bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental Signaling Disorders in Craniofacial Anomalies and Cancers
Authors: Zhang Yan , Wang Hua , Kamegai Akihide , Hata Tsuyoshi , Kitamura Naoya , Hosoda Masaru , Tani Ryouji , Hayashido Yasutaka , Toratani Shigeaki , Okamoto Tetsuji
Published: August 2012

Normal human development requires the precise functioning and coordination of many complex pathways. Abnormalities in these signaling cascades often result in developmental perturbations, giving rise to congenital anomalies and cancers. There are 21,787 genes in each human nucleus, different gene subsets are expressed in different cell types, and different gene networks make different signal cascades. Among a large number of genes, in this review, we describe signaling disorders of sonic hedgehog and its receptor, patched‐1; Tie2 ; fibroblast growth factor receptor in craniofacial anomalies and oral cancers.
Hydrostatic Pressure Induces Cytokine Production in Human Periodontal Ligament Cells
Authors: Yamamoto Toshiro , Kita Masakazu , Kimura Isao , Oseko Fumishige , Amemiya Takeshi , Nakanishi Akira , Sakao Kei , Takahashi Kenji , Kubo Toshikazu , Kanamura Narisato
Published: August 2012

Periodontal tissue has a unique structure in that the human periodontal ligament (hPDL) lies between the hard tissues of cementum and alveolar bone. Although the role of cytokines in hPDL function is not clearly understood, we investigated the effect of mechanical stress as hydrostatic pressure (HP) on cytokine expression in hPDL cells.

The hPDL cells were obtained from a healthy maxillary third molar. After the 3rd to 4th passage, the cells were exposed to HP ranging from 1 MPa to 6 MPa as previously described. The expression of cytokine mRNA was determined by RT‐PCR and cytokines in the culture supernatants were assessed by enzyme‐linked immunosorbent assay (ELISA).

The exposure to 6 MPa of HP caused no morphological changes of hPDL cells, and did not affect cellular viability. No expression of IL‐1β, IL‐6, IL‐8, TNF‐α, RANK, RANKL or OPG mRNA was observed in the control cells under atmospheric pressure, whereas in hPDL cells treated with HP, enhancement of IL‐6, IL‐8, RANKL and OPG mRNA expression was observed between 10 and 60 minutes after the exposure to HP. After the exposure to HP, the production of IL‐6 and TNF‐α were induced significantly in hPDL cells, but IL‐1β and IL‐8 were not produced.

These results suggest that hPDL cells may play a role in the production of cytokines in response to mechanical stress in vivo.
A Case of Symmetrical Lipomatosis of the Tongue Presenting as Macroglossia
Authors: Ishikawa Yoshimi , Katada Yu , Enomoto Masahiro , Kawada Kensuke , Okamoto Yoshiyuki , Ozawa Mikio
Published: August 2012

Symmetrical lipomatosis is characterized by symmetrical infiltration of adipose tissue into the head, neck, or upper trunk. By contrast, oral involvement is extremely rare. The present report describes a case of symmetrical lipomatosis of the tongue (SLT) presenting as macroglossia. The patient was a 63‐yearold Japanese male who developed progressive dysarthria secondary to enlargement of the tongue. The patient's medical history was notable for alcoholic hepatitis and hyperlipidemia. Marginal glossectomy was performed on both sides of the tongue to achieve volume reduction and restore normal speech. Histopathologic examination of the resected tissue revealed diffuse infiltration with adipose tissue lacking a fibrous capsule. The patient's postoperative course was uneventful, and he remained free of recurrence or regrowth and functional deficits at the 6‐year follow‐up time point.
Successful Hemostasis after Dental Extraction with the Use of Recombinant Activated Factor VII in a Factor VII Deficient Patient
Authors: Koji Satoh , Masataka Okamoto , Aya Torimura , Rina Taguchi , Yasuhisa Mineno , Hideki Mizutani
Published: August 2012

We report our experience of successful hemostasis after dental extraction with the use of rFVII a in a FVII deficient patient. Preoperative PT% was 25%, and FVII was less than 3%. Thirty minutes before tooth extraction, 1.2 mg of rFVII a was injected. At the beginning of the operation, PT% was more than 200%, FVII was 336%, and the hemostasis after dental extraction was excellent. rFVII a was used effectively and safely for dental extraction in this case of FVII deficiency.
Ultrasonographic Evaluation and Differentiation of Tumorous Lesions in the Floor of the Mouth:
Authors: Ariji Yoshiko , Maeda Hatsuhiko , Naitoh Munetaka , Gotoh Masakazu , Izumi Masahiro , Aimiya Hidetoshi , Shimozato Kazuo , Kurita Kenichi , Ariji Eiichiro
Published: August 2012

Ultrasonography may provide some information as to the tissue characteristics of tumorous lesions in the floor of the mouth, which have not been sufficiently clarified. Ultrasonographic imaging characteristics of these lesions are presented and the differential diagnoses are discussed. Ultrasonographic images of 5 patients with metastatic lingual lymph nodes (squamous cell carcinoma), lymphangioma, Schwannoma, ranula and dermoid cyst are presented. The literature on the imaging features of tumorous lesions in the floor of the mouth was searched using Medline. Five cases of tumorous lesions in the floor of the mouth are presented. The differential diagnosis through a review of the references was discussed. Ultrasonographic images clearly showed the internal structures of the mass. The homogeneity varied according to the degree of closeness of the cells and tissues, or the presence of fluid, hemorrhage, cystic degeneration and calculus. The echogenicity was due to the high acoustic impedance of calculus, cholesterol, and so on. The imaging features varied according to the ratio of the tissues, such as fat and fibrous tissue (in lipoma), or cholesterol and keratin (in dermoid cyst). A high vascular mass indicated malignant salivary gland tumors and hemangioma. In conclusion, ultrasonographic images revealed the distinctive features of the lesions and were useful for the differential diagnosis. Therefore, ultrasonography could be used to conjecture the content of the lesions and is considered to be useful for easy and accurate diagnosis prior to treatment.
Etiology of Trigeminal Neuralgia
Authors: Toda Katsuhiro
Published: August 2012

Neurovascular compression at the root entry zone accounts for more than 80% of trigeminal neuralgia (TN) cases, but not all patients with TN have neurovascular compression. Many non‐TN subjects have neurovascular contract at the root entry zone. TN is reported to occur in 0.9% to 4.5% of patients with multiple sclerosis (MS). In patients with TN, 1.7% to 15% of patients suffer from MS. The reported range for patients with TN due to tumors is from 0.8% to 11.6%. Because carbamazepine may relieve pain temporarily, relief of pain with carbamazepine does not exclude the diagnosis of a tumor or cyst. There are the peripheral cause theory, central cause theory, peripheral origin central pathogenesis theory, and multiple factors theory in the pathology of TN. Dental pain and/or treatment may trigger TM. Alveolar cavitational osteonecrosis may also cause TN.
Expression of Urokinase‐type Plasminogen Activator (uPA), uPA Receptor, and Plasminogen Activator Inhibitor‐1 in Oral Squamous Cell Carcinoma
Authors: Inoue Yoshiko , Sugiura Tsuyoshi , Matsuki Ryousuke , Ishii Kotaro , Seki Katsuhiro , Shirasuna Kanemitsu
Published: August 2012

We investigated whether the expression levels of urokinase‐type plasminogen activator (uPA), uPA receptor (uPAR), and plasminogen activator inhibitor‐1 (PAI‐1) correlate with clinicopathological features of oral squamous cell carcinoma (SCC). We immunohistochemically examined the expression levels of uPA, uPAR, and PAI‐1 in 160 biopsy specimens of oral SCC. Positive stainings for uPA, uPAR, and PAI‐1 were observed mainly in SCC cells, and their intensity and number of positive cells were related to lymph node involvement (p < 0.001, p < 0.001, and p < 0.001, respectively). The expression levels of uPA and uPAR were also related to the pattern of invasion (p < 0.05 and p < 0.001, respectively), while both were associated with tumor size (p < 0.05). Moreover, a poor survival rate was related to the expression of uPAR (p < 0.01) and PAI‐1 (p < 0.05). These findings suggest that the uPA system may regulate the invasion and metastasis of oral SCC cells.
Multilineage Cells from Apical Pulp of Human Tooth with Immature Apex
Authors: Abe Shigehiro , Yamaguchi Satoshi , Amagasa Teruo
Published: August 2012

The human tooth with immature apex is a developing organ available for investigation. In this tooth, especially in the apical pulp, the proliferation and differentiation of various cells are activated to make a complete tooth. We investigated the notion that unique cells are included in the apical pulp of human tooth with immature apex. Human impacted third molars with immature apex freshly extracted for orthodontic reasons or treatment were obtained. Histological analyses revealed that BrdU‐incorporating cells and cells positive for the mesenchymal stem cell markers SH2 and SH3 were located in the same region. The cells from the apical pulp of a human tooth with immature apex, designated here as apical pulp‐derived cells (APDCs), can be cultured easily in vitro under ordinary serum‐supplemented culture condition. The expression of surface markers of expanded APDCs is similar to that of bone marrow mesenchymal stem cells, except for CD49d (α4‐integrin). APDCs differentiated into mineralized cells, adipocytes, chondroblasts and neural cells in vitro. APDCs have a high capacity for proliferation and multilineage potential in vitro. Our results indicate that human tooth with immature apex is a precious tissue source for the research of human adult stem cells and for the advancement of dental and regenerative medicine.
Effects of Heparin‐binding Epidermal Growth Factor on the Invasion Activity of an Oral Cancer Cell Line
Authors: Furukawa Masayuki , Ohnishi Yuichi , Kakudo Kenji
Published: August 2012

Heparin‐binding epidermal growth factor (EGF)‐like growth factor (HB‐EGF), which belongs to the EGF family, has been shown to stimulate the growth of a variety of cells in an autocrine or paracrine manner. Although HB‐EGF is widely expressed in tumors when compared to normal tissue, its contribution to tumor invasion is still not known. In the present study, we analyzed the effects of HB‐EGF on the invasion activity of a cultured oral cancer cell line using short interfering RNA (siRNA).

Oral squamous carcinoma cell lines, HSC3 and SAS, were transfected with siRNA targeting HBEGF. Expression of HB‐EGF was analyzed by real‐time PCR. The invasiveness of the transfected cells was determined using a matrigel invasion assay, and MMP‐9 production was measured by RTPCR and gelatin zymography.

The expression of HB‐EGF was reduced in HSC3‐siRNA and SAS‐siRNA cells. The matrigel invasion assay demonstrated that the invasiveness of HSC3‐siRNA and SAS‐siRNA cells was reduced. Gelatin zymography demonstrated that in HSC3‐siRNA and SAS‐siRNA cells, MMP9 production was decreased.

These findings suggest that HB‐EGF expression is related to the invasion activity of oral cancer, particularly via regulation of MMP9.
Cystadenoma Arising from the Retromolar Region: A Case Report
Authors: Takahashi Yoshihiro , Kawano Kenji , Yanagisawa Shigetaka , Yokoyama Shigeo
Published: August 2012

Cystadenoma is an uncommon benign epithelial neoplasm. Cystadenoma usually occurs on the palatal and buccal mucosa, but is less commonly found in the retromolar regions.

A 43‐year‐old male patient noticed a swelling on his gingiva distal to the right mandibular second molar. Physical examination showed a diffuse poorly circumscribed swelling extending from the lingual gingiva distal to the right mandibular second molar to the floor of the mouth and pharynx. The tumor size was 20 × 27 mm. The surface mucosa was purply‐blue in parts. About 4 ml of pale yellow serous fluid was aspirated. The tumor was surrounded by a capsule and was excised successfully above the periosteum, incorporating a 2 mm safety margin including the surface mucosa. The tumor consisted of a fibrous capsule with multiple cystic cavities of various sizes. The cysts were lined by a layer of columnar epithelium, with intracystic papillary proliferation in some areas. No cytologic atypia or invasion of the surrounding tissues were observed.

There is no evidence of recurrence ten years after excision, suggesting that complete excision is sufficient treatment in such cases.
Benign Fibrous Histiocytoma of the Upper Lip: A Case Report
Authors: Toyohara Yukiyo , Hashitani Susumu , Sakurai Kazunari , Takaoka Kazuki , Urade Masahiro
Published: August 2012

A rare case of benign fibrous histiocytoma arising in the upper lip in a 76‐year‐old female is presented. A well‐defined tumor measuring 1 cm existed in the submucosal area of the right side of the upper lip. With the patient under local anesthesia, the tumor was excised. Microscopically, the excised tumor was diagnosed as a benign fibrous histiocytoma. There has been no evidence of tumor recurrence after the operation.
Morphometric Analysis of Nuclear Features and Volume‐Corrected Mitotic Index in the Prognosis of Oral Squamous Cell Carcinoma
Authors: Natarajan Srikant , Mahajan Sumita , Boaz Karen , George Thomas
Published: August 2012

In the present study, an objective and reproducible evaluation of mitotic activity and nuclear morphometric factors was attempted in 30 patients of oral squamous cell carcinoma with a view to predicting local relapse and survival. Various nuclear parameters and volume‐corrected mitotic index were calculated and compared with the recurrence and death of the study group (n = 30). Volume‐corrected mitotic index (M/V index) was the single best prognosticator for recurrence of oral squamous cell carcinoma (p = 0.008 for recurrence; p = 0.015 for death). The combination of M/V and SD of nuclear area (forward stepwise regression) was a more efficient and better predictor of survival (Log rank test, Kaplan‐Meier’s survival analysis; χ2 = 17.46, p = 0.00001). The present study proved the effectiveness of the M/V index in predicting the biological behavior and the outcome of oral squamous cell carcinoma patients.
Preliminary Clinical Study to Evaluate the Relationship between Systemic Bone Turnover and the Microstructure of the Alveolar Bone
Authors: Arisaka Ryuichi , Matsuo Akira , Chiba Hiroshige , Takahashi Hidetoshi , Takeuchi Sawako , Watanabe Masato , Hojo Satoru
Published: August 2012

The objective of this study was to assess the possibility of developing a clinical minimally invasive and standardized method to evaluate the relationship between the microstructure of the jaw bone and systemic bone turnover. For this purpose, we performed standardized bone biopsy of the alveolar bone, and compared the 3D bone microstructure using micro‐computed tomography (micro‐CT) with bone mineral density (BMD) of the lumbar spine and biochemical markers of bone turnover. We evaluated a total of 9 samples taken from 6 patients by standardized biopsy using a trephine bur. BMD was evaluated using dual energy X‐ray absorptiometry (DXA). Regarding the biochemical markers of bone turnover, serum bone‐specific alkaline phosphatase (BAP) and serum osteocalcin (OC) were used as bone formation markers, and urinary cross‐linked N‐telopeptides of type I collagen (NTx) and urinary deoxypyridinoline (DPD) were selected as bone resorption markers. We scanned micro‐CT images of these samples. Bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Spac), fractal dimension, trabecular bone pattern factor (TBPf) and node‐strut (Nd.Nd/TV, TSL/TV) were measured. Regarding the correlations between the parameters of bone microstructures, TB/TV, Tb.N, fractal dimension, and node‐strut seemed to be positively correlated and Tb.Spac and TBPf seemed to be negatively correlated with each other, but Tb.Th seemed to have a low correlation with other parameters. OC and/or BAP showed a significantly high correlation with many structural parameters (p < 0.05%). In conclusion, some microstructural parameters may change according to the systemic bone turnover.
Complications and Outcome of Free Flap Transfers for Oral and Maxillofacial Reconstruction: Analysis of 213 Cases
Authors: Yamashiro Masashi , Hasegawa Kazuki , Uzawa Narikazu , Michi Yasuyuki , Ishii Junichi , Yoshitake Hiroyuki , Kobayashi Junji , Yagihara Kazuhiro , Okabe Sadao , Amagasa Teruo
Published: August 2012

Microvascular free flap transfers have become a preferred reconstructive technique ; however, rare complications may still prove devastating. This study reviewed 213 consecutive freetissue transfers in order to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the oral and maxillofacial region. In most cases, reconstruction was undertaken after resection of a malignant tumor. The flap donor sites were the radial forearm (n=111), rectus abdominis (n=88), scapula (n=13), and latissimus dorsi (n=1). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. The overall flap success rate was 99%. There were 7 cases of postoperative vascular thrombosis (6 venous and 1 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re‐exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re‐exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.
Regulation of the Wnt Signaling Pathways during Cell Culture of Human Mesenchymal Stem Cells for Efficient Bone Regeneration
Authors: Katagiri Wataru , Yamada Yoichi , Nakamura Sayaka , Ito Kenji , Hara Kenji , Hibi Hideharu , Ueda Minoru
Published: August 2012

Tissue engineering and bone regeneration techniques using mesenchymal stem cells (MSCs) have started to be applied to the field of oral and maxillofacial surgery. Clinically, a shortened treatment time and improved efficiency are necessary because of the patients' needs and the running cost of cell culture. In the present study, the cultivation process for human MSCs (hMSCs) was examined by regulating the Wnt signaling pathway. We activated Wnt signaling with LiCl and inhibited Wnt signaling with sFRP‐3 (secreted Frizzled‐Related Protein‐3). The proliferation of LiCl‐treated hMSCs was examined by studying the cell growth rate and performing BrdU assays. Osteogenic differentiation of sFRP‐3‐treated hMSCs was examined by alizarin red staining, and osteogenic gene expression on days 7 and 14 after induction was examined by reverse‐transcription polymerase chain reaction (RT‐PCR) analysis and quantitative real‐time RT‐PCR analysis. LiCl‐treated hMSCs showed increased cell numbers and BrdU‐positive cells as compared to the untreated cells. Alizarin red staining showed early mineralization of hMSCs on day 7 of the sFRP‐3 treatment. A high expression level of the alkaline phosphatase gene on days 7 and 14 of sFRP‐3 treatment was also demonstrated. These results suggest that the regulation of the Wnt signaling pathway contributes to the increased cell numbers and the early osteogenic differentiation of hMSCs. This study supports the possibility that the regulation of the Wnt signaling pathway contributes to the development of effective and efficient bone regeneration techniques.
Objective Assessment of Erythema caused by Metal Patch Testing using an Erythema Index Meter
Authors: Takada Atsushi , Fujimoto Masaru , Ukichi Ken‐ichiro , Morimoto Mitsuaki , Tonogi Morio , Yamane Gen‐yuki , Takahashi Shin‐ichi
Published: August 2012

The patch test is the most reliable method for diagnosing a metal allergy. However, interpretation of patch test results depends on the experience of the investigator and on the conditions of the individual patient. In the case of patch tests for metal salts, irritant reactions such as pustular or follicular reactions are quite common. Therefore, one must be careful not to interpret irritant reactions as allergic responses, and objective standards to evaluate erythema in patch tests need to be established.

In the present study, we attempted to objectively evaluate patch test results for metal salts using an erythema index meter. We used the Erythema Index Difference (EID) (patch test site erythema index (EI) minus the mean EI of healthy skin outside the patch test area and at the unit tape site) rather than the EI itself in order to eliminate the effects of the patch test unit and individual differences. We measured the EID over time in patients with suspected metal allergies to various metals. Significant differences in EID were observed among ++ assessments, + assessments and irritant reactions based on International Contact Dermatitis Research Group (ICDRG) standards. In considering changes in EID over time, allergic and irritant reactions can be discriminated with high sensitivity (73.3%) and specificity (91.2%).

These results suggest that the measurement of erythema over time with an erythema index meter is useful for the objective assessment of metal patch test reactions.
A Case of Cat Cry Syndrome Associated with Cleft Lip
Authors: Kashima Koji , Igawa Kaori , Yokota Rie , Yoshioka Izumi , Sakoda Sumio
Published: August 2012

Cat cry syndrome (cri‐du‐chat syndrome) is an extremely rare condition characterized by a high shrill cry during infancy, resulting from either the deletion of the short arm of chromosome 5 or unbalanced translocation inherited from a parent. We report the case of a 1‐year‐old girl with cat cry syndrome associated with cleft lip. The patient showed a ventricular septal defect, cleft lip, growth and mental retardation, micrognathia, ptosis of the eyelids, hypertelorism, epicanthal folds, and a preauricular tag on the right side. A chromosomal study revealed the terminal deletion of chromosome 5 (46, XX, del(p14.2)ish del(5)). Repair of the cleft lip was carried out concurrently with resection of the preauricular tag, and the patient's postoperative course was uneventful.
Intraosseous Schwannoma of the Mandibular Symphysis: Report of a Case
Authors: Kawasaki Goro , Yanamoto Souichi , Yoshida Hajime , Mizuno Akio , Fujita Shuichi , Ikeda Tohru
Published: August 2012

Schwannoma is a benign neoplasm originating from the neural sheath and occurs most commonly in the soft tissues of the head and neck. Intraosseous Schwannoma in the maxillofacial region is extremely rare. The present study reports the case of an intraosseous Schwannoma located in the mandibular symphysis of a 27‐year‐old male patient. The tumor was completely excised, and there has been no evidence of recurrence in the nearly two years since the operation. A review of the related literature is also included.
Analysis of Biological Apatite Orientation in Rat Mandibles
Authors: Nagisa Noriko , Nakano Takayoshi , Hashiguchi Norihiro , Fujitani Wataru , Umakoshi Yukichi , Shimahara Masashi
Published: August 2012

Recently, significant progress has been made in medical techniques for regenerating bone. However, bone evaluation techniques generally assess bone quantity as opposed to bone quality. The use of c‐axis crystallite orientation of biological apatite (BAp) as a bone quality index has recently generated great interest. BAp demonstrates strong crystallographic anisotropy, and preferential alignment of BAp in each bone varies depending on the shape and stress conditions in vivo. In the mandible, complicated bone shape and stress conditions in vivo might be associated with both bone quantity and quality. In this study, we aimed to elucidate changes in the bone microstructure in the mandible using crystallographic orientation of BAp as a bone quality index. Using Crj : CD (SD) IGS female rats, we observed changes in the dentulous mandible during bone growth. Measuring points on the mandible were determined based on its positional relationship with the teeth. For analysis of bone quantity, the area and bone mineral density of cortical bone were evaluated using peripheral quantitative computed tomography (pQCT), while the orientation of the BAp c‐axis, as analyzed by a micro‐beam X‐ray diffraction system, was used to assess bone quality. The results of both bone quantity and quality assessments indicated that changes during bone growth varied depending on the presence of teeth. We concluded that the microstructure (especially the texture) of BAp crystallite changes in correlation with variations in stress distribution in vivo resulting from changes in chewing conditions designed to optimize the dynamic chewing function.
Incidence and Characteristics of Ventricular Fibrillation in Bystander‐witnessed Out‐of‐hospital Cardiac Arrest with Cardiac Etiology in the City of Sendai, Japan
Authors: Watanabe Jun , Kanazawa Masaharu , Yagi Tetsuo , Odakura Hironori , Kameyama Motonobu , Sakurai Katsuhiko , Hiramoto Tetsuya , Uenohara Hiroshi , Endo Tomoyuki , Koseki Yoshito , Shinozaki Tsuyoshi , Shiba Nobuyuki , Karibe Akihiko , Sakuma Masahito , Fukuda Koji , Kagaya Yutaka , Numakura Katsunori , Yamaki Masayuki , Shinozawa Yotaro , Shirato Kunio
Published: August 2012

Ventricular fibrillation (VF) in out‐of‐hospital cardiac arrest (OHCA) is a main target for resuscitation.

Methods and results: We analyzed Utstein‐style data in Sendai City (population 1,020,000), Japan from January 2002 to March 2004. The incidence of OHCA overall was 62.3/100,000/year. The incidence of the bystander‐witnessed VF was 2.5/100,000/year. In younger patients (20–65 years of age), the percentage of VF was 52% when cardiac origin was presumed by bystander witness, and ECG was recorded within 10 minutes from the collapse. In older patients (over 65 years of age), however, the percentage of VF was 21% when they were bystander‐witnessed, and ECG was recorded within 10 minutes from the collapse. No VF was reported when the ECG was recorded more than 15 minutes after the collapse. The thirty‐day survival rate was 21% in the bystander‐witnessed VF cases with cardiac etiology, but 0% in the non‐VF cases. The bystander CPR was significantly associated with improved 30‐day survival rate. Conclusion: Younger age, male gender, and shorter collapse‐to‐ECG time are significantly associated with the appearance of VF in bystander‐witnessed OHCA with cardiac etiology. Bystander CPR was significantly associated with the improvement in prognosis of those VF patients.
Atrial Fibrillation and Atrial Fibrillation Intervals—Frequency Analysis and Interpretation—
Authors: Shimizu Akihiko
Published: August 2012

Introduction: Atrial fibrillation (AF) is the most frequently occurring atrial arrhythmia. Fibrillation intervals are used to characterize AF and have a potential to determine the strategy for AF therapy regardless of its etiology. However, measuring local fibrillation intervals requires an extensive period of time when using visual methods, and such methods are also subject to data bias. Recently several methods for measuring the atrial fibrillation cycle length (AFCL) using computers have been developed. Atrial activation during AF was considered to be random or chaotic. From recent studies, however, it was found that AF has various degrees of organization, and therefore activation during AF can be analyzed by spectral analysis. Several kinds of spectral analysis have become available for characterization of AF, and fast Fourier transform analysis is most frequently used. Autocorrelation function also can be used for analysis of AF intervals and could give us further information, such as minimum AFCL. Further, the frequency analysis of AF may be useful to predict the effect of antiarrhythmic drugs, cardioversion and catheter ablation for AF. This review was designed to investigate the analysis of AF intervals and to assess methods, interpretation and clinical implications.
Ablation of Ventricular Tachycardia Originating from the Right Ventricle Associated with Scleroderma Cardiomyopathy
Authors: Nakano Yukiko , Ogi Hiroshi , Miyoshi Miwa , Oda Noboru , Hirai Yukoh , Okimoto Tomokazu , Ishibashi Ken , Yoshizumi Masao , Kato Masaya , Dote Keigo , Chayama Kazuaki
Published: August 2012

A 49‐year‐old male was referred to the hospital because of syncope caused by ventricular tachycardia (VT) with a pulse of 240 bpm and QRS morphology with a LBBB configuration and superior axis. The patient had been on a long‐term regimen of steroids to treat his scleroderma. Satisfying 2 major criteria (QRS widening and an epsilon wave in the right chest leads) and 3 minor criteria (a slight enlargement and akinesis of the right ventricle, positive late potential in the signal averaged electrocardiogram and left bundle branch block‐type VT) he was diagnosed with arrhythmogenic right ventricular cardiomyopathy. A voltage map of his right ventricle (RV) during sinus rhythm was obtained using an electroanatomical mapping system (CARTO, Biosense‐Webster, Diamond, CA, USA). Two islet‐like low voltage areas were found and linear double potentials were recognized between areas in the lateral wall of the right ventricle (RV) very close to the tricuspid annulus. The earliest activation of the double potential line during VT was 70 msec prior to the QRS onset. We applied radiofrequency energy at that point during the VT and it successfully slowed and terminated the VT. Thereafter the VT could not be induced by any stimulation from multiple RV sites.
Unexpected Lethal Complication of Ventricular Fibrillation in Symptom Free Variant Angina Pectoris
Authors: Nogami Yashiro , Takase Bonpei , Kato Ryuichi , Isoda Susumu , Shimizu Masafumi , Kawase Isamu , Ohsuzu Fumitaka , Ishihara Masayuki , Maehara Tadaaki
Published: August 2012

We report an unexpected sudden cardiac death due to variant angina complicated by ventricular fibrillation occurring during routine ambulatory electrocardiographic monitoring. The patient had one previous episode of ventricular fibrillation before the lethal event. He had no significant coronary artery disease and was asymptomatic throughout his illness. In clinical practice, when an episode of ventricular fibrillation is noted, one should be aware of the risk of sudden cardiac death, even if the patient's vasospastic angina is relatively stable and asymptomatic.
Inverse Relation between Condition of Heart Failure and Intrathoracic Impedance Measured by Implantable Cardioverter Defibrillator—A case report—
Authors: Matsushita Kohei , Ishikawa Toshiyuki , Sumita Shinichi , Kobayashi Tsukasa , Ogawa Hideyuki , Inoue Noriko , Matsumoto Katsumi , Taima Minoru , Nakazawa Ichirou , Sugano Teruyasu , Ishigami Tomoaki , Uchino Kazuaki , Kimura Kazuo , Umemura Satoshi
Published: August 2012

The patient was a 78‐year‐old man with dilated cardiomyopathy. His cardio‐thoracic ratio was 60.4% and left ventricular ejection fraction (LVEF) was 33%. He had been repeatedly admitted for congestive heart failure. He underwent implantation of an implantable cardioverter‐defibrillator (ICD) for ventricular fibrillation. We compared the values of BNP and shock impedance stored by the ICD. The correlation coefficient (p‐value) between BNP and shock impedance was −0.700 (p < 0.0005), increase of BNP and shock impedance was −0.778 (p < 0.0001), percent increase of BNP and shock impedance was −0.767 (p < 0.0005). In conclusion, there is an inverse relation between BNP and shock impedance, and measurements of shock impedance may be useful in the management of congestive heart failure.
Modification of Electrophysiological Properties of Pulmonary Veins and Adjacent Left Atrial Tissue by Radiofrequency Thermal Balloon Circumferential Ablation around the Pulmonary Vein Ostia: Correlation with Non‐recurrence of Atrial Fibrillation
Authors: Sohara Hiroshi , Satake Shutaro , Tanaka Kazushi , Saito Shigeru , Domae Hiroshi , Takahashi Saeko , Taketani Yoshio , Shiono Takaaki , Miyashita Yusuke , Tanaka Shinji , Watanabe Yoshio , Ueno Hideki , Suma Hisayoshi , Murakami Masato , Ishigaki Sugako , Takasu Nobuyuki , Yamaguchi Yoshio , Takekoshi Noboru
Published: August 2012

Objective: The purpose of this study was to provide detailed information as to the modification of electrophysiological properties of pulmonary veins (PVs) and adjacent left atrial (LA) tissue caused by circumferential ablation (ABL) of superior and inferior pulmonary vein ostia using a novel radio‐frequency balloon catheter (RBC), and to correlate such changes with recurrence or non‐recurrence of atrial fibrillation (AF).

Background: Although isolation of the triggering foci in PVs using conventional ABL techniques is useful in the treatment of AF, ABL of PVs per se is time consuming and tends to be associated with high AF recurrence rate.

Methods and Results: Forty‐nine patients with AF refractory to antiarrhythmic medication underwent circumferential ablation of PV‐LA junction by RBC. Post ablation changes in electrophysiological properties around the PV ostia were studied with a basket catheter and were correlated with AF recurrence in 34 (1st study) early cases (ablating 68 superior PVs) and 15 (2nd study) later cases (53 superior and inferior PVs). Total elimination of PV potentials or PV‐LA dissociation was achieved in 93% (63/68 PVs) and 93% (49/53 PVs), respectively. During mean follow‐up periods of 24.1 ± 4.1 and 13.3 ± 1.7 months, AF recurred in 38% (13/34 cases) and 13% (2/15) in early and later groups, respectively, but no case developed severe PV stenosis. Although the amplitude of PV and periostial LA potentials were decreased (p < 0.0001) in all patients, the remaining PV potentials in 34 non‐recurrence cases were definitely smaller than those in 15 recurrence cases (p <0.0001). When a cut‐off level of less than 0.4 mV in receiver operating characteristic curves was used, its negative predictive value for non‐recurrence of AF was 93% and specificity was 95%.

Conclusions: Circumferential ablation around the PV ostia using the RBC is effective in the treatment of AF even in a single session, and AF recurrence may well be predicted by precisely measuring the amplitude of remaining PV‐LA potentials.
Restoring the Recurrent Extrusion of the Subcutaneously Implanted Defibrillator by Means of Subpectoral Replacement: The Benefits of Subpectoral Implantation in the Current ICD Era
Authors: Morishima Itsuro , Sone Tatahito , Tsuboi Hideyuki , Mukawa Hiroaki , Satoda Masahiko , Uesugi Michitaka , Kato Hisakazu , Morishima Yoko
Published: August 2012

A 72‐year‐old man with a thin build had an ICD system with a generator implanted at left prepectoral space. The generator was exposed through thin overlying skin at 11 months following surgery. Although it was undermined with the adjacent skin, it was exposed again 6 months later. The generator was replaced in the ipsilateral subpectoral space. Since then, no signs of recurrence have been observed for the subsequent 12 months, with the patient pleased with its cosmetic appearance. This case illustrates the benefits of subpectoral implantation in the current ICD era in which subcutaneous implantation is common.
Safety and Effectiveness of Placement of Pacemaker Leads for Cardiac Resynchronization Therapy in the Axillary Vein by Double Target‐guided Venipuncture
Authors: Kawakami Toru , Haruta Seiichi , Kouno Hiroki , Takebayashi Hideo , Akanuma Hiroshi , Okamoto Kenzou , Ohashi Norihiko , Sahara Shinji , Ida Jun , Yamazato Ryo , Taguchi Takahiro , Obata Syougo , Mukai Syougo , Shimakura Tadayuki
Published: August 2012

Background: The increasing incidence of damage to pacemaker leads for cardiac resynchronization therapy (CRT. is an emerging problem that should be prevented. The extrathoracic venipuncture approach has been suggested as a technique for venous access to avoid the problem. Methods and Results: 10 patients had pacemaker lead placement for CRT using the double target method. The lead was inserted in the extrathoracic portion of the subclavian and/or axillary veins without complications in all of the patients. Conclusion: This approach achieves accurate, safe, and speedy extrathoracic venipuncture and is especially suitable for multiple lead placements for CRT.
Acute Effects on Signal‐Averaged Electrogram Parameters and Suppressing Premature Ventricular Contractions in Single or Combined Use of Class I Antiarrhythmic Drugs
Authors: Kamei Shin‐ichiro , Katoh Takao , Ohara Toshihiko , Kanemura Masafumi , Kuroki Shin‐ichi , Takano Teruo
Published: August 2012

Disopyramide (DP), mexiletine (MX), and flecainide (FL) are class I antiarrhythmic drugs. However, these drugs exert different effects on the electrocardiogram (ECG) based on their unique actions on cardiac myocytes. The electrocardiographic changes during combination therapy with these drugs are not well understood. The purpose of the present study was to evaluate acute morphologic changes in the ECG based on signal‐averaged high resolution ECG (SAECG) after administration of the drugs in relation to their antiarrhythmic eficacy and safety. Twenty‐one patients with frequent and stable premature ventricular contractions (PVC) were studied. Changes in the filtered QRS duration (f‐QRS) and the root mean square voltage of the last 40 msec of the QRS complex (RMS40) were evaluated. Suppression of PVCs was achieved soon after intravenous administration of the drugs (63% for DP, 43% for MX, 86% for FL and 100% for DP+MX). Although DP and FL significantly prolonged f‐QRS, MX had little effect on f‐QRS. DP+MX also prolonged f‐QRS, but the degree of prolongation was moderate. RMS40 was significantly decreased by DP and FL, but not by MX. DP+MX also decreased RMS40, but the decrease was less than for DP alone. Late potentials were observed after administration in 56% of patients with DP, 0% with MX, 67% with FL and 0% with DP+MX. No adverse events were reported during the study.

In summary, the class I antiarrhythmic drugs exerted different acute effects on SAECG parameters. The combination of DP and MX increased the eficacy on suppressing PVC without excess additive changes on SAECG parameters. We conclude that combination therapy with DP and MX is eficacious and safe in patients with PVC and the analysis of SAECG during antiarrhythmic therapy is clinically important.
Bone Marrow Cell Transplantation into the Heart is Not a Crucial Factor of Ventricular Fibrillation in a Rat Doxorubicin‐Induced Cardiomyopathy Model
Authors: Hamamoto Masaki , Tomita Shinji , Inagaki Masashi , Yutani Chikao , Yamashiro Seiji , Sunagawa Kenji , Nakatani Takeshi , Kitamura Soichiro
Published: August 2012

To verify the susceptibility of ventricle to arrhythmia after bone marrow mononuclear cell transplantation (BMMNCT), we measured ventricular fibrillation threshold (VFT) and monophasic action potential duration (MAYD90). Lewis rats with doxorubicin‐induced cardiomyopathy were divided into 2 groups: transplantation group (D‐TX: BMMNC (1 × 106) given transplants into the apex at 4 weeks after doxorubicin administration) and nontransplantation group (D‐N). Age‐matched normal group (N‐N) was prepared. At 4 weeks after BMMNCT, the following electrophysiologic tests were performed. Experiment 1 (VFT): Two stainless wires were placed at the apex and a single train of 10 square wave stimuli was delivered across T wave. The lowest current developing ventricular fibrillation was determined as VFT. Experiment 2 (MAPD90): The catheter was inserted into the left ventricle and pressed against the endocardium near the apex under regular cycle lengths. Experiment 1: VFT of D‐TX and D‐N were significantly lower than that of N‐N (p < 0.01). There was no difference between D‐TX and D‐N. Experiment 2: MAYD90 of each group was lined up in length D‐N>D‐TX>N‐N at every cycle lengths. There was a significant difference between D‐N and N‐N (p < 0.01), and D‐TX and N‐N (p < 0.05). In this model, BMMNCT did not increase susceptibility to arrthythmia.
When Should We Decide to Perform a Repeat Pulmonary Vein Isolation Procedure in Patients with Atrial Fibrillation?
Authors: Inada Keiichi , Yamane Teiichi , Kanzaki Yasuko , Matsuo Seiichiro , Shibayama Kenri , Miyanaga Satoru , Date Taro , Miyazaki Hidekazu , Sugimoto Kenichi , Mochizuki Seibu
Published: August 2012

Background: It is sometimes difficult to differentiate the transient appearance of atrial fibrillation (AF) after pulmonary vein (PV) isolation from a true recurrence of AF. We attempted to differentiate them by analyzing the time course after the procedure.

Methods and Results: 79 patients who underwent PV isolation were divided into two groups (successful: N = 60 and unsuccessful: N = 19) according to the final outcome. Antiarrhythmic drugs were used either temporarily or continuously to treat re‐appearance of AF after the procedure. The transient appearance of AF in the successful group gradually faded, while true AF recurrence in the unsuccessful group consistently increased in line with the follow‐up (F/U) period. The appearance of AF after 3 months predicted a subsequent failure of the procedure with a positive/negative predictive value of 87/90%, respectively.

Conclusion: Since the transient appearance of AF decreased and the true recurrence of AF increased in line with the F/U period, we should therefore wait at least 3 months before judging the outcome of PV isolation.
Arrhythmogenic Mechanism of Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Liu Nian , Colombi Barbara , Priori Silvia G.
Published: August 2012

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a highly lethal form of inherited arrhythmogenic disease characterized by adrenergically mediated polymorphic VT. The identification of the genetic substrate of the disease has allowed to achieve important milestones in the understanding of the arrhythmogenic mechanisms of the disease. Abnormal calcium leak from the mutant cardiac ryanodine receptor has been associated with the induction of delayed afterdepolarization suggesting that arrhythmogenesis in CPVT is likely to be induced by triggered activity. Here we review the current knowledge and some controversial issues about the molecular mechanism of arrhythmias initiation in CPVT and we discuss their implications for the development of novel therapeutic strategies in CPVT.
Identifying the Origin of Right and Left Ectopic Atrial Beats Triggering Atrial Fibrillation before Atrial Transseptal Procedure
Authors: Ohkubo Kimie , Watanabe Ichiro , Okumura Yasuo , Yamada Takeshi , Ashino Sonoko , Hashimoto Kenichi , Shindo Atsushi , Sugimura Hidezou , Nakai Toshiko , Ozawa Yukio , Saito Satoshi
Published: August 2012

Atrial premature depolarizations (APDs) triggering atrial fibrillation (AF) originate from mainly the pulmonary veins (PVs), but, in some cases, atrial ectopic beats (AEBs) triggering AF originate from the right atrium (RA) or the superior vena cava. Accurate identification of the origin of APDs in the PVs by means of RA and coronary sinus mapping is difficult. Purpose: The aim of this study was to identify the origin of AEBs triggering AF before transseptal catheterization. Electrode catheters were placed in the posteroseptal RA (PSRA), right pulmonary artery (RPA), left pulmonary artery (LPA), and esophagus in 10 patients with paroxysmal AF. We analyzed endocardial electrograms from the PSRA, RPA and LPA, and epicardial electrograms from the esophagus. The origin of the AEBs in the PVs was determined before PV ablation by mapping 4 PVs simultaneously. Four AEBs originated from the left superior PV (LSPV), 2 from the left inferior PV (LIPV), 4 from the right superior PV (RSPV), 2 from the RA or superior vena cava. In AEBs originating from the RA, the PSRA activation was the earliest and it proceeded in a cranial to caudal direction. In AEBs originating from the RUPV, RPA was the earliest. The esophageal activation sequence was in a cranial to caudal direction. In AEBs from the LSPV, LPA was the earliest and the esophageal activation sequence proceeded in a cranial to caudal direction. In AEDs from LIPV, LPA was the earliest, and the esophageal activation sequence was nearly simultaneous. Atrial activation sequences from the PSRA, RPA, LPA, and esophageal catheters can accurately identify the location of the initiating foci of AF before a transseptal procedure.
Improvement of Left Ventricular Function by Permanent Direct His‐Bundle Pacing in a Case with Dilated Cardiomyopathy
Authors: Sashida Yukiko , Mori Fumiaki , Arashi Hiroyuki , Hosaka Fumitaka , Itai Tsutomu , Ohnishi Satoshi
Published: August 2012

The patient was a 67‐year‐old female diagnosed with dilated cardiomyopathy. She had chronic atrial fibrillation (AF) with bradycardia and low left ventricular function (left ventricular ejection fraction (LVEF) 40%). She was admitted for congestive heart failure. She remained New York Heart Association (NYHA) functional class III due to AF bradycardia. Pacemaker implantation was necessary for treatment of heart failure and administration of dose intensive β‐blockers. As she had normal His‐Purkinje activation, we examined the optimal pacing sites. Hemodynamics of His‐bundle pacing and biventricular pacing were compared. Pulmonary capillary wedge pressure (PCWP) was significantly lower on Hisbundle pacing than right ventricular (RV) apical pacing and biventricular pacing (13mmHg, 19mmHg, and 19mmHg, respectively) with an almost equal cardiac index. Based on the examination we implanted a permanent pacemaker for Direct His‐bundle pacing (DHBP). After the DHBP implantation, the LVEF immediately improved from 40% to 55%, and BNP level decreased from 422 pg/ml to 42 pg/ml. The number of premature ventricular complex (PVC) was decreased, and non sustained ventricular tachycardia (NSVT) disappeared. Pacing threshold for His‐bundle pacing has remained at the same level. His‐bundle pacing has been maintained during 27 months and her long‐term DHBP can improve cardiac function and the NYHA functional class.
Cardiac Resynchronization Therapy (CRT) —Its History, Indication, Usefulness and Problems—
Authors: Matsumoto Kazuo
Published: August 2012

This report was an overview of pacing therapy for heart failure to explain the usefulness and problems of CRT in broad terms. It is not an exaggeration to say that pacemakers were originally developed to improve cardiac function in patients with heart failure. However, it must be understood that pacing itself is unphysiological, and we should know what pacing does to the heart. Concerning the simple issue of pacing, it is true that there are a lot of matters that we think we understand but actually we do not, such as the effects of the differences in site, output, and frequency. At least, it seems clear that the currently available CRT devices are effective for patients with heart failure and for improving survival. Further improvement in their effectiveness is an important issue we must continue to address.
Non‐Pharmacological Management of Neurocardiogenic Syncope
Authors: Abe Haruhiko , Kohno Ritsuko , Sumiyoshi Masataka , Oginosawa Yasushi , Takemasa Hiroko , Tsurugi Takuo , Nagatomo Toshihisa , Otsuji Yutaka
Published: August 2012

Neurocardiogenic syncope is a common disorder. It is diagnosed by obtaining a detailed history and performing a head‐up tilt test, with or without drug provocation. Several studies have been performed pertaining to its management. However, no treatment, whether pharmacological or non‐pharmacological, except for counterpressure maneuvers and daily orthostatic tilt training, has been proven effective. Randomized studies of therapies for neurocardiogenic syncope are needed.