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• This case-control study documents new risk factors strongly related with cardiac rupture (CR) after primary percutaneous coronary intervention. • Acute hyperglycemia and thrombocytopenia are strongly associated with early and late CR, respectively. • Emergent surgical repair may lead to a reduction of in-hospital mortality in CR patients. • Early prediction of CR using clinical risk factors may improve mortality in ST-elevation myocardial infarction patients. Cardiac rupture (CR) is a catastrophic complication of acute myocardial infarction. Primary percutaneous coronary intervention (pPCI) reduces the incidence of CR. This study aimed to investigate the clinical risk factors and characteristics of CR after pPCI. This was a retrospective, case-control, multicenter study. We enrolled 2444 consecutive patients with ST-elevation myocardial infarction (STEMI) who had undergone pPCI between 2009 and 2015; 33 patients experienced CR (1.35%): 19 were assigned as early CR (≤72 h) and 14 as late CR (>72 h). The 132 controls were randomly selected from the 2411 STEMI patients without CR, by matching institutions at a 1:4 ratio. : Multivariate logistic regression revealed that female sex, acute hyperglycemia, thrombocytopenia (platelets <15 × 104/µL), and incomplete revascularization [post-PCI thrombolysis in myocardial infarction (TIMI) <3] were independent risk factors for CR (p <0.05). Older age, female sex, and emergency surgical repair were strongly associated with in-hospital death, which occurred in 66.7% of CR patients (p <0.05). Univariate logistic regression adjusted for age and sex revealed that low systolic blood pressure, anterior infarction, acute hyperglycemia, Killip class >1, and post-PCI TIMI <3 were significantly associated with early CR, and that Killip class >1 and thrombocytopenia were strongly associated with late CR. Early CR occurred more frequently between 12:00 and 21:00 h, whereas the peak incidence of late CR was bimodal between 6:00–12:00 and 21:00–24:00 h. In STEMI patients after pPCI, acute hyperglycemia and thrombocytopenia are new risk factors for early and late CR, respectively. Clinical risk factors and time of occurrence of early and late CR may differ in the PCI era. [Display omitted] [ABSTRACT FROM AUTHOR]

FreeStyle Libre has been approved for use in patients undergoing hemodialysis (HD) in Japan, unlike Europe and the United States; however, evidence regarding its accuracy in such patients is sparse. Forty‐one participants with type 2 diabetes undergoing HD were recruited. The overall mean absolute relative difference and mean absolute difference were 23.4% and 33.9 mg/dL, respectively. Sensor glucose levels and capillary glucose levels were significantly correlated (r = 0.858, P <.01), although the sensor glucose levels were significantly lower than the capillary glucose levels. The accuracy of FreeStyle Libre in patients undergoing HD became deteriorated with the days of usage. The percentage of sensor results in Zones A and B in the consensus error grid analysis and in the Clarke error grid analysis were 99.7% and 99.0%, respectively. Its insufficient accuracy necessitates adjunct usage of FreeStyle Libre with self‐monitoring of blood glucose in patients undergoing HD. [ABSTRACT FROM AUTHOR]

The molecular conformation of oligo‐proline peptides composed of two oligo‐proline block sequences and a non‐proline linker residue, designated as (Pro)m‐Gly/Ala‐(Pro)n peptides, was analyzed by circular dichroism (CD) spectroscopy. The CD spectra in water and trifluoroethanol indicated that the two oligo‐proline blocks were separated by an inserted residue independent of polyproline‐II (PP‐II). In addition, the stability of the (Pro)m‐Gly/Ala‐(Pro)n peptides was analyzed using a conformational transition system, during transition from PP‐II to polyproline‐I (PP‐I) in aliphatic alcohols, methanol (MeOH), and 1‐propanol (1‐PrOH). Interestingly, the PP‐II/PP‐I transition was inhibited after a Gly/Ala was inserted at the center of the oligo‐proline; the inhibitory effect of Ala was stronger than that of Gly. When the position of the inserted Ala moved towards the C‐terminal, the (Pro)m‐Gly/Ala‐(Pro)n peptides displayed a PP‐II/PP‐I transition in 1‐PrOH. Our results confirmed that (Pro)m‐Gly/Ala‐(Pro)n peptides prefer to form PP‐II hairpin conformations even in MeOH and 1‐PrOH. Thus, our findings suggest that the insertion of Gly/Ala acts as a stabilizer in PP‐II in proline‐rich peptides. [ABSTRACT FROM AUTHOR]

The molecular conformation of oligo‐proline peptides composed of two oligo‐proline block sequences and a non‐proline linker residue, designated as (Pro)m‐Gly/Ala‐(Pro)n peptides, was analyzed by circular dichroism (CD) spectroscopy. The CD spectra in water and trifluoroethanol indicated that the two oligo‐proline blocks were separated by an inserted residue independent of polyproline‐II (PP‐II). In addition, the stability of the (Pro)m‐Gly/Ala‐(Pro)n peptides was analyzed using a conformational transition system, during transition from PP‐II to polyproline‐I (PP‐I) in aliphatic alcohols, methanol (MeOH), and 1‐propanol (1‐PrOH). Interestingly, the PP‐II/PP‐I transition was inhibited after a Gly/Ala was inserted at the center of the oligo‐proline; the inhibitory effect of Ala was stronger than that of Gly. When the position of the inserted Ala moved towards the C‐terminal, the (Pro)m‐Gly/Ala‐(Pro)n peptides displayed a PP‐II/PP‐I transition in 1‐PrOH. Our results confirmed that (Pro)m‐Gly/Ala‐(Pro)n peptides prefer to form PP‐II hairpin conformations even in MeOH and 1‐PrOH. Thus, our findings suggest that the insertion of Gly/Ala acts as a stabilizer in PP‐II in proline‐rich peptides. [ABSTRACT FROM AUTHOR]

Background: Many mortality risk scoring tools exist among patients with ST-elevation Myocardial Infarction (STEMI). A risk stratification model that evaluates STEMI prognosis more simply and rapidly is preferred in clinical practice. Methods and Findings: We developed a simple stratification model for blood examination by using the STEMI data of AMI-Kyoto registry in the derivation set (n = 1,060) and assessed its utility for mortality prediction in the validation set (n = 521). We selected five variables that significantly worsen in-hospital mortality: white blood cell count, hemoglobin, C-reactive protein, creatinine, and blood sugar levels at >10,000/μL, <10 g/dL, >1.0 mg/dL, >1.0 mg/dL, and >200 mg/dL, respectively. In the derivation set, each of the five variables significantly worsened in-hospital mortality (p < 0.01). We developed the risk stratification model by combining laboratory variables that were scored based on each beta coefficient obtained using multivariate analysis and divided three laboratory groups. We also found a significant trend in the in-hospital mortality rate for three laboratory groups. Therefore, we assessed the utility of this model in the validation set. The prognostic discriminatory capacity of our laboratory stratification model was comparable to that of the full multivariable model (c-statistic: derivation set vs validation set, 0.81 vs 0.74). In addition, we divided all cases (n = 1,581) into three thrombolysis in myocardial infarction (TIMI) risk index groups based on an In TIME II substudy; the cases were further subdivided based on this laboratory model. The high laboratory group had significantly high in-hospital mortality rate in each TIMI risk index group (trend of in-hospital mortality; p < 0.01). Conclusions: This laboratory stratification model can predict in-hospital mortality of STEMI simply and rapidly and might be useful for predicting in-hospital mortality of STEMI by further subdividing the TIMI risk index. [ABSTRACT FROM AUTHOR]

Background: We encountered a case of unstable predilution online HDF due to elevated transmembrane pressure (TMP) when performing constant-speed predilution online hemodiafiltration (HDF) as treatment for restless legs syndrome (RLS) in a dialysis patient. We report the effectiveness of incorporating a newly developed constant-pressure predilution online HDF system as a preventive measure against unstable online HDF and frequent adjustment of settings when treating dialysis patients with RLS. Case presentation: A 55-year-old man had suffered from RLS and been undergoing constant-speed online HDF with 45 L target predilution and an ABH-21P hemodiafilter. The symptoms of RLS rated 10 on the International Restless Legs Syndrome Rating Scale (IRLS). The α1-microglobulin (α1-MG) removal rate was only 27.8%, so the hemodiafilter was subsequently replaced with a PEPA hemodiafilter. However, episodes of elevated TMP exceeding 250 mmHg occurred frequently after the replacement and were managed by reducing dialysate flow rate. Therefore, we incorporated a constant-pressure predilution online HDF that maintains TMP below 200 mmHg. The amount of replacement was maintained at approximately 43.5 ± 6.98 L and the α1-MG removal rate was 39.5%, with no need to manually reduce the flow rate. The Alb leakage in dialysate waste was 7.9 g. The patient has maintained an IRLS rating of 0 with no RLS symptoms for the past 4 years. Conclusions: Using the constant-pressure mode enabled achieved the clinical endpoint, namely, resolution of RLS with no need to manually reduce the flow rate. [ABSTRACT FROM AUTHOR]

Background: Data regarding the relationship between systolic blood pressure (SBP) at admission and in-hospital outcome in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are still lacking in Japan. Methods and results: A total of 1475 primary PCl-treated AMI patients were classified into quintiles, based on admission SBP based on admission SBP (<105 mmHg, n = 300; 105-125 mmHg, n = 294; 126-140 mmHg, n = 306; 141-158 mmHg, n = 286; and (≽159 mmHg n = 289). The patients with SBP< 105 mmHg tended to have higher age, previous myocardial infarction, chronic kidney disease (CKD), Killip class ≽ 3 at admission, right coronary artery, left main trunk (LMT), or multivessels as culprit lesions, larger number of diseased vessels, lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery before primary PCI, and higher value of peak creatine Phosphokinase concentration. Patients with SBP < 105 mmHg had a significantly higher mortality, while mortality was not significantly different among the other quintiles: 24.3% (<105 mmHg), 4.8% (105-125 mmHg), 4.9% (126-140 mmHg), 2.8% (141-158 mmHg), and 5.2% (≽159mmHg) (p<0.001). On multivariate analysis, Killip class≽3 at admission, LMT or multivessels as culprit lesions, admission SBP< 105mmHg, CKD, and age were the independent positive predictors of in-hospital mortality, whereas admission SBP141-158mmHg and TIM13 flow after PCI were the negative ones, but admission SBP 105-125 mmHg, admission SBP 126-140 mmHg, and admission SBP ≽ 159 mmHg were not. Conclusions: These results suggest that admission SBP 141-158 mmHg might be correlated with better in-hospital prognosis, whereas admission SBP <105 mmHg was associated with in-hospital death in Japanese AMI patients undergoing primary PCI. [ABSTRACT FROM AUTHOR]

Summary: Background: Prolonged pre-hospital time for acute myocardial infarction (AMI) is associated with decreased indication for primary percutaneous coronary intervention (PCI). However, the efficacy of primary PCI in AMI patients with prolonged pre-hospital time has not been fully investigated in Japan. Methods and results: A total of 3010 consecutive AMI patients admitted to AMI-Kyoto Multi-Center Risk Study Group hospitals were retrospectively analyzed, and the clinical characteristics and in-hospital prognosis of these patients were reviewed. Patients with pre-hospital delay [elapsed time (ET)>12h] had a lower frequency of Killip≥3 (9.3%) and less frequently received primary PCI (77.7%) compared with patients with ET≤12h. In the ET>12h group, older patients or patients with MI history tended to be complicated by heart failure. Primary PCI was performed for patients with ET>12h, irrespective of the severity of heart failure [Killip 1 (78.7%) vs Killip≥2 (74.0%); p =0.3827]. On multivariate logistic regression analysis, age [odds ratio (OR) 1.053], MI history (OR 2.860), Killip≥2 (OR 10.235), and multi-vessels or left main coronary artery as culprit (OR 11.712) were significant independent positive predictors of in-hospital mortality for patients with ET>12h. Practice of primary PCI was not a significant negative predictor for patients with ET>12h (OR 0.812), but it was for patients with ET≤12h (OR 0.425). Conclusions: These findings indicate that patients with ET>12h have a less severe condition and less frequently receive primary PCI compared with patients with ET≤12h. Although primary PCI is often performed for these patients irrespective of the severity of heart failure, no preferable effect of primary PCI on the in-hospital mortality is demonstrated. In contrary, practice of primary PCI is a significant negative predictor of in-hospital mortality for patients with ET≤12h. [Copyright &y& Elsevier]

Summary: Background: Predictors of suboptimal coronary flow in the infarct-related artery (IRA) after stent-based primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) have not been fully investigated. Methods and results: Using the AMI-Kyoto Multi-Center Risk Study database, we retrospectively compared clinical manifestations and in-hospital prognosis between AMI patients undergoing stent-based primary PCI with final Thrombolysis In Myocardial Infarction (TIMI) grade ≤2 in the IRA (nonoptimal group, n =69) and those with final TIMI grade 3 (optimal group, n =1200). The nonoptimal group had higher prevalence of Killip class ≥3 at admission, higher frequency of mechanical support devices during procedures, larger value of maximal creatine phosphokinase, and a significantly higher in-hospital mortality rate (27.5% for nonoptimal vs. 9.0% for optimal, P <0.001), compared with the optimal group. On multivariate analysis, Killip class ≥3 at admission was the independent predictor of the final nonoptimal flow (odds ratio 2.33, 95% confidence intervals 1.27–4.26 P =0.006), but TIMI 3 flow before primary PCI and elapsed time (symptom onset-to-admission time)<24h were not. Conclusions: Killip class ≥3 at admission is an independent predictor of the final nonoptimal flow in AMI patients undergoing primary PCI with stent implantation. [Copyright &y& Elsevier]

Summary: Background: Recurrent acute myocardial infarction (AMI) is a disastrous condition with high in-hospital morbidity and mortality. However, the relation between location of previous myocardial infarction (MI) and in-hospital outcome in repeat-AMI patients undergoing primary percutaneous coronary intervention (PCI) remains unclear. Methods and results: Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous anterior MI (anterior group, n =151) and those with previous non-anterior MI (non-anterior group, n =157). Clinical backgrounds, angiographic findings, results of primary PCI, and in-hospital outcome did not differ significantly between the two groups. On multivariate analysis, Killip class ≥3 at admission, number of diseased vessels ≥2 or diseased left main trunk at initial coronary angiography, and age were the independent predictors of in-hospital mortality in the recurrent-AMI patients, but not the anterior location of previous MI. Conclusions: These results suggest that among recurrent-AMI patients undergoing primary PCI, in-hospital prognosis mostly depends on the severity of acute heart failure at the onset and the residual myocardial ischemia rather than previous MI sites. [Copyright &y& Elsevier]

Abstract: A new metamorphosis-enhancing macrodiolide, luminaolide (1), was isolated from the crustose coralline algae (CCA) Hydrolithon reinboldii. Its structure was determined by spectroscopic analysis. A fraction (1.30μg/mL) eluted with 80% aqueous MeOH by ODS gel column chromatography of the same CCA extract induced larval metamorphosis (25.9±7.4%) against Leptastrea purpurea, and its metamorphosis-inducing activity was further enhanced to 92.6±2.9% with the addition of 1 (25.6ng/mL). [Copyright &y& Elsevier]

The discovery of new ecologically active compounds often triggers the development of basic scientific concepts in the field of biological sciences, since such compounds have direct physiological and behavioral effects on other living organisms. We have focused on the identification of natural key compounds that control biologically and physiologically intriguing phenomena. We describe three recent aspects of chemical ecology that we have investigated: natural toxins, coral communities, and symbiotic relationships. Blarina toxin (BLTX) is a lethal mammalian venom that was isolated from the short-tailed shrew. Duckbilled platypus venom shows potent Ca2+ influx in neuroblastoma cells. The venom of the solitary wasp contains arginine kinase-like protein and is used to paralyze its prey to feed its larva. The ecological behaviors of corals are controlled by combinations of small molecules. The polyol compound symbiodinolide may serve as a defense substance for symbiotic dinoflagellates to prevent digestion of their host animals. These compounds reveal the wonder of nature, in both terrestrial and marine ecological systems. [ABSTRACT FROM AUTHOR]

The sea cucumber Holothuria atra is a broadcast spawner. Among broadcast spawners, fertilization occurs by means of an egg-derived substance(s) that induces sperm flagellar motility activation and chemotaxis. Holothuria atra sperm were quiescent in seawater, but exhibited flagellar motility activation near eggs with chorion (intact eggs). In addition, they moved in a helical motion toward intact eggs as well as a capillary filled with the water layer of the egg extracts, suggesting that an egg-derived compound(s) causes motility activation and chemotaxis. Furthermore, demembranated sperm flagella were reactivated in high pH (>7.8) solution without cAMP, and a phosphorylation assay using (γ-32P)ATP showed that axonemal protein phosphorylation and dephosphorylation also occurred in a pH-dependent manner. These results suggest that the activation of sperm motility in holothurians is controlled by pH-sensitive changes in axonemal protein phosphorylation. Ca2+ concentration affected the swimming trajectory of demembranated sperm, indicating that Ca2+-binding proteins present at the flagella may be associated with regulation of flagellar waveform. Moreover, the phosphorylation states of several axonemal proteins were Ca2+-sensitive, indicating that Ca2+ impacts both kinase and phosphatase activities. In addition, in vivo sperm protein phosphorylation occurred after treatment with a water-soluble egg extract. Our results suggest that one or more egg-derived compounds activate motility and subsequent chemotactic behavior via Ca2+-sensitive flagellar protein phosphorylation. Cell Motil. Cytoskeleton 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

α-Tricalcium phosphate (α-TCP) macroporous ceramic scaffold was chemically treated with a buffered solution at pH = 4. Mesopores were formed m the scaffold after the treatment to result in a remarkable increase in surface area of the scaffold. The increase in the surface area is caused by precipitation of octacalcium phosphate (OCP). Bimodal pore size distribution consisting of mesopores and macropores obtained by the treatment of α-TCP scaffold having higher initial porosity brought about high adsorption of bovine serum albumin (BSA) than monomodal pore size distribution of mesopores. Adsorption of BSA, acidic protein, was suggested to result from crystallographic characters of OCP. [ABSTRACT FROM AUTHOR]

Background: Turbellarian species can post-embryonically produce germ line cells from pluripotent stem cells called neoblasts, which enables some of them to switch between an asexual and a sexual state in response to environmental changes. Certain low-molecular-weight compounds contained in sexually mature animals act as sex-inducing substances that trigger post-embryonic germ cell development in asexual worms of the freshwater planarian Dugesia ryukyuensis (Tricladida). These sex-inducing substances may provide clues to the molecular mechanism of this reproductive switch. However, limited information about these sex-inducing substances is available. Results: Our assay system based on feeding sex-inducing substances to asexual worms of D. ryukyuensis is useful for evaluating sex-inducing activity. We used the freshwater planarians D. ryukyuensis and Bdellocephala brunnea (Tricladida), land planarian Bipalium nobile (Tricladida), and marine flatworm Thysanozoon brocchii (Polycladida) as sources of the sex-inducing substances. Using an assay system, we showed that the three Tricladida species had sufficient sex-inducing activity to fully induce hermaphroditic reproductive organs in asexual worms of D. ryukyuensis. However, the sex-inducing activity of T. brocchii was sufficient only to induce a pair of ovaries. We found that yolk glands, which are found in Tricladida but not Polycladida, may contain the sex-inducing substance that can fully sexualize asexual worms of D. ryukyuensis. Conclusions: Our results suggest that within Tricladida, there are one or more common compounds or functional analogs capable of fully sexualizing asexual worms of D. ryukyuensis; namely, the crucial sex-inducing substance (hydrophilic and heat-stable, but not a peptide) produced in yolk glands. [ABSTRACT FROM AUTHOR]

Two new brominated toxic compounds, corallinafuran (1) and corallinaether (2), have been isolated from crustose coralline red algae (CCA). Their structures were elucidated based on a detailed analysis of spectral data. Compounds 1 and 2 showed toxicity against larvae of the scleractinian coral Pseudosiderastrea tayamai, with LD99 values of 1.9 and 0.14 µg/mL, respectively. [ABSTRACT FROM AUTHOR]

The majority of marine invertebrates produce dispersive larvae which, in order to complete their life cycles, must attach and metamorphose into benthic forms. This process, collectively referred to as settlement, is often guided by habitat-specific cues. While the sources of such cues are well known, the links between their biological activity, chemical identity, presence and quantification in situ are largely missing. Previous work on coral larval settlement in vitro has shown widespread induction by crustose coralline algae (CCA) and in particular their associated bacteria. However, we found that bacterial biofilms on CCA did not initiate ecologically realistic settlement responses in larvae of 11 hard coral species from Australia, Guam, Singapore and Japan. We instead found that algal chemical cues induce identical behavioral responses of larvae as per live CCA. We identified two classes of CCA cell wall-associated compounds - glycoglycerolipids and polysaccharides - as the main constituents of settlement inducing fractions. These algae-derived fractions induce settlement and metamorphosis at equivalent concentrations as present in CCA, both in small scale laboratory assays and under flow-through conditions, suggesting their ability to act in an ecologically relevant fashion to steer larval settlement of corals. Both compound classes were readily detected in natural samples. [ABSTRACT FROM AUTHOR]