Compound Danshen injection improves endotoxin-induced microcirculatory disturbance in rat mesentery

AIM: To investigate the effect of compound Danshen injection on lipopolysaccharide (LPS)-induced rat mesenteric microcirculatory dysfunctions and the underlying possible mechanism by an inverted intravital microscope and high-speed video camera system. METHODS: LPS was continuously infused through the jugular artery of male Wistar rats at the dose of 2 mg/kg per hour. Changes in mesenteric microcirculation,such as diameters of arterioles and venules,velocity of RBCs in venules,leukocyte rolling,adhesion and emigration,free radicals released from post-capillary venules,FITC- albumin leakage and mast cell degranulation,were observed through an inverted intravital microscope assisted with CCD camera and SIT camera. Meanwhile,the expression of adhesion molecules CD11b/CD18 and the production of free radical in neutrophils,and the expression of intercellular adhesion molecule 1 (ICAM-1) in human umbilical vein endothelial cells (HUVECs) were quantified by flow cytometry (FACS) in vitro. RESULTS: The continuous infusion with LPS resulted in a number of responses in microcirculation,including a significant increase in the positive region of venulestained with Monastral blue B,rolling and adhesion of leukocytes,production of oxygen radical in venular wall,albumin efflux and enhanced mast cell degranulation in vivo,all of which,except for the leukocyte rolling,were attenuated by the treatment with compound Danshen injection. Experiments performed in vitro further revealed that the expression of CD11b/CD18 and the production of oxygen free radical in neutrophils,and the expression of ICAM-1 in HUVECs were increased by exposure to LPS,and they were attenuated by compound Danshen injection. CONCLUSION: These results suggest that compound Danshen injection is an efficient drug with multi-targeting potential for improving the microcirculatory disturbance.

Adenoid cystic carcinoma of breast: Recent advances

Adenoid cystic carcinoma(ACC) of the breast is a rare special subtype of breast cancer characterized by the presence of a dual cell population of luminal and basaloid cells arranged in specific growth patterns. Most breast cancers with triple-negative, basal-like breast features(i.e., tumors that are devoid of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression, and express basal cell markers) are generally high-grade tumors with an aggressive clinical course. Conversely, while ACCs also display a triple-negative, basal-like phenotype, they are usually low-grade and exhibit an indolent clinical behavior. Many discoveries regarding the molecular and genetic features of the ACC, including a specific chromosomal translocation t(6;9) that results in a MYB-NFIB fusion gene, have been made in recent years. This comprehensive review provides our experience with ACC of the breast, as well as an overview of clinical, histopathological, and molecular genetic features.

Pneumatosis intestinalis with obstructing intussusception:A case report and literature review

Pneumatosis intestinalis(PI) often represents a benign condition that should not be considered as an argument for surgery. We report a patient with PI and obstructing intussusception who underwent urgent colectomy and review the literatures regarding PI with intussusception. A 20-year-old man presented at our hospital with a 3-d intermittent lower abdominal pain history. He underwent steroid therapy for membranoproliferative glomerulonephritis for 4 years. Computed tomography revealed ascending colon intussusception with air within the wall. Intraoperative colonoscopy revealed numerous soft polypoid masses with normal overlying mucosa and right hemicolectomy was performed. Histological examination of colonic wall sections revealed large cysts in the submucosal layer. The pathological diagnosis was PI. Nine cases of intussusception associated with primary PI have been reported. Although primary PI often represents a benign condition that should not be considered as an argument for surgery,if the case involves intussusception and obstruction,emergent laparotomy should be considered.

Erythropoietin -induced proliferation of gastric mucosal cells

AIM： To analyze the localization of erythropoietin receptor on gastric specimens and characterize the effects of erythropoietin on the normal gastric epithelial proliferation using a porcine gastric epithelial cell culture model. METHODS： Erythropoietin receptor was detected by RT-PCR, Western blotting and immunohistochermistry. Growth stimulation effects of erythropoietin on cultured gastric mucosal cells were determined by ELISA using bromodeoxyuridine （BrdU）. RESULTS： Erythropoietin receptor was detected on cultured porcine gastric mucosal epithelial cells. Erythropoietin receptor was also detected histochemically at the base of gastric mucosal epithelium. BrdU assay demonstrated a dose-dependent increase in growth potential of cultured porcine gastric mucosal epithelial cells by administration of erythropoietin, as well as these effects were inhibited by administration of antierythropoietin antibody （P〈 0.01）. CONCLUSION： These findings indicate that erythropoietin has a potential to proliferate gastric mucosal epithelium via erythropoietin receptor.

Overexpression of S-adenosylmethionine decarboxylase(SAMDC)in Xeno-pus embryos activates maternal program of apoptosis as a "fail-safe"mechanism of early embryogenesis

In Xenopus, injection of S-adenosylmethionine decarboxylase (SAMDC) mRNA into fertilized eggs or 2-cell stage embryos induces massive cell dissociation and embryo-lysis at the early gastrula stage due toactivation of the maternal program of apoptosis. We injected SAMDC mRNA into only one of the animalside blastomeres of embryos at different stages of cleavage, and examined the timing of the onset of theapoptotic reaction. In the injection at 4-and 8-cell stages, a considerable number of embryos developed intotadpoles and in the injection at 16-and 32-cell stages, all the embryos became tadpoles, although tadpolesobtained were sometimes abnormal. However, using GFP as a lineage tracer, we found that descendant cellsof the blastomere injected with SAMDC mRNA at 8-to 32-cell stages are confined within the blastocoel atthe early gastrula stage and undergo apoptotic cell death within the blastocoel, in spite of the continued development of the injected embryos. These results indicate that cells overexpressed with SAMDC undergo apoptotic cell death consistently at the early gastrula stage, irrespective of the timing of the mRNA injection.We assume that apoptosis is executed in Xenopus early gastrulae as a 'fall-safe' mechanism to eliminate physiologically-severely damaged cells to save the rest of the embryo.

急性脊髓损伤患者治疗的临床操作指南:关于MRI基线在临床治疗决策与结果预测中作用的几点建议（英文）

The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

Connexin mutant embryonic stem cells and human diseases

Intercellular communication via gap junctions allows cells within multicellular organisms to share small molecules. The effect of such interactions has been elucidated using mouse gene knockout strategies. Although several mutations in human gap junction-encoding connexin(Cx) have been described, Cx mutants in mice do not always recapitulate the human disease. Among the 20 mouse Cxs, Cx26, Cx43, and Cx45 play roles in early cardiac or placental development, and disruption of the genes results in lethality that hampers further analyses. Embryonic stem cells(ESCs) that lack Cx43 or Cx45 have made analysis feasible in both in vitro differentiated cell cultures and in vivo chimeric tissues. The success of mouse ESCs studies is leading to the use of induced pluripotent stem cells to learn more about the pathogenesis of human Cx diseases. This review summarizes the current status of mouse Cx disruption models and ESC differentiation studies, and discusses their implication for understanding human Cx diseases.

Jumbo biopsy is useful for the diagnosis of colonic prolapsing mucosal polyps with diverticulosis

We report here a case of multiple prolapsing mucosal polyps with diverticulosis in the sigmoid colon. A 52-year- old man was admitted to our hospital because of bloody diarrhea. Colonoscopy and barium enema showed multiple diverticula, markedly thickened mucosal folds and polypoid lesions with mucus on the top of them in the sigmoid colon. Endoscopic ultrasonography showed thickening of the mucosal and submucosal layers. Several endoscopic biopsy specimens were taken from the polypoid lesions. Histological examination revealed only chronic inflammatory cell infiltration. In order to obtain a definite diagnosis, we performed endoscopic jumbo biopsy for the polypoid lesions after obtaining informed consent. Histological examination revealed marked lymphocyte infiltration, hemosiderin deposits and fibromuscular obliteration in the lamina propria, features similar to those of mucosal prolapsing syndrome. After anti-diarrhetic treatment, clinical findings were improved. Thus, jumbo biopsy is useful for diagnosis and treatment of prolapsing mucosal polyps.

Recent Advances in Treatment for Uremic Pruritus

This review highlights recent advances in pathophysiology and treatment for uremic pruritus, especially focusing on various interventions. Pruritus in patients on hemodialysis (HD) and peritoneal dialysis (PD) still remains an unresolved issue. Recently, the efficacy and safety of nalfurafine hydrochloride have been reported in Japan, and at present, more than thirty thousand patients receive this new drug. In comparison with the efficacy of this new drug, acupuncture, a form of traditional Japanese therapy, has been validated for relief of symptoms of pruritus. In this review, various interventions for relief of symptoms of pruritus as well as recent studies on its pathophysiology will be introduced. This review will be helpful for treatment of pruritus in patients on dialyzed therapy in clinical practice.

Beneficial effect of an omega-6 PUFA-rich diet in non-steroidal anti-inflammatory drug-induced mucosal damage in the murine small intestine

AIM: To investigate the effect of a fat rich diet onnon-steroidal anti-inflammatory drug(NSAID)-induced mucosal damage in the murine small intestine.METHODS: C57BL6 mice were fed 4 types of diets with or without indomethacin.One group was fed standard laboratory chow.The other groups were fed a fat diet consisting of 8% w/w fat,beef tallow(rich in SFA),fish oil,(rich in omega-3 PUFA),or safflower oil(rich in omega-6 PUFA).Indomethacin(3 mg/kg) was injected intraperitoneally from day 8 to day 10.On day 11,intestines and adhesions to submucosal microvessels were examined.RESULTS: In the indomethacin-treated groups,mucosal damage was exacerbated by diets containing beef tallow and fish oil,and was accompanied by leukocyte infiltration(P < 0.05).The mucosal damage induced by indomethacin was significantly lower in mice fed the safflower oil diet than in mice fed the beef tallow or fish oil diet(P < 0.05).Indomethacin increased monocyte and platelet migration to the intestinal mucosa,whereas safflower oil significantly decreased monocyte and platelet recruitment(P < 0.05).CONCLUSION: A diet rich in SFA and omega-3 PUFA exacerbated NSAID-induced small intestinal damage via increased leukocyte infiltration.Importantly,a diet rich in omega-6-PUFA did not aggravate inflammation as monocyte migration was blocked.

Liposome-Encapsulated Hemoglobin Vesicle Improves Persistent Anti-arrhythmogenesis through Improving Myocardial Electrical Remodeling and Modulating Cardiac Autonomic Activity in a Hemorrhagic Shock-Induced Rat Heart Model

Objective Shock heart syndrome(SHS)is associated with lethal arrhythmias(ventricular tachycardia/ventricular fibrillation,VT/VF).We investigated whether liposome-encapsulated human hemoglobin vesicles(HbVs)has comparable persistent efficacy to washed red blood cells(wRBCs)for improving arrhythmogenesis in the subacute to chronic phase of SHS.Methods Optical mapping analysis(OMP),electrophysiological study(EPS),and pathological examinations were performed on blood samples from Sprague-Dawley rats following induction of hemorrhagic shock.After hemorrhagic shock,the rats were immediately resuscitated by transfusing 5%albumin(ALB),HbV,or wRBCs.All rats survived for 1 week.OMP and EPS were performed on Langendorff-perfused hearts.Spontaneous arrhythmias and heart rate variability(HRV)were evaluated using awake 24-h telemetry,cardiac function by echocardiography,and pathological examination of Connexin43.Results OMP showed significantly impaired action potential duration dispersion(APDd)in the left ventricle(LV)in the ALB group whereas APDd was substantially preserved in the HbV and wRBCs groups.Sustained VT/VF was easily provoked by EPS in the ALB group.No VT/VF was induced in the HbV and wRBCs groups.HRV,spontaneous arrhythmias,and cardiac function were preserved in the HbV and wRBCs groups.Pathology showed myocardial cell damage and Connexin43 degradation in the ALB group,all of which were attenuated in the HbV and wRBCs groups.Conclusion LV remodeling after hemorrhagic shock caused VT/VF in the presence of impaired APDd.Similar to wRBCs,HbV persistently prevented VT/VF by inhibiting persistent electrical remodeling,preserving myocardial structures,and ameliorating arrhythmogenic modifying factors in the subacute to chronic phase of hemorrhagic shock-induced SHS.

Autoantibodies against myelin antigens in patients with neuromyelitis optica

In this study, we investigated the clinical relevance of anti-myelin antibodies in patients with neuromyelitis optica (NMO);titers of antibodies against myelin oligodendrocyte glycoproteins, proteolipid proteins and myelin basic proteins were measured in the sera of patients with NMO and compared to healthy controls, as well as to patients with other diseases. The frequency of presence of anti-myelin antibodies in patients with NMO was significantly higher than that in healthy and diseased controls. The expanded disability status scale scores correlated with the titers of the anti-myelin antibodies. Patients with anti-myelin antibody exhibited other autoantibodies significantly more frequently than patients without the antibody. Anti-myelin antibodies may be useful markers for predicting severe clinical courses in patients with NMO.

Late Secondary Rupture of Flexor Tendons in the Palm of the Hand

Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.

Lung Injury Resulting from Fluted Silastic Soft Drain Extraction under Negative Pressure Suction

We experienced two cases of lung injury resulting from fluted silastic drain extraction under reservoir-generated negative pressure suction. In the first case, a 67-year-old man underwent coronary artery bypass grafting. A 19 Fr BLAKE drain was placed at the pericardial cavity, the mediastinum, and the left thoracic cavity. All three drains were connected to J-VAC reservoirs. After removing the drains (which maintained the negative pressure), subcutaneous emphysema and hemopneumothorax occur. A trocar catheter was inserted. Bleeding and the air leak terminated within a day. In the second case, a 73-year-old man underwent aortic valve replacement. Right pneumothorax occurred after the removal of the pleural cavity drain, which maintained the negative pressure generated by the reservoir. We inserted a trocar catheter, and the air leak terminated within a day. We hypothesized that the reservoir-generated negative pressure causes the pleura to enter the groove of the drain and become damaged during extraction. We stopped using a reservoir to connect to the fluted silastic drain placed at the pleural cavity and removed the negative pressure when extracting the pleural cavity drain. Since implementing this change, we have not experienced a similar lung injury in more than 500 cardiac surgery patients.

A simplified protocol for the semi-large scale recovery of plasmids from <i>Escherichia coli</i>grown on agar plates

Semi-large scale liquid cultivation of transformed Escherichia coli (E. coli) in medium (100-200 ml) has been widely used for the acquisition of relatively large amounts of plasmid DNA (50-300 μg). However, this method requires an expensive high-speed centrifugation apparatus to precipitate E. coli before lysis, which is both laborious and time-consuming. Here, we demonstrate a method for agar plate-based cultivation of bacteria that does not employ a high-speed centrifugation apparatus. This procedure proves to be simple and reproducible, yielding an average of 82 μg of plasmid DNA per experiment. It may therefore be valuable for cloning/transfection experiments under limited financial backgrounds.

Papillary Fibroelastoma of the Papillary Muscle of the Tricuspid Valve: Reconstruction of the Papillary Muscle

Cardiac papillary fibroelastoma is the third most frequent primary cardiac tumor, after myxoma and fibroma. A papillary fibroelastoma that arises from the papillary muscle is rare. We removed a papillary fibroelastoma located at the anterior papillary muscle of the tricuspid valve. The papillary muscle needed reconstruction. We used the loop technique to adjust the length of the papillary muscle and performed annuloplasty by using an artificial ring.

Off-Pump Multilayered Sutureless Repair for a Left Ventricular Blowout Rupture after Aortic Dissection Repair

A left ventricular (LV) free wall rupture is a highly lethal condition. A 75-year-old female who experienced chest pain was diagnosed as having an acute aortic dissection Stanford type A and underwent emergent surgery. Under cardiopulmonary bypass with LV venting through the right superior pulmonary vein, a proximal aortic stamp was formed. The patient was cooled, selective antegrade brain perfusion was performed, and a hemiarch repair was performed. After the patient was transferred to the intensive care unit, her blood pressure suddenly fell to 50 mmHg. She had a blowout rupture in the left ventricular anterolateral free wall. Since the bleeding hall was not large and the damage to the surrounding left ventricular tissue was not very wide, an off-pump multilayered sutureless repair was performed by using three layers of collagen fleece squares with fibrinogen-based impregnation (TachoComb;CSL Behring, Tokyo, Japan) and three layers of gelatin-resorcin-formalin glue reinforced by an equine pericardial patch (Xenomedica;Edwards Lifesciences, LLC, Irvine, CA). The blow-out rupture seemed to be caused by perioperative myocardial infarction generated by the compression of the left ventricular vent to the LV lateral wall. The patient was free from re-rupture or aneurysm enlargement. The thickness of the hemostatic material seemed to help control the bulging of the aneurysm and to prevent further LV aneurysm enlargement and re-rupture.

Morbidity of Open Saphenous Vein Harvesting after Preoperative Ultrasonic Mapping

Preoperative echography of a saphenous vein graft (SVG) was studied. In 58 cases of consecutive coronary artery bypass grafting, 31 patients underwent SVG echography. Preoperative assessment revealed vein caliber, branching, or varicose saphenous veins. The location of the saphenous vein was marked. Saphenous veins were harvested by the open harvest technique, and the caliber of the veins and the availability of the anastomosis device were recorded. Postoperative morbidity was recorded. Preoperative findings revealed that four (6.5%) of 62 femoral saphenous veins were estimated as “not graftable” because of being a varicose vein or having a small caliber. Seven of 32 lower saphenous veins were estimated as “not graftable”. The mean discrepancy of the caliber was 0.6 mm undersized with preoperative estimation. During harvesting, one of 31 patients had a wrong marking. We were able to use all harvested veins. The morbidity of saphenous harvesting was observed in two (6.5%) of 31 patients. One patient whose marking was wrong had minor skin necrosis. Another patient experienced a hematoma because of the excess effect of warfarin. Preoperative ultrasonic mapping of the saphenous vein reduced useless harvesting, provided information concerning anastomosis device availability, and seemed to reduce morbidity because dissection can be minimal.

Fibrin Sealant Patch to Treat Dialysis-Associated Hemorrhagic Pericarditis

A 73-year-old male patient with a 3-year history of hemodialysis was admitted for the treatment of pericardial effusion. Echocardiography suggested a diagnosis of effusive pericarditis. Pericardiocentesis was performed several times. Six weeks after the admission, the patient developed cardiac tamponade. Surgical pericardiotomy showed the epicardium had a diffuse shaggy and hemorrhagic surface. To control diffuse oozing, fibrin sealant patches (Tachosil;CSL Behring, Tokyo, Japan) were attached to the epicardium. Oozing was then controlled.