No abstract

The results suggest that oral theophylline may be beneficial for the treatment of patients with sick sinus syndrome.

We report a case of a papillary fibroelastoma originating from the left ventricular endocardium in the outflow tract which was discovered by echocardiography in an asymptomatic patient. Two echocardiographic features were observed: (1) the tumor surface was smooth, and characteristic papillary formation was not detected; and (2) the outline of the mass was clearly defined as a dense echo, with the central, radiolucent, portion surrounded by a highly refractive linear echo at the level of the maximum diameter of the mass. The excised tumor was covered with a gelatinous substance that masked multiple papillae on the surface, but its echolucent center could not be explained by the pathology of the tumor which was solid centrally. Our case indicates that a papillary fibroelastoma may sometimes show echocardiographic findings similar to those of a myxoma, although other investigators have not noted the smooth surface and the echolucent center makes it indistinguishable from a myxoma. Thus, in some cases, it is difficult to distinguish papillary fibroelastoma from myxoma by echocardiography.

Background: L-carnitine is an essential nutrient that plays a vital role in fatty acid energy metabolism of the heart and skeletal muscles. Primary or secondary carnitine insufficiency contributes to progressive left ventricular systolic dysfunction and physical frailty. However, the clinical features of patients with heart failure with preserved ejection fraction (HFpEF) and carnitine insufficiency remain unclear. Objectives: The present study aimed to evaluate the clinical characteristics and outcomes of these patients. Design: A prospective cohort study. Setting: Tottori University hospital. Participants: 117 patients who were hospitalized with HFpEF (ejection fraction ≥45%). Measurement: All measurements were obtained at hospital discharge. Carnitine insufficiency was defined as the lowest quantile of free carnitine level (<56.3 μmol/L) or the highest quantile of acylcarnitine to free carnitine ratio (≥0.35). Nutritional status and physical activity were assessed by the Geriatric Nutritional Risk Index (GNRI) and Barthel index (BI). Left ventricular diastolic function was assessed by echocardiography. The composite endpoints were hospitalization for heart failure and death from cardiac causes. Results: Patients with carnitine insufficiency (44.4%) had lower values of GNRI and BI, higher B-type natriuretic peptide levels, and lower early diastolic mitral annular velocity in the subgroups with sinus rhythm compared with those with preserved carnitine (all p<0.05). During a mean follow-up of 472±249 days, composite endpoints occurred in 26.5% of patients. Multivariate Cox hazard analysis showed that carnitine insufficiency was an independent predictor of cardiac events (p<0.05). Conclusions: Carnitine insufficiency is associated with adverse outcomes in patients with HFpEF.

In various studies encompassing large spatiotemporal scales, the densities of non-indigenous species and indigenous species in the same habitat increased and decreased, respectively, prior to reaching an equilibrium. We examined whether this is true for a non-indigenous mussel Mytilus galloprovincialis, introduced into Japan before 1934, and the sympatric indigenous bivalves: Septifer virgatus, Septifer bilocularis, Hormomya mutabilis, Saccostrea kegaki, Saccostrea mordax and Barbatia (Savignyarca) virescens. Seven quadrat surveys during 1978-2006 on 19 rocky shores (26.6-41.4°N) showed unexpected results. Density of M. galloprovincialis decreased on 89% of the shores where this mussel had previously been found. In contrast, densities of the indigenous bivalves decreased on lower percentages (17-71%) of shores where the bivalves had been found. Shore-toshore mean density of M. galloprovincialis decreased from the 1970s (27.0-88.7 m -2 ) to the 2000s (0.0-1.1 m -2 ), more sharply than any of the indigenous bivalves (from 4.6-9.1 m -2 to 0.7-1.5 m -2 for S. bilocularis, which showed the most marked reduction). The conspicuous decrease for M. galloprovincialis suggests that some factors on the studied shores have become disadvantageous especially for this nonindigenous mussel from the earlier to the later surveys.