for the Japan Thyroid Association Background: Thyroid storm (TS) is life threatening. Its incidence is poorly defined, few series are available, and population-based diagnostic criteria have not been established. We surveyed TS in Japan, defined its characteristics, and formulated diagnostic criteria, FINAL-CRITERIA1 and FINAL-CRITERIA2, for two grades of TS, TS1, and TS2 respectively. Methods: We first developed diagnostic criteria based on 99 patients in the literature and 7 of our patients (LIT-CRITERIA1 for TS1 and LIT-CRITERIA2 for TS2). Thyrotoxicosis was a prerequisite for TS1 and TS2 as well as for combinations of the central nervous system manifestations, fever, tachycardia, congestive heart failure (CHF), and gastrointestinal (GI)/hepatic disturbances. We then conducted initial and follow-up surveys from 2004 through 2008, targeting all hospitals in Japan, with an eight-layered random extraction selection process to obtain and verify information on patients who met LIT-CRITERIA1 and LIT-CRITERIA2. Results: We identified 282 patients with TS1 and 74 patients with TS2. Based on these data and information from the Ministry of Health, Labor, and Welfare of Japan, we estimated the incidence of TS in hospitalized patients in Japan to be 0.20 per 100,000 per year. Serum-free thyroxine and free triiodothyroine concentrations were similar among patients with TS in the literature, Japanese patients with TS1 or TS2, and a group of patients with thyrotoxicosis without TS (Tox-NoTS). The mortality rate was 11.0% in TS1, 9.5% in TS2, and 0% in Tox-NoTS patients. Multiple organ failure was the most common cause of death in TS1 and TS2, followed by CHF, respiratory failure, arrhythmia, disseminated intravascular coagulation, GI perforation, hypoxic brain syndrome, and sepsis. Glasgow Coma Scale results and blood urea nitrogen (BUN) were associated with irreversible damages in 22 survivors. The only change in our final diagnostic criteria for TS as compared with our initial criteria related to serum bilirubin concentration > 3 mg/dL. Conclusions: TS is still a life-threatening disorder with more than 10% mortality in Japan. We present newly formulated diagnostic criteria for TS and clarify its clinical features, prognosis, and incidence based on nationwide surveys in Japan. This information will help diagnose TS and in understanding the factors contributing to mortality and irreversible complications. 1 The First Department of Medicine, Wakayama Medical University, Wakayama, Japan. 2 Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan. 3 Department of Medicine 2, Tokyo Women's Medical University, Tokyo, Japan. 4 Division of Endocrinology and Metabolism, Department of Internal Medicine, Fujita Health University, Toyoake, Japan. 5 Department of Internal Medicine, Keio University, Tokyo, Japan. 6 Department of Clinical and Molecular Endocrinology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. 7 Division of Diabetes, Metabolism, and Endocrinolog...

Aim-Excessive oxidative stress has been implicated in the pathology and complications of diabetes, which leads to myocardial ischemia reperfusion injury. The present study was designed to examine whether resveratrol (trans-3,5,4′-trihydroxystilbene), a polyphenolic compound present in red wine has a direct cardioprotective effect on diabetic myocardium.Methods-Resveratrol (2.5mg/kg b.wt/day) and L-NAME (25mg/kg b.wt/day) were administered orally for 15 days to streptozotocin (65mg/kg) induced diabetic rats. Sprague Dawley rats were divided into 5 groups i) Control ii) Diabetic iii) Diabetic+resveratrol iv) Diabetic+Resveratrol+L-NAME (nitric oxide synthase inhibitor), v) Diabetic+L-NAME. In our present study resveratrol demonstrated significant reduction in glucose level in diabetic rats. After the treatment, the hearts were excised and subjected to 30 min of global ischemia followed by 2 hours of reperfusion.Results-Resveratrol treated diabetic rats demonstrated significant reduction in glucose levels as compared to the non treated diabetic animals, improved left ventricular function throughout reperfusion compared to the diabetic or L-NAME treated animals (dp/dt max 1457 ± 51 vs 999 ± 44 mmHg/sec at 120 min reperfusion). Cardioprotection from ischemic injury in resveratrol treated diabetic rats showed decreased infarct size (42% vs 51%) and cardiomyocyte apoptosis (35% vs 40%) by TUNEL assay. Resveratrol produced significant induction of p-AKT, p-eNOS, Trx-1, HO-1 and VEGF in addition with increased activation of Mn-SOD activity in diabetic animals compared to non-diabetic animals. However treatment with L-NAME in resveratrol treated and non-treated diabetic animals demonstrated significant downregulation of the above mentioned protein expression profile and MnSOD activity. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HO-1 and VEGF in addition with increased MnSOD activity and reduced blood glucose level. Thus this study shows a novel mechanism of pharmacological preconditioning with resveratrol in the diabetic myocardium. Conclusion-In NIH Public Access

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We investigated whether enhanced expression of alphaB crystallin, a stress-inducible molecular chaperone of the small heat shock family, can protect myocardial contractile apparatus against ischemia reperfusion (I/R) injury. Transgenic mice overexpressing alphaB crystallin were generated using the 0.76 kb rat alphaB crystallin cDNA cloned into a pCAGGS plasmid driven by a human cytomegalovirus expression system. Southern analysis confirmed transgene integration and Northern and Western blotting characterized expression (3.1-fold and 6.9-fold elevations in myocardial mRNA and protein levels, respectively). Extent of functional recovery over a 3 h reperfusion period following a 20 min ischemic period in transgenic and wild-type mouse hearts was assessed using an ex vivo work-performing heart preparation. The transgenic group displayed significantly higher values of DP at R45 min (29.14+/-1.9 mm Hg vs. 17.6+/-0.7 mm Hg), R60 min (31.56+/-1.7 mm Hg vs. 17.8+/-0.8 mm Hg), and R75 min (32.5+/-2.2 mm Hg vs. 16.9+/-0.9 mm Hg), and of dLVP/dt at R45 min (1740.2+/-111.5 mm Hg.s-1 vs. 548.7+/-82.2 mm Hg.s-1) and R60 min (1199.8+/-104.6 mm Hg.s-1 vs. 466.9+/-61.1 mm Hg.s-1). The transgenic group also displayed development of less oxidative stress, decreased extent of infarction, and attenuated cardiomyocyte apoptotic cell death. Transgene overexpression of alphaB crystallin was therefore successful in diminishing the independent contributory effects of both necrosis and apoptosis on I/R-induced cell death.

Resveratrol (trans-3,4',5-trihydroxystilbene), a recently described grape-derived polyphenolic antioxidant, has been found to protect the heart from ischemic-reperfusion injury. The present study sought to determine the mechanism of cardioprotection by investigating the ability of resveratrol to precondition the heart. Isolated perfused rat hearts were randomly divided into six groups: group I was perfused for 15 min with Kreb-Henseleit buffer (KHB) only; group II was perfused with 10 microM resveratrol; group III was perfused with 10 microM resveratrol plus 100 microM N(G)-nitro-L-arginine methyl ester (L-NAME), a nonselective nitric oxide (NO) synthase (NOS) inhibitor; group IV was perfused with 10 microM resveratrol plus 100 microM aminoguanidine (AG), an inducible NOS (iNOS) blocker; and groups V and VI consisted of hearts perfused with L-NAME and AG, respectively. The perfusion was then switched to working mode, and all hearts were made globally ischemic for 30 min followed by 2 h of reperfusion. Preconditioning of the hearts with resveratrol provided cardioprotection as evidenced by improved postischemic ventricular functional recovery (developed pressure and aortic flow) and reduced myocardial infarct size and cardiomyocyte apoptosis. Resveratrol-mediated cardioprotection was completely abolished by both L-NAME and AG. In a separate study, hearts were examined for iNOS mRNA induction. Resveratrol caused an induction of the expression of iNOS mRNA beginning at 30 min after reperfusion, increasing steadily up to 60 min of reperfusion, and then decreasing progressively up to 2 h after reperfusion. Preperfusion of the hearts with AG almost completely blocked the induction of iNOS. The results of our study demonstrate that resveratrol can pharmacologically precondition the heart in a NO-dependent manner.