Cardiogenic Shock Secondary to Dynamic Left Ventricular Outflow Tract Obstruction and Apical Ballooning after Nonmitral Cardiovascular Surgery.

BACKGROUND: The dynamic obstruction of the left ventricular outflow tract (LVOT) is a well-known complication in mitral annuloplasty but rarely seen in nonmitral cardiovascular surgery. The dynamic LVOT obstruction can lead to hemodynamic instability, even shock and the treatment is significantly different from the standard approach. Case Presentation. We reported a case of low cardiac output syndrome (LCOS) with severe mitral regurgitation (MR), dramatically reduced left ventricular ejection fraction (LVEF) after coronary artery bypass grafting in a 72-year-old female requiring an escalation of inotropic support, volume restriction, and mechanical support. The detailed echocardiography combined with lung ultrasound revealed a dynamic systolic anterior movement of the anterior mitral leaflet (SAM), apical ballooning, and no significant lung congestion. Intravenous fluids were given, diuretics withdrawn, inotrope discontinued, and vasopressors uptitrated. The dynamic SAM was rapidly relieved, the hemodynamics was stabilized, and the LVEF was improving. The patient was discharged in good condition without residual LVOT obstruction and trace MR. CONCLUSION: We strongly suggest that a detailed echocardiography should be performed in any patient who presents in shock to rule out a dynamic LVOT obstruction. Lung ultrasound should be a routine examination in addition to echocardiography. Once SAM is detected, treatment should be based on volume expansion, inotrope discontinuation, and a careful afterload increasing.

Encapsulation of tagitinin C in liposomes coated by Tithonia diversifolia pectin.

Tagitinin C, a sesquiterpene lactone compound from Tithonia diversifolia, is known to have various bioactivities including anticancer effects. The disadvantages of tagitinin C which make its therapeutic application limited are low water solubility and poor stability. In this work, we encapsulated tagitinin C in the form of liposomal nanoparticles to overcome its limitations and evaluated its anticancer activity. Liposomes were prepared using phosphatidylcholine, tween 80 and with/without T. diversifolia pectin. Tagitinin C liposomes exhibited small sizes, a range of 252-311 nm, and negative surface charges. Liposomes coated by T. diversifolia pectin resulted in a slightly slower release rate than pectin-uncoated liposomes. The cytotoxicity of tagitinin C in pectin-coated liposomes was more pronounced than that in liposomes without pectin. Tagitinin C in liposomes showed significantly increased toxicity against human lung cancer cells LU-1 in comparison with DMSO-tagitinin C. Therefore, tagitinin C liposomes demonstrate significant potential as delivery systems for cancer therapy.

Anti-proliferative diterpenes from Dacrycarpus imbricatus.

A new diterpene, cassipouryl hexadecanoate (2), in addition to the cassipourol (1) and four terpenes (3-6) were isolated from the twigs and leaves of Dacrycarpus imbricatus (Blume) de Laub. The structures of the two monocyclic diterpenes (1, 2), were elucidated on the basic of 1D and 2D NMR spectroscopic data and compared with the literature. These two monocyclic diterpenes (1, 2) were tested for their anti-proliferative activity on acute myeloid leukemia (OCI-AML) cells. The results showed that 1 had significantly anti-proliferative activity whereas 2 was weakly active.

In vitro culture of Keratinocytes from human umbilical cord blood mesenchymal stem cells: the Saigonese culture.

There have been many attempts to acquire and culture human keratinocytes for clinical purposes including from keratotome slices in media with fetal calf serum (FCS) or pituitary extract (PE), from skin specimens in media with feeder layers, from suction blister epidermal roofs' in serum-free culture and from human umbilical cord blood (hUCB) mesenchymal stem cells (MSCs) in media with skin feeder layers. Conversely this study was designed to investigate whether keratinocytes could be obtained directly from hUCB MSCs in vitro. It is widely established that mesenchymal stem cells from human umbilical cord blood have multipotent capacity and the ability to differentiate into disparate cell lineages hUCB MSCs were directly induced to differentiate into keratinocytes by using a specific medium composed of primary culture medium (PCM) and serum free medium (SFM) in a ratio 1:9 for a period of 7 days and tested by immunostain p63 and K1-K10. Cells thus cultured were positive in both tests, confirming the possibility to directly obtain keratinocytes from MSCs hUCB in vitro.