These findings suggest that stenosis of the right coronary ostium is a high-risk lesion for stent restenosis. In addition to excessive intimal growth, chronic stent recoil might be an important etiologic factor at this particular location.

Abstract:Background: While preprocedural statin treatment for acute coronary syndrome (ACS) is widely regarded as beneficial, there has been no prospective randomized multicenter trial of patients with non-ST elevation ACS in the Japanese population to examine the efficacy of preprocedural aggressive statin use. The aim of this study was to confirm this effect by prospective randomized multicenter design. Methods: Fifty patients who presented with non-ST elevation ACS were enrolled, and randomly assigned to aggressive statin administration before percutaneous coronary intervention (PCI). Troponin-T (TnT), creatine phosphokinase (CK), CK-myocardial band (CK-MB), high-sense Creactive protein (hs-CRP), and brain natriuretic peptide (BNP) were measured at baseline and/ or after procedure. Results: Three days after PCI, the statin group had significantly less CK elevation compared with the nonstatin group (84±17 IU/l versus 180±68 IU/l, respectively, p ¼ 0.02). CK-MB elevation also tended to be lower in the statin group than in the nonstatin group (3.2±1.9 versus. 7.0±3.0, respectively, p ¼ 0.07), as was BNP level (3.2±1.9 versus 7.0±3.0 pg/ml, respectively, p ¼ 0.07). The change of serum LDL cholesterol was significantly correlated with CK (p ¼ 0.01) and TnT (p ¼ 0.02) at 1 day after PCI. Conclusions: Aggressive statin usage before PCI to Japanese patients with non-ST elevation ACS appears to reduce myocardial damage after procedure. The degree of serum lipid level reduction may reflect the vulnerability of atheromatous plaques that could cause cardiac damage after PCI.

When performing intravascular ultrasound studies, the backward echo image can show marked attenuation, although there are no calcified deposits and it may be impossible to detect the intraplaque architecture. The pathology underlying this phenomenon was investigated in autopsy specimens. We hypothesize that the mechanism responsible for the attenuation involves micro-calcification and lipid in unstable plaques causing ultrasonic wave reflection and dispersion.

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The Ministry of Health, Labor and Welfare (former MHW) of Japan issued a Directive in 1997 advising restaurants and caterers to freeze portions of both raw food and cooked dishes for at least 2 weeks. This system has been useful for determining vehicle foods at outbreaks. Enumeration of bacteria in samples of stored food provide data about pathogen concentrations in the implicated food. Data on Salmonella concentrations in vehicle foods associated with salmonellosis outbreaks were collected in Japan between 1989 and 1998. The 39 outbreaks that occurred during this period were categorized by the settings where the outbreaks took place, and epidemiological data from each outbreak were summarized. Characteristics of outbreak groups were analyzed and compared. The effect of new food-storage system on determination of bacterial concentration was evaluated. Freezing and nonfreezing conditions prior to microbial examination were compared in the dose-response relationship. Data from outbreaks in which implicated foods had been kept frozen suggested apparent correlation between the Salmonella dose ingested and the disease rate. Combined with results of epidemiological investigation, quantitative data from the ingested pathogen could provide complete dose-response data sets.

estenosis is the main limitation of percutaneous coronary intervention (PCI), but the introduction of drug-eluting stents (DES) is a breakthrough development. Clinical trials of DES have reported a markedly decreased rates of restenosis and revascularization compared with bare metal stents (BMS), [1][2][3][4][5][6] but the efficacy of DES in Japanese people is still unclear.Prior to getting approval for the sirolimus-eluting stent (SES: Cypher stent, Cordis Corp, a Johnson&Johnson Company) in Japan, a pharmacokinetic (PK) study evaluating the PKs of sirolimus in Japanese patients and the 1-year clinical outcomes was conducted. 7 Methods Study SubjectsThe PK study was the first clinical trial of the SES in Japan, and its aim was to evaluate the PKs of sirolimus in Japanese patients and to evaluate early and late clinical outcomes. It was a nonrandomized open trial, comprising 20 patients with 30 lesions who underwent implantation of SES. The patients were all symptomatic and/or had functionally significant de novo native coronary artery disease. Patients were excluded from this study if they had (1) acute myocardial infarction, (2) unstable angina (Braunwald III B, III C), (3) bifurcation lesions, (4) ostial lesions, (5) left main trunk disease, (6) severe calcification, (7) chronic total occlusion, (8) renal dysfunction (serum creatinine >3.0 mg/dl) or liver dysfunction, (9) proximal reference diameter <2.5 mm, (10) allergy to antiplatelet drugs, heparin and sirolimus, (11) extreme bending lesion, (12) left ventricular ejection fraction <25%, (13) cardiac transplantation or (14) another stent within 5 mm of target lesion. The ethical committee at each participating institute approved the protocols, and all patients gave written informed consent. ProcedureBefore angioplasty, heparin was given intravenously and titrated to maintain an active clotting time more than 250 ms. All patients received a BX velocity stent (3× 18 mm) loaded with a total sirolimus doses of 150 g. All lesions were pre-dilated before stent implantation and adequate post dilatation was performed. All patients received aspirin (200 mg/day indefinitely) and ticlopidine (200 mg/day) from 3 days before the procedure and continued daily for 3 months after SES implantation. Quantitative Coronary Angiography (QCA)Detailed QCA parameters of the target lesion were evaluated before and after the procedure and at the time of angiographic follow-up using a computer-based system (QCA-CMS 5.1, MEDIS, Leiden, the Netherlands) and an independent observer at Toho University Ohashi Medical Center. This QCA software allows us to also measure automatically all parameters for 5 mm proximal and distal to the stented segment. At the follow-up analysis, in-stent restenosis (ISR) was defined as a diameter stenosis >50% within the stent segment. In-segment restenosis was defined as >50% either within the stented segment or within Angiographic and Clinical Outcomes of a Pharmacokinetic Study of Sirolimus-Eluting Stents Lesson From Restenosis CasesMasato Nakamura, MD; M...

The growth responses of Vibrio parahamolyticus to pH, NaCl concentration and temperature changes were studied using serotype O3 : K6 and other strains. Growth curves were obtained for 27 di#erent sets of conditions, comprised of three levels of NaCl concentration, pH and temperature. The temperature, pH and NaCl concentrations most favorable for growth were in the order of 25ῌ, 20ῌ and 15ῌ, pH 8, 7 and 5.8, and 1῍, 3῍ and 7῍, respectively. The bacteria grew most rapidly at 25ῌ, at a pH of 7 or 8 in the presence of 1῍ or 3῍ NaCl, with the population (initial, ca. 2.5 log CFU/mL) reaching a level log 7 CFU/mL at 12 h. A growth predictive model using the Gompertz equation was generated from the experimental data for any combination of NaCl concentration, pH and temperature within the range used in this study.

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