心血管疾患と診断

Background: Molecular imaging for detection of the atherosclerotic plaque burden has been highlighted as a modality for the diagnosis of atherosclerosis. We recently developed a novel and noninvasive positron emission tomography (PET) that was functionalized with an apolipoprotein (Apo) A-I mimetic peptide [known as Fukuoka University Apo A-I mimetic peptide (FAMP)] radiolabeled with gallium-68 (68Ga) - 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (DOTA) to specifically image the status of atherosclerotic plaque in myocardial infarctionprone Watanabe heritable hyperlipidemic rabbits (WHHL-MI). Methods and Results: To achieve more sensitive molecular imaging, FAMP was modified with 4, 11 - bis (carboxymethyl) - 1, 4, 8, 11 - tetraazabicyclo (6.6.2) hexadecane (CB-TE2A) and radiolabeled with copper-64 (64Cu) for PET, and the ability of 64Cu-TE2A-FAMP to image plaque was compared with that of 68Ga-DOTA-FAMP. Japanese white normal (JW) and WHHL-MI rabbits were intravenously injected with 64Cu-CB-TE2A-FAMP or 68Ga- DOTA-FAMP, and subjected to continuous PET (25-30 MBq). Interestingly, 64Cu-CB-TE2A-FAMP was not taken up by atherosclerotic lesions in the aorta of WHHL-MI, whereas 68Ga-DOTA-FAMP was dramatically illuminated in the aorta of WHHL-MI. Moreover, 64Cu-CB-TE2A-FAMP was rapidly decomposed and 64Cu was excreted to the intestine, liver or urinary bladder in both JW and WHHL-MI rabbits. Conclusions: These results demonstrated that FAMP may be a target molecule for atherosclerotic molecular imaging with 68Ga-DOTA, but not with 64Cu-CB-TE2A. The selection of a suitable radio-nuclide and chelator might be important for HDL functioning imaging.

We describe a case of 47-year-old man who suffered a sinus node reentrant tachycardia and a typical counterclockwise cavotricuspid isthmus dependent atrial flutter. The dynamic isopotential mapping with non-contact mapping system showed that source and propagation sequence of the sinus node reentrant tachycardia almost identical to that of sinus rhythm, only the foremost was slightly different. The ablation on the source point terminated the tachycardia. The characteristics of the target electrogram in tachycardia were fractional and before onset of surface ECG P wave.

Introduction: Atrial septal defects (ASD) are a type of congenital heart disease that are characterized by a communication between the left atrium with the right atrium. Preoperative intraoperative transesophageal echocardiography (TEE) evaluates cardiac anatomy and function. The objective of this paper was to compare the use of intraoperative TEE in corrective surgeries for ASD in pediatric patients. Material and Methods: After approval by the local Ethics Committee for Research, a retrospective descriptive study was conducted in children aged 3 to 18 years who underwent an ASD repair between January 2011 and January 2015 divided in two groups: TEE group (n=24) and No-TEE group (n=28). Were assessed the demographic data, Qp/Qs ratio, pulmonary hipertension (PH), left ventricle ejection fraction (EF), and major clinical outcomes. Results: There were differences between the two groups in demographics data in age and wieght that were higher in the No-TEE group. There were no differences between the two groups in pulmonary infection, renal dysfunction, congestive heart failure, time of extubation in the ICU and intra-hospital mortality. There was 4% atrial arrhythmias in the TEE group and 0% in the No-TEE group (p=0.46). The No-TEE group showed more time to wean from CPB (35.1 ± 17.3 minutes vs 43.6 ± 27.2 minutes; p=0.01) and more time to release from ICU than TEE-group (42 ± 13.2 hours vs 58.9 ± 30.4 hours, p=0.01). Conclusions: We concluded that the use of intraoperative TEE is safe and economically feasible. It enables an assessment of cardiac anatomy and functions in the pre-CPB period and guide the weaning from CPB with lower time of CPB and ICU length stay than No-TEE group.

Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in acute STelevation myocardial infarction (MI), but is unclear what electrocardiographic (ECG) signs on admission show that it is too late to transfer the patients to a PCI-capable hospital. Therefore, we performed this exploratory study. Methods: A prospective cohort study enrolling 42 patients with the chosen signs of a late ECG stage of MI on admission was performed. Long-term outcomes were compared in 15 patients treated conservatively and 12 patients transferred to a PCI-capable hospital who underwent PCI. The new ischemic events, deaths, changes in the ECG QRS score, echocardiographic ejection fraction, and index of impaired myocardial contraction were assessed after 1.5 years. Results: No significant differences were found in the groups, except for impaired myocardial contraction, which improved in the PCI group (a score of 1.83 ± 0.98 vs. 0.78 ± 0.44, P = 0.04), but this group was significantly younger (65.3 ± 13.86 vs. 80.1 ± 6.17, P = 0.006). Conclusions: There were no clear advantages of the transfer for PCI over conservative treatment at this ECG stage of MI on admission, except the improvement of impaired myocardial contraction. That is a hypothesis for later confirmation in larger age standardized studies, because in our study many patients were lost due to specific patients arriving to a non-PCI-capable hospital and the patients transferred for PCI were significantly younger. We hope this study will help plan further researches.

Based on my clinical experience and knowledge gained through extensive research in this area, I have come up with a hypothesis which sheds more light in the pathogenesis of cardiovascular diseases. Atherosclerosis is implicated as playing the key role in the pathogenesis of cardiovascular diseases which involves large and medium sized arteries. There is now evidence that atherosclerosis is an immuno- inflammatory process. My hypothesis is that chronic psychosocial stress is the main trigger for the systemic inflammation which results by activation of hypothalamus-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) axis. This stress response sets into motion innate immune response, initiating a cascade of events which include: release of neuro-endocrine transmitters, endothelial dysfunction, increased permeability of micro vascular circulation and increased delivery of free fatty acids in circulation among others. Liver responds by increased low density lipoproteins production which continuously enter the arteries, excess LDL is transformed into oxidized low density lipoproteins (ox LDL). ox LDL goes through pattern recognition and is recognized as antigen. Adaptive immunity is activated. ox LDL is pro oxidant, it results in inflammation, reactive oxygen species are released causing oxidative stress. This causes atherosclerosis in large and medium sized arteries and tissue damage in organs sub served by micro vasculature. Hence the process being systemic inflammation is not limited to large and medium sized arteries but is global in reach involving the entire vasculature. This article will review stress and pathophysiology of stress, pathophysiology of cardiovascular diseases which includes pathogenesis of atherosclerosis and Inflammation in atherosclerosis. It discusses microcirculation, and goes over disorders involving microcirculation. Oxidative stress is reviewed followed by conclusion.

Objective: The cross adaptation of humans suffering the consequences of external low-dose ionising radiation impact (ELDIRI) was to be studied. Methods: The observational investigation in a XXXXX secondary care centre included 507 non-smoking men (male, age 50.14 ± 10.39 years) and was approved by the commission on ethics. Results: The radiation haematologic stress is not related to cytomegalovirus infection, unlike the haematologic stress. The latter is the response of the human body as an ecosystem, but it can be a synergist of cytomegalovirus, which is capable of inducing haematologic stress as well as systolic and isolated systolic hypertension. Latent iron deficiency can cause hypertension, including diastolic hypertension, in humans, including those suffering from ELDIRI. Conclusions: Many human biology features may be explained by the absence of inverse correlation between T3 and T4 (except in the case of patients with thyroid diseases). The health of Russian cosmonauts may be superior to that of US astronauts because of the use of reserpine for radioprotection in the USA. As long as biologic age is inversely correlated to the α2-macroglobulin/α1-protease inhibitor ratio, so it would be interesting to study the selection of humans with elevated α2-macroglobulin contents for longitudinal interplanetary flights. Advances in knowledge The radiation haematologic stress has been described. It may be the more ancient stress in evolution than haematologic stress and Selye’s general adaptation syndrome.

Background: The greater saphenous vein is frequently used as a conduit for coronary artery bypass grafting (CABG). Previously, veins were most often harvested using open vein harvesting (OVH), however, endoscopic vein harvesting (EVH) techniques have become increasingly popular. Nevertheless, the long-term cost-effectiveness of EVH remains unknown. The present study estimated the long-term cost-effectiveness of EVH versus OVH for CABG. Methods: A Markov model was developed to estimate life-time costs (UK Pounds Sterling) and quality adjusted life-years (QALYs) with comparative results presented as incremental cost-effectiveness ratios (ICERs). Costs and probabilities of events in the OVH group were mainly drawn from a previously published study. Resource consumption and event probabilities in the EVH group were estimated using a meta-analysis to reflect the best available evidence. Parameter uncertainty was assessed using both one-way sensitivity analyses and probabilistic sensitivity analyses. Results: The life-time cost/QALY was £8219 rendering EVH cost-effective compared to OVH. Sensitivity analyses showed that EVH was cost-effective in 60.4% of simulations at a threshold of £30 000/QALY, reflecting a large uncertainty in the point estimate of the ICER. The main causes of uncertainty were the time-horizon and the event rates of major clinical events in the treatment groups. Conclusions: Current evidence indicates that EVH is cost-effective for harvesting saphenous vein segments for CABG compared to OVH. Further studies on long-term clinical outcomes are needed to reach a more precise costeffectiveness estimate.

Pulmonary edema is a significant complication of a number of disease and conditions. Its main manifestation is the leakage of fluid from the pulmonary capillaries into the cavity of the alveoli through the alveolar-capillary membrane. This leads to a number of severe clinical manifestations and requires immediate treatment. The underlying mechanisms causing this complication include cardiogenic and noncardiogenic factors. A formula is proposed to attempt to unify the causes of pulmonary edema, reflecting the relationship of all factors involved in the process. The formula is simple and evident, and covers all the factors that cause or contribute to the development of pulmonary edema. It also explains the pathogenesis of cardiogenic and noncardiogenic pulmonary edema and their relationship.