Influence of Cryopreservation on Structural, Chemical, and Immunoenzymatic Properties of Aortic Valve Allografts.

OBJECTIVES: The problems in preparing (including cryopreservation) and implanting aortic valve allografts (AVAs) is widely elaborated, but some issues need explanation. MATERIAL AND METHODS: Twenty AVAs cryopreserved in dimethylsulphoxide/RPMI solution under -160°C for 1-15 years and 3 controls stored at +4°C up to 2 weeks, from 19 male and 4 female donors, aged 20-51, ±30.8 years, were examined using light (LM), digital (DM), and scanning electron microscopy (SEM), energy dispersion X-ray spectroscopy (EDS), and enzyme-linked immunosorbent assay immunoenzymatic tests (PECAM1, CD34). RESULTS: All AVAs were macroscopically correct. LM revealed normal structure of leaflets but massive endothelial decellularization (±59 cells remained on the surface of 5 mm scraps). DM and SEM demonstrated generally normal collagen structures, but local alterations, probably influenced by freezing-thawing (gaps, separated plates) or being initial phase of native degeneration (grains). EDS detected a little elevated calcium amount in 1 specimen only. The mean PECAM1 and CD34 concentrations were at similar low level in all probes. CONCLUSIONS: Fresh and cryopreservation technologies did not significantly influence the basic properties of AVA leaflets; however, massive endothelial decellularization was present in both groups. Therefore, no endocardial cell activity nor signs of inflammation were observed. These results were independent of donors' age and sex, processing technology, and time of storage of cryopreserved AVAs.

Polish Guidelines on Diagnosing Brain Death in Adults vs the International Perspective: Are We in Need of an Update?

INTRODUCTION: The Polish definition of brain death originated from the original Harvard criteria and has been revised several times. Practitioners worldwide are required to regularly update their national guidelines on the definition of brain death to fit the latest international research concerning this topic. AIMS: (1) Compare current Polish guidelines on diagnosing brain death in adults with the American, British, Australian, and New Zealand recommendations; and (2) evaluate existing differences for the purposes of updating the Polish guidelines. MATERIALS: Current guidelines on diagnosing brain death published by The American Academy of Neurology (USA, 2010), the Academy of Medical Royal Colleges (United Kingdom, 2008), the Australian and New Zealand Intensive Care Society (AU/NZ, 2013), and the Polish Ministry of Health (Poland, 2007). RESULTS: All guidelines outline similar recommendations regarding the need for a suitable observation period before clinical examination and for basic medical conditions and exclusions to be evaluated before testing, the obligatory role of clinical examination including brain stem reflexes and apnea testing, and the nonobligatory role of ancillary tests. There is no consensus regarding: the recommended time period of pretesting observation, the number, seniority, and specialty of clinicians performing the testing, the role of additional exclusion criteria, the repeatability of clinical tests, the methodology of apnea testing, and recommended confirmatory tests. CONCLUSIONS: Current Polish guidelines on diagnosing brain death in adults remain up-to-date in comparison to the guidelines analyzed, though additional recommendations concerning apnea testing, drug and toxin clearance, and medical exclusion criteria for potential brain dead patients might be considered an important point of interest in the future.

Correlations between demographics, knowledge, beliefs, and attitudes regarding organ transplantation among academic students in Poland and their potential use in designing society-wide educational campaigns.

BACKGROUND: Family objection precludes 10% of cadaveric donations in Poland. Academic students represent a socially influential demographic group. Educational campaigns improving their attitudes may increase overall donation rates. The aim of this study was to assess correlations between knowledge, beliefs, and attitudes regarding organ transplantation and the identification of the most critical factors affecting one's donation preferences. METHODS: Eight hundred students from 4 public universities in Krakow, Poland, participated in the study; participants were diverse in age, sex, hometown population, and academic discipline (400 medical, 400 non-medical). This cross-sectional study was conducted with the use of a group-administered questionnaire inquiring into demographics, general and professional knowledge, beliefs, and attitudes toward organ transplantation. RESULTS: Attitudes toward organ donation correlate positively with beliefs (ρ = 0.36), general knowledge (ρ = 0.48), and professional knowledge (ρ = 0.23) scores. Beliefs were proven to correlate with general (ρ = 0.21) and professional (ρ = 0.26) knowledge as well. Misconceptions about the medical criteria allowing cadaveric organ recovery, distrust for brain death reliability, fear of "do not resuscitate" approach toward Organ Donor Card holders, a strong belief in organ trafficking, and unawareness of family members' attitudes are the most important factors influencing one's refusal/uncertainty to donate. CONCLUSIONS: Knowledge, attitudes, and refusal rates differ, depending on the academic discipline as well as other demographics, indicating a need for a specifically targeted approach in designing educational campaigns. Sources of knowledge are related to donation rates, with pre-academic education evaluated as unfavorable, as opposed to healthcare providers and the media.

Current state of knowledge, beliefs, and attitudes toward organ transplantation among academic students in Poland and the potential means for altering them.

INTRODUCTION: Students manifest a high level of social commitment. Improving their knowledge and developing more positive attitudes toward organ transplantation may increase the number of organ donations. This study was an assessment of the knowledge and attitudes toward organ transplantation among young people in Poland, with an overview of current beliefs and potential methods for improving transplantology awareness. SUBJECTS AND METHODS: The study included 400 medical students and 400 nonmedical students from public universities in Kraków, Poland. Data were collected by using an anonymous questionnaire examining demographic factors and transplantology issues. RESULTS: Despite the overall positive attitude toward transplantology among academic students in Poland, the state of knowledge of the nonmedical population remains relatively low. The most important issues for social education to focus on are the role of presumed consent and brain death diagnosis, actual hazards of living donations, recipient qualification criteria, and the attitudes of religious authorities. The overall level of knowledge and the number of positive attitudes were significantly higher among medical students than among nonmedical students, proving that formal educational programs are more efficient than the more accessible but less reliable sources of knowledge. CONCLUSIONS: Introduction of transplantology issues in schools and churches, promoting the positive outcomes of organ transplantation rather than negating false beliefs, and eliminating misleading information from the media may significantly increase young people's knowledge and result in more positive attitudes toward transplantology in a society-wide fashion. This outcome could create a favorable background for introducing an opt-in system of consent for organ donation.

Organ Donor Cards--concepts versus reality: a study among academic students in Poland.

INTRODUCTION: Organ Donor Cards (ODCs), despite presenting no legal value in Poland, are considered an important mean of expressing one's intent toward organ donation. This study was an assessment of the effectiveness of ODCs in social communication and their connection to one's transplantology knowledge, attitude, and beliefs. SUBJECTS AND METHODS: The study included 400 medical students and 400 nonmedical students from public universities in Kraków, Poland. Data were collected by using an anonymous questionnaire with attached ODCs examining demographic factors and transplantology issues. RESULTS: Approximately 41% of students possess an ODC, and the majority of the remaining group are willing to sign one. The main reasons for not having an ODC originate from a positive or neutral interest in organ donation (eg, previous conversation with the family, lack of knowledge about ODCs and how to obtain them) rather than a negative one (fear of "do not resuscitate" approach or organ trade) and remain open for modification. Eighty-three percent of ODC holders are aware of its ethical rather than legal value, and 3 of 4 have informed their family about their attitude, proving ODCs are an effective way of expressing one's intent toward organ donation. An actual ODC holder presents a more explicit positive attitude than a potential one, and his or her level of transplantology knowledge is significantly higher. CONCLUSIONS: The support for informed consent for organ donation is particularly strong among students presenting with the highest level of transplantology awareness, with a good/very good state of knowledge and extremely positive attitudes, already owning an ODC, and using it correctly. Thus, such a decision will have the status of a truly conscious and thoroughly considered choice.

Brain death versus irreversible cardiac arrest--the background and consequences of young people's opinions on stating death in Polish transplantology.

BACKGROUND: Brain death and irreversible cardiac arrest (ICA) are legally valid diagnoses obligatory for stating organ donors' death in Poland. Their misinterpretation may affect one's attitude toward organ donation. We assessed young people's knowledge and attitudes toward stating death in transplantology and their impact on attitude toward organ transplantation. METHODS: A total of 400 medical and 400 nonmedical students from public universities in Kraków, Poland, participated. Data were collected with a questionnaire examining demographic factors and transplantologic issues. RESULTS: Brain death diagnosis has a stronger association with stating death in transplantology than ICA, although the level of trust for this diagnosis remains relatively low among nonmedical respondents (38.5% vs 78.5%). Professional knowledge about stating brain death did not correlate with the level of trust for said diagnosis as strongly as it was expected, suggesting the presence of alternate contributing factors, some identified as doubts about brain death criteria (31.5%), distrust for the medical staff's education (25%), and objectivity (20%). CONCLUSIONS: The number of nonpositive attitudes toward organ transplantation was significantly higher among respondents unwilling to accept brain death as the death of a human being, a statement proven to be related to one's opinion about the reliability of said diagnosis, one's awareness of an alternative diagnosis of ICA, and one's general transplantologic knowledge. However, a low number of respondents acknowledging ICA as the only diagnosis valid for stating death of a cadaveric donor (7.6%) suggests that the majority of young Poles are willing to accept brain death as an equally valid, if not more significant, diagnosis.

Nɛ-homocysteinyl-lysine isopeptide is associated with progression of peripheral artery disease in patients treated with folic acid.

OBJECTIVE: Folic acid (FA) administration can reduce plasma total homocysteine (tHcy); however, it fails to decrease cardiovascular events and progression of peripheral artery disease (PAD). Nɛ-homocysteinyl-lysine isopeptide (Nɛ-Hcy-Lys) is formed during catabolism of homocysteinylated proteins. We sought to investigate factors that determine the presence of Nɛ-Hcy-Lys in PAD patients with hyperhomocysteinemia receiving FA. PATIENTS AND METHODS: We studied 131 consecutive PAD patients with tHcy > 15 µmol l(-1) taking FA 0.4 mg d(-1) for 12 months. Serum Nɛ-Hcy-Lys was determined by high-performance liquid chromatography (HPLC). We also measured interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), asymmetric dimethylarginine (ADMA) and 8-iso-prostaglandin F(2α) (8-iso-PGF(2α)). RESULTS: FA administration resulted in a 70.5% decrease in tHcy (p < 0.0001). However, serum Nɛ-Hcy-Lys was detectable in 28 (21.4%) patients on FA who were more frequently current smokers and survivors of ischaemic stroke (p < 0.001). They had higher tHcy by 46.0%, PAI-1 by 51.7%, 8-iso-PGF(2α) by 59.1% and ADMA by 26.4% (all, p < 0.0001). The presence of Nɛ-Hcy-Lys was associated with lower ankle-brachial index (ABI) values (p < 0.001) and higher prevalence of cardiovascular events (p < 0.001) following therapy. CONCLUSION: The presence of Nɛ-Hcy-Lys in one-fifth of hyperhomocysteinemic individuals with PAD despite FA treatment is associated with progression of PAD and with increased ADMA formation, oxidative stress and hypofibrinolysis.

[Knowledge transfer methods in German disease prevention and health promotion. A survey of experts in the federal prevention research program]. / Transfermethoden der deutschen Prävention und Gesundheitsförderung. Eine Expertenbefragung im Förderschwerpunkt Präventionsforschung (BMBF).

AIM OF THE STUDY: This expert survey analyzed the application and perceived usefulness of knowledge transfer methods for disease prevention and health promotion research. METHODS: 302 experts from 70 administratively distinct projects sponsored under the German federal prevention research program received a questionnaire on transfer methods used for preparation, dissemination and implementation of their project results and the perceived expediency of these methods. 130 experts (43%) from 59 projects (84.3%) responded. 40% were cooperation partners from health care suppliers or practitioners, and 60% worked in research institutions. Descriptive statistics and ANOVA were used for data analysis. RESULTS: The experts had wide range of transfer methods at their disposal. The main implementation barriers were scarce funding and the complexity of disease prevention and health promotion programs. The predominant channels of dissemination were scientific media (congresses, journals) and the Internet. Manuals and handouts were the most common methods of processing of research results for facilitators. Regarding implementation, two-thirds of the projects conducted user training, integrated experts in program development, and co-operated with important institutions. Most of the transfer methods implemented were perceived as useful, but some rated as useful were rarely used, e. g. health economics and quality assurance in wide-scale rollout. There were no substantial rating differences between experts from research and user institutions. CONCLUSIONS: In view of the fundaments for the broad application of knowledge transfer technologies laid by prevention scientists, health care suppliers and decision-makers should support the transfer of prevention research, and precendence should be given to evidence-based programs with quality assurance in the implementation stages. Prevention researchers, in turn, should further develop health economics evidence and quality assurance for effective interventions. The rich skills available for knowledge transfer in disease prevention and health promotion can be systematically developed and disseminated in the future.

[Abscess of the mitral annulus mimicking left atrial tumour - case report]. / Ropien pierscienia zastawki mitralnej imitujacy guz lewego przedsionka. Problem diagnostyczny.

A case of a 70-year-old female with hypertension, atrial fibrillation and angina pectoris, admitted to the hospital due to echocardiographically detected left atrial tumour, is presented. Differential diagnosis included thrombus, myxoma, infectious or neoplastic tumour. The patients underwent surgery. Histopathological examination revealed the presence of an abscess in the left atrium. This report underlines the difficulties in the diagnosis of cardiac tumours.

[Self-estimation of the quality of life in adult patients after surgical correction of atrial septal defect type II (ASD II)]. / Samoocena jakosci zycia doroslych po chirurgicznej korekcji ubytku w przegrodzie miedzyprzedsionkowej typu II (ASD II).

Health estimation was performed in 134 patients (where 67% were women), aged 17-70, mean 42 years, 2-3 years after surgical correction of atrial septal defect type II (ASD II). The study consists of clinical examination and self-estimation of the quality of life with help of a mall questionnaire, with return ratio of 90%. The improvement of health status was declared by 80% of patients, where 23% stated considerable improvement. While 15% did not confirm any significant changes and 5% noticed worsening quality of life status (mainly connected with postoperative pain). The physical condition improved similarly, with range of tolerable physical effort doubled. The frequency of dyspnea, chest pain and palpitation decreased from 72%, 67% and 87% to 47%, 43% and 47%, respectively, as well as their intensity. More over, the frequency of anxiety decreased from 70% to 62% with reduction of its intensity. Both, before and after surgery, the environmental estimation and self-estimation was very good (77% versus 78%, 78% versus 89%) respectively, and predominant were optimistic attitudes. Post-operative improvement of the quality of life correlating to the clinical state, confirms the suitableness of surgical correction of ASD II, independent of age.

Effects of cyclosporin A on contractile activity and cytoskeleton in chick embryo cardiomyocytes.

The effects of cyclosporin A (CsA), a clinically used immunosupressive drug, on contractile activity of chick cardiomyocytes grown as small aggregates or explants suspended on a network of elastic glass fibres or cultured in a monolayer were analysed in vitro with computer-aided image cytometry methods. At therapeutic concentrations (200-1500 ng/mL), CsA induced changes in the frequency and amplitude of the beating activity of cardiomyocytes 15 min after application. Longer treatment of cardiomyocytes, for 20-24 h, additionally induced changes in their shape and cytoskeleton organization (F-actin and alpha-actinin distribution). These results indicate that CsA is able to affect directly the contractile activity, morphology, and cytoskeleton architecture of heart cells.

The quality of life after aortic valve replacement with homografts or prosthetic valves.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the quality of life in patients after homograft or prosthetic aortic valve implantation. Evaluation was based on clinical and echocardiographic examinations, and on analysis of data from patient questionnaires. METHODS: Patients undergoing either homograft (HV, n = 220) or prosthetic (PV, n = 220) aortic valve replacement were investigated. The patients groups were similar in age, sex, follow up period, risk factors and type of heart defect, and did not demonstrate any dysfunction of the replacement valve. RESULTS: During both pre- and postoperative periods, no significant inter-group differences were identified with regard to the occurrence of retrosternal pain, dyspnea, palpitation, fear reaction and circulatory efficiency based on NYHA classification, and self-evaluation of physical activity assessed by patient questionnaires. The majority of patients in both groups noticed on increase in their quality of life and physical activity. The reduced sexual activity (50%) and fear reaction (30%) in both groups did not correlate with their improved sense of well-being. Up to 14.6% of PV patients did not accept the implanted valve, and 65 (29.5%) would have preferred an HV, despite the need for reoperation. Following surgery, 21% of HV patients resumed work, compared with only 7.7% of PV patients. The frequency of claims for disability pension after surgery did not correlate with the considerate clinical and subjective improvement. CONCLUSIONS: In patients receiving either homograft or prosthetic valves, the subjective evaluation of life quality is comparable with the clinical evaluation, though the homograft valve was better accepted than its prosthetic counterpart.

[Not Available]. / Das trauma in der Sicht der Budapester Schule.

The author shows some crucial points of the Budapest School of psychoanalysis, founded by Ferenczi, like the role of external reality, and of social factors in the development and psychopathology of the human being. He introduces Ferenczi's theory of trauma and tries to show that Ferenczi's ideas from 1932 contain all important elements of modern concepts on trauma. Ferenczi's pupils, as Imre Hermann, Alice and Michael Balint, Istvan Hollos a.o. contribute to the further development of the thoughts of their teacher and don't turn their back on the trauma as psychoanalysis in general did. The author closes with some contributons to the theory of trauma by present Hungarian psychoanalysts, especially about the phenomenon of social traumatisation.

[Coronary bypass grafting after failed percutaneous angioplasty (PTCA)]. / Pilne pomostowanie tetnic wiencowych po powiklanych angioplastykach wiencowych (PTCA).

Between January 1991 and September 1997, in the Cardiovascular Surgery Department of the Institute of Cardiology of Jagiellonian University Medical School, 23 patients underwent emergency CABG due to acute myocardial ischaemia in result of failed PTCA. Over the same period of time invasive cardiologists performed 1883 PTCAs out of which 23 (1.2%) were emergency cardiosurgical procedures, and in 38 patients, stents were implanted in the damaged coronary arteries. The patients' age ranged from 37 to 67 years (median 52.2). In all patients good left ventricular function was preserved, median ejection fraction being 64%. Two patients required IABP to support left ventricular function. 1-4 bypass grafts were implanted (median 1.9 per patient). In one patient, internal mammary artery was collected and then implanted into anterior interventricular branch. The most common complication was myocardial infarction which occurred in 12 patients (52%). In ten patients low output was observed postoperatively. One operated patient (a female died (4.3%). The mean time of hospitalization was 11 days. Emergency myocardial revascularisation procedures performed after failed PTCA, bring higher risk of mortality and dangerous postoperative complications.

[Calcification of allogenic aortic heart valves]. / Mineralizacja allogennych zastawek aortalnych serca.

The material used for the studies consisted of allogenic aortic valves (AAV) collected from 14 individuals. The necessity of AAV replacement arose from growing circulation insufficiency and AAV dysfunction. The aim the study was the determination of the elemental composition and crystallographic structure of the inorganic deposits in AAV. Moreover, the results of the physicochemical investigations were correlated with clinical data (age of the patient, time between valve replacement surgeries, endomyocarditis, number of infections during last 12 months, arterial hypertension and disturbance of the lipid balance) and with echocardiographic examinations (cusp mineralization and perforation, vegetation, systolic and diastolic dimensions of the left ventricle, maximal and average gradient through allograft valve as well as range of the recoil wave to left ventricle). It was found that mineralization of the AAV cusps was a time-dependent process and took place predominantly at the surface of the cusp. The elemental composition and crystallographic data revealed that the inorganic deposits in AAV were composed of hydroxyapatite crystals. However, the presence of other calcium salts was also found. The development of the mineralization process in AAV does not correlate with endomyocarditis, arterial hypertension and the disturbance of the lipid balance. Probably, endomyocarditis and arterial hypertension induce the pathologic alternations of AAV independently from the mineralization process. The echocardiographic estimations of the pathomorphologic changes of the aortic valve cups are not always consistent with the results of the physicochemical studies.

Clinical and echocardiographical study of the aortic homograft implantations in patients with Marfan syndrome.

The aim of the study was to assess the long-term results of surgical treatment with homogenic aortic grafts (HAGs) implantation in patients with Marfan syndrome. There were 31 patients with Marfan syndrome and aortic aneurysm who were operated on between 1980 and 1996. Aortic dissection was diagnosed in 14 patients, DeBakey Type I in six patients and Type II in eight patients. Four patients had to be operated urgently in cardiogenic shock with cardiac tamponade. Sealing up and reinforcement with strip of felt or Gore-Tex has been applied in 22 patients. The surgical modifications mentioned above have been applied since 1987 in all patients with the diameter of the aortic ring exceeding 30 mm or with active infective endocarditis or during reoperation. In 16 patients the space between the aortic homograft and patients own aortic wall was joined to the right atrial auricle. Patients were followed up for 12-179 months (average: 94.6 +/- 499). Three patients died in the early postoperative period and four patients died in the late postoperative period. Rethoracotomy because of bleeding complications was necessary in five patients. HAG damage was responsible for six other reoperations-new HAGs have been implanted in three patients and artificial prostheses were implanted in the other three patients. In the late follow-up period significant improvement in cardiac performance was observed in 24 patients (NYHA I or II). Survival probability of 15 years for the whole group was 80%. The lowest survival probability has been shown in the group of patients with DeBakey Type I aortic dissection (35% survived 15 years after operation). Echocardiographic follow-up has shown that the pressure gradient in HAG was low (7.4 +/- 6.2 mmHg). Only in two patients did the HAG gradient exceeded 20 mmHg. There were no significant differences concerning aortic ring diameters, dimensions of HAG and echocardiographic parameters between the group with surgical modifications, i.e. sealing up and reinforcement with strip of felt or Gore-Tex applied and the group in which these modifications were not applied. Homogenic aortic graft implantation as a method of surgical treatment of aortic aneurysm in patients with Marfan syndrome avoids postoperative anticoagulation, results in substantial improvement of cardiac performance and prolongs life. Surgical treatment should be considered in asymptomatic patients with large aneurysms (exceeding 55-65 mm) in patients with Marfan syndrome because there is a high risk of death in this group of patients in the case of dissection.

Successful full-term pregnancy in a patient three and a half years after a heart transplant.

The patient is a 28 year old woman who received a heart transplant in 1992 secondary to hypertrophic cardiomyopathy with unremarkable post-operative course. In the period immediately post transplantation the patient was on a four-drug immunosuppressive regimen which was subsequently changed to standard three-agent therapy. This therapy was continued until the patient became pregnant. In the first trimester only Cyclosporine (CsA) was used, and thereafter, the patient was continued on the previous three agent regimen. Toward the end of pregnancy a rise in systolic pressure was observed, but the child was delivered by spontaneous vaginal delivery without complications in the 38th week of pregnancy. The newborn weighed 3320 g and was in good health. A sharp fall in the newborn CsA blood levels was observed post delivery reaching zero level on the third day of life. At the present time, both mother and baby are in good health, 6 weeks after delivery.

Mineral-cholesterol concentrations of the aortic aneurysmatic wall.

Mineralogical investigations were performed on specimens from the aneurysmatic wall of ascending and descending thoracic and abdominal aortas collected intraoperatively from 10 patients (8 male, 2 female) aged 40-80 years. Scanning electron microscopy with energy dispersive x-ray analyses (microprobe-SEM/EDXA), and atomic absorption spectroscopy (AAS) showed incipient mineral and cholesterol depositions in the tissues of the patients when compared with the normal aorta of the young individual. Grains and crystals of cholesterol, and spherulitic mineralization, probably apatitic, were detected. It is suggested that localized cations imbalance precedes mineralization and is the potential co-factor of aortic wall pathology and aneurysm formation.

[Use of mineralogic methods for examination of human tissues. I. Methods of mineralogic examination]. / Zastosowanie metod mineralogicznych w badaniach tkanek czlowieka. I. Sposoby badania mineralizacji.

Pathologic mineralization in the human body may produce severe morbidity. Application of mineralogic methods of investigation makes possible closer cognizance of this process, and facilitates prophylaxis and treatment. The principles and employment of following methods are discussed: polarized light microscopy, transmission and scanning electron microscopy, infrared spectroscopy, X-ray diffraction, atomic absorption spectroscopy, electron microprobe, and neutron activation analysis.