OBJECTIVES: This study was performed in order to investigate the molecular mechanism regulating nitric oxide synthase(NOS) induced by alpha-quartz in Rat2 fibroblast. METHODS: alpha-quartz-induced nitric oxide(NO) and H2O2 formation and alpha- quartz-induced iNOS protein expression in Rat2 fibroblast were monitored. With iNOS inhibitor(L-N6- (1-iminoethyl)lysine hydrochloride, L-NIL) or antioxidant(catalase), we observed NO and H2O2 formation and iNOS protein expression in Rat2 fibroblast stimulated with alpha-quartz. RESULTS: alpha-quartz stimulated iNOS-induced NO and H2O2 formation in Rat2 fibroblast. L-NIL inhibited H2O2 formation and iNOS protein expression by alpha-quartz in Rat2 fibroblast. Pretreatment with catalase blocked the autoinhibitory pathway of iNOS by iNOSinduced H2O2, therefore H2O2 and NO production and iNOS protein expression were increased in Rat2 fibrobalst stimulated with alpha-quartz CONCLUSIONS: alpha-quartz-induced iNOS stimulated H2O2 formation in Rat2 fibroblast. INOS-induced H2O2 by alpha-quartz plays an important role in the autoinhibition pathway for regulating the iNOS function in Rat2 fibroblast
Catalase ; Fibroblasts* ; Homeostasis* ; Hydrogen Peroxide* ; Hydrogen* ; Nitric Oxide ; Quartz

Background/Aims: Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. Methods: Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. Results: The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. Conclusions The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

Background/Aims: Ascertaining the prevalence of isolated nocturnal hypertension (INHT) in the general population and identifying the characteristics of patients with INHT may be important to determine patients who should receive 24- hour ambulatory blood pressure (BP) measurements. This study aimed to evaluate the prevalence and characteristics of INHT in the general population. Methods: Of 1,128 participants (aged 20 to 70 years), we analyzed 823 who had valid 24-hour ambulatory BP measurements and were not on antihypertensive drug treatment. Results: The prevalence of INHT in the study was 22.8%. Individuals with INHT had a higher office, 24-hour, and daytime and nighttime ambulatory systolic and diastolic BPs compared to individuals with sustained day-night normotension. INHT was more prevalent in individuals with masked hypertension (MH) than in those with sustained hypertension (59.8% vs. 15.6%, p < 0.001). Among individuals with INHT, 92.6% had MH. Among individuals with office BP-based prehypertension, 34.5% had both INHT and MH. The prevalence of INHT was highest in individuals with office BP-based prehypertension. INHT was an independent determinant of MH after adjustment for age, sex, body mass index, diabetes, low-density-lipoprotein cholesterol, 24-hour systolic and diastolic BP, systolic and diastolic BP dipping, and systolic and diastolic BP non-dipping. Conclusions The present study showed that INHT is not uncommon and is a major determinant of MH. Our findings strongly suggest the use of 24-hour ambulatory BP measurement for individuals within the prehypertension range of office BP owing to the high prevalence of INHT and MH in this population.

The determination of arterial pressure wave-derived cardiac output (APCO) and central venous O2 saturation (ScvO2) has been introduced as a less invasive procedure for monitoring cardiac function and oxygen delivery. We have used an APCO sensor (FloTracTM) and a monitor for ScvO2 (Vigileo(TM)) in two cases of cardiac valve surgery, where placement of pulmonary artery catheter (PAC) was not applicable due to unfavorable cardiac structure (case 1) and was contraindicated due to an unstable cardiac conduction disorder and arrhythmia (case 2). In case 1, monitoring of APCO was started from the beginning of anesthesia induction and a ScvO2 monitoring central venous catheter was inserted just after anesthesia induction. APCO, ScvO2 and other hemodyanamic information such as arterial BP, CVP, and data obtained from transesophageal echocardiography (TEE) during the pre- cardiopulmonary bypass (CPB) period were measured. APCO and ScvO2 during the post-CPB period showed a reliable correspondence with continuous cardiac output (CCO) and mixed venous O2 saturation (SvO2) as measured by PAC at the end of CPB. In case 2, APCO and ScvO2 were monitored instead of CCO and SvO2. The values of APCO showed a good correlation to intraoperative COs indirectly calculated by the velocity-time integral of the aortic outflow determined in the TEE examination. We experienced that monitoring APCO and ScvO2 is useful for anesthesia management in cardiac valve surgery and can be an alternative to CCO and SvO2 if the placement of PAC and the thermodilution method are not applicable.
Anesthesia ; Arrhythmias, Cardiac ; Arterial Pressure* ; Cardiac Output* ; Cardiopulmonary Bypass ; Catheters ; Central Venous Catheters ; Echocardiography, Transesophageal ; Heart Valves ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*

Achondroplasia is the most common non-lethal skeletal dysplasia. Underdevelopment and premature ossification of bones result in characteristic craniofacial and spinal abnormalities. Achondroplastic dwarfs have low fertility rates and require delivery by cesarean section due to their cephalo-pelvic disproportion. Controversy exists regarding the ideal anesthesia for an achondroplastic parturient dwarf for urgent cesarean section. Anesthesia, whether general or regional, presents many potential problems during cesarean section. We report the experience of the epidural anesthesia in an achondroplastic dwarf undergoing elective cesarean section.
Achondroplasia ; Anesthesia ; Anesthesia, Epidural ; Birth Rate ; Cesarean Section ; Female ; Pregnancy

BACKGROUND: Although left ventricular hypertrophy (LVH) is a compensatory process to pressure overload, there are gender differences in left ventricular function and vascular stiffness in hypertension. We evaluated that inappropriate LVH was related with Framingham risk score (FRS) and vascular stiffness in hypertensive women. METHODS: Total 226 hypertensive women consecutively underwent carotid ultrasound and echocardiography, from which LV mass (LVM), carotid intima-media thickness (IMT) and beta-stiffness were measured. Inappropriate LVH was calculated by the ratio of observed LVM to the value predicted for sex, height and stroke work at rest and defined as > 128% of predicted. FRS was obtained using by National Cholesterol Education Program Adult Treatment Panel III. RESULTS: Of 226 subjects, 59 subjects (26%) had inappropriate LVH. As compared with appropriate LVH, subject with inappropriate LVH showed older age, higher FRS, and IMT. Although LV ejection fraction was not different, diastolic parameters of E/A ratio and left atrial volume were significantly worse in inappropriate LVH group. CONCLUSIONS: The presence of inappropriate LVH in hypertensive women was strongly associated with higher FRS, decreased diastolic function and increased IMT, which might influence future cardiovascular events.
Adult ; Carotid Intima-Media Thickness ; Echocardiography ; Female* ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular* ; Ultrasonography ; Vascular Stiffness* ; Ventricular Function, Left

Traditional risk factors for acute myocardial infarction are hypertension, diabetes, dyslipidemia, smoking, and a family history of coronary heart disease. Most acute myocardial infarction patients have at least one of these risk factors. Polycythemia vera is a rare etiological factor for acute myocardial infarction. Polycythemia vera leads to hyperviscous milieu of the blood and increased platelet activity, which increases the chance of thrombotic occlusion of coronary arteries. In this article we report a rare case of polycythemia vera presenting as an ST-elevation myocardial infarction without any traditional risk factors for cardiovascular disease.
Blood Platelets ; Cardiovascular Diseases ; Coronary Disease ; Coronary Vessels ; Dyslipidemias ; Humans ; Hypertension ; Myocardial Infarction* ; Polycythemia Vera* ; Risk Factors ; Smoke ; Smoking

Objective: We compared appendiceal visualization on 2-mSv CT vs. conventional-dose CT (median 7 mSv) in adolescents and young adults and analyzed the undesirable clinical and diagnostic outcomes that followed appendiceal nonvisualization. Materials and Methods: A total of 3074 patients aged 15–44 years (mean ± standard deviation, 28 ± 9 years; 1672 female) from 20 hospitals were randomized to the 2-mSv CT or conventional-dose CT group (1535 vs. 1539) from December 2013 through August 2016. A total of 161 radiologists from 20 institutions prospectively rated appendiceal visualization (grade 0, not identified; grade 1, unsure or partly visualized; and grade 2, clearly and entirely visualized) and the presence of appendicitis in these patients. The final diagnosis was based on CT imaging and surgical, pathologic, and clinical findings. We analyzed undesirable clinical or diagnostic outcomes, such as negative appendectomy, perforated appendicitis, more extensive than simple appendectomy, delay in patient management, or incorrect CT diagnosis, which followed appendiceal nonvisualization (defined as grade 0 or 1) and compared the outcomes between the two groups. Results: In the 2-mSv CT and conventional-dose CT groups, appendiceal visualization was rated as grade 0 in 41 (2.7%) and 18 (1.2%) patients, respectively; grade 1 in 181 (11.8%) and 81 (5.3%) patients, respectively; and grade 2 in 1304 (85.0%) and 1421 (92.3%) patients, respectively (p < 0.001). Overall, undesirable outcomes were rare in both groups. Compared to the conventional-dose CT group, the 2-mSv CT group had slightly higher rates of perforated appendicitis (1.1% [17] vs. 0.5% [7], p = 0.06) and false-negative diagnoses (0.4% [6] vs. 0.0% [0], p = 0.01) following appendiceal nonvisualization. Otherwise, these two groups were comparable. Conclusion The use of 2-mSv CT instead of conventional-dose CT impairs appendiceal visualization in more patients. However, appendiceal nonvisualization on 2-mSv CT rarely leads to undesirable clinical or diagnostic outcomes.