Force-Induced Alignment of Nanofibrillated Bacterial Cellulose for the Enhancement of Cellulose Composite Macrofibers.

Bacterial cellulose, as an important renewable bioresource, exhibits excellent mechanical properties along with intrinsic biodegradability. It is expected to replace non-degradable plastics and reduce severe environmental pollution. In this study, using dry jet-wet spinning and stretching methods, we fabricate cellulose composite macrofibers using nanofibrillated bacterial cellulose (BCNFs) which were obtained by agitated fermentation. Ionic liquid (IL) was used as a solvent to perform wet spinning. In this process, force-induced alignment of BCNFs was applied to enhance the mechanical properties of the macrofibers. The results of scanning electron microscopy revealed the well-aligned structure of BCNF along the fiber axis. The fiber prepared with an extrusion rate of 30 m min-1 and a stretching ratio of 46% exhibited a strength of 174 MPa and a Young's modulus of 13.7 GPa. In addition, we investigated the co-spinning of carboxymethyl cellulose-containing BCNF with chitosan using IL as a "container", which indicated the compatibility of BCNFs with other polysaccharides. Recycling of the ionic liquid was also verified to validate the sustainability of our strategy. This study provides a scalable method to fabricate bacterial cellulose composite fibers, which can be applied in the textile or biomaterial industries with further functionalization.

[Aortic Root Partial Reconstruction Combined with Intraoperative Aortic Dissection:Report of a Case].

A 73-year-old woman with Valsalva aneurysm and mitral regurgitation was introduced to our department. We performed combined operation including aortic root partial repair and mitral valve repair. After wenning from cardiopulmonary bypass, intraoperative aortic dissection was confirmed by transesophageal echocardiography from the ascending aorta to the descending aorta, entry was near to proximal anastomosis line of the ascending aorta. To avoid heart failure, the ascending aorta wrapping by prothesis graft was performed to protect from urgent rupture postoperative at first stage. According to contrast computed tomography (CT) findings, location of entry was correspond with aortic clamping. We performed partial aortic replacement including innominate artery reconstruction for her at fourth day postoperative for treating aortic dissection at second stage. Postoperative course was uneventful.

Resection of left atrial appendage aneurysm and full maze procedure as curative management for stroke recurrence.

Left atrial appendage aneurysm (LAAA) is a rare congenital heart anomaly that frequently becomes apparent after middle age. We report a case of LAAA in a 63-year-old woman with stroke. After stabilization of ischemic cerebral stroke, the patient underwent left atrial appendectomy with full maze procedure and tricuspid annuloplasty under cardiac arrest with cardiopulmonary bypasss. She has been living a healthy life without anticoagulants postoperatively. Resection and the full-maze procedure is an efficacious and durable procedure for LAAA with chronic atrial fibrillation.

[Valve Replacement for Tricuspid Regurgitation with Congenitally Corrected Transposition of the Great Arteries].

Congenitally corrected transposition of the great arteries accounts for less than 1% of congenital heart diseases, and is defined as ventriculoarterial and atrioventricular discordance. We report a case of a 56-year-old woman complaining of persistent cough, who was diagnosed with congenitally corrected transposition of the great arteries and dextrocardia. Moderate regurgitation of the systemic tricuspid valve was revealed. The surgeon was positioned on the left side of the patient, and performed tricuspid valve replacement through the left atrium. Furthermore, mitral valve annuloplasty, atrial septal defect closure, and myocardial electrode implantation were performed. The postoperative course was uneventful.

Rate of Stenotic Bicuspid Aortic Valve Aortic Dilatation After Aortic Valve Replacement, Calculated Using a 3-Dimensional Reconstruction Tool.

BACKGROUND: Progression of asymmetric dilated aorta associated with bicuspid aortic valve (BAV) is difficult to evaluate conventionally. The aim of the study was to calculate the rate of progression of the dilated BAV aorta after aortic valve replacement (AVR) using a 3-dimensional (3-D) reconstruction tool.Methods and Results:Fourteen stenotic BAV and 14 stenotic tricuspid aortic valve (TAV) patients with mildly dilated ascending aorta were reviewed. A patient-specific 3-D aortic model was reconstructed from preoperative and postoperative computed tomography data (BAV, 2.5±1.9 years after AVR; TAV, 2.2±1.8 years after AVR). Aortic diameter, including the longest and shortest, was measured on the maximum perpendicular cross-section tangential to the 3-D centerline of the reconstructed model. The longest diameter was defined as that passing through the distal point of the greater curvature of the aorta. The shortest diameter was defined as perpendicular to the longest. The progression rates were compared between the BAV and TAV groups. The progression rate of ascending aortic diameter was greater for BAV (longest diameter, 1.02±1.03 vs. -0.075±0.78 mm/year, P<0.001; shortest diameter, 0.41±0.62 vs. -0.016±0.59 mm/year, P=0.003). The longest diameter of the proximal arch also grew more rapidly in the BAV group (P<0.001). CONCLUSIONS: Ascending aortic dilatation with stenotic BAV progresses after AVR at a maximum rate of 1.02±1.03 mm/year. Expansion toward the greater curvature frequently progresses to the proximal arch.

Cannulation needle-induced anterior wall tenting of internal jugular vein causing posterior wall penetration.

Unintentional posterior venous wall penetration during internal jugular vein (IJV) cannulation may cause critical arterial injuries in spite of ultrasound guidance. We aimed to evaluate whether small venous diameter and anterior venous wall tenting by a needle would be associated with posterior venous wall penetration, and to seek factors related to the venous wall tenting. We conducted a retrospective review in patients who underwent IJV cannulation. Using an ultrasound view obtained when puncturing, venous diameter, venous wall thickness, anterior venous wall tenting length, and needle angle were measured, and posterior venous wall penetration was determined. Eleven cannulations in 56 patients were assigned to posterior venous wall penetration. Small venous diameter (p = 0.004), and long anterior venous wall tenting (p = 0.007) were associated with posterior venous wall penetration. The longer anterior venous tenting would be expected with reducing needle angle (p = 0.004) or increasing anterior venous wall thickness (p = 0.006). In conclusion, small IJV and anterior venous wall tenting lead to posterior venous wall penetration. Anterior venous wall tenting is longer with reducing needle angle, or increasing the anterior venous wall thickness.

Cardiac stab injury by a bodkin.

A 46-year-old male had a cardiac stab injury resulting in cardiac tamponade as a result of a suicide attempt using a bodkin, a sharply pointed instrument for making holes. The patient was transferred to our hospital about 12 hours after the injury. Pericardiotomy at the emergency operation revealed the penetration of the right ventricle and the hole was repaired following removal of the bodkin. Postoperative course was uneventful.

Aortic valve perforation due to latent infective endocarditis.

A 64-year-old man underwent aortic valve replacement for aortic regurgitation. The aortic valve was perforated in the noncoronary cusp. Pathological findings showed that the perforation probably occurred due to infective endocarditis. However, the patient had no obvious inflammatory signs preoperatively, to suggest latent infective endocarditis.

Remarkable improvement of hemodynamics by continuous hemodiafiltration in patients after operation for thoracic aortic dissection.

Severe circulatory failure after cardiovascular surgery is occasionally difficult to treat and the mortality risk is high. Systemic inflammatory response syndrome (SIRS) is one of the complications resulting in circulatory failure and, continuous hemodiafiltration (CHDF) seems to be a potentially effective treatment to improve the critical condition by removing proinflammatory cytokines. We present two recent cases of SIRS with critical circulatory failure which were successfully treated by CHDF after operation for thoracic aortic dissection.

Surgical management of tunnel-like subaortic stenosis via ventricular septal defect in a patient with the interrupted aortic arch.

A 24-day-old male with interrupted aortic arch (type B), ventricular septal defect, and tunnel-like subaortic stenosis underwent a one-stage surgical treatment. The operative procedure comprised reconstruction of the aortic arch, transatrial excision of the subaortic fibromuscular tissue via the ventricular sepatal defect, and patch closure of the defect. The patient tolerated the procedure well and the postoperative echocardiography demonstrated a residual pressure gradient across the left ventricular outflow tract of 20 mmHg. Our result suggests that the transatrial surgical management of subaortic stenosis via the ventricular sepatal defect produces a safe and promising surgical option.

Mitral valve repair in a child with infectious endocarditis followed by meningitis.

A one-year-old boy without congenital cardiac anomaly suffered from meningitis and subsequent acute infective endocarditis that resulted in mitral regurgitation. During antibiotic therapy and management of congestive heart failure, he suddenly developed an acute subdural hematoma, and an aneurysm of the cerebral artery was detected by brain computed tomography. Clipping of the aneurysm was performed by neurosurgery, and 9 days after clipping, we performed mitral valve repair. Kay-Reed annuloplasty was performed and annulus size was reduced from 20 to 16 mm, and edge to edge repair of anterior and posterior leaflets near the commissure to reconstruct ruptured anterior leaflet chordae. This method is easy and useful to control mitral regurgitation when mitral chordae are detached from near commissure especially in child case.

Transventricular annuloplasty for ischemic mitral regurgitation in the Dor procedure.

Since the residual mitral regurgitation after the Dor procedure contributes to increasing postoperative mortality, repair of mitral regurgitation has become one of the essential surgical approaches. We describe two cases of transventricular posterior annuloplasty using a trimmed Duran ring for surgical management of ischemic mitral regurgitation performed with the Dor procedure. This procedure is easy to perform and provides secure annuloplasty because the mitral annulus can be easily exposed through the same ventriculotomy incision.

Production of growth related oncogene protein-alpha in human umbilical vein endothelial cells stimulated with soluble interleukin-6 receptor-alpha: role of signal transducers, janus kinase 2 and mitogen-activated kinase kinase.

Growth-related oncogene protein-alpha (GRO-alpha) is a member of the C-X-C chemokine family with a wide variety of biological activities. We studied the production of GRO-alpha by human umbilical vein endothelial cells (HUVEC) in response to the stimulation with soluble form of interleukin-6 receptor alpha (sIL-6R). sIL-6R stimulated HUVEC to express GRO-alpha mRNA and secrete GRO-alpha protein in concentration-and time-dependent manners. The sIL-6R-induced GRO-alpha expression was inhibited by the pretreatment of the cells with AG490, a janus kinase 2 (JAK2) inhibitor, or with U0126, a MAP kinase-ERK kinase (MEK) inhibitor. sIL-6R also induced the phosphorylation of both Src homology 2-protein tyrosine phosphatase-2 (SHP-2), signal transducer and activator of transcription 3 (STAT3) and MEK. AG490 pretreatment inhibited the MEK phosphorylation but did not affect the STAT3 phosphorylation. We conclude that sIL-6R induces GRO-alpha expression in HUVEC through the activation of JAK2 and MEK.