Validation of a Handprint for Clinical Evaluation of Dupuytren's Contracture.

Objective We have developed a handprint-based method for visualizing and quantifying the palmar contact of patients with Dupuytren's contracture. The purpose of this study was to examine whether the generated handprint was useful for assessing the severity of flexion contracture of the fingers and for evaluating the therapeutic effects of collagenase clostridium histolyticum (CCH) injection for Dupuytren's contracture. Methods The handprint was created by applying medical-grade ethanol-containing hand sanitizer over the entire palmar surface of the affected hand and then pressing it on thermal paper for word processors. The reliability of the handprint was evaluated through test-retest of 10 healthy volunteers at an interval of 10 days, and the validity of the handprint was assessed using a flexion contracture model in which the little finger was fixed in an Alfence splint. In addition, we obtained handprints of the affected hand in 33 patients with unilateral Dupuytren's contracture both before CCH injection and at the final observation after injection to investigate the contact area of the hand (CAH) and the length of the hand (LH). The relationships between CAH, LH, total extension deficit angle (TEDA), and patient-reported outcome measures (Japanese Society for Surgery of the Hand Version of the Quick Disability of Arm, Shoulder, and Hand Questionnaire [Quick DASH-JSSH] and Hand20) were examined. Results The test-retest correlation coefficient was 0.9187 ( p < 0.001) for CAH and 0.9052 ( p < 0.001) for LH, indicating high reliability of the handprint. The ratios of CAH and LH decreased gradually as the contracture angle of the splinted finger increased. The handprint revealed a marked improvement of palmar contact after CCH injection for Dupuytren's contracture. Furthermore, the ratios of CAH and LH were strongly correlated with TEDA, Quick DASH-JSSH, and Hand20 before treatment. Conclusion Our handprint-based assessment method was extremely useful for clinical evaluation of CCH treatment for Dupuytren's contracture. Type of Study/Level of Evidence Therapeutic.

A unidirectional porous beta-tricalcium phosphate promotes angiogenesis in a vascularized pedicle rat model.

BACKGROUND: Various types of artificial bone have been developed as alternatives to autologous bone grafts. In designing artificial bone, a porous structure is essential for the infiltration of blood and cells, which promotes angiogenesis within the bone matrix and ultimately ossification. However, it remains unclear what kind of pore system best promotes ossification. Here, we investigated angiogenesis in three different types of porous ß-tricalcium phosphate (ß-TCP) in a vascularized pedicle rat model. METHODS: Three types of porous ß-TCP-ß-TCP60 (60% porosity), ß-TCP75 (75% porosity), and unidirectional porous ß-tricalcium phosphate (UDPTCP; 57% porosity)-were examined. A cylindrical piece of artificial bone was implanted beneath the superficial inferior epigastric (SIE) vessels in the groin of rats and angiogenesis was allowed to occur. Two weeks after surgery, India ink or lectin was systemically injected to detect newly formed blood vessels originating from the SIE vessels. Immunohistochemistry for von Willebrand factor, α-smooth muscle actin, or type IV collagen was performed to clarify the structural features of the newly formed capillaries within the vascularized UDPTCP. RESULTS: The vascularity of the UDPTCP was superior to that of ß-TCP60 and ß-TCP75. The UDPTCP pore structure was completely filled with capillaries at 3 weeks after implantation. Immunohistochemistry showed that the walls of the capillaries contained endothelial cells, pericytes, and basement membrane originating from the SIE vessels, and that the cells proliferated and the basement membrane formed simultaneously as the newly formed capillaries extended through the unidirectional pore structure of the UDPTCP. CONCLUSIONS: UDPTCP had greater angiogenic potential than ß-TCP60 and ß-TCP75 in a vascularized pedicle rat model. Vascularized UDPTCP grafts may be an alternative to vascularized autologous bone grafts.

Synchronized Collective Proton-Assisted Electron Transfer in Solid State by Hydrogen-Bonding Ru(II)/Ru(III) Mixed-Valence Molecular Crystals.

A proton-coupled electron transfer (PCET) reaction was widely studied with isolated organic molecules and metal complexes in solution in view of the biological catalytic reaction, while studying this reaction in the crystalline or solid-state phase, which has a novel example, would give insight into the rather internal environment of proteins without solvation and a creation of new molecular materials. We tried to crystallize a hydrogen-bonded (H-bonded) coordination polymer with one-dimensional nanoporous channels, formed from redox-active RuIII complexes, [RuIII(Hbim)3] (Hbim- = 2,2'-biimidazolate monoanion). As a result, a synchronized collective PCET phenomenon was observed for the molecular nanoporous crystal by novel solid-state cyclic voltammetry (CV), which could be measured by only setting some crystals on the electrode surface. The nanoporous crystals, {[RuIII(Hbim)3]}n (1), are simultaneously induced to a synchronized collective RuIIRuIII mixed-valence state, {RuIIRuIII}n, with alternating arrays of RuII and RuIII complexes by PCET in a way of the reductive state of {RuIIRuII}n. Further, a new crystal with {RuIIRuIII}n, {[RuII(H2bim)(Hbim)2][RuIII(bim) (Hbim)2][K(MeOBz)6]}n (2), was also prepared, and the solid-state CV revealed the same electrochemical behavior of {RuIIRuIII}n with 1. The single crystal with {RuIIRuIII}n of 2 was unusually a semiconductor with 5.12 × 10-6 S/cm conductivity at 298 K by an impedance method (8.01 × 10-6 S/cm by a direct-current method at 277 K). Thus, an unprecedented electron-hopping conductor driven by a low-barrier proton transfer through a PCET mechanism (Ea = 0.30 eV) was realized in the H-bonding molecular crystal with {RuIIRuIII}n. Such studies on a PCET reaction in the crystalline state is not only worthwhile as a model of essential biological reactions without solvation, but also proposed to a new design of molecular materials to occur an electron transfer by using an intermolecular H-bond.

Effect of Artificial Nerve Conduit Vascularization on Peripheral Nerve in a Necrotic Bed.

BACKGROUND: Several types of artificial nerve conduit have been used for bridging peripheral nerve gaps as an alternative to autologous nerves. However, their efficacy in repairing nerve injuries accompanied by surrounding tissue damage remains unclear. We fabricated a novel nerve conduit vascularized by superficial inferior epigastric (SIE) vessels and evaluated whether it could promote axonal regeneration in a necrotic bed. METHODS: A 15-mm nerve conduit was implanted beneath the SIE vessels in the groin of a rat to supply it with blood vessels 2 weeks before nerve reconstruction. We removed a 13-mm segment of the sciatic nerve and then pressed a heated iron against the dorsal thigh muscle to produce a burn. The defects were immediately repaired with an autograft (n = 10), nerve conduit graft (n = 8), or vascularized nerve conduit graft (n = 8). Recovery of motor function was examined for 18 weeks after surgery. The regenerated nerves were electrophysiologically and histologically evaluated. RESULTS: The vascularity of the nerve conduit implanted beneath the SIE vessels was confirmed histologically 2 weeks after implantation. Between 14 and 18 weeks after surgery, motor function of the vascularized conduit group was significantly better than that of the nonvascularized conduit group. Electrophysiological and histological evaluations revealed that although the improvement did not reach the level of reinnervation achieved by an autograft, the vascularized nerve conduit improved axonal regeneration more than did the conduit alone. CONCLUSION: Vascularization of artificial nerve conduits accelerated peripheral nerve regeneration, but further research is required to improve the quality of nerve regeneration.

Acute aortic regurgitation due to aortic dissection confined to the sinus of Valsalva.

A 34-year-old man with severe heart failure was diagnosed with acute aortic regurgitation (AR) by transthoracic echocardiography (TTE). However, this differential diagnosis was incomplete. Only transesophageal echocardiography (TEE) revealed an intimal flap, leading to a diagnosis of Stanford type A aortic dissection. No abnormal findings were observed in the ascending aorta by contrast-enhanced computed tomography (CT). Aortic dissection confined to the sinus of Valsalva has rarely been reported; however, TEE should still be considered for the differential diagnosis of acute AR, even if there is no evidence of dissection by TTE or contrast-enhanced CT.

Risk analysis of feline immunodeficiency virus infection in Tsushima leopard cats (Prionailurus bengalensis euptilurus) and domestic cats using a geographic information system.

In this study, based on the data from FIV screening surveys of captive cats conducted by the Kyushu Veterinary Union and collaborators as part of the infection control program for Tsushima leopard cats (Prionailurus bengalensis euptilurus), we elucidated the spatial distribution of FIV-positive individuals among leopard cats and domestic cats using a geographic information system. Data from FIV screening surveys carried out among 86 leopard cats (1996-2006) and 713 captive domestic cats (2001-2006) were used for analysis. The analysis results were then spatially layered with the population density of leopard cats and that of captive domestic cats estimated from the number of households and used for assessment of FIV infection risk in each area. The prevalence rates of FIV were 3% (3/86) in leopard cats in Kami-shima, 13.6% (38/280) in domestic cats in Kami-shima and 10.6% (46/433) in domestic cats in Shimo-shima. The distribution of FIV on Tsushima Island was not uniform; on Kami-shima Island, FIV-positive domestic cats were concentrated in particular areas. We also performed risk analysis based on the population density of leopard cats, the prevalence rate of FIV among domestic cats in each area and the estimated population density of captive domestic cats and identified high FIV infection risk areas. All FIV-positive leopard cats were found in the identified high FIV infection risk areas.

Surveys on the prevalence of pediatric bronchial asthma in Japan: a comparison between the 1982, 1992, and 2002 surveys conducted in the same region using the same methodology.

BACKGROUND: We conducted and reported the first (1982; 55,388 subjects), and second (1992; 45,674 subjects), epidemiological surveys conducted on bronchial asthma in elementary students across 11 prefectures in western Japan. The 2 surveys were conducted in the same regions using the same methodology employing a modified Japanese version of the American Thoracic Society-Division of Lung Diseases (ATS-DLD) Epidemiology Questionnaire. We conducted the third survey in 2002, and compared the findings to those of previous studies. METHODS: In the third survey, 37,036 students attending the same schools as in previous surveys (in 11 prefectures) were given the questionnaire. A total of 35,582 responses (96.1%) were collected. An ATS-DLD Epidemiology Questionnaire was also used in this study, and the findings were compared to those of previous studies. RESULTS: 1. The prevalence of bronchial asthma (BA) in boys, girls, and all students was 3.8%, 2.5%, and 3.2%, respectively, for the first survey; 5.6%, 3.5%, and 4.6% for the second survey; and 8.1%, 4.9%, and 6.5% for the third survey. 2. A decline in the BA prevalence in older subjects which could be seen in the first survey was absent in the second and third surveys. There were no regional differences in the third survey. 3. The boys-to-girls ratio in the first, second, and third surveys was 1.5, 1.6, and 1.6, respectively. 4. BA was more prevalent among subjects with a past history of respiratory disease in infancy and those with a family history of allergic disease. 5. The prevalence of asthma symptoms and wheezing in the first, second, and third surveys was 7.1%, 9.8%, and 11.8%, respectively. 6. A comparison of the prevalence of other allergic diseases between the second and third surveys revealed a decrease in atopic dermatitis and an increase in allergic rhinitis, allergic conjunctivitis, and cedar pollinosis. CONCLUSIONS: BA prevalence in the third survey increased 2.1 and 1.4 times respectively compared to the first survey and second survey, indicating an upward trend in all regions and age groups surveyed.

Aging adversely affects postinfarction inflammatory response and early left ventricular remodeling after reperfused acute anterior myocardial infarction.

BACKGROUND AND AIMS: We have demonstrated that an increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of left ventricular (LV) remodeling. We sought to clarify the effect of aging on the postinfarction inflammatory response and LV remodeling. METHODS: We studied 102 patients who underwent primary angioplasty for a first anterior Q-wave AMI. Serum CRP levels, plasma neurohormones and interleukin-6 (IL-6) levels, and LV volume by left ventriculography were serially measured. Patients were divided into two groups according to their age (>or=70 years, n=33; <70 years, n=69). RESULTS: There was no difference in use of cardiovascular drugs and coronary angiographic findings. Older patients had a greater increase in LV end-diastolic volume during 2 weeks after AMI (p=0.0007) and a higher peak CRP level (12.4+/-7.3 vs. 5.5+/-4.2 mg/dl, p<0.0001), although peak CK level was comparable between the two groups. Plasma atrial natriuretic peptide, brain natriuretic peptide and IL-6 levels were higher in older patients at 2 weeks and 6 months after AMI. CONCLUSIONS: Augmented and prolonged activation of the inflammatory system after AMI was observed in older patients, in association with exaggerated LV remodeling. Aging may adversely affect LV remodeling through modification of the inflammatory response after AMI.

Lateral position prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal lymphoblastic lymphoma.

Lymphoblastic lymphoma, an aggressive mediastinal mass, is recognized as serious threat to the patient in developing cardiac tamponade or airway obstruction. Surgical procedure is often required to relieve clinical emergency and to establish prompt pathological diagnosis. However, in such a patient, acute respiratory occlusion in the spine position can be a life-threatening complication during general anesthesia. We describe a 17-year-old man whose cardiac tamponade was treated by pericardial-pleural window through a left anterior thoracotomy in the lateral position. The patient recovered from hemodynamic compromise without showing respiratory occlusion during general anesthesia and remained in the lateral position until extubation. Pathological diagnosis was precursor T-lymphoblastic lymphoma. There were no complications attributable to the operative procedure. Further chemotherapy reduced the mediastinal mass in size after two weeks when the patient developed sepsis and died. Lateral position prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal tumor with airway obstruction.

Beta-blockers are effective in congestive heart failure patients with atrial fibrillation.

BACKGROUND: It is controversial whether or not beta-blockers are effective in patients with congestive heart failure (CHF) who are complicated by persistent atrial fibrillation (AF). METHODS: We attempted to determine the potential differences in the efficacy between atrial fibrillation and sinus rhythm in 70 CHF patients with NYHA class II-IV and radionuclide ejection fraction (LVEF) <40% who received metoprolol or carvedilol over 16 weeks. RESULTS: Left ventricular end-diastolic dimension was decreased in AF group (n=24) 4 weeks (early) and 16 to 48 weeks (late) after introduction of beta-blockers (P<.05, P<.001), but not in the sinus rhythm (NSR) group (n=46). End-systolic dimension was decreased in both the AF group (P<.01, P<.0001) and the NSR group (P<.01, P<.0001). LVEF was increased in both the AF group (P<.0005, P<.0001) and the NSR group (P<.0001, P<.0001) early and late after the therapy. Increase in LVEF by the therapy tended to be higher in the AF group than in the NSR group (P=.056). Plasma brain natriuretic peptide level did not change significantly throughout the observation period, although the level tended to be lowered in the AF group late after introduction of beta-blockers (P=.093). CONCLUSIONS: Because beta-blockers are effective in both NSR and AF patients with CHF, such a mode of therapy should be recommended in patients with AF.

[Autoantibodies: new upstream targets of paroxysmal atrial fibrillation in patients with congestive heart failure].

OBJECTIVES: The clinical implications of autoantibodies (Abs) were investigated as upstream indicators of paroxysmal atrial fibrillation in patients with congestive heart failure. METHODS: Circulating Abs against myosin (M-Abs) detected by immunofluorescence, Abs against beta 1-adrenergic receptors (Beta 1-Abs) detected by enzyme-linked immunosorbent assay (ELISA), and Abs against NA-K-ATPase (NKA-Abs) detected by ELISA were screened in 95 congestive heart failure patients with < or = 45% left ventricular ejection fraction (coronary artery disease, n = 48; dilated cardiomyopathy, n = 47) and 48 age-matched control patients with hypertension. No patient received antiarrhythmic therapy. All patients were enrolled with angiotensin converting enzyme inhibitors in the chronic stable state. Relationship of the presence of paroxysmal atrial fibrillation to other clinical variables were assessed by 48-hour Holter monitoring. RESULTS: No control patient had Abs. However, M-Abs, Beta 1-Abs, and NKA-Abs were detected in 22%, 26% and 16% of patients with congestive heart failure (coronary artery disease; 8%, 10%, and 4%, dilated cardiomyopathy; 36%, 43%, and 28%, respectively). Paroxysmal atrial fibrillation was more frequent in patients with dilated cardiomyopathy than in those with coronary artery disease (47% vs 15%, p < 0.01). Multivariate analysis suggested that NKA-Abs was an independent risk factor for the occurrence of paroxysmal atrial fibrillation (p < 0.01), although there were no differences in other clinical factors: age, sex, New York Heart Association functional class, concomitant medication, left ventricular ejection fraction, left atrial diameter, severity of mitral regurgitation, serum potassium, plasma norepinephrine, and atrial natriuretic peptide concentration. CONCLUSIONS: Autoantibodies against sarcolemmal Na-K-ATPase were closely related to the occurrence of paroxysmal atrial fibrillation in patients with congestive heart failure, so an autoimmune process may be an upstream factor in atrial fibrillation.

Long-term effect of lipid-lowering therapy on atherosclerosis of abdominal aorta in patients with hypercholesterolemia: noninvasive evaluation by a new image analysis program.

Recent clinical studies have demonstrated that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are effective in the prevention of cardiovascular events and regression of atherosclerotic lesions evaluated by angiography. In this study, the authors investigated how lipid-lowering therapy effects on the progression of aortic atherosclerosis by using plain and enhanced computed tomography (CT) of the lower abdominal aorta. Twenty-nine hyperlipidemic patients (mean age 61.4 +/- 7.2 yr) were enrolled in a prospective open-labeled study. All patients underwent baseline CT scanning of abdominal aorta, screening for serum lipid profile and coagulation-fibrinolysis measurement, then treatment with simvastatin was begun. After 2 years, a follow-up CT scan was done and atherosclerotic lesions were compared between baseline and on-treatment scan. In spite of significant improvement of lipid and fibrinolytic profiles by simvastatin administration, mean aortic wall thickening volume (AWV) was increased during observation period. When patients were divided into subgroups by the levels of on-treatment LDL cholesterol (LDL-C), development rate of AWV was more potently suppressed in patients whose on-treatment LDL-C were below 125 mg/dL (median LDL-C). We could not find any associations of coagulation-fibrinolysis measurements with atherosclerotic lesions. In regard to aortic calcification volume (ACV), low levels of total and HDL cholesterol and higher age were associated with aortic calcification at baseline. These results suggest that aggressive treatment with LDL-C below 125 mg/dL may suppress the progression of wall thickening and factors that promote arterial calcifications and those for wall thickening may be different.

Constant variation in structure and function of geometrical isomers of acitretin under natural light.

Acitretin, a beneficial retinoid, was shown to undergo constant structural interconversions among its geometrical isomers (all-trans-acitretin, 9-cis-acitretin, 13-cis-acitretin, 9, 13-di-cis-acitretin, etc.) by photoisomerization under natural light. The photoisomerization was zero order reaction with an apparent velocity of 4x107 M/min under illumination by white fluorescent lamps (1, 200 lx). An equilibrium mixture of the geometrical isomers (all-trans-acitretin 20%, 9-cis-acitretin 15%, 13-cis-acitretin 30%, 9, 13-di-cis-acitretin 15%, and unidentified compounds 20%) was formed at around 30 min. Equilibrium mixtures with similar composition were obtained by photoisomerization reactions starting from other geometrical isomers. Geometrical isomers of acitretin thus formed, showed different effects to induce differentiation of human acute promyelocytic leukemia cells (HL-60 cells): activity of all-trans-acitretin (ED50, 3.2 x 10(-6) M), 9-cis-acitretin (ED50, 2.3 x 10(-5)M), 13-cis-acitretin (ED50, 1.1 x 10(-5)M), 9, 13-di-cis-acitretin (ED50, 2.6 x 10(-6)M). 9-cis-Acitretin acted synergistically with all-trans-acitretin, 13-cis-acitretin and 9, 13-di-cis-acitretin on HL-60 cells. On the other side, all-trans-acitretin, 13-cis-acitretin and 9, 13-di-cis-acitretin acted additively. Geometrical isomers of acitretin showed different effects on differentiation of human epidermal keratinocytes; expression of keratinocyte differentiation markers, keratin 1 and keratin 10, were suppressed more strongly by 9-cis-acitretin and 13-cis-acitretin as compared to all-trans-acitretin or 9, 13-di-cis-acitretin.