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Gracillin, a kind of steroidal saponin isolated from the root bark of wild yam Dioscorea nipponica has been reported to exert antitumor activity. In the present study, we investigated the anticancer activity of gracillin against HL60 cells, and evaluated the possible mechanism involved in its antineoplastic action. The cell proliferation was evaluated by cell counting Kit-8 (CCK-8) assay, gracillin inhibited the growth of HL60 cells in a time- and concentration-dependent manner. Flow cytometry was used to analyze the cell cycle distribution whereas Annexin V-FITC/PI flow cytometry analysis was carried out to confirm apoptosis induced by gracillin, Our results demonstrated that gracillin could induce cell cycle arrest of G1 and apoptosis in HL60 cells. Furthermore, based on the biochemical methods, induction of oxidative stress by gracillin was indicated by increased the content of malondialdehyde (MDA), and decreased superoxide dismutase (SOD) activity. In addition, real time-PCR verified the expression of apoptosis-related genes, the mRNA level of Bcl-2 was decreased dramatically, while Bax was remarkably increased by gracillin. Taken together, gracillin could induce cell cycle arrest, oxidative stress, and apoptosis in HL60 cells, and has the potential to be developed as an antitumor agent.

We studied the first 202 patients with rheumatic mitral stenosis (MS) who underwent percutaneous balloon mitral valvuloplasty (PBMV) with the Inoue balloon catheter for a follow-up (FU) period of 5–11 years. Pre- and post-PBMV and at FU, the mean left atrial pressure was 21.3 ± 7.4, 10.2 ± 5.6, and 11.2 ± 4.1 mm Hg; mean diastolic mitral gradient was 18.4 ± 7.3, 2.9 ± 3.2, and 5.1 ± 4.3 mm Hg; and mitral valve area was 1.0 ± 0.3, 2.1 ± 0.6, and 1.7 ± 0.5 cm2. Functional status improved from New York Heart Association (NYHA) class IV in 3, class III in 119, and class II in 80 pre-PBMV to class I in 163, class II in 37, and class III in 2 post-PBMV, and was class I in 146, class II in 39, and class III in 17 patients at FU. In the 17 patients with NYHA class III at FU, mitral restenosis was the culprit; 4 underwent repeat PBMV, 12 had mitral valve replacement for severe mitral calcification and subvalvular fusion, and 1 refused further intervention. Thus PBMV using the Inoue balloon catheter is an effective method of relieving MS with excellent long-term results in patients without severe mitral calcification and subvalvular fusion. Cathet. Cardiovasc. Diagn. 43:132–139, 1998. © 1998 Wiley-Liss, Inc.

ObjectivesThis study sought to report the long-term result (up to 8 years) of percutaneous transluminal balloon angioplasty (PTBA) for Budd-Chiari syndrome (BCS) caused by membranous obstruction of the inferior vena cava (MOVC).BackgroundWe previously reported on this nonoperative form of therapy in a smaller series of patients and found the short-term results to be excellent.MethodsWe studied the long-term results of PTBA in the treatment of BCS caused by MOVC in 42 patients who underwent PTBA with the Inoue balloon catheter between June 1988 and February 1996. There were 28 men and 14 women with a mean age of 35.6 years (range 16 to 56). MOVC was incomplete in 27 patients and complete in 15. PTBA was successful in 38 patients (91%). The longest follow-up period was 8 years.ResultsAll 38 patients who successfully underwent PTBA showed marked symptomatic improvement. Immediately after PTBA, the diameter of the inferior vena cava at the MOVC increased from 1.7±2 to 19.9±3.5 mm (p

A feasibility clinical study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects with the centering buttoned device. The centering buttoned device is a modification of the regular buttoned device in which a centering counter-occluder is sutured at the central 40% portion of the occluder. During centering it is stretched, forming a parachute-shaped structure and pulling the occluder over the center of the defect. During buttoning, the counter-occluder forms a double figure eight, opposing the right atrial side of the atrial septum. Occlusion was performed in 12 patients aged 6 to 56 years. All had been rejected for transcatheter occlusion by the regular buttoned device, because of either their defect size or the lack of adequate septal rim. The defect size varied between 23 and 31 mm, and the device size varied between 45 and 60 mm. Nine had immediate effective occlusions of their defects and three residual shunts. One patient with unbuttoning had hemolysis at 2 weeks and underwent surgery. Early results of the transcatheter occlusion of large atrial septal defects are promising, and larger clinical trials are justified.

Virosecurinine, the major alkaloid isolated from Securinega suffruticosa Pall Rehd was found to exhibit growth inhibition and cytotoxicity against huaman colon cancer SW480 cells via the microculture tetrazolium (MTT) assay. Due to its greater cytotoxic potency and selectivity towards SW480 cells, flow cytometry was used to analyze the cell cycle distribution of control and treated SW480 cells whereas Annexin V-FITC/PI flow cytometry analysis was carried out to confirm apoptosis induced by virosecurinine in SW480 cells. Apoptotic regulatory genes were determined by RT-PCR analysis. Virosecurinine was found to induce G1/S cell cycle arrest which led to predominantly apoptotic mode of cell death. Mechanistically, virosecurinine was found to up-regulated the Bax gene expression and down-regulated the Bcl-2 expression in SW480, The ratio of Bcl-2 to Bax was significantly decreased. Hence, we suggest that virosecurinine induced apoptosis in SW480 cells by affecting the expression of bcl-2 and bax.

The initial 85 patients who successfully underwent percutaneous mitral valvuloplasty (PMV) with the Inoue balloon catheter at the Guangdong Cardiovascular Institute between November 1985 and November 1988 had a mean follow-up period of 5 +/- 1 year (range 43 to 79 months). Before and after PMV and at follow-up, mean diastolic mitral gradients by the catheter method were 17.5 +/- 6.2, 3.1 +/- 3.3 and 3.3 +/- 3.4 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler method were 18 +/- 6, 8 +/- 5 and 9 +/- 5 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mean diastolic mitral gradients by the Doppler method were 18 +/- 6, 8 +/- 5 and 9 +/- 5 mm Hg, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Mitral valve areas by the echo-Doppler method were 1.1 +/- 0.3, 2.0 +/- 0.4 and 1.8 +/- 0.5 cm2, respectively (p0.001 before vs after PMV and before vs follow-up; and p0.05 after PMV vs follow-up). Phonocardiographic and vectorcardiographic studies, and cardiopulmonary exercise testing showed significant improvement after PMV and at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous transluminal angioplasty (PTA) was performed with the Inoue balloon catheter in nine patients with membranous obstruction of the inferior vena cava (MOVC) between November 1988 and April 1991. There were five men and four women, aged 30.8 +/- 8.5 years. Two patients had had previous surgical treatment. Three patients had complete and six had incomplete MOVC. The caval pressure below the MOVC was 24.0 +/- 5.6 and 11.8 +/- 5.3 mm Hg (p less than 0.0001) before and after PTA, respectively. The caval diameter at the site of MOVC increased from 1.5 +/- 1.7 to 20.3 +/- 2.6 mm (p less than 0.0001), and the maximal caval diameter below the MOVC decreased from 28.7 +/- 12.9 to 19.8 +/- 9.9 mm (p = 0.006), before and after PTA, respectively. One patient died of massive pulmonary embolism following successful PTA. All the other eight patients remained asymptomatic during an 18.5 +/- 11.5 months (range 3.5 to 32) follow-up period. Two-dimensional ultrasonograms showed no recurrence of MOVC. We conclude that PTA with the Inoue balloon catheter is an effective and safe alternative to surgical treatment of MOVC.

To the Editor: We are writing in support of the conclusions reached by Iung et al1 concerning the late results of percutaneous balloon mitral valvuloplasty (PBMV). The French experience confirmed the Chinese experience that was reported earlier with a larger number of patients, namely, a PBMV can be performed with good late results in a variety of patient subsets.2 3 The Inoue balloon technique, which the Chinese investigators have used since November 19854 and the French investigators began using more recently, is the procedure of choice for the treatment of mitral stenosis.5 We also found that a hemodynamic evaluation did not provide any information additional …

Percutaneous balloon valvuloplasty has been the accepted first-line treatment for congenital pulmonic stenosis in children. Its efficacy in adolescents and adults is less well defined.Between December 1985 and July 1995 we performed percutaneous pulmonic valvuloplasty with a single Inoue balloon catheter in 53 adolescent or adult patients 13 to 55 years of age (mean [+/- SD], 26 +/- 11). Follow-up studies were performed 0.2 to 9.8 years after the procedure (mean, 6.9 +/- 3.1) by Doppler echocardiography (in all the patients) and by cardiac catheterization and angiography (in nine patients).After balloon valvuloplasty, the systolic pressure gradient across the pulmonic valve decreased from 91 +/- 46 mm Hg to 38 +/- 32 mm Hg (P0.001), and the diameter of the pulmonic-valve orifice increased from 8.9 +/- 3.6 mm to 17.4 +/- 4.6 mm (P0.001). In the nine patients catheterized at follow-up, the systolic gradient decreased from 107 +/- 48 mm Hg before valvuloplasty to 50 +/- 29 mm Hg after valvuloplasty and to 30 +/- 16 mm Hg at follow-up (P0.001 for the comparison of the gradient before and after valvuloplasty; P0.001 for the comparison before valvuloplasty and at follow-up; and P0.05 for the comparison after valvuloplasty and at follow-up). In the same nine patients, the diameter of the pulmonic valve, as measured by right ventricular angiography, increased from 8.3 +/- 1.4 mm before valvuloplasty to 17.2 +/- 2.0 mm after valvuloplasty (P0.001) and to 18.4 +/- 1.4 mm at follow-up (P = 0.08). Incompetence of the pulmonic valve was noted in 7 of the 53 patients (13 percent) after balloon valvuloplasty, but it had disappeared at follow-up in all of them.Patients with congenital pulmonic stenosis who present in late adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that are similar to those in young children.

Between November 1985 and January 1994, 4832 patients with rheumatic mitral stenosis from 120 medical centers in China underwent PBMV by the Inoue technic. There were 1440 men and 3392 women with a mean age of 36.8 +/- 12.3 years. The procedure success rate was 99.30%. Major complications included death in 0.12%,or = 3+/4+ mitral regurgitation in 1.41%, cardiac tamponade in 0.81%, and thromboembolism in 0.48%. After PBMV, the mean left atrial pressure decreased from 26.2 +/- 7.6 mm Hg to 11.4 +/- 6.1 mm Hg (p0.001); mean mitral diastolic gradient decreased from 18.3 +/- 5.1 mm Hg to 5.4 +/- 3.1 mm Hg (p0.001); pulmonary artery systolic pressure decreased from 51.2 +/- 14.8 mm Hg to 33.9 +/- 8.8 mm Hg (p0.001); cardiac output increased from 3.8 +/- 1.3 L/min to 4.8 +/- 1.2 L/min (p0.001); and mitral valve area expanded from 1.1 +/- 0.3 cm2 to 2.1 +/- 0.2 cm2 (p0.001). Functional status was NYHA class IV in 5.6%, class III in 38.8%, class II in 55.5%, and class I in 0.1% of patients before PBMV and improved to class I in 75.8%, class II in 23%, and class III in 1.2% after PBMV. The rate of restenosis was 5.2% over a follow-up period of 32.2 +/- 14.2 months in the entire group and 4.6% over a follow-up period of 5.1 +/- 1.0 years in Guangdong Cardiovascular Institute, where PBMV was begun in China.(ABSTRACT TRUNCATED AT 250 WORDS)

A feasibility study was conducted for the transcatheter occlusion of large ostium secundum atrial septal defects (ASDs) using the centering buttoned device (CBD). The CBD is a modification of the buttoned device, in which a centering counter-occluder (COC) is sutured at the central 40% portion of the occluder (OCC); when the centering COC is stretched is forming a balloon shaped structure, pulling the OCC over the center of the ASD; subsequently the COC is buttoned with the OCC, forming a double 8 disk on the right side of the atrial septum. Occlusion was performed in 10 patients 6–56 years old (median 22). All had been rejected for occlusion by the regular buttoned device, either because of large defect size, or inadequate septal rim. The defect size varied between 23–31 mm (median 27) and the device size between 45–60 mm (median 50). All devices were introduced through 11F long sheaths. All patients remained stable. Seven had immediate effective occlusions and three had residual shunts. Follow-up ranged between 2–6 months. Unbuttoning without embolization was experienced in the second case; despite the trivial residual shunt, the patient developed severe hemolysis and was operated 2 weeks after implantation. The other patients are doing well. Conclusions The CBD can offer transcatheter repair in large ASDs corrected only by Surgery in the past. The early results are promising; larger trials are justified.

Between November 1985 and December 1991, percutaneous balloon mitral valvuloplasty (PBMV) with the Inoue balloon catheter (Toray Marketing & Sales [America], Inc., New York, N.Y.) was performed in 53 patients with rheumatic mitral stenosis and associated mild to moderate aortic regurgitation. Mean left atrial pressure was 22.5 +/- 8.6 mm Hg and 9.7 +/- 5.5 mm Hg before and after PBMV, respectively (p < 0.001). The mean diastolic mitral gradient as determined by the catheter method decreased from 18.7 +/- 11.4 mm Hg to 2.1 +/- 3.1 mm Hg (p < 0.001). The echocardiographic mitral valve area was 1.0 +/- 0.2 cm2, 2.0 +/- 0.6 cm2, and 1.9 +/- 0.5 cm2, before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The mean diastolic mitral gradient as determined by two-dimensional and Doppler echocardiography was 19.3 +/- 8.4 mm Hg, 5.2 +/- 4.1 mm Hg, and 6.6 +/- 3.3 mm Hg, before and after PBMV and at follow-up, respectively (p < 0.001). The phonocardiographic interval between the Q wave and the mitral component of the first heart sound was 85.2 +/- 15.2 msec, 74.2 +/- 13.4 msec, and 72.3 +/- 15.7 msec before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The phonocardiographic interval between the aortic second sound and opening snap was 73.4 +/- 18.1 msec, 88.7 +/- 9.6 msec, and 92.1 +/- 11.7 msec before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The voltage of P loop in the frontal plane of the vectorcardiogram was 0.25 +/- 0.04 mV, 0.21 +/- 0.04 mV, and 0.20 +/- 0.03 mV before and after PBMV and at follow-up (p < 0.001 before PBMV vs after PBMV and at follow-up). The New York Heart Association classification improved from class II in 26 patients and class III in 27 patients before PBMV to class I in 48 patients and class II in five patients after PBMV. These hemodynamic, noninvasive, and clinical results were not significantly different from those that were obtained in 112 patients with mitral stenosis without associated aortic regurgitation, who were studied during the same period in our cardiac catheterization laboratory. It was concluded that patients with rheumatic mitral stenosis are suitable candidates for PBMV whether or not they have associated aortic regurgitation of mild to moderate degree.

The first 71 patients with rheumatic mitral stenosis who successfully underwent single rubber-nylon balloon (Inoue balloon) percutaneous mitral valvuloplasty (PMV) from November 1985 to August 1988 had a mean follow-up period of 27.1 ± 11.6 months (range, 14 to 48 months). Functional status before PMV was New York Heart Association (NYHA) functional class IV in two, class III in 38, and class II in 31. Pre and post PMV and follow-up mean diastolic mitral gradient by catheter method was 17.5 ± 6.9, 2.7 ± 3.5, and 3.3 ± 3.4 mm Hg ( p p > 0.05 post PMV versus follow-up). By Doppler method the mean diastolic gradient was 17.4 ± 5.5, 8.5 ± 4.7, and 9.2 ± 4.1 mm Hg, respectively ( p p > 0.05 post PMV versus follow-up). Mitral valve area was 1.12 ± 0.26, 2.04 ± 0.41, and 1.92 ± 0.45 cm 2 , respectively ( p > 0.001 pre versus post PMV and pre PMV versus follow-up; and p > 0.05 post PMV versus follow-up). The phonocardiographic and vectorcardiographic studies and cardiopulmonary exercise testing showed significant improvement after PMV and at follow-up. At follow-up the NYHA functional class was I in 57 patients, class II in 13, and class III in one patient with severe mitral valve calcification and subvalvular fusion, in whom restenosis occurred 18 months after PMV. Thus single rubber-nylon balloon PMV can achieve very good short-term and long-term results in relieving symptomatic rheumatic mitral stenosis. Patients with severe mitral calcification and subvalvular fusion do not appear to be good candidates for PMV.

To compare the single rubber-nylon balloon and double polyethylene balloon techniques, 94 patients with rheumatic mitral stenosis underwent percutaneous transseptal balloon mitral valvuloplasty between November 1985 and September 1988. The single balloon technique was used in 73 patients and the double balloon technique was used in 21. The two groups were similar in age, weight, severity of the lesion, and cardiac functional status. The mean mitral valve diastolic gradient decreased from 17.9 +/- 6.5 to 2.9 +/- 3.1 mm Hg (p less than 0.001), 18.5 +/- 6.7 to 5.8 +/- 3.1 mm Hg (p less than 0.001), and 18.1 +/- 5.9 to 3.2 +/- 3.7 mm Hg (p less than 0.001) in the single balloon group, double balloon group, and the entire series, respectively. The final mitral diastolic gradient in the single balloon group was lower than in the double balloon group (p less than 0.05). Complications in the single balloon group were lower than in the double balloon group. Additional advantages of single over double balloon technique were easier maneuverability and higher success rate. The initial and long-term follow-up results confirmed the earlier impressions that percutaneous transseptal balloon mitral valvuloplasty is an effective and safe nonsurgical method of treatment for rheumatic mitral stenosis, and the single rubber-nylon balloon technique is at least as effective as, if not superior to, the double polyethylene balloon technique.

Percutaneous balloon valvuloplasty was successfully performed in a 55-year-old Chinese woman with severe recurrent tricuspid and pulmonic stenoses 11 1/2 years following open valvotomies. An Inoue balloon catheter with the balloon made of double-layered rubber and nylon micromesh was used. The orifices of the tricuspid and pulmonic valves increased from 13 to 27 mm in diameter and from 6 to 14 mm in diameter, respectively, following concurrent balloon valvuloplasties. The present report demonstrated for the first time the feasibility of percutaneous balloon valvuloplasty for combined valvular stenoses.