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Biomedical subjects

J Kato

Publications and source records attributed to J Kato.

At least 253 records · Page 14Linked to original sources
PubMed1996

Development in lung function of the affected side after repair of congenital diaphragmatic hernia.

The widespread use of newly developed techniques including extracorporeal membrane oxygenation (ECMO) has led to the survival of a number of patients with congenital diaphragmatic hernia (CDH) and associated hypoplastic lung. However, it is not fully recognized whether the hypoplastic and small lung of the affected side has the ability to develop its function after repair of CDH. The authors studied the lung function of 32 patients with CDH in whom these new methods were used. Two parameters, lung volume and pulmonary perfusion amount, were used to evaluate lung function. The former (checked by computed tomography scan) was used to evaluate the size of lung; the latter (checked by perfusion scintigram) was used to assess vascular density. The patients were divided into two groups, based on values of alveolar-arterial difference in oxygen content (AaDo2) at the time of admission. In group A (AaDo2 < 500 mm Hg; 12 cases), whose respiratory distress was mild and could be managed with ventilator care alone, the mean lung volume value for the affected side was 86% of the contralateral lung value from the initial study, and reached 93% at the time of follow-up study. The perfusion amount also exceeded 80% of the contralateral lung value from the initial study. Thus, it is likely that group A's affected-side lung is not small and has developed at a rate similar to that of the contralateral lung. However, in group B patients (AaDo2 > 500 mm Hg; 20 cases), who had severe respiratory distress at the admission and were managed with new techniques including ECMO, both lung volume and perfusion amount of the affected side initially were low in all cases (ie, mean values were 61% and 53% of contralateral-lung values, respectively). At the time of follow-up, the lung volume had increased in most cases (mean value, 88% of the contralateral lung value), but the perfusion amount of the affected side had not increased in most cases. It remained low, or decreased to below the initial value; the mean was 53% of the contralateral lung value. The initial mean perfusion: volume ratio (87%) had decreased significantly (to 62%) by the time of follow-up. This tendency was exaggerated in the 11 ECMO cases. These data might indicate that in most group B cases, the lung of the affected side has little ability to develop arterial branches, or certainly will be delayed in comparison to the contralateral lung, and that enlargement of lung volume may depend on overexpansion or emphysematous change rather than cellular growth. The present data also suggest that, in group B cases, total lung function will depend on the contralateral lung for a relatively long time.

Child↗
PubMed1996

Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation.

The effects of venoarterial extracorporeal membrane oxygenation on left ventricular performance have not been studied in detail. Coronary arterial flow obtained by direct measurement with an electromagnetic flowmeter and blood gas analysis from the aortic root were tabulated during venoarterial extracorporeal membrane oxygenation 14 puppies, and these parameters were evaluated with respect to changes in the venoarterial extracorporeal membrane oxygenation flow. Unique automatic blood pumps generating pulsatile flow were used for the venoarterial extracorporeal membrane oxygenation bypass. Coronary arterial flow decreased as the extracorporeal membrane oxygenation flow increased (106 +/- 26 ml/min per 100 gm of left ventricle at 20 ml x min(-1) x kg bypass flow to 71 +/- 17 ml/min per 100 gm of left ventricle at 100 ml x min(-1) x kg bypass flow, p < 0.01). There were no significant changes in the mean or diastolic pressures in the ascending aorta despite changes in the extracorporeal membrane oxygenation flow. Arterial oxygen tension in the ascending aorta was not increased even under high-flow venoarterial extracorporeal membrane oxygenation. This result indicates that oxygenated blood from the extracorporeal membrane oxygenation circuit does not pass in a retrograde fashion into the aortic root and thus does not perfuse the coronary arteries. The diastolic aortic pressure did not correlate with the changes in extracorporeal membrane oxygenation flow. The decrease in coronary arterial flow is therefore predominantly caused by increased coronary arterial resistance. Tension-time index, an indicator of myocardial oxygen consumption, did not decrease with venoarterial extracorporeal membrane oxygenation. In conclusion, high-flow venoarterial extracorporeal membrane oxygenation causes undesirable hemodynamic effects on the left ventricle.

Analysis of Variance↗
PubMed1996

Seasonal variation in blood pressure in normotensive women studied by home measurements.

1. The factors influencing the seasonal variation in blood pressure measured at home in normotensive women were examined. 2. Sixteen female subjects (56.3 +/- 7.9 years old, mean +/- SD) measured their blood pressure and pulse rate at home each morning for more than 20 times per month for at least 1.5 years. Blood pressure and body weight were also determined in the office once or twice a month in that period. Monthly means of outdoor and indoor temperatures and daytime length were obtained from the Meteorological Observatory. The single cosinor method was used to evaluate circannual rhythm. 3. We observed a biphasic seasonal variation in self-recorded blood pressure measured at home, environmental temperature and daytime length but found no apparent seasonal variation in body weight and blood pressure measured in the office. The lowest levels of systolic and diastolic blood pressure measured at home were observed in July. The longest daytime length was recorded in June, while the highest outdoor temperature and indoor temperature were recorded in August, indicating that the longest daytime length preceded and the highest environmental temperature lagged behind the lowest level of blood pressure. The shortest daytime length is in December. The lowest outdoor and indoor temperature were observed in January, while the highest levels of self-recorded systolic blood pressure and diastolic blood pressure were in January and December, respectively. Half-amplitudes of self-recorded systolic and diastolic blood pressure were 2.6 +/- 1.0 mmHg and 2.0 +/- 0.8 mmHg, respectively. 4. These findings indicate the importance of a seasonal effect, i.e. daytime length and the environmental temperature, on the blood pressure of individuals.

Adult↗
PubMed1996

DNA nicking by Escherichia coli topoisomerase IV with a substitution mutation from tyrosine to histidine at the active site.

BACKGROUND: Escherichia coli topoisomerase IV is a type II topoisomerase composed of ParC and ParE subunits and plays a major role in the decatenation of replicated molecules. The reaction with type II topoisomerases involves the cutting through transesterification between an active-site tyrosine and a DNA phosphodiester bond and a rejoining of cleaved DNA. RESULTS: To genetically analyse the mechanism of this reaction, we isolated dominant-negative topoisomerase IV mutants. In one of them, the parC10 mutant, there was a substitution by histidine of the active-site tyrosine. Purified mutant topoisomerase IV did not show normal DNA cutting activity but retained DNA nicking activity, even in the absence of ATP. The DNA ends of the product were not covalently bound to the ParC subunits, suggesting that the DNA is not cut via transesterification but by hydrolysis. CONCLUSIONS: We have shown genetically that the 120th tyrosine residue is important for the DNA cutting step in the topoisomerase reaction. The 120th amino acid residue, tyrosine or histidine, appears to be activated and the histidine residue forces the hydrogen-bonded water to attack the phosphoryl group of the DNA in hydrolysis, while the tyrosine residue directly attacks the phosphoryl group during transesterification.

Base Sequence↗
PubMed1996

A molecular analysis of viral persistence in surface antigen-negative chronic hepatitis B.

To identify the mechanisms of viral persistence in patients with chronic hepatitis B after the acquisition of anti-hepatitis B surface antigen antibodies (antiHBs), we serially analyzed the nucleotide sequence of the envelope region in a cohort of infected patients. Four patients with histological diagnoses of chronic hepatitis B who had at least 5 years of observance by our hospital staff were studied. All but one showed normalization of serum alanine aminotransferase (ALT) concentration after clearance of the hepatitis B surface of antigen (HBsAg) and the appearance of anti-HBs. Hepatitis B virus (HBV) DNA was still detectable by polymerase chain reaction (PCR) amplification assay in serum specimens from two patients, even in the presence of circulating anti-HBs. The envelope gene was amplified by PCR in serum samples obtained both before and after seroconversion, and direct cycle sequencing of the PCR products was performed. A mutation resulting in a premature stop codon was found in the pre-S1 region of one patient just prior to clearance of HBsAg. Two years later, the stop codon was converted to a leucine codon and three mutations developed in the "a" loop. In the other patient, 16 amino acids had been deleted between amino acids 8 and 23 in the pre-S2 region before clearance of HBsAg. After the appearance of circulating anti-HBs, the pre-S2 gene reverted to the wild type but three additional mutations appeared inside the "a" loop. These results suggest that HBV mutates when HBsAg is cleared, which may contribute to viral persistence due to an evasion of the host immune surveillance.

Amino Acid Sequence↗
PubMed1996

A new technique for laparoscopic cholecystectomy--retrograde laparoscopic cholecystectomy: an analysis of 81 cases.

BACKGROUND AND STUDY AIMS: A new technique of laparoscopic cholecystectomy is presented here. This new method, retrograde laparoscopic cholecystectomy (RLC) from fundus to cystic duct downward, may have advantages when exposure of the cystic duct and the common duct are difficult and therefore hazardous. PATIENTS AND METHODS: We carried out laparoscopic cholecystectomy in 173 patients; RLC was performed in 81, The operative procedure is as follows: first, the cystic duct and artery are exposed at the junction of the ampulla. The cystic duct is clipped, and the artery is divided. Removal of the gallbladder is then started from the fundus to cystic duct downward. After the gallbladder has been dissected from the liver bed, the cystic duct is double-clipped and divided. This approach provides better visualization of the gallbladder, cystic duct, and common duct, with less chance of common duct injury, due to clear identification of the ductal system, without the need for intraoperative cholangiography. RESULTS: Eighty-one RLCs were performed without severe complications, either immediate or late. The mean operating time was 23 minutes shorter in RLC than in the usual laparoscopic cholecystectomy, because intraoperative cholangiography was used much less often. CONCLUSION: RLC appears to be a safe procedure, and does not affect the conventional method.

Adult↗
PubMed1996

Effects of mutations of RAD50, RAD51, RAD52, and related genes on illegitimate recombination in Saccharomyces cerevisiae.

To examine the mechanism of illegitimate recombination in Saccharomyces cerevisiae, we have developed a plasmid system for quantitative analysis of deletion formation. A can1 cyh2 cell carrying two negative selection markers, the CAN1 and CYH2 genes, on a YCp plasmid is sensitive to canavanine and cycloheximide, but the cell becomes resistant to both drugs when the plasmid has a deletion over the CAN1 and CYH2 genes. Structural analysis of the recombinant plasmids obtained from the resistant cells showed that the plasmids had deletions at various sites of the CAN1-CYH2 region and there were only short regions of homology (1-5 bp) at the recombination junctions. The results indicated that the deletion detected in this system were formed by illegitimate recombination. Study on the effect of several rad mutations showed that the recombination rate was reduced by 30-, 10-, 10-, and 10-fold in the rad52, rad50, mre11, and xrs2 mutants, respectively, while in the rad51, 54, 55, and 57 mutants, the rate was comparable to that in the wild-type strain. The rad52 mutation did not affect length of homology at junction sites of illegitimate recombination.

Adenosine Triphosphatases↗
PubMed1996

Comparison of the clinicopathological characteristics of premenopausal and postmenopausal endometrial carcinomas: analysis of endocrinologically evaluated cases.

A study was performed to clarify the clinicopathological differences between premenopausal endometrial carcinoma, which occurs during the reproductive period, and postmenopausal endometrial carcinoma. We analyzed 76 patients with endometrial carcinoma treated in our department between January 1984 and July 1994. Using classification criteria which included menstrual history and results of endocrinological tests (serum FSH, LH and estradiol), 50 (65.7%) patients were defined as postmenopausal, 16 (21.0%) as premenopausal, and 10 (13.1%) as unclassified. From an epidemiologic viewpoint, the incidence of nulliparity was higher in the premenopausal (37.5%) than in the postmenopausal (10%) patients. However, no significant differences were observed between the two groups with regard to the incidence of obesity, diabetes and hypertension. The results of our clinicopathological study revealed that premenopausal endometrial carcinoma had a significantly higher incidence of well differentiated (63.1%) and relatively less advanced (31.1% of cases at stages III and IV) cancers than postmenopausal carcinoma (38% and 46%, respectively). These features were positively correlated with prognosis, i.e., premenopausal patients in general had a much better prognosis than postmenopausal patients.

Adult↗
PubMed1996

Spontaneous rupture of the uterus due to placenta percreta at 25-weeks' gestation: a case report.

Placenta percreta is a rare but serious complication of pregnancy, and is rarely diagnosed in the second trimester of pregnancy. We report a very rare case of placenta percreta accompanied by spontaneous uterine rupture at 25-weeks of gestation. A 30-year-old woman with severe abdominal pain was admitted to our hospital at 25 weeks of gestation. A laparotomy was immediately performed because of intraabdominal bleeding. The uterus revealed a perforation of the fundus. A supra-vaginal hysterectomy was performed. A pathological investigation of the uterus revealed placenta percreta. The patient had neither gravity nor any prior uterine operation. It is very rare for placenta percreta to be recognized in a primigravida woman or in the second trimester of pregnancy.

Abdominal Pain↗
PubMed1996

Clinical evaluation of plasma fibronectin level as a biomarker of preeclampsia.

OBJECTIVE: To evaluate the clinical feasibility of plasma fibronectin as a biomarker and predictor for preeclampsia. METHODS: A total of 13 patients who had severe preeclampsia in prior pregnancies were enrolled for longitudinal study, and the profiles of plasma fibronectin were observed throughout their pregnancies. In cross-sectional study, the correlation between plasma fibronectin within a week before delivery and the grade of preeclampsia were analyzed in 96 pregnant women including tangible preeclampsia. RESULTS: In the longitudinal study, 5 patients developed severe preeclampsia, in whom plasma fibronectin was elevated over the normal range 2-9 weeks before the onset of preeclampsia. In the cross-sectional study, plasma fibronectin levels elevated significantly corresponding with the severity of preeclampsia, and the abnormal elevation of fibronectin reflected the existence of preeclampsia with satisfactory sensitivity and specificity. CONCLUSION: Increased plasma fibronectin levels may be a highly sensitive and specific diagnostic indicator for preeclampsia.

Biomarkers↗
PubMed1996

Effect of estriol on bone loss in postmenopausal Japanese women: a multicenter prospective open study.

OBJECTIVES: To assess the effects of oral estriol on the bone mineral density (BMD) and bone metabolism in postmenopausal women. METHODS: Seventy-five natural postmenopausal women with a BMD of more than 10% below the peak bone density were treated for 50 weeks with 2 mg/day estriol (E3) cyclically and 0.8 g/day of calcium lactate continuously. BMDs at L2-L4 were measured by dual energy X-ray absorptiometry (DXA). RESULTS: The BMD increased 1.79% (p < 0.01 vs. pretreatment) after 50 weeks, accompanied with decrease of biochemical markers of bone turnover. With regard to climacteric symptoms, Kupperman's menopausal index improved (p < 0.01 vs. pretreatment) after 5 weeks of treatment. As to the incidence of adverse events genital bleeding was observed in only 8.0% of the subjects. Endometrial histology and cytology showed neither abnormalities nor hyperplasia during and after the treatment. CONCLUSIONS: Estriol prevented postmenopausal bone loss and improved climacteric symptoms effectively with low incidence of genital bleeding.

Bone Density↗
PubMed1996

Analysis of CA repeats in first intron of class I ADH gene in Long-Evans Cinnamon rats developing fatal intoxication after ethanol intake.

The Long-Evans Cinnamon (LEC) rat is a mutant strain established from Long-Evans rats that displays spontaneous hepatitis and liver cancer. We previously demonstrated that LEC rats died of acute ethanol intoxication after being fed a liquid diet containing 5% ethanol. Furthermore, we found that both alcohol dehydrogenase (ADH) and aldehyde dehydrogenase activities were remarkably suppressed in the liver of LEC rat, compared with Wistar rats. In the present study, we further investigated ethanol metabolism in the non-ADH pathway and what caused the decrease of liver ADH activity in LEC rats. Blood ethanol concentration 5 hr after intraperitoneal administration of ethanol in LEC rats was higher than in the Wistar rats, indicating that ethanol oxidation was impaired in LEC rats. The expression of liver cytochrome P-450IIE1 in the LEC rat was as much as that in Wistar rats. Regarding decreased ADH activity in the liver of LEC rats, we examined an alternating purine-pyrimidine (CA) repeat-length polymorphism in the first intron of a class I ADH gene that would play a role in altering ADH activity. A polymerase chain reaction method was used to amplify the CA repeat in the first intron of this class I ADH gene, a nine CA repeat insertion and a point mutation were detected in LEC rats. These results suggest that this alternating sequence would modify transcription of the class I ADH gene in LEC rats. Thus, LEC rats have abnormal ethanol metabolism in the ADH pathway.

Alcohol Dehydrogenase↗
PubMed1996

Detection of activity in the conditioned medium of ethanol-treated HepG2 cells which stimulates collagen synthesis in IMR-90 cells.

Hepatic fibrosis often occurs in alcoholic liver diseases without accompanying tissue necrosis or inflammation. However, the precise mechanism of this fibrosis has not been fully clarified. In the present study, using the hepatoblastoma cell line HepG2 as a model for hepatocytes, we identified a factor that stimulates collagen synthesis of fibroblasts in a conditioned medium of HepG2 cells after treatment with ethanol. Type 1 procollagen peptide (PIC) in a culture of human fibroblast IMR-90 markedly increased after incubation with the conditioned medium of ethanol-treated HepG2 cells. The stimulating activity on the production of PIC by IMR-90 remained after the dialysis and evaporation of the conditioned medium of HepG2 cells, indicating this factor was not as volatile from low molecular substances such as acetaldehyde, acetate, or lactate. The activity of this factor diminished with heat or trypsin treatment. A gel chromatographic analysis disclosed that the molecular weight of this factor was approximately 8000 Da. These results suggest that a polypeptide factor secreted from HepG2 cells by treatment with ethanol stimulates collagen synthesis of fibroblasts.

Carcinoma, Hepatocellular↗
PubMed1996

Immunohistochemical changes in the distribution of nerve fibers in the periodontal ligament during an experimental tooth movement of the rat molar.

We examined the distribution of nerve fibers containing neurofilament protein (NFP), calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP) and neuropeptide Y (NPY) in the periodontal ligament (PDL) of the rat first molar. In addition, we observed changes in the distribution of these nerve fibers in the PDL during experimental tooth movement induced by insertion of a separating elastic. In normal animals, both NFP- and CGRP-containing nerve fibers were observed in the apical part of the PDL, smaller numbers being found in the cervical part in normal rats. They terminated as free nerve endings in the apical part; no specialized endings were observed. VIP- and NPY-containing nerve fibers were associated with blood vessels near the alveolar bone in the apical part of the PDL of normal animals. Three days after tooth movement, the number of NFP- and CGRP-containing nerve fibers increased in both stretched and compressed parts of the PDL, and returned to normal levels after 14 days. Immediately after tooth movement, VIP-containing nerve fibers disappeared in the stretched part, and returned to the normal level after 14 days. VIP-containing nerve fibers were always observed during tooth movement in the compressed part of the PDL. NPY-containing nerve fibers disappeared immediately after tooth movement in the stretched part and returned to the normal level after 3 days. NPY-containing nerve fibers were not observed 1 day after insertion of the elastic in the compressed part and were the same as in the normal controls after 14 days. These results suggest that NFP-, CGRP-, VIP- and NPY-containing nerve fibers in the PDL play important roles in the modulation of pain, tissue remodeling and blood flow regulation during tooth movement.

Animals↗
PubMed1996

Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese.

BACKGROUND AND PURPOSE: We conducted a cross-sectional epidemiological survey using ambulatory blood pressure monitoring and brain MRI in a cohort from northern Japan to determine whether an inappropriately low nocturnal blood pressure, or an excess fall in nocturnal blood pressure, might be responsible for silent cerebrovascular lesions in the elderly. METHODS: Untreated subjects over 55 years and under 64 years of age (late middle age; 24 men and 46 women, 60% of eligible people) and over 65 years and under 75 years of age (elderly; 29 men and 52 women, 91% of eligible people) participated in the study. We evaluated the relationship between the amplitude (Daytime Average-Nighttime Average) or the rate ([Daytime Average-Nighttime Average]/Daytime Average) of the fall in nocturnal blood pressure and the incidence of silent cerebrovascular lesions on MRI (number of lacunar infarctions or extent of periventricular hyperintensity). RESULTS: The amplitude or the rate of the fall in nocturnal blood pressure in elderly women with one or two lacunar infarctions was significantly higher than that in those without such infarctions. There was a significant positive correlation between the amplitude or the rate of the fall in nocturnal blood pressure and the extent of periventricular hyperintensity in the elderly women. This relationship was observed in women, but not in men, of late middle age; this was not seen in elderly men. CONCLUSIONS: Results indicate that an inappropriately low nocturnal blood pressure, or an excessive fall in nocturnal blood pressure, is associated with ischemic silent cerebrovascular lesions, at least in elderly women. Treatment of hypertension in such women should be administered with care and with regard to nocturnal blood pressure.

Age Distribution↗
PubMed1996

Estradiol-induced diurnal changes in lactotroph proliferation and their hypothalamic regulation in ovariectomized rats.

Pentobarbital anesthesia during the proestrous afternoon delays proliferation of lactotrophs of the anterior pituitary from estrus to diestrus 1 in cycling female rats. We determined whether estradiol treatment induced diurnal changes in rates of lactotroph proliferation in ovariectomized rats, and if so, examined whether hypothalamic neural activity was involved in the occurrence of the estradiol-induced diurnal changes. Dispersed anterior pituitary cells were obtained from ovariectomized rats bearing estradiol implants that had been treated with 5-bromo-2'-deoxyuridine (BrdU) 3 h before decapitation. BrdU-labeling indices representative of the proliferation rate of lactotrophs were determined by double immunofluorescence staining for BrdU and PRL. After treatment of ovariectomized rats with estradiol on day 0, BrdU-labeling indices of lactotrophs as determined by injecting BrdU at 1000 h increased markedly with time peaking on days 4-7. Levels of BrdU-labeling indices at 1000 h on day 4 were 2.8-fold higher than those at 2200 h on day 3 or 4 after estradiol treatment. However, levels of BrdU-labeling indices at 1000 h on day 14 were 35% lower than those at the same time on day 4 and did not differ from those at 2200 h on day 13 or 14. In addition, a difference in BrdU-labeling indices as observed between 1000 and 2200 h on day 4 in the ovariectomized rats was not detected in estradiol-treated orchidectomized male rats. Serial determinations of BrdU-labeling indices throughout day revealed that the difference in BrdU-labeling indices between 1000 and 2200 h on day 4 in the ovariectomized rats reflected estradiol-induced diurnal changes that were characterized by a peak between 0700-0900 h and a nadir between 1900-2200 h. Pentobarbital injected at 0900 or 2100 h on day 3 decreased slightly high levels of BrdU-labeling indices at 0800 h on day 4. However, pentobarbital injection at 1345 h on day 3, which was effective in blocking estradiolinduced surges of LH and PRL secretion, suppressed markedly the high levels at 0800 h on day 4. In these pentobarbital-blocked rats, the diurnal changes in BrdU-labeling indices whose peak would normally have occurred at 0700-0900 h on day 4 were delayed not by the time corresponding to the duration of pentobarbital anesthesia but exactly by 24 h. These results suggest that 1) hypothalamic and sexually dependent diurnal changes in lactotroph proliferation can be induced by short-term estradiol treatment in ovariectomized rats as well as in cycling rats, and 2) estradiol treatment for 14 days rather prevents the diurnal changes in lactotroph proliferation.

Animals↗
PubMed1996

Plasma adrenomedullin concentration in patients with heart failure.

We measured plasma concentrations of adrenomedullin (AM), a novel bioactive peptide with potent vasodilator activity, in 21 patients with chronic congestive heart failure due to various heart diseases and compared them to levels in age- and sex-matched healthy subjects to examine the pathophysiological role of plasma AM in heart failure. In addition, the relationship between plasma AM and other hormones known to control the cardiovascular system was examined in these patients. The plasma AM level in the patients with heart failure was significantly (P < 0.01) higher than that in the control subjects (mean +/- SEM, 2.94 +/- 0.15 fmol/mL; n = 16), with a significantly (P < 0.05) higher concentration in patients in class III or IV (11.82 +/- 1.81 fmol/mL; n = 5) of the New York Heart Association functional classification than in those in class I or II (8.74 +/- 0.44 fmol/mL; n = 16). There were no significant correlations between plasma AM and catecholamine levels, whereas the plasma AM level was significantly correlated with the concentrations of plasma atrial natriuretic peptide (r = 0.58; P < 0.01), brain natriuretic peptide (r = 0.47; P < 0.05), and PRA (r = 0.77; P < 0.01) in the patients. Thus, the plasma AM concentration increased in proportion to the severity of heart failure along with the hormones known to modulate the development of congestive heart failure. The present findings suggest a possible role for AM as a circulating hormone participating in the defense mechanism against further deterioration of congestive heart failure in patients with heart disease.

Adrenomedullin↗