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There is little information about the relationship between balloon inflation time and sirolimus-eluting stent (SES) expansion. In this randomized intravascular ultrasound (IVUS) study, 92 de novo lesions in native coronary arteries that underwent SES implantation were enrolled. Sirolimus-eluting stent was implanted using an inflation pressure of 14 atm. Stent balloon was gradually inflated until 14 atm in 10 s. In the short inflation group, it was deflated immediately after an image of the balloon inflated at 14 atm was taken. Stent balloon inflation lasted 60 s in the long inflation group. Intravascular ultrasound was then performed. The long balloon inflation resulted in a larger stent cross-sectional area (4.9 +/- 1.6 mm(2) vs 4.3 +/- 1.4 mm(2), P < 0.05) and expansion (71% +/- 13% vs 60% +/- 13%, P < 0.001) compared to the short balloon inflation, although stent expansion was relatively low in both groups. The relatively longer balloon inflation time using an inflation pressure of 14 atm results in better SES expansion. However, in the majority of lesions, adequate stent expansion is not achieved even using long balloon inflation, if it is inflated at 14 atm.

To elucidate the mechanism of the high incidence of lower respiratory tract infections in patients with diabetes mellitus, we investigated the kinetics of production of macrophage inflammatory protein 2 (MIP-2), an important mediator of lung neutrophil recruitment, using mice with streptozotocin-induced diabetes. Intratracheal challenge with 1 mg of lipopolysaccharide (LPS), an endotoxin, per kg of body weight resulted in a time-dependent increase in the levels of MIP-2 protein in bronchoalveolar lavage (BAL) fluid, with the peak concentration (49.4 ؎ 13 ng/ml) occurring at 3 h and significant neutrophil accumulation becoming apparent by 3 h in normal mice. In diabetic mice, the peak level of MIP-2 protein in BAL fluid did not occur until 6 h and was reduced to 21.9 ؎ 10 ng/ml. Immunohistochemical studies using anti-MIP-2 antibody confirmed that the main cellular source of MIP-2 in the lung after LPS challenge was alveolar macrophages (AMs) in normal mice. The lungs in diabetic mice, however, showed no AMs staining for MIP-2 within 3 h after LPS challenge. PCR analysis using whole-lung RNA showed a time-dependent increase in MIP-2 mRNA levels after LPS instillation. The level of MIP-2 mRNA in diabetic mice was markedly decreased compared to that in normal mice. Our results indicate that impairment of MIP-2 mRNA expression in the AMs in diabetic mice resulted in delayed neutrophil recruitment in the lungs, and this may explain the development and progression of pulmonary infection in diabetes mellitus.

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he maintenance dose of ticlopidine is lower in Japan (100 mg twice daily) than that used in the United States (US) and Europe (250 mg twice daily). 1,2 Thus a lower maintenance dose of clopidogrel may be appropriate for Japanese patients. The present study evaluated the safety and efficacy of low-dose (50 mg) clopidogrel in patients undergoing coronary stenting.The Ethics Committee of Chiba University approved the study. Patients and the family were informed of (1) differences in the maintenance dose of ticlopidine for patients in Japan and those in the US and Europe, (2) the standard regimen after coronary stenting of clopidogrel plus aspirin that is used in almost all countries because of the better safety profile of clopidogrel, (3) the approval of 75-mg clopidogrel for Japanese patients with thrombotic stroke (and those undergoing coronary stenting for acute coronary syndrome from October 2007), (4) the use of 75-mg clopidogrel in the US and Europe, and (5) the potential risks and benefits of taking 50-mg clopidogrel. Patients were enrolled if both the patient and the family gave informed consent for taking 50-mg clopidogrel.Between October 2006 and December 2007, 202 patients underwent successful coronary stent implantation and of them, 26 patients who had taken ticlopidine without any side-effects were excluded. Because there was not enough time to obtain informed consent, 42 patients who underwent emergency coronary angiography for acute myocardial infarction (MI) or unstable angina were excluded. Because