oth coronary artery bypass grafting and percutaneous coronary intervention ameliorate angina pectoris, prevent myocardial infarction and improve the long-term survival of patients with atherosclerotic coronary artery disease. However, the nature of coronary arteries significantly impacts the quality of life. Standard therapies for myocardial revascularization are often limited because of diffuse lesions or small-caliber vessels. Angiogenic therapy to induce myocardial neovascularization is not dependent on vessel caliber and provides an alternative treatment alone or in combination with standard revascularization. Basic fibroblast growth factor (bFGF) is a potent angiogenic protein that induces endothelial and smooth muscle cell proliferation in vivo and elicits angiogenesis that includes the migration and proliferation of endothelial cells, vascular tube formation and linkage to the extant vascular network. 1 Intracoronary injections of bFGF reduce infarct size in a canine model of myocardial infarction and improve myocardial function in chronically ischemic porcine hearts. 2,3 We have previously shown that the intramyocardial administration of bFGF increased the number of capillaries and arterioles in the peri-infarct region, increased regional myocardial blood flow and consequently improved ven- Circulation Journal Vol.70, April 2006tricular function in a canine infarction model. 4 However, angiogenesis induced by growth factors has not been always successful. Despite high binding affinity for acidic polysaccharides such as heparin and heparan sulfate in the extracellular matrix, bFGF has a short biological half-life in tissues. 5 The sustained release of bFGF might help to enhance its angiogenic activity in vivo. 6,7 Gelatin is a nontoxic, biodegradable, natural polymer with low antigenicity and gelatin hydrogel is considered to be a preferable matrix for the sustained release of protein drugs, such as growth factors. 8,9 However, the effects of intramyocardial injections of slow-release bFGF on vascular growth, cardiomyocyte apoptosis and cardiac function have not been investigated in detail. The present study evaluates the ability of gelatin hydrogels to enhance the benefits of bFGF on neoangiogenesis, cardiomyocyte apoptosis, myocardial fibrosis, ventricular remodeling and cardiac function in a rat infarction model. Methods Preparation of bFGFHuman recombinant bFGF and gelatin hydrogels were provided by Kaken Pharmaceutical, Tokyo, Japan. Gelatin with an isoelectric point of 4.9 was prepared using alkaline treatment of bovine collagen with Ca(OH)2. To obtain gelatin hydrogels that incorporated bFGF, 0.7 ml of saline containing 350 g of bFGF was impregnated into freezedried hydrogels. The release of biologically active bFGF is sustained as a result of hydrogel degradation in vivo. Empty gelatin hydrogels free of bFGF were similarly prepared. Background Basic fibroblast growth factor (bFGF) stimulates neoangiogenesis. Incorporation into biodegradable gelatin hydrogels provides the sustained release of bFGF....

VASCULAR AND INTERVENTIONAL RADIOLOGYC olorectal cancer (CRC) is one of the most common malignancies in the world, with metastases to the lungs in approximately 10%-20% of patients (1). Surgery is performed when both the primary tumor and the lung metastases are completely resectable, with a 3-year overall survival (OS) rate of 53%-82% after lung metastasectomy (2-6). Systemic chemotherapy is administered for patients who are not candidates for surgery, but its 3-year OS rate is less than 50% (7,8). Stereotactic radiation therapy is another treatment option for CRC lung metastases but is usually performed in patients who are not candidates for surgery, with a reported 3-year OS rate of 43%-51% (9,10).Radiofrequency ablation (RFA) is another minimally invasive local-regional treatment for malignant lung neoplasms. It has been considered a reasonable alternative to stereotactic radiation therapy, with the advantages of requiring only one treatment procedure, with less cost, and the feasibility of repeat RFA for residual or recurrent tumor (11). The OS rate of RFA for the treatment of CRC lung metastases in patients who are not candidates for surgery is similar to that of stereotactic radiation therapy. In fact, the 3-year OS rates after RFA for colorectal pulmonary metastasis are 46%-57% in prospective studies (12,13) and 46%-76% in retrospective studies (14-16). From Results: Seventy participants with CRC (mean age, 66 years 6 10; 49 men) were evaluated. The 3-year OS rate was 84% (59 of 70 participants; 95% confidence interval [CI]: 76%, 93%). In multivariable analysis, factors associated with worse OS included rectal rather than colon location (hazard ratio [

Abstractsistent pulmonary hypertension of the newborn. 5 In many patients with acute respiratory Background -Inhaled nitric oxide (NO) is a selective pulmonary vasodilator which distress syndrome (ARDS) inhaled NO reduces the pulmonary artery pressure and increases can improve gas exchange in acute lung injury. However, it is uncertain that this arterial oxygenation by lessening intrapulmonary shunt. 6 Experimentally, inhaled NO effect on arterial oxygenation can be generalised to all lung diseases.reverses hypoxic pulmonary vasoconstriction. 7Inhaled NO, however, can worsen gas exchange Methods -The effects of inhaled NO on gas exchange were studied in nine patients by overcoming the usual physiological mechanisms of matching ventilation (V) and perwith chronic obstructive pulmonary disease (COPD), 11 patients with severe pul-fusion (Q). Whilst inhaled NO acts as a selective pulmonary vasodilator in some monary hypertension, and 14 healthy volunteers. A randomised sequence of patients with chronic obstructive pulmonary disease (COPD), it fails to improve 40 ppm of NO or air was inhaled for 20 minutes through an orofacial mask.oxygenation. 8 9 It is important to establish in which diseases inhaled NO fails to improve Results -Inhaled NO reduced mean (SE) transcutaneous arterial oxygen tension gas exchange. We have studied the change in arterial oxygenation during NO inhalation in (TcPO 2 ) from 9.6 (0.3) to 8.9 (0.4) kPa in healthy volunteers and from 7.4 (0.6) to patients with COPD and compared it with normal volunteers and patients with severe pul-7.0 (0.5) kPa in patients with COPD. There was no change in TcPO 2 in patients with monary hypertension. severe pulmonary hypertension. During inhalation of NO and air no change occurred in transcutaneous arterial carbon Methods dioxide tension (TcPCO 2 ), arterial oxygen Nine patients with COPD, 11 with severe pulsaturation (SaO 2 ) measured by pulse oxi-monary hypertension, and 14 healthy vometer, or cardiac output determined by lunteers were studied. All gave their informed the transthoracic impedance method. consent and the study was approved by the Conclusions -Inhaled NO does not im-local hospital ethics committee. The diagnosis prove TcPO 2 nor increase cardiac output in of COPD was established from a history of normal subjects and patients with COPD, clinical and physiological evidence of irsuggesting that inhaled NO worsens gas reversible airway obstruction. All patients with exchange. This could represent inhaled Section of Respiratory COPD ceased bronchodilators 12 hours before NO overriding hypoxic pulmonary vasoMedicine, the study. The diagnosis of severe pulmonary

Background-Pulmonary vasodilatation with a 100 ppm concentration of NO given as a short burst of a few milliliters at the beginning of each breath (NO min ) was compared with conventionally inhaled NO, in which a full breath of 40 ppm of NO was inhaled (NO CD ). Methods and Results-NO min was studied in 16 patients with severe pulmonary hypertension and in 16 isolated porcine lungs with experimentally induced pulmonary hypertension. We compared volumes of 8 to 38 mL of 100 ppm NO in N 2 injected at the beginning of each breath with conventional inhalation of 40 ppm NO in air. NO CD and NO min were studied in 4 pigs after inhibition of NO synthase with N G -nitro-L-arginine methyl ester (1 to 2 mg/kg IV) had raised the pulmonary vascular resistance index (PVRI) from 4.4Ϯ0.

Background: Subfascial endoscopic perforator surgery (SEPS) with a two-port system utilizing screw-type ports, CO 2 insufflation and an ultrasonic coagulation system, is a useful procedure that does not require burdensome apparatus and techniques. SEPS was accepted as a national advanced medical system by the Japanese