Electrical storm 11 days after acute myocardial infarction: a case report.

BACKGROUND: The definition of electrical storm is still debated. For example, an electrical storm is defined as a clustering of three or more separate episodes of ventricular tachycardia/ventricular fibrillation within 24 hours or one or more episodes occurring within 5 minutes of termination of the previous episode of ventricular tachycardia/ventricular fibrillation. When it is refractory to medications, prompt assessments by coronary angiography, sedation, and overdrive pacing should be performed. An electrical storm may occur anytime, including at night or after the patient leaves an intensive care unit. CASE PRESENTATION: A 70-year-old Japanese man with type 2 diabetes mellitus was diagnosed as having ST-elevation myocardial infarction. His clinical course after an urgent percutaneous coronary intervention was uneventful, but he developed electrical storm that was refractory to antiarrhythmic medications on day 11 of hospitalization. We used sedative medications and performed ventricular overdrive pacing and transferred him to a university hospital for further treatment, which included electrical ablation and cardioverter-defibrillator implantation. CONCLUSION: An electrical storm is a relatively rare and fatal complication of acute myocardial infarction. It is important that the treatment choices for this condition are known by non-cardiologist physicians who might encounter this rare condition.

Clinical significance of reversed R wave progression in right precordial leads.

Objective: Poor R wave progression in right precordial leads is a relatively common electrocardiogram (ECG) finding that indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP) may be more specific to cardiac disorders; however, the significance of RRWP in daily clinical practice is unknown. The purpose of this study was to clarify the significance of RRWP in clinical practice. Materials and Methods: We analyzed consecutive ECGs obtained from 12,139 patients aged ≥20 years at Mito Kyodo General Hospital in Ibaraki between November 2009 and August 2012. Our setting is a secondary emergency hospital in the community, and the study participants were inpatients or patients who visited the general or emergency outpatient departments. RRWP was defined as RV2 < RV1, RV3 < RV2, or RV4 < RV3. Regarding ECGs considered to show RRWP, we confirmed the presence or absence of an abnormal Q wave and whether ultrasound cardiography, contrast-enhanced computed tomography, coronary angiography, and/or left ventriculography were performed to obtain detailed information. Results: RRWP was identified in 34 patients (0.3%). Among these patients, 29 (85%) had undergone cardiac evaluation. The final diagnosis was previous anterior MI in 12 patients (41%) and ischemic heart disease (IHD) without MI in 5 patients (17%). All 17 patients with IHD had left anterior descending (LAD) artery stenosis. The other patients were diagnosed with dilated (two patients, 7%) and hypertrophic (one patient, 3%) cardiomyopathy, left ventricular hypertrophy (one patient, 3%), or pulmonary embolism (one patient, 3%). Only seven patients (24%) were normal. Conclusions: RRWP is rare in daily clinical practice; however, it is a highly indicative marker for cardiac disease, particularly IHD with LAD artery stenosis.

Oligoamylose-entwined porphyrin: excited-state induced-fit for chirality induction.

An oligoamylose-strapped porphyrin displayed circularly polarized luminescence (CPL) in the S1 state despite being silent in circular dichroism (CD) in the ground state, suggesting chirality induction in the photoexcited porphyrin moiety from the oligoamylose-strap in the photoexcited state.

Self-complementary double-stranded porphyrin arrays assembled from an alternating pyridyl-porphyrin sequence.

Oligomeric porphyrin arrays with an alternating pyridyl-porphyrin sequence were synthesized to explore double-strand formation through self-complementary pyridyl-to-zinc axial coordination bonds. Competitive titration experiments revealed the thermodynamic aspects involved in the zipper effect within double-strand formation. Multiple axial coordination bonds defined the stacked conformation, despite a marginal contribution to the stability of the double-strands. Thus, the zipper cooperativity was the dominant factor for the remarkable stability. Moreover, the dimeric and trimeric porphyrin arrays were independently assembled into double-strands by self-sorting from a binary mixture. Double-strand formation engineered discretely stacked π-systems. Successive slipped-cofacial stacks of the porphyrin rings progressively extended the π-system via exciton coupling over the double-strand while keeping a relatively high fluorescence quantum yield.

Diabetes and obesity are significant risk factors for morning hypertension: from Ibaraki Hypertension Assessment Trial (I-HAT).

AIMS: Although morning hypertension (HT) has been identified as a major cardiovascular risk, susceptible populations remain unknown. This study aimed to clarify the relationship between morning HT and diabetes or obesity in a large-scale population. MAIN METHODS: Clinic blood pressure (BP) and BP upon awakening were recorded in 2554 outpatients with HT who attended 101 clinics or hospitals for two weeks. Mean clinic and awakening BP>140/90 and >135/85 mmHg, respectively, were considered as HT. The patients were classified according to values for clinic and home BP, into normal BP, white coat HT, masked HT, and sustained HT. KEY FINDINGS: Morning BP (mmHg) significantly and progressively elevated in the order of normal glucose tolerance, impaired glucose tolerance and diabetes (134.1 ± 12.2, 135.4 ± 13.1 and 137.5 ± 11.5; p<0.0001). The incidence of morning HT significantly increased and progressively in the same order (53.4%, 55.6%, 66.4%, p<0.0001). Morning BP was significantly higher among obese patients with diabetes than among non-obese and non-diabetic patients (138.8 ± 10.5, 133.1 ± 11.9, p<0.0001). In addition, the incidence of morning HT was significantly higher in obese diabetic patients than in non-obese and non-diabetic patients (73.0% vs. 49.9%, p<0.0001). SIGNIFICANCE: Diabetic or obese patients frequently have morning HT.

Highly fluorescent slipped-cofacial phthalocyanine dimer as a shallow inclusion complex with α-cyclodextrin.

Supramolecular control of the π-stacked configuration of aqueous phthalocyanine (Zn[Pc(SO(3))(4)]) was achieved, allowing organization of a J-type slipped-cofacial dimer with per-O-methylated α-cyclodextrin (TMe-α-CDx) by the aid of host-guest interactions. Pristine Zn[Pc(SO(3))(4)] forms nonfluorescent face-to-face aggregates in water. The π-stacked configuration was controlled in the slipped-cofacial dimer, which was formed as a shallow inclusion complex with TMe-α-CDx, giving remarkably enhanced fluorescence with a very small Stokes shift. Organization of the J-type slipped-cofacial dimer as a 2:2 Zn[Pc(SO(3))(4)]-TMe-α-CDx complex was achieved through π-stacking of the unencapsulated segment of Zn[Pc(SO(3))(4)] shallowly encapsulated by a small TMe-α-CDx cavity.

Hexameric subphthalocyanine rosette.

A highly congested hexameric subphthalocyanine array was synthesized by axial chlorine-to-phenoxy substitution of a hexakis(4-hydroxyphenyl)benzene based subphthalocyanine, and photoinduced symmetry-breaking charge separation was demonstrated in polar solvent.

Ligand-assisted J-type aggregates of zinc porphyrin: anticooperative molecular organization in self-assembled bolaamphiphile.

Bolaamphiphilic zinc porphyrins bearing a 2-pyridylethynyl or 4-methoxyphenylethynyl group, Zn(PyPor) or Zn(ArPor), respectively, were newly synthesized in order to explore the molecular organizing behaviours within the interior hydrophobic layer of aqueous self-assemblies. Well-ordered J-type aggregates of Zn(PyPor) were formed in aqueous self-assembled bolaamphiphile, whereas J-type aggregates of Zn(ArPor) were disordered. The titration experiments suggest that axial coordination bond improves the structural uniformity of the J-type aggregates of Zn(PyPor). In a homogeneous isotropic media, on the other hand, Zn(PyPor) formed an antiparallel dimer through self-complementary coordination. Unprecedented molecular organization of ligand-assisted J-type aggregates is described in the term of anticooperative effect under the bulk conditions.

Long-term follow-up evaluation for more than 10 years after endoscopic treatment for postoperative bile duct strictures.

BACKGROUND: Endoscopic stent therapy is routinely used to treat postoperative bile duct strictures. However, no studies have detailed long-term follow-up evaluation for more than 10 years. METHODS: This study enrolled 22 consecutive patients with a diagnosis of postoperative bile duct strictures from 1987 to 2006. Cases involving digestive tract reconstruction were excluded. Dilation was performed after passage of a guidewire through the stricture followed by temporary stent placement. The final objective was to achieve stent free status after sufficient dilation. The stent was removed when the cholangiogram showed apparent resolution of the stricture. If stent removal was not possible within 12 months, the authors proposed a surgical treatment option. RESULTS: Initial therapy was performed for 21 patients (21/ 22, 95%). The remaining patient had complete occlusion, which required surgical repair. For 3 of the 21 cases, guidewire passage through the narrow stricture under fluorographic guidance alone was impossible. However, visualization by peroral cholangioscope enabled passage of the guidewire in all three cases. In two cases, the stricture persisted longer than 12 months, rendering stent removal impossible. Therefore, stent removal within 12 months was achieved in 90% of the cases (19/21). Two patients requested prolonged stenting in lieu of the authors' proposal to repeat the surgery. This resulted in sufficient dilation after an additional 6 months. Consequently, a total of 21 patients were enrolled for long-term follow-up evaluation. The posttreatment follow-up period was 121 + or - 64 months (range, 31-254 months; median, 120 months). Three patients died of causes unrelated to hepatobiliary disease. The remaining patients were successfully followed up until this writing. The overall long-term success rate was 95% (20/21). No hepatobiliary malignancies developed within the follow-up period. CONCLUSIONS: Endoscopic stent therapy is available for postoperative bile duct strictures. Long-term prognosis for more than 10 years is excellent. Repeat surgical interventions may be unavoidable in some cases, but endoscopic treatment should be proposed as the first-line treatment.

Long-term prognosis of patients with endoscopically treated postoperative bile duct stricture and bile duct stricture due to chronic pancreatitis.

AIM: To compare the outcome of endoscopic therapy for postoperative benign bile duct stricture and benign bile duct stricture due to chronic pancreatitis, including long-term prognosis. METHODS: The subjects were 20 patients with postoperative benign bile duct stricture and 13 patients with bile duct stricture due to chronic pancreatitis who were 2 years or more after initial therapy. The patients underwent transpapillary drainage with tube exchange every 3 to 6 months until being free from the tube. Successful therapy was defined as a stent-free condition without hepatic disorder. RESULTS: Endoscopic therapy was successful in 90% (18/20) of the patients with postoperative bile duct stricture. The stent was removed (stent free) in 100% (20/20) of the patients, but jaundice resolved in only 10% (2/20) of patients while biliary enzymes kept increasing. Restructure occurred in 5% (1/20) of the patients, but after repeat treatment the stent could be removed. In patients with bile duct stricture due to chronic pancreatitis the therapy was successful in only 7.7% (1/13) of the patients; the stent was retained in 92.3% (12/13) of the patients during a long period. Severe acute pancreatitis occurred in 3.0% (1/33) of the patients as an accidental symptom attributable to endoscopic retrograde cholangiopancreatography (ERCP); however, it remitted after conservative treatment. CONCLUSION: Our results further confirm the usefulness of endoscopic therapy for postoperative benign bile duct strictures and good long-term prognosis of the patients.

Bidirectional and colorimetric recognition of sodium and potassium ions.

Host 1 based on the phenolphthalein skeleton and two crown ether moieties demonstrated opposite behaviors toward sodium and potassium cations caused by bidirectional complexation. [reaction: see text]

Syntheses and photophysical studies of cyclodextrin derivatives with two proximate anthracenyl groups.

A series of permethylated cyclodextrin derivatives, cyclodextrin dimers doubly bridged with two anthracene moieties (An2CD2) and singly bridged with one (AnCD2) and the monomer bearing two anthracene moieties (An2CD), were newly synthesized. For An2CD2, the two isomeric forms are also identified. All compounds are soluble in both aqueous and various organic solvents. The bisanthracene systems, An2CD2 and An2CD, show the thermal equilibrium in an aqueous solution between the intramolecularly interacting (closed) and less-interacting (open) states of the anthracene moieties, which results in the temperature-dependent absorption changes. These systems also show the characteristic excimer emission that is enhanced in water and weakened in organic solvents. The excitation spectra for the monomer and excimer fluorescence are found to be quite different from each other and similar to the absorption spectra of the open and the closed forms, respectively. The observed unique parallelism between excitation and absorption spectra for the present excimer systems indicates the dual ground state-dual excitation scheme where the excitation state formed from the closed ground state mainly gives excimer. The fluorescence lifetime analyses reveal that the rates of the conversion from the excited state of the open form to that of the closed one (6.0 x 10(6) s(-1) for An2CD2-2) are largely retarded compared with that of the ethyleneoxy linked bisanthracene system (8.8 x 10(7) s(-1)).

Nonameric porphyrin assemblies--formation and intra-assembly energy transfer reactions.

The nonameric porphyrin assemblies constructed with the series of free base tetraphenylporphyrins Pn having four pyrazine moieties linked with alkyl chains of different lengths, (CH2)n (n = 1, 5, 9, 17, 30), and dimeric [meso-tetrakis(2-carboxy-4-nonylphenyl)porphyrinato]zinc(II), ZnP2, show the effective light-collection effect and the typical Forster-type energy transfer from ZnP2 to Pn.

Construction of porphyrin-cyclodextrin self-assembly with molecular wedge.

A new host porphyrin bearing four permethyl-beta-cyclodextrin moieties for multi-porphyrin assembly forms a unique 2 : 2 assembly with the tetra-anion of tetrakis(p-sulfonylphenyl)porphyrin (TPPS) in aqueous solution.

Static and dynamic behavior of 2:1 inclusion complexes of cyclodextrins and charged porphyrins in aqueous organic media.

Two heptakis(2,3,6-tri-O-methyl)-beta-cyclodextrin (TMe-beta-CD) molecules strongly include the peripheral substituents at the 5- and 15-positions of the charged meso-tetrasubstituted porphyrins, PorSub(4) [TPPS(4) (Sub = p-C(6)H(4)-SO(3)(-)), TPPOC3PS (p-C(6)H(4)-O-(CH(2))(3)-p-C(6)H(4)-SO(3)(-)), TCPP (Sub = p-C(6)H(4)-CO(2)(-)), and TPPOC3Py (p-C(6)H(4)-O-(CH(2))(3)-Py(+)Br(-)), where Py(+) = N-alkylpyridinium] in aqueous ethylene glycol. The binding constants (K(1) and K(2)) and the rate constants (k(1) and k(2)) for formation of the 1:1 and 2:1 complexes of TMe-beta-CD and PorSub(4) were determined. Both the binding constants and the rate constants for anionic TPPS(4), TCPP, and TPPOC3PS were much larger than those for cationic TPPOC3Py. The smaller k(1) and k(2) values for TPPOC3Py indicate a higher barrier for penetration of a cationic guest into the TMe-beta-CD cavity. The methyl groups at the rims and the cavity wall of the host are positively polarized due to the inductive effect of the ethereal oxygens. The positively polarized rims and interior of the host cavity should prevent the penetration of the cationic substituent of TPPOC3Py into the TMe-beta-CD cavity. The 2:1 TMe-beta-CD-PorSub(4) complexes are extraordinary stable in aqueous solutions, even in the case of cationic TPPOC3Py. Formation of both 1:1 and 2:1 complexes is promoted by negative and large enthalpy changes, suggesting a strong van der Waals interaction as the main binding force.

Aortic valve replacement in a woman with osteogenesis imperfecta.

The mortality rate in cardiac surgery patients with heritable generalized connective tissue disorders, such as Marfan s syndrome and osteogenesis imperfecta, is high due to tissue friability. We describe a successful open heart surgery for repair of aortic regurgitation in a woman with osteogenesis imperfecta (OI). Although tissue friability caused no problems during surgery in this case, it should be kept in mind when operating on patients with OI.

Light-harvesting heptadecameric porphyrin assemblies.

New porphyrin assemblies containing 17 porphyrin molecules are constructed by using free base TPP-type porphyrins having eight pyrazine moieties 1. Spectroscopic titration of dimeric [meso-tetrakis(2-carboxy-4-nonylphenyl)porphyrinato]zinc(II) 2 with these porphyrins shows that the processes of the formation of the heptadecameric porphyrin assemblies may be analyzed as eight independent equilibrium processes with an identical binding constant. All binding constants are larger than 5 x 107 M-1 which is the determinable upper limit of the present titration method. In all cases, the fluorescence spectrum of the 1:8 mixture of 1 and 2 consists of the major fluorescence of 1 and the minor one of 2.pyrazine complex even in the presence of the large excess of the antenna pigments. The observed spectra are well reconstructed by the form of faF1 + fbF2, where F1 and F2 are the fluorescence of 1 and the 2.pyrazine complex measured separately at the corresponding concentrations. Interestingly, the general trend that values of fa are nearly equal to those of r564 x (1 - fb) in all cases is found, where r564 is the absorption ratios of the 2.pyrazine moiety and the central free base porphyrin in the assemblies at 564 nm. The observation indicates the excitation of the central porphyrin is directly enhanced by the absorption of the antenna pigments even in such large scale assemblies. Thus, the antenna effect for 1 having largest r564 results in 77 times fluorescence enhancement of the central free base porphyrin. The systems also show interesting dependency of energy-transfer efficiencies on the topological arrangement of the antenna elements.