Assessing the cumulative impacts of geographically isolated wetlands on watershed hydrology using the SWAT model coupled with improved wetland modules.

Despite recognizing the importance of wetlands in the Coastal Plain of the Chesapeake Bay Watershed (CBW) in terms of ecosystem services, our understanding of wetland functions has mostly been limited to individual wetlands and overall catchment-scale wetland functions have rarely been investigated. This study is aimed at assessing the cumulative impacts of wetlands on watershed hydrology for an agricultural watershed within the Coastal Plain of the CBW using the Soil and Water Assessment Tool (SWAT). We employed two improved wetland modules for enhanced representation of physical processes and spatial distribution of riparian wetlands (RWs) and geographically isolated wetlands (GIWs). This study focused on GIWs as their hydrological impacts on watershed hydrology are poorly understood and GIWs are poorly protected. Multiple wetland scenarios were prepared by removing all or portions of the baseline GIW condition indicated by the U.S. Fish and Wildlife Service National Wetlands Inventory geospatial dataset. We further compared the impacts of GIWs and RWs on downstream flow (i.e., streamflow at the watershed outlet). Our simulation results showed that GIWs strongly influenced downstream flow by altering water transport mechanisms in upstream areas. Loss of all GIWs reduced both water routed to GIWs and water infiltrated into the soil through the bottom of GIWs, leading to an increase in surface runoff of 9% and a decrease in groundwater flow of 7% in upstream areas. These changes resulted in increased variability of downstream flow in response to extreme flow conditions. GIW loss also induced an increase in month to month variability of downstream flow and a decrease in the baseflow contribution to streamflow. Loss of all GIWs was shown to cause a greater fluctuation of downstream flow than loss of all RWs for this study site, due to a greater total water storage capacity of GIWs. Our findings indicate that GIWs play a significant role in controlling hydrological processes in upstream areas and downstream flow and, therefore, protecting GIWs is important for enhanced hydrological resilience to extreme flow conditions in this region.

Accuracy and precision of direct bone conduction measurements.

OBJECTIVES: Variability in Baha® sound processor fittings arise from several sources including the nature of the implant-to-bone transmission and transcranial attenuation in patients with single-sided sensorineural deafness. One method of improving the predictability of Baha fittings is to measure the individual patient's actual bone conduction thresholds via the implant, thereby removing the influence of skin thickness and/or implant location site. METHODOLOGY: One hundred thirty eight adult wearers of the Baha System participated in the study. Direct bone conduction thresholds were obtained through the BC Direct feature of the Cochlear™ Baha Fitting Software combined with the CochlearBaha BP100 sound processor. Test-retest reliability measurement was performed in 58 participants. RESULTS: Improved transmission of sound through the implant rather than transcutaneously through the skin was confirmed. On average, the BC Direct thresholds were closer to the patient's unmasked thresholds than the masked values. In patients with single-sided sensorineural deafness, BC Direct results were elevated compared to the contralateral bone conduction thresholds due to transcranial attenuation. The test-retest reliability for the BC Direct measurements was within ±5 dB, which is in within the accepted variability for audiometric test measurements. CONCLUSIONS: Direct bone conduction measurement provides a validated method of comparing the transcutaneous thresholds as measured through audiometry with the percutaneous responses from the Baha sound processor. The Baha fitting based on direct measurements of bone conduction may require less fine-tuning and provide a greater understanding of the variability of the bone conduction sound pathway.

Storm water pollutant removal performance of compost filter socks.

In 2005, the U.S. Environmental Protection Agency (USEPA) National Menu of Best Management Practices (BMPs) listed compost filter socks (FS) as an approved BMP for controlling sediment in storm runoff on construction sites. The objectives of this study were to determine if FS with or without the addition of a flocculation agent to the FS system can significantly remove (i) suspended clay and silt particulates, (ii) ammonium nitrogen (NH(4)-N) and nitrate-nitrite nitrogen (NO(3)-N), (iii) fecal bacteria, (iv) heavy metals, and (v) petroleum hydrocarbons from storm water runoff. Five separate (I-V) 30-min simulated rainfall-runoff events were applied to soil chambers packed with Hartboro silt loam (fine-loamy, mixed, active, nonacid, mesic fluvaquentic Endoaquepts) or a 6-mm concrete veneer on a 10% slope, and all runoff was collected and analyzed for hydraulic flow rate, volume, pollutant concentrations, pollutant loads, and removal efficiencies. In corresponding experiments, runoff was analyzed for (i) size of sediment particles, (ii) NH(4)-N and NO(3)-N, (iii) total coliforms (TC) and Escherichia coli, (iv) Cd, Cr, Cu, Ni, Pb and Zn, and (v) gasoline, diesel, and motor oil, respectively. Results showed that: (i) FS removed 65% and 66% of clay (<0.002 mm) and silt (0.002-0.05 mm), respectively; (ii) FS removed 17%, and 11% of NH(4)-N and NO(3)-N, respectively and when NitroLoxx was added to the FS, removal of NH(4)-N load increased to 27%; (iii) total coliform and E. coli removal efficiencies were 74 and 75%, respectively, however, when BactoLoxx was added, removal efficiency increased to 87 and 99% for TC and 89 and 99% for E. coli, respectively; (iv) FS removal efficiency for Cd, Cr, Cu, Ni, Pb, and Zn ranged from 37 to 72%, and, when MetalLoxx was added, removal efficiency ranged from 47 to 74%; and (v) FS removal efficiency for the three petroleum hydrocarbons ranged from 43 to 99% and the addition of PetroLoxx increased motor oil and gasoline removal efficiency in the FS system.

Uncertainty evaluation of coliform bacteria removal from vegetated filter strip under overland flow condition.

Vegetated filter strips (VFS) have become an important component of water quality improvement by reducing sediment and nutrients transport to surface water. This management practice is also beneficial for controlling manure-borne pathogen transport to surface water. The objective of this work was to assess the VFS efficiency and evaluate the uncertainty in predicting the microbial pollutant removal from overland flow in VFS. We used the kinematic wave overland flow model as implemented in KINEROS2 coupled with the convective-dispersive overland transport model which accounts for the reversible attachment-detachment and surface straining of infiltrating bacteria. The model was successfully calibrated with experimental data obtained from a series of simulated rainfall experiments at vegetated and bare sandy loam and clay loam plots, where fecal coliforms were released from manure slurry applied on the top of the plots. The calibrated model was then used to assess the sensitivity of the VFS efficiency to the model parameters, rainfall duration, and intensity for a case study with a 6-m VFS placed at the edge of 200-m long field. The Monte Carlo simulations were also performed to evaluate the uncertainty associated with the VFS efficiency given the uncertainty in the model parameters and key inputs. The VFS efficiency was found to be <95% in 25%, <75% in 23%, and <25% in 20% of cases. Relatively long high-intensity rainfalls, low hydraulic conductivities, low net capillary drives of soil, and high soil moisture contents before rainfalls caused the partial failure of VFS to retain coliforms from the infiltration excess runoff.

Permeation enhancer effect of chitosan and chitosan derivatives: comparison of formulations as soluble polymers and nanoparticulate systems on insulin absorption in Caco-2 cells.

In this study four quaternized derivatives of chitosan: trimethyl chitosan (TMC), dimethylethyl chitosan (DMEC), diethylmethyl chitosan (DEMC) and triethyl chitosan (TEC) with degree of substitution of approximately 50+/-5% were synthesized and their effect on the permeability of insulin across intestinal Caco-2 monolayers was studied and compared with chitosan both in free-soluble form and in nanoparticulate systems. Transepithelial electrical resistance (TEER) studies revealed that all four chitosan derivatives in free-soluble forms were able to decrease the TEER value in the following order TMC>DMEC>DEMC=TEC>chitosan, indicating their abilities to open the tight junctions. Recovery studies on the TEER showed that the effect of the polymers on Caco-2 cell monolayer is reversible and proves the viability of cells after incubation with all polymers. A similar rank order was also observed when measuring the zeta-potentials of the various polymers in solution form. Transport studies of insulin together with the soluble polymers across Caco-2 cell layers showed the following ranking: TMC>DMEC>DEMC>TEC>chitosan which is in agreement with the strength of the cationic charge of the polymer. In comparison to the free-soluble polymers, the nanoparticles prepared by ionic gelation of the chitosan and its quaternized derivatives had much lower effect on decreasing the TEER by opening of the tight junctions. This can be explained by the reduced available amount of positive charge at the surface of the nanoparticles. In accordance with these results, the insulin loaded nanoparticles showed much less permeation across the Caco-2 cell monolayer in comparison to the free-soluble polymers. Mass balance transport studies revealed that a substantial amount of the nanoparticles has been entrapped into the Caco-2 monolayer or attached to the cell surface. It can thus be stated that while free-soluble polymers can reversibly open the tight junctions and increase the permeation of insulin, the nanoparticles had basically only a low effect on the opening of the tight junction and the paracellular transport of insulin across the Caco-2 cell monolayer. These data convincingly show that nanoparticles consisting of chitosan and its quaternary ammonium derivatives loaded with insulin are less effective in facilitating paracellular transport across Caco-2 cell monolayers than the corresponding free polymers.

Preparation, characterization and antibacterial activities of chitosan, N-trimethyl chitosan (TMC) and N-diethylmethyl chitosan (DEMC) nanoparticles loaded with insulin using both the ionotropic gelation and polyelectrolyte complexation methods.

TMC and DEMC, quaternized derivatives of chitosan, have been shown to have penetration enhancement properties and able to open the tight junctions of the intestinal epithelia at neutral and alkaline pH environments. The use of the nanoparticulate systems has the advantage of protecting the peptidic drugs from the harsh environment of the gastrointestinal tract. Hence, the aim of this study was to synthesize and characterize TMC and DEMC, both with quaternization degrees of 50+/-5%, which were then used to prepare insulin nanoparticles with two different methods: ionotropic gelation and the polyelectrolyte complexation (PEC) techniques. The obtained nanoparticles were then characterized for size, zeta potential, insulin loading and release as well as antibacterial activities. The results showed that nanoparticles prepared by the PEC method had higher insulin loading efficiency and zeta potential than those made by the ionotropic gelation method and may subsequently be used for further in vitro, ex vivo and in vivo studies. Moreover, the antibacterial studies suggest that the polymers in free form have higher antibacterial activity against Gram-positive bacteria than in the nanoparticulate form.

Evaluation of cerebral metabolism and quantitative electroencephalography after hypothermic circulatory arrest and low-flow cardiopulmonary bypass at different temperatures.

Although widely used for repair of complex cardiovascular pathologic conditions, long intervals of hypothermic circulatory arrest and low flow cardiopulmonary bypass may both result in cerebral injury. This study examines cerebral hemodynamics, metabolism, and electrical activity to evaluate the risks of cerebral injury after 60 minutes of hypothermic circulatory arrest at 8 degrees C, 13 degrees C, and 18 degrees C, compared with 60 minutes of low flow cardiopulmonary bypass at 18 degrees C. Thirty-two puppies were randomly assigned to one of four experimental groups and centrally cooled to the appropriate temperature. Serial evaluations of quantitative electroencephalography, radioactive microsphere determinations of cerebral blood flow, calculations of cerebral oxygen consumption, cerebral glucose consumption, cerebral vascular resistance, cerebral oxygen extraction, systemic oxygen metabolism, and systemic vascular resistance were done. Measurements were obtained at baseline (37 degrees C), at the end of cooling, at 30 degrees C during rewarming, and at 2, 4, and 8 hours after hypothermic circulatory arrest or low flow cardiopulmonary bypass. At the end of cooling, cerebral vascular resistance remained at baseline levels in all groups, but systemic vascular resistance was increased in all groups. Cerebral oxygen consumption became progressively lower as temperature was reduced: it was only 5% of baseline at 8 degrees C; 20% at 13 degrees C; and 34% and 39% at 18 degrees C. Quantitative electroencephalography was silent in the 8 degrees C and 13 degrees C groups, but significant slow wave activity was present at 18 degrees C. Systemic vascular resistance and cerebral oxygen consumption returned to baseline values in all groups by 2 hours after hypothermic circulatory arrest or low flow cardiopulmonary bypass, but cerebral vascular resistance remained elevated at 2 and 4 hours, not returning to baseline until 8 hours after hypothermic circulatory arrest or low flow cardiopulmonary bypass. All but two of the long-term survivors (27 of 32) appeared neurologically normal; after hypothermic circulatory arrest at 8 degrees and 18 degrees C two animals had an unsteady gait. Comparison of quantitative electroencephalography before operation and 6 days after operation showed a significant increase in slow wave activity (delta activity) after hypothermic circulatory arrest and low flow cardiopulmonary bypass at 18 degrees C, a change that suggests possible cerebral injury. Although undetected after operation by simple behavioral and neurologic assessment, significant differences in cerebral metabolism, vasomotor responses, and quantitative electroencephalography do exist during and after hypothermic circulatory arrest and low flow cardiopulmonary bypass at various temperatures and may be implicated in the occurrence of cerebral injury.(ABSTRACT TRUNCATED AT 400 WORDS)

Metabolic correlates of neurologic and behavioral injury after prolonged hypothermic circulatory arrest.

Thirty-two inbred weanling puppies were divided into four groups to study the effect on cerebral blood flow and metabolism of different hypothermic strategies for cerebral protection similar to those used during cardiac operations in infancy. All animals were cooled to 18 degrees C. The animals in the hypothermic control group were immediately rewarmed. One group underwent 30 minutes of hypothermic circulatory arrest at 18 degrees C; another group had 90 minutes of hypothermic circulatory arrest at 18 degrees C, and the final group had low-flow cardiopulmonary bypass (25 ml/kg per minute) at 18 degrees C for 90 minutes. All animals had preoperative and postoperative neurologic and behavioral evaluation and extensive intraoperative monitoring of cerebral blood flow, cerebral vascular resistance, and oxygen and glucose uptake and metabolism: quantitative electroencephalography was also monitored before, during and after operation, but those results are reported separately. Two animals in the 90-minute arrest group died, and all the survivors showed evidence of clinical, neurologic, and behavioral impairment on postoperative day 1, with residual abnormalities in all but one animal on day 6. In contrast, the survivors in all the other groups showed no significant clinical or behavioral sequelae. Cerebral metabolism was reduced only to 32% to 40% of baseline values at 18 degrees C in all groups, although systemic metabolism was only 16% of normal. Cerebral metabolism returned promptly to baseline in all groups during rewarming and remained at baseline levels throughout the 8 hours of follow-up. Cerebral blood flow showed marked hyperemia in the hypothermic arrest groups during rewarming but then significant reductions below baseline values in all groups except the controls at 2 and 4 hours after the operation, lasting as late as 8 hours after the operation in the 90-minute arrest group. Cerebral vascular resistance showed increases in all groups at 2 and 4 hours after the operation, which persisted in the 90-minute arrest group at 8 hours. Cerebral metabolism was maintained at baseline levels despite postoperative decreases in cerebral blood flow and increases in cerebral vascular resistance by increases in oxygen and glucose extraction. The result was very low sagittal sinus oxygen saturations in all groups, most marked in the 90-minute arrest groups, which had a saturation of only 24% 8 hours after the operation. Our data show a severe, prolonged disturbance in cerebral blood flow and cerebral vascular resistance after 90 minutes of hypothermic circulatory arrest at 18 degrees C, which correlates with clinical evidence of cerebral injury.(ABSTRACT TRUNCATED AT 400 WORDS)

The outcome of cardiac operations in infants weighing two kilograms or less.

OBJECTIVE: A review of our recent experience of operating on infants weighing 2 kg or less who had congenital heart disease was performed to determine the outcome of early surgical repair or palliation. METHODS: A retrospective review of hospital records was performed for infants who weighed 2 kg or less and who were identified to have undergone cardiac operation at our institution January 1992 to June 1997. The data collected included age, weight, gestational age, cardiac diagnosis, surgical procedure, and outcome measures such as length of stay, morbidity, and mortality rate. Outpatient charts were reviewed for follow-up survival and cardiac status. RESULTS: Thirty-three operations were performed on 30 patients. Median age at operation was 19.5 days (1 to 140 days), and median weight was 1.8 kg (1.1 to 2.0 kg). Cardiac diagnoses varied, with coarctation of the aorta and tetralogy of Fallot most common. Twenty-four patients were born at 37 or fewer weeks' gestation. Hospital survival was 83% with no difference in mortality rates based on age, weight, or type of surgical procedure. Premature infants tended to have worse hospital survival. Median postoperative length of stay was 39 days (6 to 122 days). Median duration of mechanical ventilation in survivors was 6 days (2 to 24 days). Neurologic complications were documented in eight patients. Of the 25 hospital survivors, 20 (80%) are alive with good cardiac status at a mean follow-up of 13 months. CONCLUSION: Cardiac operations in a selected group of infants weighing 2 kg or less can provide acceptable hospital survival. In most instances, complete repair is possible with good medium-term outcome in the survivors. Investigation into neurologic outcomes in these patients is warranted.

Cardiac xenotransplantation in primates.

Successful cardiac xenotransplantation would alleviate the severe shortage of donor organs that presently limits the availability of cardiac transplantation. Early attempts at human xenotransplantation achieved minimal success. However, the effectiveness of cyclosporine in nonhuman xenotransplant models has received little experimental investigation. We have therefore studied the effect of cyclosporine-based immunosuppression in primate cardiac xenograft models using cynomolgus monkey donors and baboon recipients. Donor hearts were transplanted heterotopically into the necks of recipients or in the orthotopic position. Recipients were treated with no immunosuppression (controls), cyclosporine and steroids, or cyclosporine, steroids, azathioprine, and antithymocyte globulin. Statistically significant prolongation of graft survival compared to the control group was observed in the heterotopic groups. Mean survival time of the cyclosporine-treated and steroid-treated heterotopic grafts was 61 days compared to 6 days for grafts in the control group (p = 0.01); the addition of azathioprine and antithymocyte globulin yielded a mean survival of 84 days (p less than 0.01). No significant increase in graft survival was noted in the orthotopic groups treated with either immunosuppressive regimen. Although long-term use of human xenografts as an alternative for heart replacement is not supported by these data, further investigation of the orthotopic model is clearly justified.

The natural history of thoracic aortic aneurysms.

Because improved understanding of the natural history of thoracic aneurysms would enhance our ability to determine in which cases the risk of surgical treatment is justified, the rate of enlargement of thoracic aneurysms and thoracoabdominal aneurysms was studied in 67 patients by means of serial computer-generated three-dimensional reconstructions of computed tomographic scans. Patients were followed for a mean of 1.5 +/- 0.15 years (0.2 to 5.35 years) with an average interval between examinations of 0.9 +/- 0.1 year (0.2 to 5.0 years). Thirty-nine patients continue to be followed; 7 were lost to follow-up; 14 died during follow-up (4 after aneurysm rupture), and 10 underwent an operation. Indications for operation included the presence of pain, an absolute aortic diameter larger than 8 cm, an increase in aortic diameter of more than 1 cm per year, or marked irregularity of aneurysm contour. Aortic diameter and volume data were generated from the aortic silhouette obtained by tracing each computed tomographic slice with a translucent digitizing tablet. Estimated change in aortic diameter after 1 year was 0.43 cm; estimated change in aortic volume was 88.1 ml. The impact of possible risk factors on the enlargement of aneurysms was examined by analysis of variance (p < 0.05). A significantly higher rate of aneurysm expansion was found in patients with a larger aortic diameter (> 5 cm) at diagnosis (change in diameter = 0.17 cm versus 0.79 cm; change in volume = 40 ml versus 141.8 ml), and in smokers (change in diameter = 0.35 cm versus 0.70 cm; change in volume = 78.3 ml versus 120.8 ml). Changes in diameter and volume for aneurysms of different initial diameters and volumes was predicted by exponential regression by the equations: change in diameter = 0.0167 (initial aortic diameter)2.1; change in volume = 0.0356 (initial aortic volume)1.322. No correlation was noted between the rate of enlargement and age, sex, or the presence of dissection. A history of hypertension correlated with a greater aortic diameter at diagnosis but did not significantly affect the rate of enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative electroencephalography: a method to assess cerebral injury after hypothermic circulatory arrest.

Although hypothermic circulatory arrest and low-flow cardiopulmonary bypass are routinely used for surgical correction of congenital cardiac anomalies, use of long durations of arrest, often required for more complex repairs, raises serious concerns about cerebral safety. Searching for an intraoperative assessment that can reliably predict cerebral injury, we have found an excellent correlation between changes in quantitative electroencephalography intraoperatively and immediately postoperatively after prolonged hypothermic arrest, and neurologic and behavioral evidence of cerebral injury. After epidural placement of four recording electroencephalographic electrodes and baseline neurologic/behavioral and electroencephalographic assessment, 32 puppies were randomly assigned to one of four groups: hypothermic controls in which cooling to 18 degrees C was followed immediately by rewarming, 30 minutes of hypothermic circulatory arrest at 18 degrees C, 90 minutes of arrest at 18 degrees C, and 90 minutes of low-flow cardiopulmonary bypass at 25 ml/kg per minute at 18 degrees C. An electroencephalogram was recorded at baseline, after cooling, during rewarming, and at 2, 4, and 8 hours after the start of rewarming, as well as before the operation and 1 week after the operation. Postoperative neurologic and behavioral outcome was assessed 24 hours after cardiopulmonary bypass and daily for 1 week by means of a graded scale in which 0 is normal and 12 and 13 indicate severe neurologic injury (coma and death). Thirty animals survived the experimental protocol: two animals in the 90-minute hypothermic arrest group died before neurologic evaluation could be completed, and the remainder exhibited various degrees of neurologic and behavioral impairment, more severe on day 1 than on day 6. No animal in the remaining groups had a significant neurologic deficit. Quantitative electroencephalographic analysis shows marked differences between the 90-minute arrest group and the controls in the percent electroencephalographic silence during rewarming and at 2 hours, and in the percent recovery of baseline power at 2, 4, and 8 hours. At 2 hours after the start of rewarming, a correlation between electroencephalographic amplitude and neurologic/behavioral score on day 1 was carried out, which predicts with great certainty (p < 0.00001) that if electroencephalographic power at this time is less than 500 microV2, overt neurologic injury will subsequently become apparent. In addition, a significant shift from higher to lower frequency in the day 6 postoperative electroencephalogram compared with baseline occurs only in the 90-minute arrest group.(ABSTRACT TRUNCATED AT 400 WORDS)

Revascularization of tracheal anastomosis following heart-lung transplantation.

The mechanism by which tracheobronchial arterial supply is reconstituted following heart-lung transplantation was investigated in seven monkeys (3 allografts, 2 autografts, and 2 nontransplanted control monkeys) and three patients. Descending tracheal branches of the thyrocervical arteries provided the major tracheal vascular supply. A collateral branch arising from atrial branches of the left coronary artery supplied tracheobronchial branches in the region of the carina in one allograft. In the three patients studied to date by coronary arteriography, a similar collateral supply to the region of the carina and proximal bronchi was demonstrated from atrial branches of both the left and right coronary circulation.

Heart-lung xenotransplantation in primates.

Heart and heart-lung xenografts are a potential solution to the shortage of donors. Concern over the adequacy of conventional immunosuppression in prevention of xenograft rejection, however, has hindered their use. Cyclosporine has not been successful in suppressing the rejection process in cardiac xenotransplantation, and other methods of immunosuppression need to be investigated. Therefore we studied the effect of preoperative total lymphoid irradiation (TLI) in combination with cyclosporine in a primate heart-lung xenograft model using cynomolgus monkey donors and baboon recipients. Heart-lung grafts were harvested from donors and transplanted orthotopically in baboons with use of cardiopulmonary bypass. Recipients were treated in one of three groups: (1) cyclosporine and steroids (controls), (2) cyclosporine and steroids plus TLI 20 Gy, or (3) cyclosporine, steroids, antithymocyte globulin, and TLI 6 Gy. Mean survival time of the baboons treated with cyclosporine and steroids was 8 +/- 0.6 days. The group receiving 20 Gy TLI had prohibitive perioperative mortality; however, one baboon lived an additional 90 days, and at autopsy the heart showed minimal rejection. Treatment with TLI at 6 Gy in combination with cyclosporine, antithymocyte globulin, and steroids comparatively prolonged survival (16 +/- 7.8 vs 8 +/- 0.6 days; p less than 0.001), and all animals in this group died of infection, with only minimal evidence of heart rejection noted in animals surviving 30 days. We conclude that the addition of TLI and antithymocyte globulin to cyclosporine-based standard immunosuppression is a potent immunosuppressant in heart-lung xenotransplantation; nevertheless, infection remains a common complication.

Altered cytoskeletal protein synthesis in rat cardiac isografts.

Adult rats underwent surgical placement of heterotopic cardiac isografts. From 14 to 60 days postoperatively, native heart and transplanted heart protein synthesis was determined. Right ventricle and left ventricle free walls from native and transplanted hearts were dissected, minced into cubes, and incubated in medium containing sulfur-35 methionine. Tissue was harvested, washed, and homogenized in buffer and fractionated centrifugally. Specific radioactivity of polypeptides from transplant isograft right and left ventricle fractions were 6.36 +/- 5.1 and 4.93 +/- 3.6 (mean +/- SD, x 10(-6) cpm/mg protein), respectively. In contrast, native isograft right and left ventricle specific radioactivity was 1.71 +/- 1.49 and 1.07 +/- 0.88 (mean +/- SD, x 10(-6) cpm/mg protein), respectively. Autoradiograms of two-dimensional electrophoretograms revealed increased radiodensity of resolved polypeptides from transplanted and native hearts, which comigrated with nonsarcomeric (beta, gamma) actins. Skeletin and tubulin were prominent on one-and two-dimensional autoradiograms from 14 to 60 days. Radiolabeling of alpha actin polypeptide maximized at 14 days and was found to decrease at 30 and 60 days in comparison with nonsarcomeric actin isoforms. Correlative myocardial microscopic sections showed no fiber hypertrophy, but fiber atrophy was found. Results suggest a relative increase in polypeptide synthesis in the heterotopic transplanted heart samples.

Short-term bridge to transplant using the BVS 5000 in a 22-kg child.

The availability of pulsatile mechanical assist devices for bridge to transplant in pediatric patients is limited owing to the patients' small sizes. Pulsatile devices offer potential advantages over nonpulsatile devices but the risk of hypertensive bleeding must be balanced against that of device thrombosis. We describe our experience using the BVS 5000 external pulsatile device in an 8-year old patient with a body surface area of 0.88 m2.

The incisional pulmonary artery band.

Occasionally early definitive repair of congenital heart disease carries prohibitive mortality, and interval pulmonary artery banding is necessary to protect the pulmonary arterial bed and improve systemic perfusion or prepare a systemic left ventricle for a later arterial switch operation. We describe our technique for effectively banding the pulmonary artery.

Aortic dissection involving a double aortic arch with a right descending aorta.

We report the successful surgical treatment of a 67-year-old man with a double aortic arch, right descending aorta, and a subacute dissection of the descending thoracic aorta using hypothermic circulatory arrest.

A simplified method for the occlusion of the venae cavae during cardiopulmonary bypass.

The method of caval occlusion during cardiopulmonary bypass using snares is at times cumbersome. An alternative technique of caval occlusion around venous cannulas using elastomer tape is described.

Hypothermic preservation of the heart and lungs with Collins solution: effect on cardiorespiratory function following heart-lung allotransplantation in dogs.

The effect of preserving the heart and lungs with hypothermia and Collins solution was studied in 13 mongrel dogs undergoing combined heart-lung transplantation. The five control animals who underwent an immediate transplant following Collins solution perfusion had small increases in extravascular lung water when measured 2.5 hours posttransplant as seen in a previous study. The eight animals who had hypothermic preservation following Collins solution perfusion had significantly higher extravascular lung water than controls (16.3 +/- 1.8 ml/kg in preserved animals; 11.2 +/- 1.7 ml/kg in controls p less than 0.05). The level of lung water reached at 2.5 hours postoperatively was similar to that reached with a previously reported, unacceptable preservation technique. Survival beyond this point was poor due to severe pulmonary edema. We conclude that the use of this solution, given under the experimental conditions which we describe, is not acceptable for hypothermic preservation of the heart and lungs for combined transplantation.