PURPOSE: To investigate the effects of valproic acid on the production of nitric oxide (NO) and expression of endothelial nitric oxide synthase (eNOS) in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0.25, 0.5, and 1.0 mM valproic acid for 6, 12, and 24 hours. Expression of eNOS mRNA was assessed with Reverse transcription-polymerase chain reaction, and production of NO was assessed with Griess assay. Cellular survival was assessed with the 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide (MTT) assay. RESULTS: Valproic acid at concentrations of 0.25, 0.5, 1.0 mM did not affect the cellular survival of HTMC significantly after exposure for 24 hours. Valproic acid increased NO production in a dose- and time-dependent manner. Also, valproic acid increased the degree of eNOS mRNA expression in a dose-dependent manner in HTMC. CONCLUSIONS: Valproic acid increases production of NO and expression of eNOS mRNA in HTMC. Thus, valproic acid might increase aqueous outflow through the trabecular meshwork.
Humans ; Nitric Oxide Synthase Type III ; Nitric Oxide Synthase ; Nitric Oxide ; RNA, Messenger ; Trabecular Meshwork ; Valproic Acid

Purpose: We evaluated the protective effect of trabecular outflow drugs, Rho kinase (ROCK) inhibitors against oxidative stressin trabecular meshwork cells. Methods: Primary-cultured human trabecular meshwork cells (HTMCs) were exposed to ROCK inhibitors at 10 and 20 μMY-27632, ripasudil or fasudil for 24 hours, after pretreatment with 200 μM hydrogen peroxide for 30 min. The cell viabilities andmetabolic activities were assessed using the Trypan Blue dye exclusion test and MTT assay, respectively. Reactive oxygen species(ROS) production was measured using the H2DCFDA assay, and the degree of apoptosis was measured with flow cytometryusing annexin-propidium iodide double staining. Results: In HTMCs, Y-27632 suppressed ROS production. Ripasudil and fasudil increased the metabolic activities and decreasedthe degrees of apoptosis. Fasudil showed the most cytoprotective effects among the three ROCK inhibitors tested. Conclusions Against oxidative stress, ROCK inhibitors decreased apoptosis accompanied by decreased ROS production, especiallyfasudil. ROCK inhibitors may therefore have cytoprotective properties in addition to increasing trabecular outflow.

PURPOSE: To investigate the effects of hydrogen sulfide (H₂S) on the permeability of a cultured human trabecular meshwork cells (HTMC) monolayer and its interaction with nitric oxide (NO).METHODS: After exposing primary cultured HTMCs to 0, 50, 100, and 500 µM sodium hydrogen sulfide (NaHS) for 6 hours, the permeabilities through the HTMC monolayer were measured using a Transwell assay with carboxyfluorescein. The production of NO and eNOS mRNA expression were assessed using the Griess assay and reverse transcription-polymerase chain reaction, respectively. In addition, 0, 1, and 10 µM NaHS and 10 µM sodium nitroprusside (SN) were co-exposed to evaluate the possible synergistic effect of H₂S and NO.RESULTS: Greater than 100 µM NaHS increased the permeability through the HTMC monolayer in a dose-dependent manner (p < 0.05). These increased permeabilities were not accompanied by NO production or eNOS mRNA expression (p > 0.05). When 0, 1, and 10 µM NaHS and 10 µM SN were exposed together, there was no significant change of permeability, NO production, or eNOS mRNA expression (all, p > 0.05).CONCLUSIONS: NaHS at high concentrations increased the permeability of the HTMC monolayer, which was not affected by NO. NaHS at low concentrations did not show a synergistic effect with NO. Thus, H₂S at high concentrations may increase trabecular outflow, which may not be associated with NO.

Purpose: This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures. Materials and Methods: Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed. Results: Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032).One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019). Conclusion Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.

Purpose: This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures. Materials and Methods: Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed. Results: Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032).One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019). Conclusion Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.

Purpose: This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures. Materials and Methods: Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed. Results: Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032).One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019). Conclusion Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.

Purpose: This study examined the factors affecting valgus deformities after arthroscopic reduction and internal fixation (ARIF) in lateral joint-depression tibial plateau fractures. Materials and Methods: Patients with lateral joint-depression tibial plateau fractures treated with ARIF were assessed retrospectively. The radiological evaluations included the articular depression distance (ADD) and the lateral plateau widening distance (LPWD) on preoperative and postoperative computed tomography. A postoperative valgus deformity was defined as valgus malalignment (mechanical axis ≥3°) and valgus deviation (Δmechanical axis of the operated knee from the healthy knee of ≥5°). Subgroup analyses based on a postoperative valgus deformity were performed to compare the clinical outcomes, including the range of motion, patient-reported outcomes measures, and failure and osteoarthritis progression. Furthermore, factors affecting the postoperative mechanical and Δmechanical axes were assessed. Results: Thirty-nine patients were included with a mean follow-up of 44.6 months (range, 24-106 months). Valgus malalignment and valgus deviation were observed after ARIF in 10 patients (25.6%) and five patients (12.8%), respectively. The clinical outcomes were similar in patients with and without a postoperative valgus deformity. On the other hand, lateral compartment osteoarthritis progression was significantly higher in the valgus deformity group than in the non-valgus deformity group (valgus malalignment group: 50.0% vs 6.9%, p=0.007; valgus deviation group: 60.0% vs 11.8%, p=0.032).One patient with valgus deformity underwent realignment surgery at postoperative five years. The preoperative ADD and postoperative LPWD were significantly associated with the postoperative mechanical (both, p<0.001) and Δmechanical (ADD, p=0.001; LPWD, p=0.025) axes. Moreover, the lateral meniscectomized status during ARIF was significantly associated with the Δmechanical axis (p=0.019). Conclusion Osteoarthritis progression was highly prevalent in patients with postoperative valgus deformity. Thus, the restoration of lateral plateau widening and articular depression and preservation of the meniscus are necessary to prevent a valgus deformity after ARIF in lateral joint-depression tibial plateau fractures.

Optical coherence tomography (OCT) is a useful coronary imaging tool for atherosclerotic plaque characterization and stent evaluation. However, proximal balloon inflation is required in order to reduce signal changes caused by red blood cells and to acquire a clear image. One rare acute complication related to proximal balloon occlusion is micro-thrombus formation. We report a case of multiple, acute micro-thrombi forming after an OCT procedure, despite the use of appropriate prevention for intracoronary thrombus formation.
Balloon Occlusion ; Erythrocytes ; Inflation, Economic ; Plaque, Atherosclerotic ; Stents ; Thrombosis ; Tomography, Optical Coherence

The left main coronary artery branches to form the left anterior descending and left circumflex arteries and supplies the entire myocardium of the left ventricle. Treatment guidelines recommend coronary artery bypass grafting in left main coronary artery disease. However, some recent studies have demonstrated that, although the target vessel revascularization rate is relatively high, percutaneous coronary intervention (PCI) has a comparable mortality rate to coronary artery bypass grafting in left main disease. In this case, an 80-year-old male with a recent ST elevation myocardial infarction of the right coronary artery (RCA) was transferred to our hospital for second-stage PCI for left main artery stenosis, which was found incidentally at the time of primary PCI of the RCA. Although he had severely depressed left ventricular function, a drug-eluting stent was implanted successfully in his left main coronary artery with percutaneous cardiopulmonary support.
Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Arteries ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Drug-Eluting Stents ; Equipment and Supplies ; Extracorporeal Circulation ; Glycosaminoglycans ; Heart Ventricles ; Humans ; Infarction ; Male ; Myocardial Infarction ; Myocardium ; Percutaneous Coronary Intervention ; Stents ; Ventricular Function, Left

The therapeutic indication for endoscopic submucosal dissection (ESD) can be expanded to treat small-sized (<2 cm) early gastric cancer (EGC) with undifferentiated histology. Here, we report the case of a 62-year-old woman in whom EGC was initially diagnosed by endoscopy and CT. She subsequently underwent ESD. Histological examination revealed a mixed type adenocarcinoma with poorly differentiated histology confined to the mucosa without ulcer and lymphovascular involvement. Subsequent regular examinations showed no recurrence for 7 years. She complained of fatigue and weight loss on the 7th year of follow-up. Radiologic examination showed multiple bone metastases and the bone biopsy specimen revealed adenocarcinoma resembling the previous EGC.
Adenocarcinoma ; Biopsy ; Endoscopy ; Fatigue ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Mucous Membrane ; Neoplasm Metastasis* ; Recurrence ; Stomach Neoplasms* ; Ulcer ; Weight Loss