those of Solanum aethiopicum and Solanum grandifolium of non-pollen production type CMS had orf218. The correspondence between the transcription patterns of these orfs and phenotypic expression of male sterility strongly suggests that these orfs are causal genes for each type of CMS.

Results of a Surgical Resection for Patients with Thymic Carcinoma

Objectives:

This study investigated the clinical features of patients with complete resection of thymic carcinoma.

Patients and Methods:

The clinical records from 11 patients who underwent a complete resection of thymic carcinoma were retrospectively reviewed.

Results:

Twelve of 22 patients underwent a resection (a complete resection in 11 and an incomplete in 1). Six of the 11 patients with complete had confirmed recurrent tumors. The 5-year survival rate was 45.4%, and the median survival time was 50.6 months. The patients who underwent complete resection showed significantly better prognosis than cases with incomplete resection and inoperable cases ( p = 0.048). Three of the 6 patients had a recurrence within 1 year. Frequent sites of recurrence were the pleura, pericardium, and lung.

Conclusions:

A complete resection improved the prognosis of thymic carcinoma. Further prospective studies regarding postoperative adjuvant therapy are necessary to prevent local recurrence after a surgical resection for thymic carcinoma.

[Surgical treatment for patients with descending necrotizing mediastinitis]

Descending necrotizing mediastinitis (DNM) originating from deep cervical infection is a rare and serious clinical condition with a high mortality rate. Clinical feature of 5 patients undergone surgical drainage for DNM, between 2006 and 2009 were assessed. There were 3 male and 2 female patients whose age ranged from 57 to 83 years old (mean 69.8). All 5 patients had no underlying disease except for 1 patient with severe dental caries. The primary infections of these patients were tonsillitis and pharyngitis. The mean duration from onset of symptom to the referral to our hospital was 14 days (ranged 2 to approximately 41). Two patients underwent cervical drainage for upper mediastinum, and 3 patients were required mediastinal drainage by thoracotomy. There was no post-operative death. Early and aggressive surgical drainage of the neck and mediastinum by a multidisciplinary team of surgeons is very important in the treatment of DNM.

Randomized phase II trial of the biweekly schedule of adjuvant chemotherapy with carboplatin plus paclitaxel versus carboplatin plus gemcitabine in patients with non-small cell lung cancer (NSCLC)

7562

Background: Carboplatin plus paclitaxel and carboplatin plus gemcitabine chemotherapy have shown a good response and an improved survival against advanced NSCLC. This phase II trial assessed the feasibility, safety and efficacy of a bi-weekly schedule for adjuvant chemotherapy. Methods: Patients with completely resected stage IB-IIIB NSCLC were randomized to either carboplatin (AUC3) plus paclitaxel (90mg/m2) (arm A) or carboplatin (AUC3) plus gemcitabine (1000 mg/m2) (arm B), q2w for 8 cycles within 8 weeks after surgery. The main inclusion criteria were no prior chemotherapy or radiotherapy, ECOG PS 0–1, an age of less than 80 years, and an adequate organ function. The primary endpoint was compliance, and secondary endpoints were the disease free survival (DFS) and toxicity. The patients were stratified by gender, histology (adenoca vs. non-adenoca) and disease stage. Results: Between 07/2005 and 06/2007, 76 patients were randomized and 75 were eligible (including 48 males, 27 females; median age 66 years) for intent-to-treat analysis (39 in arm A, 36 in arm B). The histologic types included adenocarcinoma (n=51), squamous cell carcinoma (n=18), large cell carcinoma (n=5), and adenosquamous cell carcinoma (n=1). The pathological stages were IB/IIA/IIB/IIIA/IIIB: 22/10/13/29/1. Twenty-one of 39 pts (54%) in arm A and 25 of 36 pts (69%) in arm B completed 8 cycles, and 59% in arm A and 81% in arm B completed ≥6 cycles. Grade 3/4 hematologic toxicities (%) in arms A/B were respectively; neutropenia 36/53, anemia 0/17, thrombocytopenia 3/0, nausea 3/3. No treatment related deaths were observed. Up to 12/2008, 11 of 39 pts in arm A and 13 of 36 pts in arm B had recurrent disease, but no significant difference was observed. Conclusions: This adjuvant bi- weekly scheduled chemotherapy in both arms resulted in a good compliance and feasible with acceptable levels of toxicity in completely resected NSCLC.

No significant financial relationships to disclose.

[Postoperative recurrence of spontaneous pneumothorax]

Few reports on recurrence after thoracoscopic bullectomy for spontaneous pneumothorax specify the follow-up period and follow-up ratio. Because of the variation in follow-up periods, many reported recurrence rates were not comparable. Some reports compared simple recurrence rate (number of recurrent cases/number of operated cases) of different groups with different follow-up periods. In this study, we employ the Kaplan-Meier method along with a set of optimal follow-up periods and ratios in order to determine a more reliable recurrence rate. Consecutive 68 patients (74 surgical procedures) underwent thoracoscopic bullectomy for spontaneous pneumothorax at our institution between November 2000 and December 2005. A follow-up survey was conducted by phone to determine the rate of recurrent pneumothorax. The follow-up ratio and the mean follow-up period were 92.6% and 1,316 +/- 481 days, respectively. Postoperative recurrence was confirmed for 4 patients. The interval up to recurrence was 144, 345, 476 and 616 days after the bullectomy, respectively. All cases of recurrent pneumothorax occurred within 2 years following the bullectomy. The 1-year, 2-year and 3-year cumulative recurrence rate was 3.0%, 6.3% and 6.3%, respectively. In light of these findings, we feel that comparison analysis of pneumothorax recurrence rates should be evaluated using the Kaplan-Meier method, furthermore, our data suggests that a follow-up period of 2 or more years is advisable.

Acute lung injury following an esophagectomy for esophageal cancer, with special reference to the clinical factors and cytokine levels of peripheral blood and pleural drainage fluid

Acute lung injury (ALI) is one of most serious complications to occur after an esophagectomy for esophageal cancer. However, the pathogenesis of ALI is still unclear. The cytokine levels of pleural drainage fluid as well as peripheral blood were measured in 27 patients who had undergone an extended radical esophagectomy. Both the clinical factors and cytokine levels were compared between 11 patients with (group I) and 16 without ALI (group II). ALI occurred more frequently in patients who underwent colon interposition than in those who received a gastric tube reconstruction (86%vs 25%, P = 0.009). The operation time of group I was significantly longer than that of group II. A logistic regression analysis revealed colon interposition to be an independent factor associated with the ALI (P < 0.05). Postoperative anastomotic leakage and systemic inflammatory response syndrome (SIRS) occurred more frequently in group I than in group II (P < 0.01). Both the serum interleukin-6 (IL-6) and IL-8 levels of group I were significantly higher than those of group II. IL-1beta and tumor necrosis factor-alpha were undetectable in the peripheral blood, whereas they were detectable in the pleural effusion. The IL-1beta of pleural effusion was higher in group I than group II. In conclusion, greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extra-thoracic site, such as necrosis and local infection around anastomosis may therefore be the second attack. Furthermore, ALI may cause not only SIRS but also other complications such as anastomotic leakage.