Cardiac surgery for patients with schizophrenia: clinical experience of six patients.

PURPOSE: The incidence of schizophrenia in Japan is 0.7%, which is similar to the worldwide incidence. The mortality rate of patients with schizophrenia is reported to be higher than that of the general population, and cardiovascular disease is high among the causes of death. Hence, strategies for cardiovascular surgery for patients with schizophrenia are necessary. METHODS: We studied six patients with schizophrenia (five males, one female) who underwent cardiac surgery in our hospital between April 2008 and December 2019. RESULT: The mean age was 63.6 years. The surgical procedures were coronary artery bypass grafting (CABG) (n = 4), CABG concomitant with valve procedures (n = 1), and resection of myxoma (n = 1). There were no major cardiovascular complications and no other fatal complications. The mean observation period was 1510.6 ± 1430.1 (140-4068) days, the mean post-operative hospital stay was 17.8 ± 3.5 (13-22) days, and there was no mortality within 30 days after surgery. During the observation period, one patient died. The survival rate was 83.3% at 1, 3, and 5 years. CONCLUSION: Cardiac surgery for patients with schizophrenia is possible with careful monitoring of indications and perioperative management.

A case of persistent sciatic artery aneurysm with recurrent embolism.

INTRODUCTION: Persistent sciatic artery (PSA) is a rare congenital vascular anomaly. It has several clinical features with the formation of aneurysms. Among the complications, leg ischemia is severe problem and the management involves revascularization and prevention of recurrence. We herein describe an anatomically annoying case of PSA aneurysm with recurrent embolism that necessitated thrombectomy and bypass surgery. And this work has been reported in line with the SCARE criteria. CASE PRESENTATION: A 76-year-old woman developed leg embolism twice from PSA aneurysm. PSA was complete type and the popliteal artery ran on the lateral side, which was difficult to approach from the standard medial side. Based on these anatomical conditions, thrombectomy of the posterior-tibial artery (PTA) and femoral-PTA bypass were performed. Additionally, the proximal side of PTA from the anastomosis site was ligated to avoid the recurrence of embolism. Residual PSA aneurysm has not yet been treated, but neither clinical complications nor dilatation have occurred. DISCUSSION: PSA is a rare disease, but should be remember in acute limb ischemia. Clear treatments have not yet been established; therefore, its plans need to be considered based on clinical symptoms and anatomical conditions. CONCLUSION: Although there were anatomical issues in the present case, thrombectomy and bypass surgery were successful and no complications have occurred one year after surgery.

Application of a Waveguide-Mode Sensor to Blood Testing for Hepatitis B Virus, Hepatitis C Virus, Human Immunodeficiency Virus and Treponema pallidum Infection.

Testing for blood-transmitted infectious agents is an important aspect of safe medical treatment. During emergencies, such as significant earthquakes, many patients need surgical treatment and/or blood transfusion. Because a waveguide mode (WM) sensor can be used as a portable, on-site blood testing device in emergency settings, we have previously developed WM sensors for detection of antibodies against hepatitis B virus and hepatitis C virus and for forward ABO and Rh(D) and reverse ABO blood typing. In this study, we compared signal enhancement methods using secondary antibodies conjugated with peroxidase, a fluorescent dye, and gold nanoparticles, and found that the peroxidase reaction method offers superior sensitivity while gold nanoparticles provide the most rapid detection of anti-HBs antibody. Next, we examined whether we could apply a WM sensor with signal enhancement with peroxidase or gold nanoparticles to detection of antibodies against hepatitis C virus, human immunodeficiency virus and Treponema pallidum, and HBs antigen in plasma. We showed that a WM sensor can detect significant signals of these infectious agents within 30 min. Therefore, a portable device utilizing a WM sensor can be used for on-site blood testing of infectious agents in emergency settings.

Surface Modification of PDMS and Plastics with Zwitterionic Polymers.

Surface modification of PDMS, polycarbonate, and acrylic resin was examined using various methacryl polymers bearing sulfobetaine, phosphoryl choline, and oligoethylene glycol units. We have found that zwitterionic polymers are adsorbed on the PDMS surface treated with plasma. The surface of PDMS is stable to keep high hydrophilicity after a month of the modification. On the other hand, one of sulfobetaine polymers showed distinguished adsorption behavior in the case of polycarbonate surface treated with plasma. Suppression effect for nonspecific adsorption of BSA was evaluated using polycarbonate and acrylic resin modified with the polymers. The modified surfaces showed suppression effect for nonspecific adsorption of BSA compared with the surface only treated with plasma.

[Second use of preserved aortic cusps for bentall procedure after aortic valve replacement with intravalvular implantation technique in aortitis syndrome].

A 44-year-old woman who had undergone aortic valve replacement with intravalvular implantation technique due to aortitis syndrome 13 years before, required Bentall procedure and hemiarch replacement because of the tissue valve dysfunction and the root and ascending aortic aneurysms. The exposed native aortic cusps sandwiched between the felt pledgets and the tissue valve seemed to be useful in reinforcing the proximal anastomosis of the composite graft. A combination of an intravalvular implantation technique and a skirted composite graft technique was applied, and her postoperative course has been uneventful for more than 2 and a half years.

A case of postpartum spontaneous coronary artery dissection.

Spontaneous coronary artery dissection is rare and usually affects younger women in the peripartum period. Here, we report an interesting case of a 34-year-old woman with spontaneous coronary artery dissection that occurred 1 month after childbirth. Emergency coronary angiography showed stenosis of the left anterior descending artery, but immediately afterwards, a new occlusion of the right coronary artery occurred. Intravascular ultrasound was used to image both right and left coronary arteries. The new occlusion of the right coronary artery was probably iatrogenic, but the left coronary artery occlusion was spontaneous. The patient underwent percutaneous coronary intervention in the right coronary artery because of her unstable hemodynamic condition. Revascularization of the left coronary artery was performed by bypass grafting. The patient was discharged on postoperative day 30. As the optimal treatment for spontaneous coronary artery dissection has not yet been established, treatments should be based on the patient's clinical presentation.

Physical properties of self-assembled monolayers of Mercapto Oligo (ethylene oxide) methyl ether on gold.

Physical properties (chemical adsorption rate, viscoelasticity, thickness, and conformation) for self-assembled monolayers (SAMs) of mercapto oligo (ethylene oxide) methyl ethers on gold were determined by quartz crystal microbalance (QCM). The values of thickness, shear viscosity and elastic shear modulus of SAMs increase with unit number of oligo (ethylene oxide) segment. However, the chemical adsorption rate determined by a Langmuir isotherm does not show such a unit number regularity. Those results suggest that difference in unit number of oligo (ethylene oxide) segment can significantly affects physical properties of SAMs.

A case of cardiac tamponade shock due to bleeding from an advanced thymoma.

Although thymomas are the most common anterior mediastinal neoplasm, those causing cardiac tamponade are unusual. To the best of our knowledge, only 13 cases have been proven in the English literature We report thymoma in a 66-year old man that caused cardiac tamponade, for which he underwent an emergency operation. On admission, he presented in a shocked state; his echocardiography results revealed pericardial effusion. Computed tomography scan indicated a thymoma infiltrating the right lung. Initially, pericardial drainage was performed through puncture; however, cardiac tamponade recurred next day. Pericardial drainage, thymectomy, and pericardiectomy were performed, but the tumor was incompletely resected. On postoperative day 2, right upper lobectomy was attempted but discontinued because of the impossibility to manipulate the pulmonary hilum, which was suspected to have tumor infiltration. He was discharged on the 27th day after the first operation, is alive at 10 months after surgery, and is under chemotherapy.

Bifunctional tri(ethylene glycol) alkanethiol monolayer modified gold electrode for on-chip electrochemical immunoassay of pg level leptin.

An on-chip enzyme-linked immunosorbent assay combined with an electrochemical detection method (EC-ELISA) was employed to detect a leptin, one of the most important adipose derived hormones, using gold electrodes modified with a tri(ethylene glycol) terminated short alkanethiol (TEGCnSH, Cn = (CH(2))n, n = 2, 4, 6, and 8) monolayer. These TEGCnSH monolayers on gold electrodes can suppress non-specific protein adsorption without affecting the electrochemical activity required for detecting p-aminophenol (PAP), which is an alkaline phosphatase (ALP) product. We measured leptin with a highly sensitive detection range (100 pg mL(-1) to 10 ng mL(-1) level) and with the desired detection limit (13.6 pg mL(-1)) by using electrochemical detection. For detecting leptin, the EC-ELISA method using TEGC4SH modified gold electrode with a poly(dimethylsiloxane) based microchannel was superior to the conventional ELISA method. With the EC-ELISA method, we were able to measure leptin with a satisfactory detection range and a pg level detection limit within 30 min, which is a much lower detection level than that obtained with conventional plate based ELISA.

Suppression of non-specific adsorption using densified tri(ethylene glycol) alkanethiols: monolayer characteristics evaluated by electrochemical measurements.

Tri(ethylene glycol) terminated short alkylchain thiols (TEGCnSHs) offer good potential for constructing ultra-thin protein-resistant monolayers because they have an alkylchain for forming a densely packed monolayer and a flexible-hydrophilic oligo ethylene glycol arm for avoiding non-specific adsorption. Hybrid monolayers consisting of TEGCnSH and a maltoside ligand (MalC12SH, for capturing lectin) were effective in detecting concanavalin A (Con A). This hybrid monolayer was more suitable for Con A detection than that modified with 100% ligands in terms of the detection limit and time. The anti-fouling properties, packing densities, interaction and homogeneity of TEGCnSH monolayers were confirmed in detail by surface plasmon resonance (SPR) measurements and electrochemical methods. SPR measurements revealed their excellent repellency to proteins and peptides of various sizes (M(W) 400-104000). The electrochemical results indicated that the lower defects in the TEGCnSH monolayers suppressed the permeation of small peptides. The stability, homogeneity and packing density of the TEGCnSH monolayers were gradually improved as their alkylchain length increased.

One-step detection of galectins on hybrid monolayer surface with protruding lactoside.

Galectins, or beta-galactoside binding lectins, are detected deep in tumor tissue and are recognized as diagnostic and prognostic markers of cancer and other serious diseases. There is a need to develop a faster, easier, and simpler method for detecting galectins. We have succeeded in forming a mixed self-assembled monolayer (SAM) interface consisting of beta-galactoside terminated alkanethiol (lactoside protuberant dodecanethiol) and tri(ethylene glycol) (TEG) terminated short alkanethiol, which proved to be a superior protein resistant material, to enable us to develop a label-free, one-step, and highly sensitive system for detecting the expected biomarker, galectin. We successfully detected nanomolar level (~ 1 nM) galectin-4 and -8 on a 4% lactoside protrusive surface, even though the affinity between the galectins and lactoside was very weak (KD = 1 x 10(-3)~1 x 10(-6)). The combination of the suppression of background noise by filling with TEG terminated short alkanethiol and control of the ligand ratio in the interface contributed to the highly sensitive detection of galectin. We also detected galectin-4 at subten nanomolar levels even in a solution containing much higher concentrations of serum proteins (1800 times larger than the galectin concentration) without using molecule labeling or an immunological method.

The rupture of descending thoracic aorta due to the necrosis of aortic intimal sarcoma.

Aortic intimal sarcoma is rare and the prognosis is very poor. We experienced a case of ruptured aortic intimal sarcoma in the descending aorta. A 69-year-old man underwent an emergency operation for the rupture of descending aorta. The postoperative course was uneventful. The histological examination of aortic wall showed aortic intimal sarcoma. The patient developed a local recurrence and abdominal dissemination of the tumor three months after surgery. We report the case and discuss about the diagnosis and treatment of thoracic aortic intimal sarcoma.

Recognition of lectin with a high signal to noise ratio: carbohydrate-tri(ethylene glycol)-alkanethiol co-adsorbed monolayer.

Densely packed co-adsorbed ultrathin mono molecular layers of short tri(ethylene glycol)-alkanethiolate (for repelling proteins) and maltoside terminated alkanethiolate (for capturing lectin) provided an extremely high signal to noise ratio surface: the repelling molecules, which had two different functions (highly flexible-hydrophilic arm and rigid packing tail group), worked as "nano barriers" in the recognition monolayer.

Synthesis of oligo(ethylene glycol) toward 44-mer.

A synthetic method for oligo(ethylene glycol) toward 44-mer (FW = 1956.35) is described. Reiteration of Williamson's ether synthesis and hydrogenation to remove protecting benzyl group affords desired oligo(ethylene glycol) toward 44-mer in moderate yields. The advantages in this method are use of commercially easily available materials as starting materials and procedures avoiding difficulty in purification of the products as much as possible.

[A clinical study of hepatic arterial infusion chemotherapy with low-dose CDDP and 5-FU for liver metastases].

We followed patients who underwent hepatic arterial infusion chemotherapy with low-dose CDDP+5-FU for liver metastases from colorectal cancer in the outpatient setting. A catheter was inserted from the femoral artery into the proper hepatic artery using the interventional technique. Two complete response (CR) and seven partial response (PR) were achieved, but later 2 of these patients had lung metastases. We conclude that this therapy may be effective, but control of extrahepatic lesions is necessary for life prolongation.

Charge Delocalization in Persistent Benz[a]anthracenium Cations BAH(+) and Related alpha-Carbocations/Carboxonium Ions: Modeling Epoxide Ring Opening in Potent Carcinogens.

Parent BA 1 protonates at C-7/C-12 to give 1H(+)() and 1aH(+)() in 3:1 ratio which remains unaffected by variation in temperature and the superacid system. Increasing steric crowding at the bay-region by introduction of a methyl at C-1 (1-MBA) changes the ratio of C-7/C-12 protonated arenium ions 2H(+)()/2aH(+)() to 10:1. The highly potent 7,12-dimethylbenz[a]anthracene, 7,12-DMBA, gives a 1:1 mixture of the two ipso-protonated cations 3aH(+)()/3H(+)() whose composition changes to 50:1 overtime in favor of 3aH(+)() (ipso-attack at bay-region), showing it to be the thermodynamic cation. 3-Methylcholanthrene, 3MC, is exclusively protonated at C-6 (-->4aH(+)()). Cation 5(+)() (a simplified model for bay-region epoxide ring opening) is cleanly formed via its carbinol 5-OH with FSO(3)H/SO(2)ClF. Ketone 6 is O-protonated in TFAH and in TFAH/H(2)SO(4) to give the bay-region carboxonium ion 6H(+)(); its diprotonation in FSO(3)H.SbF(5) (4:1)/SO(2)ClF gave the first example of the oxonium-arenium dication 6H(2)()(2+). alpha-BA-substituted secondary carbocation 7(+)() and the carboxonium ion 8H(+)() were generated to probe charge delocalization into the alpha-BA moiety via C-7. To gauge the importance of the benz[a] ring and for comparison, the anthracene-substituted carbocations 9(+)() and carboxonium ion 10H(+)() were generated and studied. Charge delocalization pathways into the PAH periphery are evaluated on the basis of Deltadelta(13)C values. AM1 was used as a complementary tool for qualitative comparison with experiment. The resulting arenium ions and benzylic carbocations exhibit strong anthracenium ion character emphasizing the importance of an electron-deficient anthracene moiety. The present study constitutes the first direct investigation of carbocations in the BA series, whose bay-region and K-region diol epoxides are considered the ultimate carcinogens en route to PAH-DNA adduct formation.