Diffusion tensor imaging in elderly patients with idiopathic normal pressure hydrocephalus or Parkinson’s disease: diagnosis of gait abnormalities

BACKGROUND: Gait abnormalities in the elderly, characterized by short steps and frozen gait, can be caused by several diseases, including idiopathic normal pressure hydrocephalus (INPH), and Parkinson’s disease (PD). We analyzed the relationship between these two conditions and their association with gait abnormalities using laboratory test data and findings from diffusion tensor imaging (DTI). METHODS: The study involved 10 patients with INPH, 18 with PD, and 10 healthy individuals (control group). Fractional anisotropy (FA) of five brain areas was measured and compared among the three groups. In addition, the association of INPH and PD with gait capability, frontal lobe function, and FA of each brain area was evaluated. RESULTS: The INPH group had significantly lower FA for anterior thalamic radiation (ATR) and forceps minor (Fmin) as compared to the PD group. The gait capability correlated with ATR FA in the INPH and PD groups. We found that adding DTI to the diagnosis assisted the differential diagnosis of INPH from PD, beyond what could be inferred from ventricular size alone. CONCLUSIONS: We expect that DTI will provide a useful tool to support the differential diagnosis of INPH and PD and their respective severities

Number of Yellow Plaques Detected in a Coronary Artery Is Associated With Future Risk of Acute Coronary Syndrome Detection of Vulnerable Patients by Angioscopy

ObjectivesWe sought to test whether the risk of acute coronary syndrome (ACS) can be estimated by angioscopy.BackgroundDisruption of vulnerable plaque and subsequent thrombosis is regarded as a major mechanism of ACS. Although yellow plaques are supposedly vulnerable, the association between angioscopically determined extent of coronary atherosclerosis and risk of ACS events has not been reported.MethodsPatients (n = 552) who received catheterization and angioscopic examination for the diagnosis of coronary artery diseases were prospectively included and followed up for new onset of ACS events. Yellow color intensities of all detected yellow plaques were graded as 1, 2, or 3 according to the standard colors. Number of yellow plaques (NYP) in a coronary artery and maximum color grade of detected yellow plaques (maxYP) were determined. Association between the incidence of ACS events and angioscopic findings were analyzed.ResultsFollow-up interval was 57.3 ± 22.1 months. Acute coronary syndrome events were detected in 39 patients (7.1%). Although maxYP was not statistically different (2.0 ± 0.7 vs. 1.8 ± 0.9; p = 0.18), NYP was higher in the patients with an ACS event than those without the event (3.1 ± 1.8 vs. 2.2 ± 1.5; p = 0.008). Patients with NYP ≥2 and those with NYP ≥5 had 2.2- and 3.8-fold higher event rates, respectively, than those with NYP 0 or 1 (9.0% and 15.6%, respectively, vs. 4.1%; p = 0.02). Multivariate logistic regression analysis revealed NYP and multivessel disease as the independent risk factors of ACS events.ConclusionsPatients with multiple yellow plaques per vessel have a higher risk of suffering ACS events than those with NYP 0 or 1. Angioscopy would be useful to detect vulnerable patients

Preparation of 1-hydroxyindole derivatives and a new route to 2-substituted indoles

金沢大学大学院自然科学研究科生理活性物質科学金沢大学薬学

Predictors of the Response to Tolvaptan Therapy and Its Effect on Prognosis in Cirrhotic Patients with Ascites

Aims: The vasopressin V2 receptor antagonist, tolvaptan, has been reported to be effective in cirrhotic patients with ascites. Here, we evaluated predictors of the response to tolvaptan. Methods: A total of 97 patients with cirrhosis (60 males; median age, 63 years) who had been treated for ascites with oral tolvaptan were enrolled. Tolvaptan efficacy was defined as urine volume increase of ≥500 mL or a urine volume ≥2000 mL/day on the day following treatment. Normalization of the serum sodium (Na) level after 1 week of treatment and the posttreatment survival rate was analyzed. Results: Tolvaptan therapy resulted in effective urination in 67% of patients. A multivariate analysis revealed that the blood urea nitrogen/creatinine (BUN/Cr) ratio and urinary Na/potassium (Na/K) ratio were predictive of the tolvaptan response (p <0.05). The serum Na level was 135 (121–145) mEq/L, and normal levels were recovered in 50.0% of the patients with an initial Na level of <135 mEq/L. The posttreatment survival rate was significantly higher in patients who responded to tolvaptan therapy (p <0.05). Conclusions: The combination of the initial BUN/Cr and urine Na/K ratios and a normalized serum Na level after 1 week was predictive of a favorable outcome to tolvaptan therapy

Angioscopic Observation After Coronary Angioplasty for Chronic Coronary Occlusion Comparison With Severe Stenotic Lesion

Objectives To clarify the underlying mechanism for the high restenosis rate after the coronary angioplasty for the chronic total occlusion by using the coronary angioscope

In-Stent Yellow Plaque at 1 Year After Implantation Is Associated With Future Event of Very Late Stent Failure The DESNOTE Study (Detect the Event of Very late Stent Failure From the Drug-Eluting Stent Not Well Covered by Neointima Determined by Angioscopy)

AbstractObjectivesThis study examined whether coronary angioscopy-verified in-stent yellow plaque at 1 year after drug-eluting stent (DES) implantation is associated with future event of very late stent failure (VLSF).BackgroundAtherosclerosis detected as yellow plaque by angioscopy has been associated with future events of acute coronary syndrome. Development of in-stent neoatherosclerosis is a probable mechanism of VLSF.MethodsThis study included 360 consecutive patients who received successful angioscopic examination at 1 year after implantation of a DES. They were clinically followed up for VLSF defined as cardiac death, acute myocardial infarction or unstable angina, or need for revascularization associated with the stent site.ResultsThe follow-up interval was 1,558 ± 890 days (4.3 ± 2.4 years). The incidence of VLSF was significantly higher in the patients with yellow plaque than in those without (8.1% vs. 1.6%; log rank p = 0.02). Multivariable analysis revealed the presence of yellow plaque (hazard ratio [HR]: 5.38; p = 0.02) and absence of statin therapy (HR: 3.25; p = 0.02) as risks of VLSF.ConclusionsIn-stent atherosclerosis evaluated by yellow plaque at 1 year after the implantation of DES and the absence of statin therapy were risks of VLSF. The underlying mechanism of VLSF appeared to be the progression of atherosclerosis as demonstrated by the yellow plaque