Hypothermic effects on gas exchange performance of membrane oxygenator and blood coagulation during cardiopulmonary bypass in pigs.

INTRODUCTION: Whether hypothermic cardiopulmonary bypass could attenuate both blood coagulation and platelet activation compared to normothermic cardiopulmonary bypass remains elusive. METHODS: Biocompatibility of a polymer-coated cardiopulmonary bypass circuit was comparatively assessed by plasma proteomics between juvenile pigs undergoing hypothermic (23°C) cardiopulmonary bypass and those undergoing normothermic (37°C) cardiopulmonary bypass (n = 6, respectively). Plasma samples were taken three times: 5 minutes after initiation of cardiopulmonary bypass (T5, before cooling), just before declamping and rewarming (Tc), and just before termination of cardiopulmonary bypass (Trw, 120 minutes). Proteomic analysis was quantitively performed by isobaric tags for relative and absolute quantification labeling. Thrombin-antithrombin complexes (TAT III) were measured by enzyme immunoassay, and vitamin K-dependent protein C (PROC), ß-thromboglobulin (TG), and P-selectin were measured by enzyme-linked immunosorbent assay. Blood gas analyses evaluated oxygenator performance. RESULTS: Hypothermic cardiopulmonary bypass had a significantly higher PaO2 at Tc and lower PaCO2 at Trw than normothermic cardiopulmonary bypass. Two hundred twenty-four proteins were identified with statistical criteria of both protein confidence (>95%) and false discovery rate (<5%). Six of these proteins significantly decreased at Tc than at T5 in hypothermic cardiopulmonary bypass (p = 0.02-0.04), with three related to platelet degranulation. Protein C decreased at Trw compared with T5 in normothermic cardiopulmonary bypass (p = 0.04). Thrombin-antithrombin complex had a slightly larger increase with normothermic cardiopulmonary bypass at Trw than with hypothermic cardiopulmonary bypass. ß-thromboglobulin and P-selectin levels were significantly lower at Trw with hypothermic cardiopulmonary bypass than with normothermic cardiopulmonary bypass (p = 0.04). CONCLUSION: Hypothermic cardiopulmonary bypass attenuated platelet degranulation/blood coagulation and maintained better oxygenator performance compared to normothermic cardiopulmonary bypass in juvenile pigs.

Polymer-coated cardiopulmonary bypass circuit attenuates upregulation of both proteases/protease inhibitors and platelet degranulation in pigs.

INTRODUCTION: Interaction of blood with a cardiopulmonary bypass (CPB) circuit activates the coagulation-fibrinolysis, complement and kinin-kallikrein systems that are mainly supported by proteases and their inhibitors. METHODS: Biocompatibility of a new polymer-coated (SEC-coated) CPB circuit was globally evaluated and compared with that of a non-coated CPB circuit by quantitative proteomics, using isobaric tags for relative and absolute quantification labeling tandem mass spectrometry. Plasma samples were taken three times (5 min after initiation of CPB, just before declamping and just before termination of CPB) in 12 pigs undergoing 120 min of CPB with the SEC-coated CPB circuit or a non-coated CPB circuit (n = 6, respectively). RESULTS: Identified were 224 proteins having high protein confidence (>99%) and false discovery rate (FDR) <5%. Among these proteins, there were 25 significantly upregulated proteins in the non-coated CPB group compared to those in the SEC-coated CPB group. Dominant protein functions were platelet degranulation, serine-type (cysteine-type) endopeptidase inhibitor activity and serine-type endopeptidase activity in the 25 proteins. Bioinformatics analysis similarly revealed upregulation of proteins belonging to platelet degranulation and negative regulation of endopeptidase activity in the non-coated CPB group; these upregulations were effectively attenuated in the SEC-coated CPB group. CONCLUSION: The new polymer (SEC)-coated CPB circuit effectively attenuated upregulation of proteins compared to the non-coated CPB circuit. These proteins were associated with both proteases/protease inhibitors and platelet degranulation.

Evaluation of the anti-inflammatory actions of various functional food materials including glucosamine on synovial cells.

The anti-inflammatory actions of glucosamine (GlcN) on arthritic disorders involve the suppression of inflammatory mediator production from synovial cells. GlcN has also been reported to inhibit the activation of the p38 mitogen-activated protein kinase (MAPK) pathway. The present study aimed to determine the cooperative and anti­inflammatory actions of functional food materials and evaluated the production of interleukin (IL)­8 and phosphorylation of p38 MAPK in IL-1ß-activated synovial cells, incubated with the combination of GlcN and various functional food materials containing L­methionine (Met), undenatured type II collagen (UC­II), chondroitin sulfate (CS), methylsulfonylmethane (MSM) and agaro-oligosaccharide (AO). The results indicated that Met, UC­II, CS, MSM and AO slightly or moderately suppressed the IL-1ß-stimulated IL­8 production by human synovial MH7A cells. The same compounds further decreased the IL­8 level lowered by GlcN. Similarly, they slightly suppressed the phosphorylation level of p38 MAPK and further reduced the phosphorylation level lowered by GlcN. These observations suggest a possibility that these functional food materials exert an anti­inflammatory action (inhibition of IL­8 production) in combination with GlcN by cooperatively suppressing the p38 MAPK signaling (phosphorylation).

Development of an iatrogenic aneurysm nine months after pacemaker implantation: Consideration of causes and treatment.

Careful technique is required in pacemaker implantation to avoid serious iatrogenic complications. A 70-year-old woman on an anticoagulant agent underwent pacemaker implantation. Nine months after implantation, a 35-mm pulsatile mass appeared just near the cranial edge of the generator. An iatrogenic pseudoaneurysm was suspected because ultrasonography showed communication with the blood stream through tiny artery. The resected mass proved to be a pseudoaneurysm. This was a rare case of iatrogenic delayed pseudoaneurysm appearing nine months later. It is essential to keep in mind the risk of pseudoaneurysm after pacemaker implantation, especially when the patient takes anticoagulant agents. .

[Influence of an Operative Strategy on Outcomes of Acute Type A Aortic Dissection Cases].

OBJECTIVE: To compare the surgical outcomes of total arch replacement with the outcomes of ascending aorta replacement in patients with acute Stanford type A aortic dissection. METHODS: From April 2002 to May 2014, 90 patients with acute Stanford type A aortic dissection underwent emergency surgical treatment at our institution. Among them, 16 underwent total arch replacement and 74 underwent ascending aorta replacement. The decision to perform total arch versus ascending aorta replacement was dependent on an intimal tearing site. RESULTS: There were no statistically significant differences in characteristics between the groups with regard to the 2 surgical procedures. Twenty early deaths were reported, but there was no statistically significant difference in mortality rate between the groups. The aortic operation had to be redone in 12 patients. The reoperations were not associated with an increased risk of death or neurological complications. Overall 5-year survival rates were 68% in the ascending aorta replacement group and 59% in the total arch replacement group. There was no statistically significant difference between the groups. CONCLUSIONS: The surgical outcome and prognosis of ascending aorta replacement is satisfactory among patients undergoing treatment of acute type A aortic dissection.

SV40 VP1 major capsid protein in its self-assembled form allows VP1 pentamers to coat various types of artificial beads in vitro regardless of their sizes and shapes.

The icosahedral capsid structure of simian virus 40 (diameter, 45 nm) consists of 72 pentameric subunits, with each subunit formed by five VP1 molecules. Electron microscopy, immuno-gold labeling, and ζ-potential analysis showed that purified recombinant VP1 pentamers covered polystyrene beads measuring 100, 200, and 500 nm in diameter, as well as silica beads. In addition to covering spherical beads, VP1 pentamers covered cubic magnetite beads, as well as the distorted surface structures of liposomes. These findings indicate that VP1 pentamers could coat artificial beads of various shapes and sizes larger than the natural capsid. Technology based on VP1 pentamers may be useful in providing a capsid-like surface for enclosed materials, enhancing their stability and cellular uptake for drug delivery systems.

[Resection of Recurrent Leiomyosarcoma of the Inferior Vena Cava with Extention into the Right Atrium and Z stent implantation；Report of a Case].

79-year-old woman, who had undergone resection of a leiomyosarcoma of the inferior vena cava(IVC)[at 68 years old], was admitted to our hospital due to local recurrence of the leiomyosarcoma with extention into the right atrium (RA). She had progressive dyspnea and bilateral edema of the lower extremities. A computed tomography (CT) scan revealed a tumor that obstructed the IVC. A transthoracic echocardiography showed a large mobile right atrial mass. To prevent sudden death, a reoperation was performed. The tumor in the IVC and the RA was resected under deep hypothermic circulatory arrest. A postoperative CT scan showed stenosis of the IVC by residual tumor, and a Z-stent was therefore implanted in the IVC. Postoperative recovery was uneventful and the patient no longer showed any symptoms.

In vivo identification of sentinel lymph nodes using MRI and size-controlled and monodispersed magnetite nanoparticles.

PURPOSE: To develop a sentinel lymph node (SN) identification method using accurately synthesized magnetic nanoparticles (MNPs), as an enhanced specific SN tracer in combination with magnetic resonance imaging (MRI) in intact rodent and SN metastasis models. MATERIALS AND METHODS: Three sizes of MNPs were originally synthesized. We developed an experimental rat SN model, with brachial lymph nodes (Br) as the SN and the axillary lymph node (Ax) as the second lymph node, and injection of MNPs via the front paw. SN detectability was evaluated in vivo using T1 -weighted MR images after injection of the synthesized MNPs, and the amount of iron in the Br and in the Ax was assessed using inductively coupled plasma optical emission spectrometry. RESULTS: The highest ratios of the amount of iron in the Br versus the Ax were 3.1 and 3.3, using 20-nm MNPs after 2- and 24-hour injections. The appropriate dose and particle diameter for MRI detection was optimized, and the SN was optimally distinguished in the normal and metastatic rat models using MRI after a 0.4 mg/kg 20-nm MNP injection. CONCLUSION: We developed and optimized a useful SN identification method using MRI in rodent models.

A mechanical plant defense defines the opening of a phenological window for gall induction by Asphondylia aucubae (Cecidomyiidae: Diptera).

Many insect herbivores can only use hosts during a specific phenological stage, i.e., a phenological window. Previous studies have primarily examined the effects of these windows on insect herbivores, but relatively little is known about the mechanisms controlling the phenological windows. In most gall insect systems, phenological windows have been attributed to the short duration of physiologically active plant tissues that induce gall formation (reactive plant tissue). In the fruit gall midge, Asphondylia aucubae Yukawa and Ohsaki, and the host plant (i.e., Aucuba japonica) system, the disappearance of reactive plant tissue closes the phenological window, but its presence does not define the opening of the window. The hard endocarp of the fruit covers most potential oviposition sites just before the midge emergence season, but decreases in proportional cover during the emergence season. We experimentally manipulated the timing of oviposition relative to fruit development. Midges that emerged earliest and attacked fruits during their earliest developmental stages were unable to oviposit because of intact, hard endocarps, whereas their counterparts that emerged later could oviposit more readily through cracks in the endocarp. We noted possible oviposition avoidance behavior and the necessity of more frequent (repeated) ovipositor insertions to intensively stimulate the decreased reactive tissues during the latter half of the emergence season. Overall, our results indicated that the fragmentation of the defensive, hard endocarp of the host plant defines the opening of the phenological window in this plant-herbivore system.