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Objectives: The purpose of this study was to investigate whether microvascular resistance index (MVRI) immediately after primary percutaneous coronary intervention (PCI) can predict the transmural extent of infarction (TEI) defined by contrast-enhanced cardiac magnetic resonance (ce-CMR) in patients with anterior acute myocardial infarction (MI)., Background: The degree of microvascular damage is an important determinant of myocardial viability and clinical outcomes in acute MI. A novel dual-sensor (pressure and Doppler velocity) guidewire has the ability to evaluate microvascular damage. ce-CMR can accurately discriminate transmural from nontransmural MI, and the TEI by ce-CMR can predict future improvement in contractile function., Methods: In 27 patients immediately after primary PCI for a first anterior acute MI, MVRI, coronary flow reserve (CFR), deceleration time of diastolic velocity (DDT), and zero flow pressure (Pzf) were measured with a dual-sensor guidewire. TEI was graded from 1 to 4 based on the transmural extent of hyperenhanced tissue (1 = 0% to 25% of left ventricular wall thickness, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = 76% to 100%). Infarct size by ce-CMR was also calculated., Results: Peak creatine kinase-myocardial band values were significantly correlated with MVRI (r = 0.77, p < 0.0001), CFR (r = -0.69, p < 0.0001), DDT (r = -0.75, p = 0.0001), and Pzf (r = 0.75, p < 0.0001). Also, infarct size by ce-CMR was significantly correlated with MVRI (r = 0.78, p < 0.0001), CFR (r = -0.67, p < 0.0001), DDT (r = -0.70, p < 0.0001), and Pzf (r = 0.72, p = 0.0002). Receiver-operating characteristic curve analyses of MVRI, CFR, DDT, and Pzf for predicting transmural MI (TEI-grade 4) demonstrated that the area under the curve tended to be higher for MVRI (0.885) than those for CFR (0.848), DDT (0.862), and Pzf (0.853). The best cut-off value for MVRI was 3.25 mm Hg x cm(-1) x s (sensitivity 75%, specificity 89%). Moreover, increased MVRI was significantly related to increased TEI-grade (p < 0.0001)., Conclusions: MVRI measured immediately after primary PCI is a useful predictor for the TEI in patients with anterior acute MI.

Recently, it has been reported that large infarcts associated with terminal QRS distortion (QRSDIS) on the admission electrocardiograms of patients with ST-elevation myocardial infarctions (STEMIs) may be caused by a failure to achieve thrombolysis in myocardial infarction (TIMI) grade 3 flow after primary percutaneous coronary intervention (PCI). However, the relationship between QRSDIS and final infarct size when TIMI grade 3 flow could be achieved by primary PCI is still unclear. Sixty-two consecutive patients with first anterior STEMI and who achieved TIMI grade 3 flow by primary PCI were classified into two groups according to the presence (Group A, n = 18) or absence (Group B, n = 44) of QRSDIS. Two weeks after the onset of acute myocardial infarction, Group A had a larger left ventricular (LV) end-systolic volume index (LVESVI) and a lower LV ejection fraction (LVEF) than Group B (LVESVI: 38 +/- 13 vs 31 +/- 12 ml/m(2), P = 0.025: LVEF: 42% +/- 10% vs 51% +/- 10%, P = 0.004). Through multivariate analysis, independent predictors of poor LV systolic function (LVEF < 40%) were determined to be the presence of QRSDIS (odds ratio 21.04, P = 0.021) and proximal left anterior descending artery occlusion (odds ratio 16.15, P = 0.033). Myocardial damage could not be reduced in patients experiencing STEMI with QRSDIS, even when TIMI grade 3 flow could be achieved by primary PCI, as much as in patients experiencing STEMI without QRSDIS.

A 58-year-old man underwent cardiac catheterization for unstable angina. The coronary angiogram revealed severe stenosis of the right coronary artery. Although 20-MHz, phased-array intravascular ultrasound (IVUS) only visualized eccentric, low echoic plaque at the culprit site, optical coherence tomography (OCT) clearly revealed ruptured plaque and an intraluminal thrombus. OCT also revealed a small ruptured plaque and an eroded plaque with intraluminal thrombi in a distal site remote from the culprit lesion, neither of which was visualized by IVUS.

Background: Plaque rupture and secondary thrombus formation play key roles in the onset of acute coronary syndrome (ACS). One pathological study suggested that the morphologies of plaque rupture differed between rest-onset and exertion-triggered rupture in men who experienced sudden death. The aim of the present study was to use optical coherence tomography to investigate the relationship in patients with ACS between the morphology of a ruptured plaque and the patient's activity at the onset of ACS., Methods and Results: The study population was drawn from 43 consecutive ACS patients (with or without ST-segment elevation) who underwent optical coherence tomography and presented with a ruptured plaque at the culprit site. Patients were divided into a rest group and an exertion group on the basis of their activities at the onset of ACS. The thickness of the broken fibrous cap correlated positively with activity at the onset of ACS. The culprit plaque ruptured at the shoulder more frequently in the exertion group than in the rest group (rest 57% versus exertion 93%, P=0.014). The thickness of the broken fibrous cap in the exertion group was significantly higher than in the rest-onset group (rest onset: 50 microm [interquartile median 15 microm]; exertion: 90 microm [interquartile median 65 microm], P<0.01)., Conclusions: The morphologies of exertion-triggered and rest-onset ruptured plaques differ in ACS patients. Our data suggest that a thin-cap fibroatheroma is a lesion predisposed to rupture both at rest and during the patient's day-to day activity, and some plaque rupture may occur in thick fibrous caps depending on exertion levels.

Objectives: The aim of the present study was to compare lesion morphologies after sirolimus-eluting stent (SES) implantation between patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) with the use of optical coherence tomography (OCT)., Background: The lesion morphologies before and after coronary stenting have been proposed as important predictors of clinical outcome. The high resolution of OCT provides detailed information of coronary vessel wall., Methods: We enrolled 55 patients (UAP: n = 24, SAP: n = 31), and examined lesion morphologies by using OCT at pre- and post-SES implantation and 9 months' follow-up., Results: The incidence of plaque rupture (42% vs. 3%, p < 0.001), intracoronary thrombus (67% vs. 3%, p < or = 0.001) and thin-capped fibroatheroma (cap thickness <65 microm; 46% vs. 3%, p < 0.001) at pre-intervention was significantly greater in UAP than that in SAP. Although stent profiles and procedural characteristics were not different between the 2 groups, inadequate stent apposition (67% vs. 32%, p = 0.038) and tissue protrusion (79% vs. 42%, p = 0.005) after percutaneous coronary intervention were observed more frequently in patients with UAP. Plaque rupture was significantly increased after percutaneous coronary intervention in patients with UAP (42% to 75%, p = 0.018), and the persistence of core cavity after plaque rupture (28% vs. 4%, p = 0.031) at 9 months' follow-up was observed more frequently in UAP patients compared with SAP patients. At 9 months' follow-up, the incidence of inadequately apposed stent (33% vs. 4%, p = 0.012) and partially uncovered stent by neointima (72% vs. 37%, p = 0.019) was significantly greater in UAP patients than that in SAP patients. All patients took aspirin and ticlopidine during follow-up period, and no patients had stent thrombosis or adverse coronary events., Conclusions: Serial OCT examinations demonstrated markedly different vascular response up to 9 months after SES implantation between UAP and SAP patients. Although the inadequate lesion morphologies after stenting were observed more frequently in UAP patients, these findings were not associated with adverse outcomes in patients with antiplatelet therapy.

Objectives: The purpose of this study was to assess the relationship between plaque color evaluated by coronary angioscopy and fibrous cap thickness estimated by optical coherence tomography (OCT) in vivo., Background: Yellow color intensity of coronary plaque evaluated by coronary angioscopy might be associated with plaque vulnerability., Methods: Seventy-seven coronary artery plaques in patients with acute coronary syndrome were observed by angioscopy and OCT. Plaque color was graded as white, light yellow, yellow, or intensive yellow., Results: There were significant differences among the groups classified by plaque color with respect to the fibrous cap thickness estimated by OCT: 389 +/- 74 mum in white plaques, 228 +/- 51 microm in light yellow plaques, 115 +/- 28 microm in yellow plaques, and 59 +/- 14 microm in intensive yellow plaques (p < 0.0001). In Spearman rank-order correlation analysis, there was a significant negative correlation between yellow color intensity and fibrous cap thickness (p < 0.0001). Furthermore, 80% of intensive yellow plaques were thin cap fibroatheroma with a cap thickness of < or =65 microm., Conclusions: The plaque color in coronary angioscopy was determined by the fibrous cap thickness, which was assessed by OCT. Although coronary angioscopy remains a specialized research tool, it might allow us to evaluate plaque vulnerability.

Objective: The purpose of this study was to propose our CT-based planning approach for knee arthroplasty on the basis of the femoral flexion-extension (FE) axis, and to evaluate whether this approach was valid by comparing the results with those obtained using conventional anterior-referenced planning., Materials and Methods: Virtual implantation of a sagittal single-radius component was performed in 34 normal knees. The transepicondylar axis (TEA) was identified as the FE axis, and was modified in the coronal plane to intersect the femoral mechanical axis at a right angle, if necessary. The implant was then selected that had a radius closest to the distance between the modified TEA and the distal condyle end. The implant position and size were compared for the two plans., Results: In almost all cases, slight modification of the TEA was required. However, there was no significant change in the distance from the TEA to the posterior and distal condyles. In comparison to the results obtained with our planning approach, the conventional plan resulted in antero-superior deviation of the implant sagittal center to the FE axis and/or selection of a larger size of prosthesis., Conclusion: Although the TEA must be modified slightly when referencing it as the FE axis, our planning approach may be valid for femoral single-radius components because the single axis of the component could be matched with the FE axis.

We evaluated the effects of conventional hand rasping and robotic milling on the clinical and radiographic results of cementless total hip arthroplasty, with the same computed tomography (CT)-based 3-dimensional preoperative planning using a ROBODOC workstation (Integrated Surgical Systems, Davis, Calif). The robotic milling group consisted of 78 hips, and the hand-rasping group 78 hips. The radiographic findings from the preoperative planning and postoperative CT data were evaluated using the most accurate CT images reconstructed by the ROBODOC workstation. The robotic milling group showed significant superior Merle D'Aubigne hip score at 2 years. In the robotic milling group, there were no intraoperative femoral fractures, and a radiographically superior implant fit was obtained. Hand rasping had the potential to cause intraoperative femoral fractures, undersizing of the stem, unexpectedly higher vertical seating, and unexpected femoral anteversion causing inferior implant fit.

We have comprehensively identified the genes whose expressions are augmented in bone marrow-derived mononuclear cells (BMMC) from patients with Rheumatoid Arthritis (RA) as compared with BMMCs from Osteoarthritis (OA) patients, and named them AURA after augmented in RA. Both stepwise subtractive hybridization and microarray analyses were used to identify AURA genes, which were confirmed by northern blot analysis and/or reverse transcription polymerase chain reaction (RT-PCR). We also assessed their expression levels in individual patients by quantitative real-time RT-PCR. Of 103 AURA genes we have identified, the mRNA levels of the following 10 genes, which are somehow related to immune responses, were increased in many of the RA patients: AREG (=AURA9), FK506-binding protein 5 (FKBP5 = AURA45), C-type lectin superfamily member 9 (CLECSF9 = AURA24), tyrosylprotein sulfotransferase 1 (TPST1 = AURA52), lymphocyte G0/G1 switch gene (G0S2 = AURA8), chemokine receptor 4 (CXCR4 = AURA86), nuclear factor-kappa B (NF-kappaB = AURA25) and two genes of unknown function (FLJ11106 = AURA1, BC022398 = AURA2 and XM&#95;058513 = AURA17). Since AREG was most significantly increased in many of the RA patients, we subjected it to further analysis and found that AREG-epidermal growth factor receptor signaling is highly activated in synovial cells isolated from RA patients, but not in OA synoviocytes. We propose that the expression profiling of these AURA genes may improve our understanding of the pathogenesis of RA.

We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.

Purpose: To examine ocular findings in Japanese patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis., Methods: A retrospective study was conducted. Information on the ocular, cutaneous, systemic, and virologic findings on pediatric and adult patients was obtained from medical records., Results: A total of 77 (45 male and 32 female) patients were enrolled in the study: 4 children had varicella, 68 adults had herpes zoster ophthalmicus, and 5 adults had acute retinal necrosis. Children with varicella had eruptions on the eyelid. Patients with herpes zoster ophthalmicus had eruptions, conjunctivitis, keratitis, iridocyclitis, and other findings. Patients with acute retinal necrosis had intracameral cells and retinal lesions. Some patients with herpes zoster ophthalmicus had malignancy, type 2 diabetes mellitus, or other disease. One pregnant woman developed acute retinal necrosis shortly after varicella infection. A total of 48% of patients with negative Hutchinson sign had ocular lesions, while all patients with positive sign showed ocular lesions. Patients with varicella and herpes zoster ophthalmicus had good visual acuity at the last visit. Some patients with acute retinal necrosis had poor visual acuity at the last visit., Conclusions: Patients with varicella, herpes zoster ophthalmicus, and acute retinal necrosis had several ocular complications. Some patients with acute retinal necrosis had poor visual outcomes. Ophthalmologists should be aware that acute retinal necrosis may develop shortly after varicella infection., (Copyright 2005 S. Karger AG, Basel.)

We constructed a 4-dimensional musculoskeletal model for patients who have undergone total hip arthroplasty (THA), which aimed to simulate the movement of the patient's inner body structure and estimate the complications that can arise with THA. The model reflects patient-specific characteristics of the bone geometry, implant alignment and hip movement. In order to estimate the direction of the muscle force and the length of the muscles, we developed a string-type muscle model that represents the route of the muscles. The strings expand and contract according to the movement of the origin and insertion location of the muscle. We developed models for the seven muscles related to movement of the hip joint. By using this model, clinicians will be able to predict the possibility of dislocation or recognize the actual causes of dislocation, as well as any possible influences the muscle may have on dislocation.

The purpose of this study was to evaluate the clinical accuracy of femoral canal preparation using postoperative reconstructed computed tomography (CT) images of 75 consecutive total hip arthroplasties performed with a two-pin-based ROBODOC system. Intraoperatively, the robot milled the femoral canal according to the preoperative planning performed with preoperative CT data and the ROBODOC workstation. Postoperative CT data was obtained 1 month postoperatively. Anteroposterior and lateral synthetic radiographs and axial images were reconstructed from CT data on the workstation. The mean difference between the preoperative planning and the postoperative CT images was less than 5% in canal fill, less than 1 mm in gap, and less than 1 degrees in the mediolateral and anteroposterior alignment. Clinical femoral canal preparation using the ROBODOC system results in a high degree of accuracy.

The objective of the study was to investigate the effects of baicalin, baicalein, and wogonin (plant flavonoids) on interleukin-6 (IL-6) and interleukin-8 (IL-8) protein production, mRNA expression, and nuclear factor-kappaB (NF-kappaB) binding activities induced by interleukin-1beta (IL-1beta) in human retinal pigment epithelial cell line (ARPE-19) cells. To induce IL-6 and IL-8 mRNA expression and protein levels, IL-1beta was added to serum-free medium of ARPE-19 cells and incubated. The flavonoids were added to the medium. IL-6 and IL-8 in the media were measured using enzyme-linked immunosorbent assay. Both IL-6 and IL-8 mRNA were measured by semiquantitative reverse transcription polymerase chain reaction. The binding activities of the transcription factor NF-kappaB complexes to IL-6 and IL-8 were measured by electrophoretic mobility shift assay. IL-6 and IL-8 in the culture media of ARPE-19 cells were increased by IL-1beta in a dose-dependent manner. Baicalin did not suppress IL-1beta-induced IL-6 and IL-8 production, but dexamethasone, baicalein, and wogonin, significantly suppressed IL-6 and IL-8 production. Elevation of IL-6 and IL-8 mRNA was not suppressed by baicalin but was significantly suppressed by dexamethasone, baicalein, and wogonin. NF-kappaB binding activities were not suppressed by baicalin and baicalein, but was suppressed by wogonin. Wogonin and baicalein inhibited IL-1beta-induced IL-6 and IL-8 mRNA and protein production in ARPE-19 cells. The data suggest that wogonin may inhibit IL-6 and IL-8 mRNA expression via the suppression of NF-kappaB binding activities.

Purpose: To evaluate the effect of topical instillation of traditional herbal medicines, herbal extracts, and their components on the elevation of aqueous flare induced by prostaglandin E(2) (PGE(2)) in pigmented rabbits., Methods: Transcorneal diffusion of 25 micro g/mL of PGE(2) was carried out through a glass cylinder placed on the cornea to induce aqueous flare elevation in pigmented rabbits. Traditional herbal medicines, herbal extracts, and their components were topically instilled before the PGE(2) application. Aqueous flare was measured with a laser flare-cell meter., Results: Two instillations, 60 and 30 minutes before PGE(2), of Kakkon-to, Sairei-to, Orengedoku-to, Senkanmeimoku-to, Scutellariae radix extract, Coptidis rhizoma extract, Gardeniae fructus extract, Phellodendri cortex extract, baicalein, baicalin, wogonin, crocetin, berberine, or glycyrrhizine did not inhibit the elevation induced by PGE(2). Two instillations, 60 and 30 minutes before PGE(2), of a Ligusticum wallichii extract (100 mg/mL) inhibited the elevation by 20%. Two instillations (5 and 3 hours before PGE(2)) of baicalein (1 mg/mL) or baicalin (5 mg/mL) inhibited the elevation by 16% and 24%, respectively. Two instillations, 5 and 3 hours before PGE(2), of wogonin, crocetin, berberine, or glycyrrhizine did not inhibit the elevation., Conclusion: Two instillations of Ligusticum wallichii extract 60 and 30 minutes before the PGE(2), and two instillations of baicalein or baicalin, 5 and 3 hours before the PGE(2), inhibited the PGE(2)-induced aqueous flare elevation in pigmented rabbits.

Little is known about scintigraphic image patterns in the various stages of coxarthrosis. We assessed bone scintigraphy in 159 patients (210 hips) with dysplastic arthrosis of the hip. Scintigraphic images were divided into 5 types related to the radiographic stages of the disease. The scintigraphic images showed little, if any, uptake in the stage of prearthrosis. In the early stage, we found an increase in uptake in the weight bearing area in 30% of cases. In the advanced stage, more than half of the cases had an increase in uptake in the medial side of the joint and in the weight bearing area. In the terminal stage, a marked increase in uptake in the weight bearing area was commonest. Since the osteoblastic reaction intensified, a marked increase in uptake was seen not only in the weight bearing area, but also throughout the entire joint. These types of scintigraphic patterns, which change with the stage of coxarthrosis, seem to reflect the natural course of the disease. All hips with rapid progression of the disease showed a marked increase in uptake of radionuclide the entire joint at earlier stages.

Postprandial hyperglycemia has been shown to increase the risk of cardiovascular disease as much as overt diabetes mellitus does. The aim of this study was to determine whether isolated post-challenge hyperglycemia during an oral glucose tolerance test (OGTT) is related to exaggerated neointimal proliferation after coronary stent implantation. Forty seven coronary lesions treated with stents in 40 patients who had normal fasting glucose levels (<110 mg/dl) were categorized into the following 2 groups according to the results of a 75-g OGTT: 29 lesions in 24 patients with normal glucose tolerance (NGT group) and 18 lesions in 16 patients with abnormal glucose tolerance (AGT group). Although there were no differences in angiographic characteristics before and immediately after stenting between the 2 groups, the minimal lumen diameter was significantly smaller (p=0.04) and the degree of stenosis and late loss were also significantly greater (p=0.01 and p=0.047) in the AGT group than in the NGT group at 6-month follow-up. Multiple regression analysis including the insulin concentrations during an OGTT revealed that the 120-min plasma glucose concentration after glucose load significantly correlated with late loss (p=0.0018) and the degree of stenosis (p=0.0100) at follow-up. It is concluded that isolated post-challenge hyperglycemia exaggerates neointimal hyperplasia after coronary stent implantation.

The salient histopathologic features of low-grade adenocarcinoma of the fetal lung type (L-FLAC)/well-differentiated fetal adenocarcinoma (WDFA) include complex glandular structures and morules with biotin-rich optically clear nuclei. Interestingly, these characteristic features are shared by the cribriform-morular variant of papillary thyroid carcinoma, whose morphology is identical to that of familial adenomatous polyposis (FAP)-associated thyroid carcinoma. Furthermore, the single reported case of lung cancer associated with FAP was L-FLAC/WDFA. These observations lead us to hypothesize that up-regulation of the Wnt signaling pathway underlies the development of L-FLAC/WDFA. To verify this hypothesis, 11 cases of L-FLAC/WDFA, including the one FAP-associated case, eight cases of high-grade adenocarcinoma of the fetal lung type (H-FLAC), 24 cases of conventional pulmonary adenocarcinoma (CAC), and 13 fetal lungs were immunostained for beta-catenin. All cases of L-FLAC/WDFA showed predominantly aberrant nuclear/cytoplasmic expression, especially in budding glands and morules, whereas six of eight cases (75%) of H-FLAC and all but one case (96%) of CAC showed predominantly membranous expression. Fetal lungs showed nuclear/cytoplasmic expression restricted to the distal branching airway epithelium. Mutational analysis of exon 3 of the beta-catenin gene in five sporadic cases of L-FLAC/WDFA showed a point mutation at codon 34 and codon 37 in two cases, respectively. The present study indicates that up-regulating disturbances in the Wnt signaling pathway, including mutation of the beta-catenin gene, underlie tumorigenesis of L-FLAC/WDFA. The expression pattern of beta-catenin in L-FLAC/WDFA resembles that of the developing fetal lung airway. With the expression pattern of beta-catenin as a marker, most cases of H-FLAC as well as CAC appear to have different oncogenic pathways from cases of L-FLAC/WDFA. The present study together with other available data also suggests that abnormal up-regulation of the Wnt signaling pathway may be a common denominator for the development of tumors with morular formation from a variety of anatomic sites.

We investigated the effects of Orengedoku-to (huanglian-jie-du-tang in Chinese) and Scutellariae radix extract on experimental aqueous flare elevation in pigmented rabbits. To produce the elevation of aqueous flare in rabbits, interleukin-1 alpha (IL-1alpha) was injected intravitreally. Animals were pretreated with oral administration of 150 g/day of food containing 0.07%, 0.2% or 0.7% (w/w) Orengedoku-to; or 0.02%, 0.07% or 0.2% Scutellariae radix extract for 5 days. The animals were further treated with the same food for 7 days after intravitreal injection of IL-1alpha. Aqueous flare was measured with a laser flare-cell meter. Treatment with 0.2% or 0.7% Orengedoku-to and 0.07% or 0.2% Scutellariae radix extract significantly (p < 0.05) suppressed elevation of aqueous flare induced by IL-1alpha. Thus, orengedoku-to and Scutellariae radix extract have an inhibitory effect on experimental elevation of aqueous flare induced by IL-1alpha in rabbits.