Effects of pharmacological lesion of the nucleus retroambiguus region on the pharyngeal phase of swallowing.

Pharyngeal swallowing is controlled by synaptic interactions within a swallowing central pattern generator (sw-CPG) that is composed of a dorsal and a ventral swallowing group (VSG). Here, we used electrical stimulation (10 s) of the superior laryngeal nerve (SLN; 20 Hz; pulse width: 100 µs) to explore the role of the VSG in an arterially-perfused brainstem preparation of rats. To investigate the effects of pharmacological lesion (local microinjection of an GABA(A)-R agonist) of the nucleus retroambiguus (NRA), a designated component of the VSG, we recorded phrenic (PNA) and vagal nerve (VNA) activities. Control SLN stimulation with stepwise increasing stimulus intensities (from 20 µA to 160 µA) elicited robust suppression of PNA and evoked sequential swallowing activity in the VNA. Lesioning of the NRA had no effect on the pattern of pharyngeal swallowing, but significantly increased the sensory gating of SLN inputs. We conclude that the NRA is not part of the VSG, but appears to have important roles for the central gating of swallowing.

Strategy for localized stenosis caused by Kawasaki disease: midterm results of percutaneous transluminal coronary balloon angioplasty in two infants.

We report the midterm results of percutaneous transluminal coronary balloon angioplasty (PCBA) for localized stenosis (LS) caused by Kawasaki disease (KD). Two 2-year-olds, a girl and a boy, underwent PCBA for severe LS of the left anterior descending artery caused by KD. After 4 years, there was no ischemia and no significant restenosis in the target vessels. PCBA provided a good result for early appearing LS caused by KD in two small infants. The 5-years-old boy was the youngest patient to undergo percutaneous transluminal coronary rotablator. Although the postprocedure result was very effective, 1 year later asymptomatic occlusion occurred.

Biosystematic studies on the family Tofieldiaceae I. Phylogeny and circumscription of the family inferred from DNA sequences of matK and rbcL.

In order to specify phylogenetic positions of the genera of Tofieldiaceae (Tofieldia, Triantha, Pleea, Harperocallis, Isidrogalvia), and to suggest reasonable circumscription of the family and genera of Tofieldiaceae, we determined DNA sequences of matK and rbcL for each genus of the family, and analyzed them phylogenetically with the 45 families and 113 genera of the monocots other than Tofieldiaceae, whose matK and rbcL sequences have already been reported. We found that Tofieldia, Triantha, Pleea, and Harperocallis form the same clade, which receives 100% bootstrap support. This clade can be regarded as corresponding to Tofieldiaceae, and is embedded in the clade of Alismatales (98%). On the other hand, Isidrogalvia is not included in this Tofieldiaceae clade, and positioned as sister to Narthecium (100%), embedded in the clade of Nartheciaceae (Dioscoreales) (100%). In the Tofieldiaceae, Pleea first diverges from the remaining three genera (100%), and then, Harperocallis diverges from the Tofieldia- Triantha complex (100%). In the Tofieldia- Triantha complex, five Tofieldia species form the same clade (100%), and two Triantha species form another clade (100%). Thus, Isidrogalvia should be transferred from Tofieldiaceae to Nartheciaceae. As Isidrogalvia, as well as the Nartheciaceae, have the carpels that are fully connate into a single style, Isidrogalvia fits the Nartheciaceae well with respect to carpel connation. After this transfer, the Tofieldiaceae correspond mainly to plants with almost free carpels and three styles. Pleea is better treated as an independent genus than included in Tofieldia. Triantha can be treated either as an independent genus or as congeneric with Tofieldia.

Acute occlusion of a simple aortic coarctation presenting as abdominal angina.

A 9-year-old boy whose past history was remarkable for a heart murmur was diagnosed with abdominal angina due to acute occlusion of a simple coarctation of the aorta. Using a single cross-clamp, we accomplished an end-to-end anastomosis after resection of the coarctation. Paradoxical hypertension and abdominal angina were treated successfully with a continuous intravenous infusion of lipo-PGE-1 and nicardipine. Three years after his operation, the patient's blood pressure was normal, with no stenosis at the site of the anastmosis.

Antithrombin modulates the leukocyte-endothelial cell interaction in the staphylococcal enterotoxin B-challenged mouse.

BACKGROUND: The beneficial effects of antithrombin on endotoxemia are well known. The purpose of this study was to examine the effects of antithrombin in a supertoxin-induced sepsis. METHODS: Mice were injected with staphylococcal enterotoxin B simultaneously with antithrombin. At 1 hour after injection, the mesenteric microcirculation was observed under intravital microscopy. In addition, humoral mediators were measured at the same time. RESULTS: The number of rolling leukocytes on the endothelium was significantly reduced in the treated mice (p < 0.01). The decrease of white blood cell and platelet counts was significantly inhibited in the treated animals (p < 0.01 for both). A comparison of the intercellular adhesion molecule-1 (p < 0.05), soluble tumor necrosis factor-alpha receptor (p < 0.05), and interleukin-6 (p < 0.01) levels showed less increase in the treated mice. CONCLUSION: Antithrombin showed a protective effects on the microcirculation of staphylococcal enterotoxin B-challenged mice by attenuating leukocyte-endothelial cell interaction. Suppression of adhesive molecule expression and cytokine production appears to play roles in this effect.

[Congenital tracheal stenosis due to complete cartilage rings with right pulmonary agenesis].

A 2-month-old male infant with severe dyspnea was diagnosed as having right pulmonary agenesis at birth and was admitted to our hospital after tracheal intubation with an endotracheal tube of 3 mm in diameter. However, the trachea was too stenotic to place the tube in the proper position. Chest X-ray on admission showed pneumonia of the left lung. Preoperative chest computed tomography (CT) scan and bronchoscopy showed that from the level of 12 mm beneath the coricoid cartilage, the trachea tapered and continuing to the tracheal carina and that the smallest tracheal level was located 18 mm distal from the coricoid cartilage, the area of which was 4 mm2. His respiratory condition rapidly deteriorated in spite of intravenous administration of antibiotics and mechanical ventilation. Percutaneous cardiopulmonary support (PCPS) was used to maintain his pulmonary function, and pericardial tracheoplasty was performed. Chest X-ray immediately after the operation did not show left lung reexpansion due to severe pulmonary edema. High-dose steroid pulse therapy was performed, but it was not effective. He died from acute respiratory failure due to infantile respiratory distress syndrome (IRDS) on postoperative day 3. The outcome in this case shows that it is very risky to repair tracheal stenosis in a patient with pneumonia using PCPS.

Jarcho-levin syndrome associated with a complex congenital heart anomaly.

Jarcho-Levin syndrome is characterized by "crab-like" rib cage deformity and multiple vertebral anomalies that cause respiratory failure. Reports of complex congenital heart defects with this syndrome are rare. We describe a female infant with this syndrome and a complex congenital heart defect and review the literature. Congenital heart defects are occasionally complicated by Jarcho-Levin syndrome. Heart defects involving heterotaxic morphology should be included as one of the important clinical features of this syndrome.

A simple objective parameter for perfusion study of renal transplant.

We proposed a simple parameter, the kidney-to-aorta ratio (KAR), for evaluation of renal transplant perfusion. KAR was calculated from the peak counts of the kidney and the aorta. The calculated values were compared with the visual interpretation of the radionuclide first-pass flow study, percent renal uptake (%RU), and tubular extraction rate (TER) by Bubeck's one point sampling method in 37 studies. KAR correlated well with the visual interpretation of the flow study and the other quantitative parameters. Representative cases, which showed the usefulness of KAR for the objective assessment of the perfusion status of renal transplants, were presented. In conclusion, KAR is a simple and practically useful parameter for objective evaluation and follow-up of renal transplant perfusion.

Helical computer assisted tomography in pulmonary hypertension complicating left-to-right shunts--correlation with pulmonary hemodynamics.

The present study analyzed the helical computer-assisted tomography (CAT) findings in 30 patients with pulmonary hypertension (PH) associated with left-to-right shunts; specifically, ventricular septal defect, 23; atrioventricular septal defect, 6; patent ductus arteriosus, 1. Eight patients had 21 trisomy. Age ranged from 1 to 18 (mean, 4.1) months, and body weight ranged from 2.6 to 10.7 (mean, 4.9) kg. In all patients, the chest CAT revealed patchy areas of high and low attenuation (mosaic pattern) and regional atelectasis in the lung fields. The volume of low attenuated lesions and of atelectasis, and the total lung volume were derived from integration of areas measured on the CAT image. The ratios of low attenuated lesion/total lung volume (Lo), volume of atelectasis/ total lung volume (Ate) and low attenuated lesion and volume of atelectasis/total lung volume (Lo&Ate) were compared with hemodynamic parameters measured at cardiac catheterization. The pulmonary to systemic resistance ratio correlated with Lo (r=0.61, p<0.01) and Lo&Ate (r=0.69, p<0.01), whereas the pulmonary vascular resistance correlated with Ate (r=0.53, p<0.01). Lo, Ate and Lo&Ate in the chest CAT are reliable parameters that can be used to estimate pulmonary vascular resistance in patients with PH associated with left-to-right shunts.

The C-terminal domain of thrombospondin-1 induces vascular smooth muscle cell chemotaxis.

OBJECTIVE: Thrombospondin-1 (TSP-1), an acute-phase reactant implicated in vascular disease, is a 420-kd multifunctional glycoprotein chemotactic for vascular smooth muscle cells (VSMCs). TSP-1 has six domains of repeating homologous amino acid sequences: N-terminal, procollagen homology, type 1 repeat, type 2 repeat, type 3 repeat/RGD (T3), and C-terminal (COOH). The purpose of this experiment was to determine which domains of TSP-1 induce VSMC chemotaxis. METHODS: A modified Boyden Chamber chemotaxis assay was used to assess VSMC migration. Serum-free medium, TSP-1, or each of the fusion proteins (10 and 20 microg/mL) synthesized for the different domains were placed in the bottom wells. Quiescent bovine aortic VSMCs (50,000) were placed in the top wells. After 4 hours at 37 degrees C, migrated VSMCs were recorded as cells per five fields (400x) and analyzed with the paired t test. To verify the fusion protein data, we performed chemotaxis assays with antibodies to each of the domains (25 microg/mL) combined with TSP-1 (20 microg/mL) in the bottom wells and VSMCs in the top wells. RESULTS: The COOH domain significantly stimulated VSMC chemotaxis (P = <.001). To a lesser extent, the N-terminal and T3 domains also induced chemotaxis (P <.05). However, only the anti-COOH antibody (C6.7) and the anti-integrin-associated protein portion of COOH antibody (D4.6) significantly inhibited TSP-1-induced VSMC chemotaxis (by 85% and 92%, respectively). CONCLUSIONS: These results implicate the COOH domain as the portion of the TSP-1 molecule primarily responsible for VSMC chemotaxis. This experiment suggests that future strategies in the prevention of VSMC migration, an initial step in the development of vascular lesions, may involve selective inhibition of the COOH domain of TSP-1.

Inhibition of phosphatidylinositol 3-kinase and protein kinase C attenuates extracellular matrix protein-induced vascular smooth muscle cell chemotaxis.

PURPOSE: Intimal hyperplasia (IH), a significant cause of vascular reconstructive failure, is characterized by abnormal vascular smooth muscle cell (VSMC) migration, proliferation, and extracellular matrix (ECM) deposition. The ECM proteins, thrombospondin-1 (TSP-1), fibronectin (Fn), and vitronectin (Vn) can induce VSMC migration; however, the cellular signaling pathways involved are not identical for each ECM protein. Phosphatidylinositol 3-kinase (PI3K) and protein kinase C (PKC) are two enzymes that have been associated with VSMC migration. We sought to elucidate the roles of these enzymes in TSP-1-, Fn-, and Vn-stimulated VSMC migration. METHODS: Chemotaxis assays were performed by using a modified Boyden Chamber. TSP-1, Fn, or Vn (20 microg/mL) or serum-free media (SFM) was placed in the bottom wells of the chamber. Quiescent bovine aortic VSMC were preincubated with LY 294002 (100 micromol/L), a PI3K inhibitor, bisindolylmaleimide I (GF 109203X, 1 micromol/L), a PKC inhibitor, or in SFM alone for 30 minutes. VSMCs (50,000 cells per well) were then placed in the top wells of the chamber, and the assay was conducted for 4 hours at 37 degrees C. Results were recorded as the number of cells migrated per five fields (400x) and analyzed by means of the paired t test, with P value less than.05 considered to be significant (n = 3). RESULTS: The VSMC migration was significantly increased by TSP-1, Fn, and Vn. LY 294002 inhibited TSP-1-, Fn-, and Vn-stimulated VSMC migration (85% to 89%, P <.05). GF 109203X inhibited only TSP-1-stimulated migration (65%, P <.05). CONCLUSION: These results suggest that TSP-1-, Fn-, and Vn-stimulated migration is at least partially dependent on PI3K. However, only TSP-1 stimulated migration is at least partially dependent on PKC.

Endothelialization of the coils used to occlude a persistent ductus arteriosus: an angiographic study.

To assess the endothelialization of the coils used to close a persistent ductus arteriosus (PDA), the present study comprised a review of the follow-up aortograms and pulmonary angiograms in 25 patients who underwent coil occlusion. The minimal diameter and the length of the PDA were measured prior to the procedure, and the shortest distance between the aortic end of the deployed coil and the aortic end of the PDA was measured after coil deployment. Evidence of endothelial coverage of the coil was sought on follow-up angiograms performed 6-24 (15+/-5) months later and the factors that determined the thickness of the endothelial coverage on the aortic end were investigated. Separation of the coil and the contrast column were detected at the aortic end in all cases and at the pulmonary end in 18 of 25 cases. The thickness of the separation ranged from 0.4 to 1.3 (0.7+/-0.2) mm at the aortic end and 0.3 to 0.8 (0.6+/-0.2) mm at the pulmonary end. The length of the ductus and of the ampulla had a significant positive correlation with the thickness of the aortic end separation. Apparent endothelial coverage of the coil was completed by 6 months after coil occlusion. Infective endocarditis or thromboembolism is an unlikely complication once endothelium covers the implanted coil.

[Application of measuring 99mTc-MAG3 plasma clearance based on one-compartment model (MPC method) to renal transplantation].

Measurement of 99mTc-MAG3 plasma clearance (CLmag) based on one-compartment model (MPC method) was applied to renal transplantation and evaluated for the factors which might affect the calculated results, especially concerning renal depth. Correlation coefficient of CLmag between MPC method using real renal depth and Russell or Bubeck single sampling method was good (r = 0.852 or 0.876, respectively). Regression equation between MPC method and Russell method was y = 1.044x - 3.0 and was more closer to y = x than that between MPC method and Bubeck method. CLmag of MPC method calculated by estimated renal depth from the abdominal thickness was also similar to that by real renal depth. Even if the fixed renal depth, 4 cm, was applied, the coefficient and regression equation between MPC method and Russell method were r = 0.884 and y = 1.004x - 10.2. In conclusion, MPC method is applicable to the evaluation of renal transplants. Though measuring renal depth is best, calculation with fixed renal depth of 4 cm might be practically acceptable.

Stretching of the ductus: an important factor in determining the outcome of coil occlusion.

The present study measured the minimal diameter of the ductus (minimal D), the stretched minimal diameter (stretched D), and the stretch index (SI) before coil occlusion in 25 patients with a patent arterial duct. The following factors were compared in the success group (22 cases, coil successfully placed after initial deployment) versus the failure group (3 cases): minimal D, stretched D, SI, the sum of the loop diameter of coils (the loop diameter), the sum of the product of the loop diameter and the number of loops (the loop diameter and number), the loop diameter/minimal D, the loop diameter/stretched D, the loop diameter and number/minimal D, and the loop diameter and number/stretched D. In the failure group, minimal D, stretched D, SI, the loop diameter, and the loop diameter and number were larger than in the success group. The loop diameter/stretched D, and the loop diameter and number/stretched D were smaller in the failure group. Although the loop diameter and number/minimal D was slightly smaller in the failure group, the loop diameter/minimal D was comparable. It is concluded that the stretched D is more reliable than minimal D to determine the appropriate size of coil for successful initial deployment.

[Comparison between continuous intravenous and oral administration of 5-FU with LV].

UNLABELLED: In case of 5-fluorouracil (5-FU)/leucovorin (LV) treatment, which is one of the most effective forms of chemotherapy for colorectal carcinoma, 5-FU is usually continuously infused from the venous route. However, since this continuous infusion limits the patients' active daily life, oral administration is preferable. In the present study, we evaluated the efficacy and side effects of orally administered 5-FU/LV. MATERIAL AND METHODS: In the continuous intravenous infusion group (civ group), colon 26 bearing mice were cannulated into central vein from external jugular vein. From this route, either 5, 10, or 20 mg/kg of 5-FU was continuously infused for 7 days (n = 6). In another group, either 10, 20, 40 mg/kg of 5-FU was infused orally (po group, n = 6). The other 6 animals were used for the non-treatment group. In the next series, 100 mg/kg of LV was added for each group above. Tumor volume, thymidylate synthase inhibition rate (TSIR) and body weight were measured at the end of infusion. During the experimental period, mice had free access to chow and water. RESULTS: The tumor/control (T/C) volumes ratio showed that approximately twice the orally administered 5-FU dose had an anti-tumor effect equal to that of 5-FU administered intravenously. Synergic antitumor effects by LV were only revealed in the civ group. Significant body weight loss was recognized only in the po group at a 5-FU dose of more than 20 mg/kg. In summary, since the modulation effect of LV was recognized only with continuously intravenous infusion of 5-FU, further improvement of oral administration is required in the LV/5-FU combination therapy.

Disopyramide improves hypoxia in patients with tetralogy of Fallot through a negative inotropic action.

The hemodynamic and right ventricular volumetric effects of disopyramide were investigated in patients with tetralogy of Fallot (TF). Intracardiac pressure and oxygen saturation were measured, before and after intravenous administration of disopyramide (2 mg/kg) in 7 patients who had not had previous surgery. Right ventricular volume and the diameter of its outflow tract were analyzed in these 7 and in a further 4 patients with a previous shunt. Aortic oxygen saturation increased from 90.4+/-7.5 (mean+/-SD) to 94.1+/-5.5% (p<0.05) with an increase in pulmonary blood flow and pressure. The systolic pressure gradient between the main pulmonary artery and the right ventricle decreased from 59+/-8 to 42+/-9 mmHg (p<0.01). Aortic pressure fell from 77+/-5 to 67+/-4 mmHg (p<0.05). Systemic vascular resistance increased from 15.3+/-2.2 to 19.4+/-3.3 u x m2 (p<0.05). Pulmonary vascular resistance remained unchanged. The diastolic and systolic diameter indices of the right ventricular outflow tract increased from 17.8+/-3.8 to 20.5+/-3.4 and from 6.5+/-3.0 to 10.4+/-2.2 mm/m2, respectively (p<0.01), whereas the right ventricular ejection fraction decreased. Disopyramide improves systemic oxygen saturation in patients with TF through its negative inotropic action on the right ventricle.