LST Group Research Articles

Safety and Effects of a Four-Week Preoperative Low-Load Resistance Training With Blood Flow Restriction on Pre- and Postoperative Quadriceps Strength in Patients Undergoing Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial.

Background/Objectives Enhancing preoperative quadriceps strength and mitigating quadriceps strength loss due to total knee arthroplasty (TKA) is crucial for post-TKA recovery. This study compared the safety and effect of a four-week preoperative regimen of low-load resistance training with blood flow restriction (LLRT-BFR) with those of low-intensity resistance training with slow movement and tonic force generation (LST) on the pre- and postoperative quadriceps strength in patients undergoing TKA. Methods In this randomized controlled trial, 22 patients were assigned to either the LLRT-BFR (n=11) or LST (n=11) group. Primary outcomes included changes in quadriceps strength before and after the intervention and surgery. To assess safety, we monitored D-dimer and high-sensitivity C-reactive protein levels pre- and post-intervention. Statistical analysis involved independent samples t-tests and Mann-Whitney U tests for group comparisons of quadriceps strength changes. Additionally, a two-way repeated-measures analysis of variance was used to assess safety parameters. Results No significant differences were observed between the BFR and LST groups in terms of the rate of increase in quadriceps strength pre- and post-intervention (BFR: median 12.1%, interquartile range -0.8% to 19.5%; LST: median 6.2%, interquartile range2.7% to 14.7%; p>0.99) or in the rate of reduction in quadriceps strength pre- and post-surgery (BFR: mean -72.4%, standard deviation±11.2%; LST: mean -75.3%, standard deviation±12.2%; p=0.57). Safety assessments showed no significant main effects of time, group, or interaction on the safety parameters (all p>0.05). Conclusions LLRT-BFR and LST demonstrated comparable effects on quadriceps strength before and after intervention and surgery in patients undergoing TKA. The lack of significant changes in the safety parameters supports the safety profile of both interventions, indicating their suitability for preoperative conditioning in patients scheduled for TKA.

Curative Effect Analysis of Endoscopic Submucosal Dissection in Giant Laterally Spreading Rectal Tumors.

The objective of this study was to investigate the clinical efficacy of endoscopic submucosal dissection (ESD) in the treatment of giant lateral developing rectal-type tumors (laterally spreading tumors, LSTs). There are no specialized studies on the efficacy of ESD in the treatment of LSTs measuring >5cm in diameter, surgery was often used in the past, but it has the disadvantages of large trauma, many complications, and high cost. The data of 185 patients with rectal LSTs who had undergone ESD in the digestive endoscopy center of our hospital from January 2012 to June 2020 were retrospectively analyzed. Based on the size of the lesions, the patients were divided into 2 groups: diameter ≤5cm (110 cases) and diameter >5cm (75 cases), and we summarized and analyzed the en bloc resection rate, curative resection rate, procedure time, muscle injury, bleeding, perforation, postoperative stricture, and recurrence. There was no difference in the en bloc resection rate and R0 resection rate between the 2 groups ( P =0.531). Moreover, there was no difference in the incidence of delayed perforation, postoperative stenosis, and recurrence, but the incidence of delayed bleeding was significantly higher in the giant LST group than the small LST group ( P =0.001). Moreover, for giant rectal LSTs, the growth pattern of the lesion, JNET classification, and the extent of postoperative mucosal defect do not significantly affect the efficacy of ESD. It is worth mentioning that the operation time was longer in the group with a diameter >5cm, in which perforation was more frequent and the muscle layer was more likely to be injured during ESD ( P <0.001). The muscle injury during ESD was mainly related to the diameter of the lesion, the crossing the rectal pouch, and the operation time. The use of ESD to treat giant rectal LSTs (>5cm) is relatively difficult and can easily lead to intraoperative muscle injury, perforation, and late postoperative bleeding. However, if active intervention is performed, patients can still achieve good efficacy and prognosis, which can be applied in hospitals with certain conditions.

Aerobic Exercise Training Prevents Insulin Resistance and Hepatic Lipid Accumulation in LDL Receptor Knockout Mice Chronically Fed a Low-Sodium Diet.

Background: A low-sodium (LS) diet reduces blood pressure, contributing to the prevention of cardiovascular diseases. However, intense dietary sodium restriction impairs insulin sensitivity and worsens lipid profile. Considering the benefits of aerobic exercise training (AET), the effect of LS diet and AET in hepatic lipid content and gene expression was investigated in LDL receptor knockout (LDLr-KO) mice. Methods: Twelve-week-old male LDLr-KO mice fed a normal sodium (NS) or LS diet were kept sedentary (S) or trained (T) for 90 days. Body mass, plasma lipids, insulin tolerance testing, hepatic triglyceride (TG) content, gene expression, and citrate synthase (CS) activity were determined. Results were compared by 2-way ANOVA and Tukey’s post-test. Results: Compared to NS, LS increased body mass and plasma TG, and impaired insulin sensitivity, which was prevented by AET. The LS-S group, but not the LS-T group, presented greater hepatic TG than the NS-S group. The LS diet increased the expression of genes related to insulin resistance (ApocIII, G6pc, Pck1) and reduced those involved in oxidative capacity (Prkaa1, Prkaa2, Ppara, Lipe) and lipoprotein assembly (Mttp). Conclusion: AET prevented the LS-diet-induced TG accumulation in the liver by improving insulin sensitivity and the expression of insulin-regulated genes and oxidative capacity.

Effects of Low-Intensity Resistance Exercise with Slow Movement and Tonic Force Generation on Short-Term Glycemic Variability in Healthy Subjects: A Randomized Controlled Study

Resistance exercise improves daily glycemic control. Low-intensity resistance exercise with slow movements and tonic force generation (LST) is a resistance exercise protocol that can increase skeletal muscle mass and strength without considerable physical burden; however, its effect on glycemic variability is unknown. The aim of this study was to investigate the effect of LST on short-term glycemic variability, expressed as the M-value, in healthy individuals. We recruited 20 healthy subjects (mean age: 27.9 ± 3.9 years) with normal glucose tolerance, and subjects were randomly assigned to the control (n = 10) or LST (n = 10) groups. Subjects in the LST group performed the resistance exercise with 40–50% of the one-repetition maximum for 40 min. All subjects wore a subcutaneous continuous glucose monitoring system and a triaxial accelerometer, and their daily glycemic variability and physical activity were measured. One hour after the intervention, in the LST group, the variability of blood glucose levels was significantly decreased compared to the control group (M-values in the LST group: pre 3.5 ± 6.2, post 2.7 ± 2.7, p = 0.575; M-values in the control group: pre 0.4 ± 0.7, post 2.7 ± 2.0, p = 0.017). However, there were no differences in total physical activity and daily glycemic control between groups. The findings of this study suggest that LST improves short-term glycemic variability in healthy subjects.

Effects of preoperative low-intensity training with slow movement on early quadriceps weakness after total knee arthroplasty in patients with knee osteoarthritis: a retrospective propensity score-matched study

BackgroundSevere and early quadriceps weakness (QW) after total knee arthroplasty (TKA), which is caused by acute inflammation resulting from surgical trauma and tourniquet-induced ischemia-reperfusion (IR) injury, can be especially problematic. We focused on tourniquet-induced IR injury, because it has been shown to be preventable through ischemic and exercise preconditioning. Low-intensity resistance exercise with slow movement and tonic force generation (LST) share some similarities with ischemic and exercise preconditioning. The present study primarily aimed to clarify the efficacy of preoperative LST program as prehabilitation for early QW among patients with TKA using propensity score matching analysis.MethodsThis single-center retrospective observational study used data from patients with knee osteoarthritis (n = 277) who were scheduled to undergo unilateral TKA between August 2015 and January 2017. Those with missing outcome data due to their inability to perform tests were excluded. The LST group included participants who performed LST and aerobic exercise (LST session) more than seven times for three months prior to surgery. The control group included participants who performed less than eight LST sessions, a general and light exercise or had no exercise for three months prior to surgery. Knee circumference, thigh volume, knee pain during quadriceps strength test (QST) and timed up and go test (TUG), quadriceps strength, and TUG were measured before and 4 days after surgery. Knee swelling, thigh swelling, Δknee pain, QW, and ΔTUG were determined by comparing pre- and postoperative measurements.ResultsPropensity score matching generated 41 matched pairs who had nearly balanced characteristics. The LST group had a significantly lower knee and thigh swelling, QW, and ΔTUG compared to the control group (all, p < 0.05). No significant differences in Δknee pain during the QST and TUG were observed between both groups (both, p > 0.05).ConclusionsThe present study demonstrated the beneficial effects of preoperative LST program on knee swelling, thigh swelling, QW, and walking disability immediately after TKA.

Lumbar spinal cord neurons putatively involved in ejaculation are sexually dimorphic in early postnatal mice.

A crucial role in ejaculation is thought to be played by a population of lumbar spino-thalamic neurons (LSt), which express galanin and other neuropeptides. In rats, these neurons are activated with ejaculation and their lesion selectively abolishes ejaculation but not other mating behaviors. Consistently with their role, in adult rats and humans, LSt neurons are sexually dimorphic, being more numerous in males. Here we examined whether sexual dimorphism arises early in development, using a transgenic mouse line in which the expression of fluorescent protein is driven by the galanin promoter. We focused on postnatal day 4, shortly after a transient perinatal androgen surge in males that could play an organizational role in LSt development. We found a population of brightly fluorescent neurons organized in bilateral columns dorsolateral to the central canal in segments L1-L5, the expected location of the LSt group. Their number was close to that of adult preparations and significantly greater in male than in female siblings (+19%; CI95% : +13% to +27%; p < .01). This was not due to a generalized higher galanin expression in the male since fluorescent L4 DRG neurons, innervating the hindlimbs and lower back, were not significantly dimorphic (-4%; CI95% : -10% to +8%; p = .92). Unexpectedly, we found in cervical segments a population of fluorescent neurons having a location relative to the central canal similar to the LSt. Thus, the LSt group is sexually dimorphic soon after birth. However, it is possible that only a subset of its neurons participate in the control of ejaculation.

Long-term effects of low-intensity training with slow movement on motor function of elderly patients: a prospective observational study

BackgroundSlow-motion training, which comprises exercising using extremely slow-movements, yields a training effect like that of high-intensity training, even when the applied load is small. We developed a slow-training exercise program that allows elderly people to safely use their own body weight without a machine. Previously, it was confirmed that functional gait and lower limb muscle strength were improved by low-intensity training using bodyweight training for 3 months. This study evaluated the long-term effects of low-intensity training using body weight with slow-movements on the motor function of frail, elderly patients.MethodsNinety-six elderly men and women aged 65 years or older whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care levels 1 and 2) volunteered to participate. Two facilities were used. Participants at the first facility used low-intensity training using body weight with slow-movements (low-stress training [LST] group, n = 65), and participants at another facility used machine training (MT group, n = 31). Exercise interventions were conducted for 12 months, once or twice per week, depending on the required level of nursing care. Changes in motor function were examined.ResultsPost-intervention measurements based on the results of the chair-stand test after 12 months showed significant improvements from pre-intervention levels (P < 0.0001) in the LST group and MT group. Although the ability of performing the Timed Up & Go test and the ability to stand on one leg with eyes open improved in both groups, no significant change was observed. When changes after 12 months were compared between the two groups, no significant difference was observed for any variables.ConclusionsSlow body weight training for 12 months without a machine improved the lower limb muscle strength. Therefore, it could have the same effects as training using a machine.Trial registrationUMIN000030853. Registered 17 January 2018 (retrospectively registered).

Behavioral Effect of Short- and Long-Term Exercise on Motor Functional Recovery after Intracerebral Hemorrhage in Rats

BackgroundIn this study, we investigated the effects of short- and long-term exercise on motor functional recovery following intracerebral hemorrhage (ICH) in rats. MethodsMale Wistar rats were randomly divided into 5 experimental groups: ICH without training (ICH group), ICH with long-term exercise for 14days from the second day after surgery (ICH + LT group), ICH with short-term exercise for 7days from the second day after surgery (ICH + EST group), ICH with short-term exercise for 7days from the ninth day after surgery (ICH + LST group), and sham operation without training (SHAM group). ICH was induced by collagenase injection into the left striatum. Forelimb sensorimotor function was evaluated using forelimb placing and horizontal ladder tests. ResultsIn the behavioral test, the ICH + LT and ICH + EST groups improved significantly compared with the ICH and ICH + LT groups. The ICH + LT and ICH + EST groups recovered motor function in an almost analogous pattern. ConclusionsOur results indicated that, when exercise was started from an early phase after ICH, both short- and long-term exercises had similar benefits on motor functional recovery. However, continuous training using simple treadmill running may have limitations to motor functional recovery.

Effects of low-intensity bodyweight training with slow movement on motor function in frail elderly patients: a prospective observational study

BackgroundSlow-motion training, an exercise marked by extremely slow movements, yields a training effect like that of a highly intense training, even when the applied load is small. This study evaluated the effects of low-intensity bodyweight training with slow movement on motor function in frail, elderly patients.MethodsNinety-seven elderly men and women aged 65 years or older, whose level of nursing care was classified as either support required (1 and 2) or long-term care required (care level 1 and 2), volunteered to participate. Two facilities were used. Participants in the first facility used low-intensity bodyweight training with slow movement (the LST group, n = 65), and participants in another facility used machine training (the control group, n = 31). Exercises were conducted for 3 months, once or twice a week, depending on the required level of nursing care. Changes in motor function were examined.ResultsPost-exercise measurements showed significant improvements from the pre-exercise levels after 3 months, based on the results of the Timed Up and Go test (p = 0.0263) and chair-stand test (p = 0.0016) in the low-intensity exercise with slow movement and tonic force generation (LST) group. Although the ability to stand on one leg with eyes open tended to improve, no significant change was found (p = 0.0964).ConclusionsWe confirmed that carrying out LST bodyweight training for 3 months led to improvements in ambulatory function and lower-limb muscle strength. In this way, it is possible that LST training performed by holding a bar or by staying seated on a chair contributes to improved motor function in elderly patients within a short time.Trial registrationUMIN000030853. Registered 17 January 2018. (retrospectively registered).

Low-load Slow Movement Squat Training Increases Muscle Size and Strength but Not Power.

We tested a hypothesis that low-load squat training with slow movement and tonic force generation (LST) would increase muscle size and strength but not necessarily power. Healthy young men were assigned to LST [50% one-repetition maximum (1-RM) load, 3 s for lowering/lifting without pause: n=9] or low-load normal speed (LN: 50% 1-RM load, 1 s for lowering/lifting with 1-s pause; n=7) groups. Both groups underwent an 8-week squat training program (10 repetitions/set, 3 sets/day, and 3 days/week) using the assigned methods. Before and after the intervention, quadriceps femoris muscle thickness, maximal torque during isometric hip extension and knee extension, 1-RM squat, lifting power from squatting position and rate of electromyography rise (RER) in knee extensors during the task, leg extension power and vertical jump height were measured. After the intervention, the LN group showed no changes in all the variables. The LST group significantly (P<0.05) increased muscle thickness (6-10%), isometric hip extension torque (18%) and 1-RM squat (10%), but not isometric knee extension torque, lifting power and RER, leg extension power and vertical jump height. These results suggest that LST can increase muscle size and task-related strength, but has little effect on power production during dynamic explosive movements.

Photoprotective Effect of Lotus (Nelumbo nucifera Gaertn.) Seed Tea against UVB Irradiation.

Lotus (Nelumbo nucifera Gaertn.) seed is widely used as a traditional medicine in countries of Asia. Among many functions of the lotus seed, one interesting activity is its skin protection from the sunlight and scar. In this study, we focused on the skin protective property of lotus seed tea against ultraviolet B (UVB) irradiation. Two groups of a hairless mouse model, water as control (water group) and lotus seed tea (LST group), were administrated a fluid drink water for six months. After 6 month of administration, UVB exposure was carried out to both groups for another 3 months. During and after the administration, the skin moisture content and the morphological and histopathological analyses through biopsy were carried out. Prior to UVB irradiation, no significant difference was discovered in the skin moisture content for the water group and LST group (P<0.05). However, drastic changes were observed after the UVB treatment. The LST group showed a clear evidence of skin protection compared to the control group (P<0.05). The moisture content, epidermal and horny layer thickness, and protein carbonyl values all revealed that the intake of the lotus seed tea enhanced protection against UVB exposure. As a result, the long-term intake of the lotus seed tea showed the effect of preventing loss of skin moisture, mitigating the formation of abnormal keratinocytes, and contributing to protein oxidation inhibition.

Evaluation of anti-nociceptive and anti-inflammatory activity of low-level laser therapy on temporomandibular joint inflammation in rodents

The aim of this study was to investigate the analgesic and anti-inflammatory activity of low-level laser therapy (LLLT) on the nociceptive behavioral as well as histomorphological aspects induced by injection of formalin and carrageenan into the rat temporomandibular joint. The 2.5% formalin injection (FRG group) induced behavioral responses characterized by rubbing the orofacial region and flinching the head quickly, which were quantified for 45min. The pretreatment with systemic administration of diclofenac sodium-DFN group (10mg/kg i.p.) as well as the irradiation with LLLT infrared (LST group, 780nm, 70mW, 30s, 2.1J, 52.5J/cm2, GaAlAs) significantly reduced the formalin-induced nociceptive responses. The 1% carrageenan injection (CRG group) induced inflammatory responses over the time-course of the study (24h, and 3 and 7days) characterized by the presence of intense inflammatory infiltrate rich in neutrophils, scanty areas of liquefactive necrosis and intense interstitial edema, extensive hemorrhagic areas, and enlargement of the joint space on the region. The DFN and LST groups showed an intensity of inflammatory response that was significantly lower than in CRG group over the time-course of the study, especially in the LST group, which showed exuberant granulation tissue with intense vascularization, and deposition of newly formed collagen fibers (3 and 7days). It was concluded that the LLLT presented an anti-nociceptive and anti-inflammatory response on the inflammation induced in the temporomandibular joint of rodents.

064 LONG-TERM OUTCOME AMONG PATIENTS WITH EARLY, LATE, AND VERY LATE STENT THROMBOSIS FOLLOWING PREVIOUS PCI FOR ST-ELEVATION MYOCARDIAL INFARCTION

Background Stent thrombosis (ST) often presents as ST Elevation Myocardial infarction (STEMI). ST has not been adequately characterised with regard to differences in outcome related to the timing of ST—early (EST), late (LST) and very late (VLST). The aim of this study was to characterise ST presenting as STEMI comparing the timing of ST in terms of baseline characteristics, clinical presentation and long-term outcome. Methods This was an observational cohort study of 3658 patients who underwent primary percutaneous coronary interventions (PPCI) from 2003 to 2012 with follow-up for a median of 3.4 years (IQR range 1.2–4.6 years). The primary end-point was the first major adverse cardiac event (MACE) defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization. Results ST overall accounted for 6.9% (251/3658) of all STEMIs. 33.1% (n=83) were early (where 3.2% acute ST ( 1 year). The VLST group had different clinical characteristics compared to the EST and LST group. The VLST group had lower rates of diabetes (VLST 22.2% vs EST 30.1% vs LST 27.5%, p=0.003), previous MI (VLST 56.6% vs EST 66.3% vs LST 63.8%, p=0.001), renal failure (VLST 12.1% vs EST 27.7% vs LST 26.1%, p=0.04), previous CABG (VLST 3.0% vs EST 10.8% vs LST 7.2%, p=0.05) and cardiogenic shock (VLST 2.0% vs EST 6.0% vs LST 13.0%, p=0.05) than those with either early or late stent thrombosis. The VLST group had clinical characteristics that were similar to patients presenting with native coronary thrombosis (table 1). The VLST group had a significantly lower cumulative incidence of MACE during follow-up (27.3% 95% CI 12.2 to 38.6) compared to the EST (66.9% 95% CI 54.7 to 76.6; p=0.016) and LST (58.5% 95% CI 43.1 to 73.3; p=0.016) group (figure 1). There was no difference in outcome between the VLST and native coronary thrombosis group (27.3% 95% CI 12.2 to 38.6 vs 25.6% 95% CI 20.5 to 30.5, p=0.245). Early (HR, 2.50; 95% CI 1.73 to 3.63; p Conclusions Differences in baseline demographic features, and long-term outcomes between the different timings of ST suggest that the predominant underlying mechanisms might be different.

Differences in findings of nocturnal polysomnography and multiple sleep latency test between narcolepsy and idiopathic hypersomnia

Objectives To compare differences in nocturnal and daytime polysomnographic findings between narcolepsy (NA) with and without cataplexy (CA) and idiopathic hypersomnia without long sleep time (IHS w/o LST). Methods Nocturnal polysomnography (n-PSG) and multiple sleep latency test (MSLT) findings were compared among subjects with NA with CA ( n = 52), NA without CA ( n = 62), and IHS w/o LST ( n = 50). Results The NA with CA group had significantly more disrupted and shallower nocturnal sleep than the other groups. On MSLT, the IHS w/o LST group had significantly longer sleep latency (SL) compared with the two NA groups. The latter two groups did not show statistical differences in diurnal variation of SL. Conclusions The IHS w/o LST group had milder objective daytime sleepiness compared with the NA groups. In patients with NA, nocturnal sleep disturbances appeared only in cases with CA, despite a similar trend in diurnal changes in sleep propensity between the two NA groups. Significance Objective nocturnal sleep disturbances are specific to NA patients with CA, whereas diurnal variations of sleep propensity are observed irrespective of the presence of CA among NA patients. These findings could be helpful for choosing optimal treatment plans for patients with these disorders.

Changes in Muscle Activation and Force Generation Patterns During Cycling Movements Because of Low-Intensity Squat Training With Slow Movement and Tonic Force Generation

Our previous studies showed that relatively low-load (approximately 50-60% 1 repetition maximum [1RM]) resistance training with slow movement and tonic force generation (LST) significantly increased muscle size and strength. However, LST is a very specific movement that differs from natural movements associated with sport activities and activities of daily life, and therefore, it might have some unfavorable effects on dynamic sport movement. We investigated the effects of LST on muscle activity and force generation patterns during cycling movement as a representative dynamic sports movement. Twenty-four healthy young men who were not in the habit of bicycle riding and did not have a history of regular resistance training were randomly assigned to the LST (approximately 60% 1RM load, 3-second lifting, and 3-second lowering movement without a relaxing phase: n = 8), a high-intensity exercise at normal speed (HM) group (85% 1RM load, 1-second lifting, 1-second lowering, and 1-second relaxed movement: n = 8), or sedentary control (CON, n = 8) group. Subjects in the training groups performed vertical squats by the assigned method. Exercise sessions consisted of 3 sets and were performed twice a week for 13 weeks. Pre- and posttraining muscle activation and force generation patterns during the cycling movements were evaluated by the coefficient of variation (CV) of the rectified electromyographic (EMG) wave from the vastus lateralis and CV of pedaling force. Both the CV of the rectified EMG and of pedaling force decreased significantly in the LST group (-21 and -18%, p < 0.05, respectively), whereas there were no significant changes in either the HN or the CON group. This decrease in CV in the LST group could mean that muscle activity and force generation during cycling movement have become more tonic. This result following LST may have an unfavorable effect on cycling movement and other dynamic sports movements.

Comparison of clinical characteristics among narcolepsy with and without cataplexy and idiopathic hypersomnia without long sleep time, focusing on HLA-DRB1 ∗1501/DQB1 ∗0602 finding

Background Clinical characteristics of narcolepsy without cataplexy (NA w/o CA) and its relation to positivity of HLA-DRB1 ∗1501/DQB1 ∗0602 remain unclarified. We investigated clinical features of NA w/o CA, particularly addressing HLA-DRB1 ∗1501/DQB1 ∗0602. Methods Comparisons of the Epworth Sleepiness Scale (ESS), multiple sleep latency test (MSLT) variables, rapid eye movement (REM)-related symptoms, and treatment response to psychostimulant medication were made for four patient groups (narcolepsy with cataplexy; NA–CA, NA w/o CA HLA-positive, NA w/o CA HLA-negative, and idiopathic hypersomnia without long sleep time; IHS w/o LST). Results Mean sleep latency was significantly shorter and the rate of reduction of ESS after medication was lower in both NA–CA and NA w/o CA HLA-positive groups than those in the IHS w/o LST group. Among the three narcoleptic groups, the NA w/o CA HLA-negative group showed the lowest REM latency and the highest reduction rate of ESS after treatment. Neither these subjective and objective sleepiness measures nor the treatment response measure was significantly different between this group and the IHS w/o LST group. Conclusions In NA w/o CA, HLA-positivity might affect hypersomnia severity and REM propensity. The NA w/o CA HLA-negative group and the IHS w/o LST group exhibit equivalent hypersomnia severity.

Abstract 6016: Pathology Of Hypersensitivity In Late Drug Eluting Stent Thrombosis

Background: Localized hypersensitivity (HS) has been reported as a pathologic risk factor for late DES thrombosis (DES-LST). The objectives of the study were to examine the pathologic features of HS in DES-LST and correlate with stent characteristics, underlying plaque morphologies and patient risk factors. Materials and methods: From a registry of 153 DES patients, 33 patients with DES-LST were identified. LST was defined as platelet-rich thrombus in a coronary stent implanted &gt; 30 days. Stented arteries were serially sectioned at 2–3 mm intervals and stained with H&amp;E, Movat stain, Luna stain (eosinophils), and UCHL (T-lymphocytes). Localized HS was defined as an inflammatory cell infiltrate composed predominantly of eosinophils and T-lymphocytes limited to the arterial wall surrounding the stent. Patient data, risk factors, stent characteristics, and underlying plaque morphology were compared between two groups: hypersensitivity (HS), and non-hypersensitivity LST (NHS). Results: Of the 33 DES-LST cases with occlusive thrombus, 6 (4 men, 2 women) demonstrated HS histologically (18%). The mean age was 54 years (range 40 – 62 years). All 6 had Cypher stents (mean stent length=24 mm), 4 had &gt;1 stent, 2 with overlapping stents. The mean stent duration was 624 days (range 112 to 990 days). Three patients were on ASA and clopidogrel, 2 ASA only, 1 discontinued ASA/clopidogrel prior to non-cardiac surgery. Patient risk factors included hyperlipidemia (n=6), hypertension (n=5) and smoking (n=4). All demonstrated underlying fibroatheroma with stent struts penetrating necrotic core in 3 and 2 with previous rupture sites. Stent malapposition was present in 5 (83%). Twenty-seven patients demonstrated NHS-LST (Cypher=7, Taxus=20). Mean stent duration was 326 days (range 31–1200 days). Malapposition was identified in 10 (37%). Compared to NHS, the HS LST group was more likely to demonstrate stent malapposition (p=0.04) and longer implant times (p=0.049). Conclusions: DES-LST is related to HS in 18% of cases, is associated with Cypher stents, malapposition and longer implantation time. Localized HS with stent thrombosis is a clinically important problem that may occur late after stenting and warrants further pathologic study.

Insulinlike Growth Factor I Affects Ocular Development: A Study of Untreated and Treated Patients with Laron Syndrome

To evaluate the ocular dimensions in patients with primary growth hormone receptor insensitivity (Laron syndrome [LS]) and to study the effect of supplemental insulinlike growth factor I (IGF-I) on ocular growth. Retrospective case series. Twelve patients with LS, 8 untreated (LS group) and 4 treated (LS-T group) with supplemental IGF-I, and 30 healthy controls. Ocular dimensions and refraction were measured, and a full ophthalmologic examination was performed. Differences in the average ocular dimension data among IGF-I-treated patients, untreated ones, and controls. The average axial length of eyes in the LS group was 21.94 mm (standard deviation [SD], 0.81). Corresponding values for the LS-T and control group eyes were 22.53 mm (SD, 1.74) and 23.20 mm (SD, 1.35) respectively. The average anterior chamber depth of eyes in the LS group was 2.55 mm (SD, 0.26). Corresponding values for eyes in the LS-T and control groups were 3.48 mm (SD, 0.09) and 3.84 mm (SD, 0.16) respectively. The average lens thickness of eyes in the LS group was 4.56 mm (SD, 0.36). Corresponding values for the LS-T and control groups were 3.77 mm (SD, 0.23) and 3.51 mm (SD, 0.25), respectively. The average corneal curvature of eyes in the LS group was 46.9 diopters (D) (SD, 2.32). Corresponding values for the LS-T and control groups were 47.6 D (SD, 2.83) and 44.4 D (SD, 1.5), respectively. Insulinlike growth factor I seems to be an important regulator of ocular growth as documented in patients with primary growth hormone insensitivity. The mechanism of this observation should be investigated further.

Changes in cerebral blood flow and their correction in the interparoxysmal period of epilepsy

Cerebral hemocirculatory disturbances are among the poorly studied pathogenetic factors of epilepsy. At the same time the facts of the increased level of paroxysmal propensity of the brain in the presence of chronic dyscirculatory hypoxia of neurons [7, 13], the emergence of an epileptic syndrome in acute cerebrovascular diseases [2, 10], the substantial similarity of the histologic changes of the brain in epilepsy with a pathomorphological substrate of chronic cerebral ischemia [11], the close association between epilepsy and migraine [6], and finally, the outward appearance of the epileptic paroxysm as a vascular crisis [5], are well known. All these facts permit the hypothesis that dyshemic disorders may play a role in the formation, development, and compensation of the paroxysmal activity of the brain. It is well known at the present time that an increase in cerebral blood flow takes place at the moment of a full-scale epileptic paroxysm [4, 8]. However, the changes in blood flow in response to a subthreshold, subclinical increase in paroxysmal activity have not been studied. This is of special significance for the study of the influence of the level of paroxysmal activity of the brain in the interictal period, when its fluctuations are accompanied by varying intensities of the metabolic processes, and, consequently, must also have a varying level of vascular supply. In the opinion of some authors [14, 15], the hemodynamic changes in the interictal period of epilepsy are manifested by a decrease in blood flow which is most marked in the epileptic focus. Other investigators [1] direct attention to the possibility of compensatory intensification of hemocirculation in the epileptic focus. An increase in local cerebral blood flow under the influence of the cerebrospinal fluid of epilepsy patients has also been demonstrated in experiments on animals [3]. It may also be noted that the level of the blood supply of the epileptic brain has not until now been established, the association of the hemodynamic disturbances with the clinical features of the disease has not been precisely defined, and the effect of anti-epileptic and vasoactive preparations on the state of the cerebrovascular bed in epilepsy patients has not been studied. We carried out an investigation of cerebral blood flow (CBF) in 75 epilepsy patients, aged from 15 to 53 years, without signs of accompanying cardiovascular diseases. Of those examined, 62 patients were younger than 40 years, which made it possible to reduce the influence of age-related factors on hemodynamics. The duration of the illness was less than five years in 36 patients, 5-10 years in 14 cases, and more than 10 years in 25. Attacks were rare in 25 individuals; they were of average frequency in 21; and they were frequent in 34 patients. The verification of the clinical diagnosis of epilepsy was accomplished though analysis of the EEG. According to H. Gastaut's classification [9], generalized secondary epilepsy (lst group) was diagnosed in 23 patients, focal temporal epilepsy (2nd group) was diagnosed in 30 patients, and focal precentral epilepsy (3rd group) was diagnosed in 22 patients. The principal method of studying the cerebral hemocirculation was radionuclide cerebral circulography (RCC). It was carfled out on an NC-110 unit (Hungary).131I-Albumin injected into the cubital vein was employed as the indicator. The cerebral blood flow time (CBb-T), the accumulation half-time Talt2, and the elimination half-time Tblr z were determined separately for each hemisphere. The radionuclide investigation of the linear cerebral blood flow (LCBF) was supplemented by the recording of the REG. We studied the baseline level of the hemocirculation prior to the prescription of treatment (47 individuals) or on the ffth day after it was discontinued (28 observations), as well as the dynamics of the CBF during a gradual increase in epileptic activity by means of the intravenous administration of corazole (48 observations) or by means of three minutes of hyperventilation (16 observations) under EEG monitoring. The investigation was repeated on the 10th to 15th day of treatment with pheobarbital, as well as its combination with papaverine or caffeine.

海産魚類の卵質および子魚の生残におよぼす要因解明に関する研究 ＩＩ マダイ自然産卵の形状

In order to identify factors for the variations in egg quality by individual brood fish, egg samples taken from the lst Group (three-year olds in the 10-ton pond) and the 2nd Group (two-to twelve-year olds in the 4, 000m2 pond) were examined for their respective characteristics. In addition to normal eggs and dead eggs, three types of abnormal eggs were found among the samples; namely, (i) wrinkly eggs which developed wrinkles on the egg membrane, (ii) spotted eggs which developed minute black spots on the egg cortex, and (iii) plasma-bulged eggs which developed swellings of cortical ooplasma. The percentage of abnormal eggs was higher in the 2nd Group than the 1st. Moreover, the percentage varied greatly by individual brood fish, reaching well over 60% in some cases.