Objective To evaluate the relation of symptom onset to balloon time and door to balloon time with long term clinical outcome in patients with ST segment elevation myocardial infarction (STEMI) having primary percutaneous coronary intervention.Design Observation of large cohort of patients with acute myocardial infarction.Setting 26 tertiary hospitals in Japan.Participants 3391 patients with STEMI who had primary percutaneous coronary intervention within 24 hours of symptom onset. Main outcome measuresComposite of death and congestive heart failure, compared by onset to balloon time and door to balloon time. ResultsCompared with an onset to balloon time greater than 3 hours, a time of less than 3 hours was associated with a lower incidence of a composite of death and congestive heart failure (13.5% (123/964) v 19.2% (429/2427), P<0.001; relative risk reduction 29.7%). After adjustment for confounders, a short onset to balloon time was independently associated with a lower risk of the composite endpoint (adjusted hazard ratio 0.70, 95% confidence interval 0.56 to 0.88; P=0.002). However, no significant difference was found in the incidence of a composite of death and congestive heart failure between the two groups of patients with short (≤90 minutes) and long (>90 minutes) door to balloon time (16.7% (270/1671) v 18.4% (282/1720), P=0.54; relative risk reduction 9.2%). After adjustment for confounders, no significant difference was seen in the risk of the composite endpoint between the two groups of patients with short and long door to balloon time (adjusted hazard ratio: 0.98, 0.78 to 1.24: P=0.87). A door to balloon time of less Correspondence to: Y Nakagawa nakagawa@tenriyorozu.jp Extra material supplied by the author (see

These findings suggest that decreased clearance from the kidney contributes to the elevated BNP in CHF patients with renal dysfunction, especially in patients with an eGFR <60 ml/min.

The molecular structure of trans-azobenzene (Ph-NdN-Ph) has been determined by gas electron diffraction. Diffraction patterns were taken at 407 K and data analysis was made using the structural constraints obtained from MP2/6-31+G* calculations. Vibrational mean amplitudes and shrinkage corrections were calculated from the harmonic force constants given by a normal coordinate analysis. Vibrational mean amplitudes were refined as groups. The torsion of each phenyl ring was treated as a large amplitude vibration. The potential function for torsion was assumed to be V(φ 1 ,φ 2 ), where φ i denotes the torsional angle around each N-C bond. Quantum mechanical calculations were performed by taking account of two torsional motions to derive a probability distribution function, P(φ 1 ,φ 2 ). Because P(φ 1 ,φ 2 ) ) N exp(-V(φ 1 ,φ 2 )/kT) was found to be a good approximation at 407 K where N is a constant, it was adopted in the data analysis. The determined potential constants (V 2 and V 4 /kcal mol -1 ) and principal structure parameters (r g /Å, ∠ R /deg) with the estimated limits of error (3σ) are as follows: V 2 ) 1.7(6); V 4 ) 0.6(13); r(NdN) ) 1.260(8); r(N-C) ) 1.427(8); ) 1.399(1); ) 1.102(7); ∠NNC ) 113.6(8); (∠NCC cis -∠NCC trans )/2 ) 5.0(9), where < > means an average value and C cis and C trans denote the carbon atoms cis and trans to the NdN bond, respectively. Thus, the stable form was found to be planar with C 2h symmetry. The observed structure was compared with those of trans-azoxybenzene (Ph-N(-O)dN-Ph) and transstilbene (Ph-CHdCH-Ph). The stability of the liquid crystals with these types of molecular cores was discussed on the basis of the gas-phase structures of the model compounds of cores. Nearly the same results were obtained in the data analysis using the constraints from RHF/6-31G** ab initio calculations.

T2 values decreased with increasing Pfirrmann classification grade in the nucleus pulposus, likely reflecting a decrease in proteoglycan and water content. Thus, T2 value-based measurements of intervertebral disk water content may be useful for future clinical research on degenerative disk diseases.

Intracoronary infusion of BK stimulates tPA release without causing any change in PAI-1 levels in the human coronary circulation. In addition, this effect of BK is augmented by an ACE inhibitor.

Neurotoxic peptides from venoms of scorpions and honey bees exhibit a consensus pattern in the two disulfide bridgings related to the sequence portions Cys-X-Cys and Cys-X-X-X-Cys. A revised three-dimensional structure of charybdotoxin, as determined by two-dimensional nmr spectroscopy, confirms that the consensus cystine dislocation generates in all these toxins a common structural element, i.e., the cystine-stabilized alpha-helical (CSH) motif, which may be correlated with their common ion channel blocking activity.

Background: We evaluated the erythropoietic effects of canagliflozin, a sodium-glucose cotransporter 2 inhibitor, in type 2 diabetes patients with anemia of chronic kidney disease.Methods: Nine diabetes patients were enrolled and administered 100 mg canagliflozin once a day for 12 weeks. The patients received fixed doses of conventional antidiabetic drugs and renin-angiotensin system inhibitors for 8 weeks before enrollment; these drugs were continued during the study. Endpoints were changes in erythropoiesis parameters, including erythrocyte and reticulocyte count, hemoglobin, hematocrit, and serum erythropoietin (EPO) concentration from baseline to 12 weeks. All variables were measured every 2 weeks.Results: Serum EPO concentration increased by 38 [15–62]% (P = 0.043) between baseline and 2 and 4 weeks. Reticulocyte count transiently increased at 2 weeks. Erythropoiesis occurred after 2 weeks of canagliflozin treatment. Erythrocyte count (from 386 ± 36 × 104/μL to 421 ± 36 × 104/μL; P = 0.0009), hemoglobin (from 11.8 ± 0.6 g/dL to 12.9 ± 1.1 g/dL; P = 0.0049), and hematocrit (from 37.1 ± 2.3% to 40.4 ± 3.2%; P = 0.002) increased from baseline to study completion. Although there were no significant changes in transferrin saturation, serum ferritin levels were decreased (P = 0.003).Conclusions: Canagliflozin treatment led to an improvement in erythropoiesis in patients with impaired kidney function. The effect on erythropoiesis appeared to be due to an EPO production-mediated mechanism and might be independent of glycemic control; however, further studies are needed to clarify this since the present study had a small sample size and no comparator group.

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