Rhodanthpyrone A and B play an anti-inflammatory role by suppressing the nuclear factor-κB pathway in macrophages

Macrophage-associated inflammation is crucial for the pathogenesis of diverse diseases including metabolic disorders. Rhodanthpyrone (Rho) is an active component of Gentiana rhodantha, which has been used in traditional Chinese medicine to treat inflammation. Although synthesis procedures of RhoA and RhoB were reported, the biological effects of the specific compounds have never been explored. In this study, the anti-inflammatory activity and mechanisms of action of RhoA and RhoB were studied in lipopolysaccharide (LPS)-stimulated macrophages. Pretreatment with RhoA and RhoB decreased inducible nitric oxide synthase and cyclooxygenase-2 expressions in RAW 264.7 cells and in thioglycollate-elicited mouse peritoneal macrophages. In addition, it downregulated transcript levels of several inflammatory genes in LPS-stimulated RAW 264.7 cells, including inflammatory cytokines/chemokines (Tnfa, Il6, and Ccl2) and inflammatory mediators (Nos2 and Ptgs2). Macrophage chemotaxis was also inhibited by treatment with the compounds. Mechanistic studies revealed that RhoA and RhoB suppressed the nuclear factor (NF)-κB pathway, but not the canonical mitogen activated protein kinase pathway, in LPS-stimulated condition. Moreover, the inhibitory effect of RhoA and RhoB on inflammatory gene expressions was attenuated by treatment with an NF-κB inhibitor. Our findings suggest that RhoA and RhoB play an anti-inflammatory role at least in part by suppressing the NF-κB pathway during macrophage-mediated inflammation.

Accuracy of mitral valve area in patients with mitral stenosis measured by echocardiography : Compared with operative mitral valve area

BACKGROUND: Measurement of echocardiographic mitral valve area (MVA) is an useful noninvasive method of estimating the stenotic mitral valve area. This study was undertaken to evaluate the accuracy of echocardiographic MVA measurement by comparing MVAs measured by the planimetric and pressure half-time method versus direct MVA measurement by using a cone shaped device specifically made for direct measurement of MVA. METHODS AND RESULTS: The study population consisted of 22 consecutive patients from August 1993 to February 1996. All the patients underwent 2D planimetry and Doppler echocardiographic MVA measurement before and after valve replacement surgery ; direct measurement also was performed after surgery. Five patients (22.7%) had normal sinus rhythm, and the rest of the patients had atrial fibrillation. Two-dimensional echocardiographic examinations were attempted in 22 patients, and adequate measurements were obtained in 21 of the patients studied. Mean mitral valve area were 0.99+/-0.32cm (2) ranged from 0.42 to 1.68cm (2) on 2D planimetry method, 0.93+/-0.32cm (2) ranged from 0.42 to 1.68cm (2) on Doppler pressure half-time method, 1.17+/-0.20cm (2) ranged from 0.93 to1.68cm (2) on direct measurement of mitral valve area after surgery. 2D planimetry method (r=0.621, p=0.003, SE=0.165), pressure half-time method (r=0.454, p=0.003, SE=0.187), and transmitral peak velocity (r=-0.480, p=0.026, SE=0.189) was relatively well correlate with operative mitral valve area. There was relatively good agreement between direct and 2D planimetric measurement and between direct and Dopler pressure-half time method. CONCLUSION: 2D planimetry and Doppler pressure half-time method on echocardiography are useful, noninvasive measurement method in patients with mitral stenosis.

Clinical Characteristics of Acute Myocardial Infarction Died during Hospitalization

BACKGROUND: Recently, the incidence of acute myocardial infarction (AMI) rapidly increased with prolongation of life spans, improvements of food and life styles in Korea. The mortality rate of AMI is higher than other disease. The purpose of this study is to evaluate which factors can affect the early outcome of AMI in Korean. METHODS: A retrospective clinical study was done on 555 consecutive patients{Male:Female=387 (69.7%):168 (30.3%), mean age 61.3 years} with AMI who had been admitted to Dong-San Medical Center from January 1990 to May 1997 . The subjects were devided into two groups. Group I was dead patients during the in-hospital period (85 patients, 15.3%), and Group II was living patients (470 patients, 84.7%) wen they discharged from hospital. We compared clinical and laboratory results in both groups and analysed the cause of death according to the time of death during hospitalization. RESULTS: The results were as folows; 1) The mean age and female percentage of Group I (65.4 years, 43%) were higher than Group II (60.5 years, 28%). The mean of systolic/diastolic blood pressure and percentage of smoker of Group I (108/65mmHg, 48%) were lower than Group II (125/76mmHg, 65%), significantly. 2) The degree of Killip classification was higher in Group I (class 1:29.4%, II:18.8%, III:21.2%, IV:30.6%) than in Group II patients (class 1:73.4%, II:13.6%, III:8.7%, IV:4.3%), significantly. 3) 47 patients were died first day of hospitalization and the most common cause of death was cardiogenic shock (27 patients, 31%). The most common cause of death within 1 week was cardiogenic shock, afterthen congestive heart failure. 4) The most common cause of death in Killip class I patients was ventricular tachycardia or ventricular fibrillation and in Killip class II-IV patients was cardiogenic shock. CONCLUSION: The risk of in-hospital death was higher in elderly, female sex, and patients with higher killip classification. Cardiogenic shock was most common cause of death within 1 week, and was congestive heart failure after 1 week.

Clinical Features and Long-Term Follow-up Results in Fifty Four Patients with Aortic Dissection

BACKGROUND: Aortic dissection is an uncommon disease but early mortality is as high as 1 percent per hour if untreated. However, major advances in the prompt noninvasive diagnosis and in the medical and surgical treatment of aortic dissection now improve the survival rate to an 75~82% of 5-year survival rate. In order to determine clinical features and long-term follow up results of patients with aortic dissection in Korea, we present a retrospective review of 54 patients with aortic dissection at our institute. METHODS: We review the medical records, echocardiograms and computed tomogram(CT) or magnetic resonance imaging(MRI) of 54 patients(mean age: 59+/-12 years, male: 27) who had aortic dissection between September 1991 and July 1997. Patients were classified according to DeBakey type. Clinical features were evaluated in relation to type. Long-term survival rate using Kaplan-Meier method were also evaluated in relation to type, sex and presence of undertaking operation. RESULTS: Of the 54 patients with aortic dissection, twenty two(41%) were classified to type I, eight(15%) to type II and twenty four(44%) to type III. Age(type I: 60 yrs, type II: 60 yrs, type III: 57 yrs), sex(male in type I: 10(45%)type II: 4(50% ), type III: 13(54%)) and pulse rate(type I: 84, type II: 75, type III: 78) according to the type of aortic dissection show no signifiant difference. In regarding to predisposing factors, hypertension was found in 40(74%) overall, Marfan syndrome 1(2%), bicuspid aortic valve 4(7%), and iatrogenic vascular injury 3(6%). Four-year survival rate was 48% in all patients who were followed for 28+/-26 months(1-168 months), 61% in type I, 44% in type II and 44% in the III. But, there are no statistically significant difference in 4-year survival rate according to type and sex or presence of undertaking operation(data not shown). There are many kinds of cause of death; multi-organ failure, renal failure, congestive heart failure, sepsis, ruptured aortic dissection, gastrointestinal bleeding, cerebrovascular disease and postoperative weaning failure in the dead patients from aortic dissection. And also we found that there are some kinds of cause of death not directly related with aortic dissection(sepsis, gastrointestinal bleeding and cerebrovascular disease) in patients, especially in type III. CONCLUSION: Overall four-year survival rate in patients with aortic dissection was 48% and there were no significant differences in survival rate accoring to type, sex and presence of undertaking operation. There were many kinds of cause of death in patients with aortic dissection and some causes of death was not directly related with aortic dissection. The survival rate in patients with aortic dissection will be increased by strict control of blood pressure and optimal timing of operation before development of aortic rupture.

A Case of Complete Papillary Muscle Rupture after Blunt Chest Trauma Confirmed by Transesophageal Echocardiography

Acute mitral regurgitation associated with rupture of papillary muscle is a rare complication of blunt chest trauma. Echocardiographic information is very useful in the diagnosis of papillary muscle rupture, evaluation of left ventricular function and other abnoramlity of heart. The value of transthoracic echocardiography in blunt chest trauma is limited because patients with severe chest wall injury often have suboptimal echocardiographic fingings. But transesophageal echocardiography can provide high quality images when the transthoracic echocardiographic image quality is poor. We report 27 year-old female with papillary muscle rupture after blunt chest trauma in whom transthoracic echocardiography could not provide a prompt diangosis, but definitive evidence of papillary muscle rupture was demonstrated by transesophageal echocardiography.

Clinical Status in Patients Who Restrictive Pattern on Doppler Transmitral Flow Pattern

BACKGROUND: Restrictive pattern on Doppler transmitral flow pattern represent reduced left ventricular compliance and associated with poor prognosis in patients with systolic dysfunction due to congestive heart failure or myocaridal infarction. Although there are many clinical evaluation about clinical significance of restrictive transmitral flow pattern, investigation about what kinds of disease reveal the characteristic restrictive transmitral flow pattern and significance according to criteria of restrictive transmitral flow pattern is few. Therefore, we have analyzed patients with restrictive transmitral flow pattern in order to evaluate clinical diagnosis and clinical significance according to criteria of restrictive transmitral flow pattern. METHODS: The study population consisted of 229 patients(male 129 patients, female 102 patients, mean age 40.6 years old) who show E/A ratio p 2 on Doppler echocardiography from september 1994 to aprial 1996. We have reviewed the medical records of that patients. RESULTS: 1) In case of patients more than 2 at E/A ratio, we found that subjects not related with cardiovascular diseases were 76 persons(33.2%), valvular heart disease 75 patients(32.3%), ischemic heart disease 25 patients(10.9%), cardiomyopathy 16 patients(6.9%). Among valvular heart disease, mitral regurgitation was most frequently observed(44.5%). In these patients, patients with left ventricular systolic dysfunction were 60 patients(26.2%). 2) Patients more than 2 at E/A ratio and less than 150msec at deceleration time of E wave were 126 patients(55.0%). In these patients, we found that valvular heart disease was also most frequently observed(49 patients, 38.8%), subjects not related with cardiovascular diseases 30 persons(23.8%), cardiomyopathy 15 patients(11.9%),pericarditis 7 patients(5.6%), hypertension 3 patients(2-3%). Patients with left ventricular systolic dysfunction in this group were 39 patients(31.0%). CONCLUSION: Although restrictive transmitral flow pattern on Doppler echocardiography represents reduced compliance of left ventricle or severe heart failure in patients with symptoms of congestive heart failure, this pattern also may be seen in persons not related with cardiovascular disease. Therefore, when making dicision about clinical significance of restrictive pattern, one should consider about any factors can influece the transmitral flow pattern and correlate the clinical diagnosis with mitral flow velocity.