Pharmacological Prevention of Peri-, and Post-Procedural Myocardial Injury in Percutaneous Coronary Intervention

In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease

Acute myocardial infarction caused by an anomalous left main coronary artery in a 16-year-old boy

SummaryA variety of structural cardiovascular abnormalities have been implicated in deaths of athletes, particularly congenital coronary arteries of anomalous origin, which are rare but major causes of myocardial ischemia and sudden death in young people. We present here the case of a rare congenital coronary artery anomaly in a 16-year-old boy who suffered from acute myocardial infarction due to occlusion of the left main trunk coronary artery, providing specific intravascular ultrasound findings for this anomaly

Transplantation of Bone Marrow-Derived Mononuclear Cells Improves Mechanical Hyperalgesia, Cold Allodynia and Nerve Function in Diabetic Neuropathy

Relief from painful diabetic neuropathy is an important clinical issue. We have previously shown that the transplantation of cultured endothelial progenitor cells or mesenchymal stem cells ameliorated diabetic neuropathy in rats. In this study, we investigated whether transplantation of freshly isolated bone marrow-derived mononuclear cells (BM-MNCs) alleviates neuropathic pain in the early stage of streptozotocin-induced diabetic rats. Two weeks after STZ injection, BM-MNCs or vehicle saline were injected into the unilateral hind limb muscles. Mechanical hyperalgesia and cold allodynia in SD rats were measured as the number of foot withdrawals to von Frey hair stimulation and acetone application, respectively. Two weeks after the BM-MNC transplantation, sciatic motor nerve conduction velocity (MNCV), sensory nerve conduction velocity (SNCV), sciatic nerve blood flow (SNBF), mRNA expressions and histology were assessed. The BM-MNC transplantation significantly ameliorated mechanical hyperalgesia and cold allodynia in the BM-MNC-injected side. Furthermore, the slowed MNCV/SNCV and decreased SNBF in diabetic rats were improved in the BM-MNC-injected side. BM-MNC transplantation improved the decreased mRNA expression of NT-3 and number of microvessels in the hind limb muscles. There was no distinct effect of BM-MNC transplantation on the intraepidermal nerve fiber density. These results suggest that autologous transplantation of BM-MNCs could be a novel strategy for the treatment of painful diabetic neuropathy

Paraganglioma that caused sinus arrest

Paragangliomas are neural-crest-derived nonepithelial neuroendocrine tumors distributed along the parasympathetic and sympathetic nerves. To our knowledge, no studies were reported regarding sinus arrest on day 4 after paraganglioma resection. A 66-year-old female patient with a history of pulmonary vein isolation visited our department for sigmoid colon cancer treatment. Enhanced computed tomography revealed an enhanced small nodule-like lymph node near the root of the inferior mesenteric artery. The patient underwent laparoscopic colectomy with regional lymph node dissection. Postoperatively, paroxysmal atrial fibrillation attacks developed, and the patient resumed oral medication. Additionally, sinus arrest after tachycardia developed. Changing the oral medication could maintain her circulatory dynamics. Pathological examination revealed that differentiated tubular adenocarcinoma infiltrated the submucosa. Immunohistochemically, the excised nodule as a lymph node was considered a functional paraganglioma. Our case indicates that paraganglioma resection and oral medication resumption may contribute to sinus arrest. When arrhythmias affecting the circulation occur perioperatively, the presence of a catecholamine-producing tumor should be considered in addition to cardiac disease

Monoclonal gammopathy of renal significance (MGRS)-related AL amyloidosis complicated by amyloid myopathy: a case report

BACKGROUND: Lately, monoclonal gammopathy of renal significance (MGRS) has been defined as a group of renal disorders that are strongly associated with monoclonal protein, including amyloid immunoglobulin light chain (AL) amyloidosis. Amyloid myopathy is rare (1.5% of all patients with amyloidosis) and the prognosis is poor. Furthermore, only approximately 20% of patients with amyloid myopathy are reported to have renal involvement, indicating a lack of data in the literature. CASE PRESENTATION: Here, we report a rare case of MGRS-related AL amyloidosis complicated by amyloid myopathy that presented with muscle weakness in the upper and lower limbs, neck and fingers, and nephrotic syndrome. Blood, urine, and bone marrow examination revealed monoclonal gammopathy of undetermined significance (MGUS) (Bence Jones protein-lambda). Muscle biopsy of the vastus lateralis muscle demonstrated amyloid proteins in the sarcolemma and in the blood vessel walls on Congo red staining, suggesting amyloid myopathy, and tiny inclusions in fibers on modified Gomori trichrome stain. Although we thought they were reminiscent of nemaline bodies, we could not confirm the nature of this structure. Renal biopsy demonstrated amyloid proteins in the mesangial region, part of the capillary walls, and the blood vessel walls on direct fast scarlet staining. As these amyloid proteins were positive for p-component staining and negative for amyloid A staining, β2-microglobulin, and pre-albumin, and as lambda light chains were positive in the mesangial region, we diagnosed the patient with MGRS-related AL amyloidosis. Although he was treated with melphalan and dexamethasone, his symptoms did not improve. CONCLUSIONS: AL amyloidosis involving the kidneys and muscles has a poor prognosis, and a delayed diagnosis of amyloid myopathy is common because of its rarity and frequent misdiagnosis, which increases organ function deterioration. Therefore, early detection, therapeutic intervention, and careful follow-up are crucial

A snake venom secreted phospholipase A2 induces foam cell formation depending on the activation of factors involved in lipid homeostasis

MT-III, a snake venom GIIA sPLA2, which shares structural and functional features with mammalian GIIA sPLA2s, activates macrophage defense functions including lipid droplet (LDs) formation, organelle involved in both lipid metabolism and inflammatory processes. Macrophages (MΦs) loaded with LDs, termed foam cells, characterize early blood vessel fatty-streak lesions during atherosclerosis. However, the factors involved in foam cell formation induced by a GIIA sPLA2 are still unknown. Here, we investigated the participation of lipid homeostasis-related factors in LD formation induced by MT-III in macrophages. We found that MT-III activated PPAR-γ and PPAR-β/δ and increased the protein levels of both transcription factors and CD36 in macrophages. Pharmacological interventions evidenced that PPAR-γ, PPAR-β/δ, and CD36 as well as the endoplasmic reticulum enzymes ACAT and DGAT are essential for LD formation. Moreover, PPAR-β/δ, but not PPAR-γ, is involved in MT-III-induced PLIN2 protein expression, and both PPAR-β/δ and PPAR-γ upregulated CD36 protein expression, which contributes to MT-III-induced COX-2 expression. Furthermore, production of 15-d-PGJ2, an activator of PPARs, induced by MT-III, was dependent on COX-1 being LDs an important platform for generation of this mediator.Fundación de Apoyo a la Investigación del Estado de São Paulo/[00 / 11624-5]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2011 / 21341-5]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2014 / 18549-1]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2010 / 06345-1]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2015 / 24701-3]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2013 / 22610-5]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[2010 / 08506-2]/FAPESP/BrasilFundación de Apoyo a la Investigación del Estado de São Paulo/[307379 / 2016-7]/FAPESP/BrasilUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP

Changes of behavior and consciousness in COVID-19

新型コロナウイルスの感染症の拡大と長期化に伴い，世の中はパンデミック状態にある一方でテレワークの普及によって，個人生活にとってはメリットもあると考えられる．そこで現在の行動やコミュニケーション等の意識の変化，さらにフレイルなど健康面の課題について①生活，行動と意識に関するアンケート，②通勤，勤務と行動と意識に関するアンケート2種類のWeb調査により実態を明らかにした．その結果，未知のウイルスに対する脅威感から，人々の意識やライフスタイルも大きく変容していて，在宅時間の増加によりメリットもある一方で，時間の使い方は自己への投資などには回っておらず，健康面では不安を抱えていることが明らかになり，フレイル等により健康寿命の短縮が危惧されるなど，新たな日常スタイルに向けての課題があることが明らかになった．With the spread and prolongation of the new coronavirus infection, the world is in a pandemic state, but the spread of telework is thought to have benefits for personal life. Therefore, awareness of current behavior and communication, etc. Regarding changes and health issues such as frailty, (1) questionnaires on life, behavior and consciousness, and (2) questionnaires on commuting work and behavior and consciousness, the actual situation was clarified by two types of Web surveys. As a result, people's consciousness and lifestyle have changed significantly due to the threat of unknown viruses, and while there are benefits to increasing the time spent at home, spending time is not used for self-investment. However, it became clear that he was worried about his health, and that there were issues for a new daily style, such as fear of shortening healthy life expectancy due to frailty syndrome

Pain Evaluation During Colonoscopy by the Erythema Index of the Facial Image

[Background] Endoscopy of the digestive tract is useful but is associated with significant pain to the patient. Its safety and tolerability could be improved by an immediate and objective method to evaluate the pain level and give feedback to the examiner. However, under the current circumstances, it is difficult to measure and assess the pain level objectively.[Methods] We previously developed a discomfort assessment device that measures the changes in brain activity caused by changes in the pain level by extracting the changes in the erythema index from facial color data. In this study, to evaluate the usefulness of this discomfort assessment device, the association between the changes in the erythema index of facial images during colonoscopy and the subjective pain level during the examination were evaluated. For the recording of the subjective pain level during the examination, a subjective pain level recording device that we developed to measure grip strength over time was used. The subjective pain level, facial image, and percutaneous venous oxygen saturation during the examination were recorded in 30 patients who underwent colonoscopy at our hospital. [Results] The duration of colonoscopy was divided into the insertion section and the removal section. The subjective pain level was found to be significantly greater during the insertion section than during the removal section, and the changes in the erythema index of the facial images were significantly different between the two groups. [Conclusion] These findings indicate that the erythema index changes on facial images determined by the discomfort assessment device may facilitate objective evaluation of the pain level during colonoscopy