Yasunori Oguma

Adaptive servo-ventilation therapy improves cardiac sympathetic nerve activity in patients with heart failure.

This study investigated whether abnormal cardiac sympathetic nerve activity (SNA) is associated with the severity of central sleep apnoea (CSA) and whether adaptive servo‐ventilation (ASV) therapy can improve cardiac SNA in heart failure (HF) patients with predominant CSA.

Comparison of anti-inflammatory effects and high-density lipoprotein cholesterol levels between therapy with quadruple-dose rosuvastatin and rosuvastatin combined with ezetimibe

BackgroundStatins are frequently administered to reduce low-density lipoprotein cholesterol (LDL-C) and vascular inflammation, because LDL-C and high sensitive C-reactive protein (hs-CRP) are associated with high risk for cardiovascular events. When statins do not reduce LDL-C to desired levels in high-risk patients with coronary artery disease (CAD), ezetimibe can be added or the statin dose can be increased. However, which strategy is more effective for treating patients with CAD has not been established. The present study compares anti-inflammatory effects and lipid profiles in patients with CAD and similar LDL-C levels who were treated by increasing the statin dose or by adding ezetimibe to the original rosuvastatin dose to determine the optimal treatment for such patients.Methods46 patients with high-risk CAD and LDL-C and hs-CRP levels of >70 mg/dL and >1.0 mg/L, respectively, that were not improved by 4 weeks of rosuvastatin (2.5 mg/day) were randomly assigned to receive 10 mg (R10, n = 24) of rosuvastatin or 2.5 mg/day of rosuvastatin combined with 10 mg/day of ezetimibe (R2.5/E10, n = 22) for 12 weeks. The primary endpoint was a change in hs-CRP.ResultsBaseline characteristics did not significantly differ between the groups. At 12 weeks, LDL-C and inflammatory markers (hs-CRP, interleukin-6, tumour necrosis factor-alpha and pentraxin 3) also did not significantly differ between the two groups (LDL-C: R10 vs. R2.5/E10: -19.4 ± 14.2 vs. -22.4 ± 14.3 mg/dL). However, high-density lipoprotein cholesterol (HDL-C) was significantly improved in the R10, compared with R2.5/E10 group (4.6 ± 5.9 vs. 0.0 ± 6.7 mg/dL; p < 0.05).ConclusionBoth enhanced therapies exerted similar anti-inflammatory effects under an equal LDL-C reduction in patients with high-risk CAD despite 2.5 mg/day of rosuvastatin. However, R10 elevated HDL-C more effectively than R2.5/E10.Trial registrationUMIN000003746

A free-floating left atrial thrombus develops intermittent entrapment in the mid-ventricle during diastole

Free-floating left atrial thrombi are rare. Here we report a case of a 75-year-old woman with atrial fibrillation who was admitted for treatment of acute myocardial infarction. A free-floating left atrial thrombus was found incidentally on echocardiography. Ten days after percutaneous coronary intervention, the patient had mild faintness with transient hypotension, and it was found that the left atrial thrombus had developed intermittent entrapment in the mid-ventricle during diastole, with abrupt rebound back to the left atrial cavity during systole. Urgent removal of the thrombus was performed successfully. Although the free-floating thrombus had appeared to be spherical, like a ball thrombus, on echocardiography, the excised thrombus was pedunculated. A cut section revealed a laminated thrombus with an onion-skin-like appearance.

Optical imaging of the spontaneous neuronal activities in the male rat major pelvic ganglion following denervation of the pelvic nerve

Measurement of groups of neuronal activities following pelvic nerve transection to the major pelvic ganglion (MPG) of the rat was performed using voltage-sensitive dye (RH795) and an optical recording system. In control MPG, averaged neuron diameters were 32.0 +/- 0.6 x 22.6 +/- 0.4 microm. Application of KCl (10-50 mM) to the ganglia exhibited excitation which increased in a dose-dependent fashion. Fluctuating membrane potentials were not observed in control ganglion neurons. After the denervation of pelvic nerve chronically (2-6 weeks), the spontaneous neuronal activities were recorded in 91% of the experiments (n = 32). The activity was occurring somewhat periodically (2-15 s). Averaged neuron diameters were 41.3 +/- 1.3 x 24.7 +/- 0.9 microm in denervated MPG which is significantly larger than control. Since average neuron size increased 4 weeks after the denervation, the new excitatory activities could have influenced the change of the neuron size. The new activities might produce contraction of target organs in the pelvic viscera.

Tricuspid valve chordae tendineae as protective filter to prevent massive pulmonary embolism

Although several cases of thrombus-in-transit associated with pro-thrombotic conditions have been reported (1-3), a transit thrombus located in the right ventricular (RV) cavity is extremely rare (4,5). Here, we report a case of nephrotic syndrome (NS) with a RV thrombus-in-transit that threatened to cause a fatal pulmonary embolism (PE).