ifferentiation of mesodermal cells to angioblasts and subsequent endothelial differentiation was believed to exclusively occur in embryonic development, 1 but this dogma was overturned when human adult peripheral blood mononuclear cells (PBMNCs) were demonstrated to differentiate into the endothelial lineage. 2 These cells named "endothelial progenitor cells" (EPCs) expressed endothelial markers, and were incorporated into Circulation Journal Vol.71, August 2007 the sites of ischemia. 3,4 We have recently demonstrated that bone marrow mononuclear cells (BMMNCs) contain EPCs in the CD34 + cell fraction and various proangiogenic factors, such as basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and angiopoietin 1 in the CD34 -cell fraction, and that implantation of BMMNCs into the site of ischemia enhances angiogenesis via harmonic supply of EPCs and angiogenic factors. 5,6 This technique has been used clinically and developed as a useful therapeutic option for human critical limb ischemia. 7 The concept of the heart as an organ composed of terminally differentiated myocytes incapable of regeneration is also being challenged. [8][9][10] Although attempts to replace necrotic tissue by transplanting other cells (eg, fetal cardiac myocytes or skeletal myoblasts) succeeded in reconstituting heart muscle, these cells failed to completely integrate structurally and to display characteristic physiological function. [11][12][13] In contrast, bone marrow cells (BMCs) have the ability to differentiate into various tissue and are likely to Circ J 2007; 71: 1199 -1207 (Received January 17, 2007 revised manuscript received March 28, 2007; accepted April 24, 2007 Background Transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) enhances neovessel formation in ischemic myocardium and limbs by releasing angiogenic factors. This study was designed to examine whether intracoronary transplantation of PBMNCs improves cardiac function after acute myocardial infarction (AMI). Methods and ResultsAfter successful percutaneous coronary intervention (PCI) for a ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24 h, patients were assigned to either a control group or the PBMNC group that received intracoronary infusion of PBMNCs within 5 days after PCI. PBMNCs were obtained from patients by COBE spectra-apheresis and concentrated to 10 ml, 3.3 ml of which was infused via over-the-wire catheter. The primary endpoint was the global left ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up. The data showed that the absolute increase in LVEF was 7.4% in the control group and 13.4% (p=0.037 vs control) in the PBMNC group. Cell therapy resulted in a greater tendency of ∆Regional ejection fraction (EF) or significant improvement in the wall motion score index and Tc-99m-tetrofosmin perfusion defect score associated with the infarct area, compared with controls. Moreover, intracoronary administration of PBMNCs did not ex...

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he correlation between cardiac disease and liver dysfunction is well documented, but constrictive pericarditis (CP) rarely presents with ischemic hepatitis. Case ReportA 57-year-old woman with disturbed consciousness was transported to the emergency room. Her blood pressure was 104/88 mmHg, pulse rate was 98/min with regular rhythm, and she was afebrile. Her jugular vein was distended and showed venous collapse in the diastolic phase. Her legs were considerably edematous. A grade 2/6 systolic regurgitant murmur was audible at the right sternal border in the 4 th intercostal space, but excess heart sounds were unclear. On pulmonary auscultation, sounds were hardly heard in the left lung field. Computed tomography (CT) did not show any evidence of organic lesion in the brain. Though she had no predisposition to hypoglycemia, her serum glucose level was 23 ng/ml and a venous infusion of glucose restored normal consciousness. The first blood gas analysis under 5 L/min oxygen inhaled when just arriving at the hospital showed severe respiratory acidosis (Table 1). However, after recovery of consciousness, the hypercapnia was soon reversed. In addition to low levels of serum glucose, laboratory results showed high necro-inflammatory activity of the liver with an alanine transferase (ALT) level of 1,755 U/L, aspartate transferase (AST) level of 3,615 U/L, lactate dehydrogenase (LDH) level of 5,160 U/L, 47% prothrombin time ratio, and total bilirubin (T-Bil) level of 3.9 mg/dl (Table 1). She was seronegative for both hepatitis B virus (HBV) and hepatitis C virus (HCV), and had not taken any hepatotoxic medicines. Ultrasonography showed no findings of the abdominal organs but there was a small amount of ascetic fluid. Her recent laboratory data and physical (Received October 29, 2007; revised manuscript received March 6, 2008; accepted April 3, 2008; released online November 11, 2008) Department of Cardiovascular Medicine, *Department of Gastroenterology, Nantan General Hospital, Nantan and **Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto, Japan Mailing address: Tetsuya Nomura, MD, Department of Cardiovascular Medicine, Nantan General Hospital, 25 Yagi-Ueno, Yagi-cho, Nantan 629-0197, Japan. E-mail: t2-ya@za2.so-net.ne.jp All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Chronic Pericardial Constriction Induced Severe Ischemic Hepatitis Manifesting as Hypoglycemic AttackTetsuya Nomura, MD; Natsuya Keira, MD; Yota Urakabe, MD; Daisuke Naito, MD; Mayuka Nakayama, MD; Atsumichi Kido, MD; Hidetoshi Kanemasa, MD*; Hiroaki Matsubara, MD**; Tetsuya Tatsumi, MD Ischemic hepatitis, otherwise known as "shock liver", is characterized by a massive, but transient increase in serum transaminase levels, usually associated with cardiac failure. A patient who did not have a predisposition to hypoglycemia was discovered at home with disturbed consciousness caused by hypoglycemia. She had been diagnosed as having constrictive pericar...

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp 1. We would like to rewrite a statement in the Methods and Results section of the Abstract.Original Statement (p.1199, Abstract, Lines 5-10):After successful percutaneous coronary intervention (PCI) for a ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24 h, patients were assigned to either a control group or the PBMNC group that received intracoronary infusion of PBMNCs within 5 days after PCI. PBMNCs were obtained from patients by COBE spectra-apheresis and concentrated to 10 ml, 3.3 ml of which was infused via over-the-wire catheter. The primary endpoint was the global left ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up.Corrected Statement: After successful percutaneous coronary intervention (PCI) for ST-elevation AMI with occlusion of proximal left anterior descending coronary artery within 24 h, patients received an intracoronary infusion of PBMNCs within 5 days after PCI (PBMNC group). PBMNCs were obtained from the patients by COBE spectra-apheresis and concentrated to 10 ml, 3.3 ml of which was infused via over-the-wire catheter. The global left ventricular ejection fraction (LVEF) change from baseline to 6 months' followup in the PBMNC group was compared with that of a control group that underwent standard PCI for similar AMI.2. We would like to correct the paragraph on the study design in the Patients and Study Protocol in the Methods section as below, in order to avoid misinterpretation of the control patients.