Chest CT findings in severe acute respiratory distress syndrome requiring V-V ECMO: J-CARVE registry.

BACKGROUND: Chest computed tomography findings are helpful for understanding the pathophysiology of severe acute respiratory distress syndrome (ARDS). However, there is no large, multicenter, chest computed tomography registry for patients requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to describe chest computed tomography findings at V-V ECMO initiation and to evaluate the association between the findings and outcomes in severe ARDS. METHODS: This multicenter, retrospective cohort study enrolled patients with severe ARDS on V-V ECMO, who were admitted to the intensive care units of 24 hospitals in Japan between January 1, 2012, and December 31, 2022. RESULTS: The primary outcome was 90-day in-hospital mortality. The secondary outcomes were the successful liberation from V-V ECMO and the values of static lung compliance. Among the 697 registry patients, of the 582 patients who underwent chest computed tomography at V-V ECMO initiation, 394 survived and 188 died. Multivariate Cox regression showed that traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality (hazard ratio [95% confidence interval] 1.77 [1.19-2.63], p = 0.005 and 1.97 [1.02-3.79], p = 0.044, respectively). The presence of traction bronchiectasis was also associated with decreased successful liberation from V-V ECMO (odds ratio: 0.27 [0.14-0.52], p < 0.001). Lower static lung compliance was associated with some chest computed tomography findings related to changes outside of pulmonary opacity, but not with the findings related to pulmonary opacity. CONCLUSIONS: Traction bronchiectasis and subcutaneous emphysema increased the risk of 90-day in-hospital mortality in patients with severe ARDS who required V-V ECMO.

High versus low positive end-expiratory pressure setting in patients receiving veno-venous extracorporeal membrane oxygenation support for severe acute respiratory distress syndrome: study protocol for the multicentre, randomised ExPress SAVER Trial.

INTRODUCTION: While limiting the tidal volume to 6 mL/kg during veno-venous extracorporeal membrane oxygenation (V-V ECMO) to ameliorate lung injury in patients with acute respiratory distress syndrome (ARDS) is widely accepted, the best setting for positive end-expiratory pressure (PEEP) is still controversial. This study is being conducted to investigate whether a higher PEEP setting (15 cmH2O) during V-V ECMO can decrease the duration of ECMO support needed in patients with severe ARDS, as compared with a lower PEEP setting. METHODS AND ANALYSIS: The study is an investigator-initiated, multicentre, open-label, two-arm, randomised controlled trial conducted with the participation of 20 intensive care units (ICUs) at academic as well as non-academic hospitals in Japan. The subjects of the study are patients with severe ARDS who require V-V ECMO support. Eligible patients will be randomised equally to the high PEEP group or low PEEP group. Recruitment to the study will continue until a total of 210 patients with ARDS requiring V-V ECMO support have been randomised. In the high PEEP group, PEEP will be set at 15 cmH2O from the start of V-V ECMO until the trials for liberation from V-V ECMO (or until day 28 after the allocation), while in the low PEEP group, the PEEP will be set at 5 cmH2O. Other treatments will be the same in the two groups. The primary endpoint of the study is the number of ECMO-free days until day 28, defined as the length of time (in days) from successful libration from V-V ECMO to day 28. The secondary endpoints are mortality on day 28, in-hospital mortality on day 60, ventilator-free days during the first 60 days and length of ICU stay. ETHICS AND DISSEMINATION: Ethics approval for the trial at all the participating hospitals was obtained on 27 September 2022, by central ethics approval (IRB at Hiroshima University Hospital, C2022-0006). The results of this study will be presented at domestic and international medical congresses, and also published in scientific journals. TRIAL REGISTRATION NUMBER: The Japan Registry of Clinical Trials jRCT1062220062. Registered on 28 September 2022. PROTOCOL VERSION: 28 March 2023, version 4.0.

A case of severe respiratory failure due to interstitial pneumonia successfully bridged to lung transplantation from a brain-dead donor using 109-day veno-arterial extracorporeal membrane oxygenation.

In Japan, successful cases of a bridge to lung transplantation (BTT) by extracorporeal membrane oxygenation (ECMO) are rare. We present the case of a man in his thirties, diagnosed with interstitial pneumonia 6 years prior and registered for lung transplant 1 year prior due to disease progression despite treatment. Due to the patient's worsening respiratory failure, he was transferred to our hospital for BTT by ECMO. Since long-term management was expected and pulmonary hypertension was present, veno-arterial (V-A) ECMO was conducted using the right atrial blood outflow via the right internal jugular vein and right axillary artery inflow via a vascular graft. After tracheostomy, he was managed as "Awake ECMO". In addition, interprofessional collaboration such as physiotherapist rehabilitation, nurses, and liaison teams prevented muscle weakness and supported the mental aspect. We were able to minimize complications such as severe infections and bleeding. A compatible brain-dead donor was found on day 108 after introducing ECMO, and the patient was transferred to a transplant facility on day 109. The peripheral upper V-A ECMO is one of the configurations suitable for long-term BTT management.

Iliopsoas Hematoma in Patients Undergoing Venovenous ECMO.

BACKGROUND: Iliopsoas hematoma occasionally occurs in patients receiving anticoagulation therapy. It may be a life-threatening complication and can cause disseminated intravascular coagulation, which could develop into abdominal compartment syndrome. The incidence of and factors associated with iliopsoas hematoma during venovenous extracorporeal membrane oxygenation (ECMO) have not been well studied. OBJECTIVES: To describe the incidence of iliopsoas hematoma and associated factors among patients undergoing venovenous ECMO. METHODS: A retrospective cohort study was conducted at Nippon Medical School Hospital from April 2015 to October 2018. All patients (>18 years old) with iliopsoas hematoma received a diagnosis based on computed tomography. RESULTS: During the study period, 54 patients were supported with venovenous ECMO. Iliopsoas hematoma occurred in 8 of those patients (15%), none of whom had disseminated intravascular coagulopathy or abdominal compartment syndrome develop. Univariate analysis indicated that management of ECMO while the patient was awake and mobilization beyond sitting on the edge of the bed were significantly different (P < .05) in patients with and patients without iliopsoas hematoma. Mortality, however, did not differ significantly between the 2 groups. CONCLUSIONS: Our findings emphasize that recognizing factors associated with iliopsoas hematoma and detecting them early are crucial during venovenous ECMO in order to treat patients with iliopsoas hematoma appropriately.

Bulky pulmonary mucosa-associated lymphoid tissue lymphoma treated with yttrium-90 ibritumomab tiuxetan.

An 84-year-old woman was admitted to our hospital with nonproductive cough and dyspnea on exertion. Computed tomography (CT) scan revealed extensive consolidation in the right lung. She was diagnosed with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma using CT-guided lung biopsy. Her pulmonary images and respiratory symptoms did not improve two months after receiving 4 cycles of rituximab weekly; therefore, yttrium-90 ibritumomab tiuxetan was chosen as salvage therapy. The abnormal shadow on her pulmonary images was significantly reduced two months later, and she had no symptoms without nonhematological toxicities. She has had no progression for 18 months. Furthermore, radiation pneumonitis has not also been observed. We herein reported bulky pulmonary MALT lymphoma treated with yttrium-90 ibritumomab tiuxetan.

Measurements of reversible and irreversible inactivation processes of a redox enzyme, bilirubin oxidase, by electrochemical methods based on bioelectrocatalysis.

The inactivation of a redox enzyme, bilirubin oxidase (BOD), by heat and guanidine hydrochloride (GuHCl) was studied by two bioelectrochemical methods. One is a conventional method, which measures the inactivation of BOD in solution, and the other is a method using a BOD-immobilized electrode (a membrane/BOD/GC electrode), which measures the inactivation of BOD in the immobilized state. The results for thermal inactivation revealed that BOD both in solution and in the immobilized state obeyed the same irreversible inactivation kinetics. The CD and absorption spectra of BOD confirmed that the irreversible thermal inactivation was accompanied by a change in the secondary structure and the dissociation of type-1 copper from BOD. The measurements in the presence of GuHCl demonstrated that the BOD activity was significantly decreased at 1 M GuHCl in both states, and that the decrease proceeded reversibly. The CD spectrum of BOD indicated that the secondary structure of BOD was little affected by GuHCl at this concentration. The effect of GuHCl on the thermal inactivation was studied and evaluated as the resulting values of the Arrhenius activation energy: DeltaG(not equal), DeltaH(not equal), and DeltaS(not equal).

Application of poly[oxyethylene(dimethylimino)propyl-(dimethylimino)ethylene] as enzyme stabilizer for bilirubin oxidase immobilized electrode.

It has been shown that polyammonium cations comprising quaternary ammonium and hydrophilic groups such as amide and hydroxyl groups stabilize a redox enzyme bilirubin oxidase (BOD). The BOD catalyzes the reaction: 4[Fe(CN)6]4- + 4H+ + O2 --> 4[Fe(CN)6]3- + 2H2O, and has been a promising enzyme for use as a cathode catalyst in biofuel cells. In this study, the stabilizing effect of poly[oxyethylene(dimethylimino)propyl(dimethylimino)ethylene] (PA1) on BOD has been investigated. The sample solution containing BOD and the PA1 salt was kept at a given temperature, and the loss of the enzymatic activity was detected after given stored times. The activity decreased exponentially with stored time so that the first-order rate-constant of inactivation was determined. The inactivation rate-constant lowered with increasing the concentration of the PA1 salt, suggesting that BOD was stabilized by the association with the PA1 cation. The PA1 cation may act like a protective colloid or decrease the local disorder of BOD by its wrapping. A membrane-covered electrode containing BOD, PA1, and [Fe(CN)6](4-/3-) in the internal solution phase was examined in air-saturated aqueous solution. The electrode gave a well-defined current-potential curve with a steady state limiting current due to the PA1-[Fe(CN)6](4-/3-) polyion complex-mediated bioelectrocatalytic current for the reduction of O2. The decreasing of the steady state limiting current became slower in the presence of the PA1 salt, indicating again the stabilizing effect of PA1 cation on BOD.

Activity measurement of chitosanase by an amperometric biosensor.

An amperometric biosensor for the detection of glucosamine (GlcN) and chitosan oligosaccharides ((GlcN)n) was introduced for an activity measurement of chitosanase. By using the biosensor, an increase in the anodic current due to the production of GlcN and (GlcN)n by chitosanase was measured in a chitosan solution. The maximum value of the slope of the current increase was proportional to the enzyme concentration up to 1.4 microg mL(-1). The present method had the advantages of being simple and rapid over the conventional Elson-Morgan method.

The silent form of quinohemoprotein amine dehydrogenase from Paracoccus denitrificans.

Quinohemoprotein amine dehydrogenase (QH-AmDH) from Paracoccus denitrificans is an alphabetagamma heterotrimeric enzyme catalyzing oxidative deamination of amines with large substitutes, such as butylamine and benzylamine. The smallest gamma subunit has cross-linking cysteine tryptophylquinone (CTQ) as a catalytic center. A hemoprotein similar to QH-AmDH in molecular mass, subunit structure, and UV-vis spectral property, but having no enzymatic activity, was isolated. The enzymatically silent form (sQH-AmDH) was activated slowly by the substrates of QH-AmDH, and quickly by reductants, dithionite and dithiothreitol. Electrolysis of sQH-AmDH yielded the active form at potentials more negative than -0.17 V (vs. SHE). The activated protein reacted with a carbonyl reagent, 4-nitrophenylhydrazine, giving a typical spectrum of 4-nitrophenylhydrazone, while sQH-AmDH did not give such a spectrum. The gamma subunit of sQH-AmDH showed a sharp peak at 390 nm in UV-vis spectrum clearly distinguishable from that of QH-AmDH. Electrospray ionization mass spectrometric analysis showed that the molecular mass of the gamma subunit of sQH-AmDH was larger than that of QH-AmDH by 15.6. The data suggest that the CTQ-like moiety of sQH-AmDH is an oxime. This hypothesis was confirmed by subsequent hydroxylamine treatment of QH-AmDH. QH-AmDH was treated with hydroxylamine yielding an oxime derivative. The UV-vis spectral properties of the gamma subunit of hydroxylamine-treated QH-AmDH were identical to those of sQH-AmDH. The hydroxylamine-treated QH-AmDH was also reactivated by butylamine, as in the case of sQH-AmDH.

Application of polyammonium cations to enzyme-immobilized electrode: voltammetric behavior of polycation-hexacyanoferrate anion complexes and applicability as electron-transfer mediator.

Cyclic voltammograms of the aqueous solution containing polyammonium cations and the [Fe(CN)6]4-. anion at a plastic-formed carbon or platinum electrode were recorded. Polyammonium salts comprising quaternary ammonium in the main chain or sub chain and those comprising primary ammonium were tested. Under certain conditions, well-developed anodic and cathodic peak currents with the midpoint potentials different from that when the polyammonium cation is absent, that is, the midpoint potential of [Fe(CN)6]3- + e- = [Fe(CN)6]4- were exhibited, indicating that the [Fe(CN)6]4-/3- anionic species associate with the polyammonium cations tested to form the polycation-[Fe(CN)6]4-/3- complex species. The polycation complex species can be easily localized around the electrode surface with a dialysis membrane. An application of the polycation complex species as an electron-transfer mediator in the catalytic electrode with a redox enzyme was examined.

Application of polyammonium cations to enzyme-immobilized electrode: application as enzyme stabilizer for bilirubin oxidase.

Bilirubin oxidase was stored in the solutions containing polyammonium salts for a given time at 30 degrees C, and the activity was assayed. The enzyme catalyzes the reaction: 4[Fe(CN)6]4- + 4H+ + O2 --> 4[Fe(CN)6]3- + 2H2O, and the activity can be measured by the absorbance at the wavelength for the absorption maxima of [Fe(CN)6)]3-. The results show that polyammonium cations comprising quaternary ammonium in the main chain and hydrophilic groups, such as hydroxyl and amide groups, stabilize the enzyme in solution. These polyammonium cations may act like a protective colloid. The membrane-covered electrode containing the polyammonium cations, the enzyme, and [Fe(CN)6]4-/3- in the internal solution phase was constructed. The electrode gave a well-defined current-potential curve with a steady state limiting current due to the polycation-[Fe(CN)6]4-/3- complex-mediated bioelectrocatalytic current for the reduction of O2. The time-dependent decrease of the limiting current indicates again the stabilizing effect of the polyammonium cations on the enzyme.

A bioelectrocatalysis method for the kinetic measurement of thermal inactivation of a redox enzyme, bilirubin oxidase.

The thermal stability of a redox enzyme, bilirubin oxidase (BOD), has been quantitatively evaluated by measuring the inactivation kinetics of BOD at several temperatures. The enzyme activity is directly related to the mediated bioelectrocatalytic current for the BOD-catalyzed reduction of O(2). Thus, the inactivation process is measured by the time-dependent decrease in the bioelectrocatalytic current. The results reveal that the inactivation obeys first-order kinetics, whose rate constants (k) are determined at pH 7.0 and at 50 - 70 degrees C. The half life of BOD activity, calculated from the k value at 50 degrees C is 114 min, which is in harmony with the thermal-stability data given in a catalog by Amano Enzyme Inc. The bioelectrocatalysis method allows in situ measurements of the inactivation kinetics in the period of a few minutes at relatively high temperatures. The rate constants show a large temperature dependence, leading to a large Arrhenius activation energy (E(A)) of 221 kJ mol(-1). The activation Gibbs energy (DeltaG(not equal)), activation enthalpy (DeltaH(not equal)), and activation entropy (DeltaS(not equal)) are also determined.

Kinetic analysis of glucoamylase-catalyzed hydrolysis of starch granules from various botanical sources.

The kinetics of glucoamylase-catalyzed hydrolysis of starch granules from six different botanical sources (rice, wheat, maize, cassava, sweet potato, and potato) was studied by the use of an electrochemical glucose sensor. A higher rate of hydrolysis was obtained as a smaller size of starch granules was used. The adsorbed amount of glucoamylase on the granule surface per unit area did not vary very much with the type of starch granules examined, while the catalytic constants of the adsorbed enzyme (k(0)) were determined to be 23.3+/-4.4, 14.8+/-6.0, 6.2+/-1.8, 7.1+/-4.1, 4.6+/-3.0, and 1.6+/-0.6 s(-1) for rice, wheat, maize, cassava, sweet potato, and potato respectively, showing that k(0) was largely influenced by the type of starch granules. A comparison of the k(0)-values in relation to the crystalline structure of the starch granules suggested that k(0) increases as the crystalline structure becomes dense.

Potential-step coulometry of D-glucose using a novel FAD-dependent glucose dehydrogenase.

This paper describes the construction and characterization of a batch-type coulometric system for the detection of D-glucose using a novel FAD-dependent glucose dehydrogenase. In order to overcome the problem of interferents, such as ascorbate and urate, a potential-step method was proposed to separate the electrolysis reactions of interferents and D-glucose by selecting a mediator possessing an appropriate formal potential. The rapid oxidative consumption of the interferents proceeded in the first step, whereas the mediator and glucose remained reduced. In the second step, the mediator was immediately oxidized, and subsequent bioelectrocatalytic oxidation of D-glucose occurred with the aid of aldose 1-epimerase. In this study, potassium octacyanomolybdate (IV) with a formal potential of 0.6 V vs. Ag|AgCl was chosen as a mediator, and the first and second electrolysis potentials were set at 0.4 V and 0.8 V, respectively, by considering the heterogeneous electron-transfer kinetics and the potential window. The background-corrected response in charge corresponded to 99+/-2 % efficiency in terms of the amount of D-glucose.

Kinetic analysis of enzymatic hydrolysis of crystalline cellulose by cellobiohydrolase using an amperometric biosensor.

An amperometric biosensor for the detection of cellobiose has been introduced to study the kinetics of enzymatic hydrolysis of crystalline cellulose by cellobiohydrolase. By use of a sensor in which pyrroloquinoline quinone-dependent glucose dehydrogenase was immobilized on the surface of electrode, direct and continuous observation of the hydrolysis can be achieved even in a thick cellulose suspension. The steady-state rate of the hydrolysis increased with increasing concentrations of the enzyme to approach a saturation value and was proportional to the amount of the substrate. The experimental results can be explained well by the rate equations derived from a three-step mechanism consisting of the adsorption of the free enzyme onto the surface of the substrate, the reaction of the adsorbed enzyme with the substrate, and the liberation of the product. The catalytic constant of the adsorbed enzyme was determined to be 0.044+/-0.011s(-1).

Novel FAD-dependent glucose dehydrogenase for a dioxygen-insensitive glucose biosensor.

A novel FAD-dependent glucose dehydrogenase (FAD-GDH) was found and its enzymatic property for glucose sensing was characterized. FAD-GDH oxidized glucose in the presence of some artificial electron acceptors, except for O2, and exhibited thermostability, high substrate specificity and a large Michaelis constant for glucose. FAD-GDH was applied to an amperometric glucose sensor with Fe(CN)6(3-) as a soluble mediator. The use of a relatively high concentration of Fe(CN)6(3-) resulted in a good linearity between the current response and the glucose concentration, taking into account a large Michaelis constant for Fe(CN)6(3-). The glucose sensor was completely insensitive to O2 and responded linearly to glucose up to 30 mM. Compared to glucose, the response to other saccharides was negligible. The sensor can be stored at room temperature in a desiccator for at least one month without any change in the response or activity.

Escherichia coli-catalyzed bioelectrochemical oxidation of acetate in the presence of mediators.

Bioelectrocatalytic oxidation of acetate was investigated under anaerobic conditions by using Escherichia coli K-12 (IFO 3301) cells cultured on aerobic media containing poly-peptone, glucose or acetate as the sole carbon source. It was found that all E. coli cells cultured on the three media work as good catalysts of the electrochemical oxidation of acetate as well as glucose with Fe(CN)6(3-), 2,3-dimethoxy-5-methyl-1,4-benzo-quinone (Q0), 2,6-dichloro-indophenol, or 2-methyl-1,4-naphthoquinone as artificial electron acceptors (mediators). Acetate-grown E. coli cells exhibited the highest relative activity of the acetate oxidation against the glucose oxidation. On the other hand, all the artificial electron acceptors used work as inhibitors for the catalytic oxidation of acetate at increased concentrations. The inhibition phenomenon can be interpreted in terms of competitive substrate inhibition as a whole. Apparent values of Michaelis constant, catalytic constant, and inhibition constant were evaluated by amperometric methods. Q0 is an effective artificial mediator as evidenced by a large reaction rate constant between the cell and Q0 at least at low concentrations (<50 microM). However, Fe(CN)6(3-) is a promising mediator in biosensor applications because the inhibition constant is very large and it works as an electron acceptor even under aerobic conditions.

Voltammetric behavior of the transfer of mono- and polyammonium ions across a phospholipid monolayer at the nitrobenzene/water interface.

The influence of a phospholipid, dipalmitoyl phosphatidylcholine, layer at a nitrobenzenelwater interface on the transfer of tetraethylammonium ion and a polyammonium anti-fungus agent, poly[(dimethylimino)(2-oxo-1,2-ethanediyl)imino1,6-hexanediylimino (1-oxo-1,2-ethanediyl)(dimethylimino)-1,6-hexanediyl] ion, across the interface was studied by normal pulse voltammetry. When the phospholipid was adsorbed to form a monolayer at the nitrobenzenelwater interface by its addition to the organic phase, the half-wave potential in the current vs. potential curves for the transfer of tetraethylammonium ion did not change, but the limiting current was significantly decreased at certain sampling times, indicating a retarding effect of the layer on the ion-transfer. On the other hand, in the current vs. potential curves for the transfer of the polyammonium ion, no significant change in either the half-wave potential or the limiting current was observed upon adding the phospholipid, indicating that the polyammonium ion can easily permeate through the phospholipid layer. The results suggest a new application of the voltammetric technique to the study of cell membrane permeability to polyionic bioactive compounds.

Production of completely flavinylated histamine dehydrogenase, unique covalently bound flavin, and iron-sulfur cluster-containing enzyme of nocardioides simplex in Escherichia coli, and its properties.

The hmd gene of histamine dehydrogenase from Nocardioides simplex was overexpressed in Escherichia coli, and the resulting enzyme was purified to homogeneity. The purified recombinant enzyme is almost identical with the native enzyme in view of molecular weight and specific activity, and is stoichiometrically assembled with the three cofactors 6-S-cysteinyl FMN, 4Fe-4S cluster, and ADP.

Mediated spectroelectrochemical titration of proteins for redox potential measurements by a separator-less one-compartment bulk electrolysis method.

One-compartment bulk electrolysis and simultaneous spectroscopic measurements are realized in a conventional spectroscopic cuvette without separator by using a mesh-type working electrode with extremely large surface area and a wire-type counter electrode with very small surface area. Spectrophotometric monitoring revealed complete electrolysis in a first-order kinetics. This technique was applied to mediated titration of cytochrome c and bilirubin oxidase for determining their redox potentials. Kinetics for the solution redox reaction between protein and mediator is described. The subtraction of spectral background due to mediator adsorption is very easy because of high reproducibility. The experiments can be done under completely anaerobic conditions. Low-absorbance protein samples (of low concentrations or small absorption coefficients) and hydrophobic proteins (such as membrane-bound proteins) are acceptable for measurements.