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- Aortic Valve Replacement Reduces Valvuloarterial Impedance but Does Not Affect Systemic Arterial Compliance in Elderly Men with Degenerative Calcific Trileaflet Aortic Valve Stenosis. [JOURNAL ARTICLE]
- J Cardiothorac Vasc Anesth 2014 Sep 26.
Standard methods of quantifying aortic valve stenosis (AS), which focus entirely on the valve itself, do not adequately characterize the magnitude, predict the onset, progression, and severity of symptoms, or identify the incidence of subsequent adverse events. Valvuloarterial impedance (Zva) is an index of global left ventricular (LV) afterload that incorporates valvular and arterial loads. The authors tested the hypothesis that aortic valve replacement (AVR) reduces Zva but does not affect the arterial component of LV afterload in elderly patients with degenerative calcific trileaflet AS.Observational study.Veterans affairs medical center.Eight elderly (age, 79±4 years) men with moderate-to-severe AS and normal preoperative LV function (ejection fraction, 61%±9%) scheduled for AVR with or without coronary artery bypass graft surgery were studied after institutional review board approval.None.A comprehensive TEE examination was performed during isoflurane-fentanyl-rocuronium anesthesia. Doppler echocardiography was used to measure pressure gradients across the aortic valve, stroke volume (continuity equation), and aortic valve area using standard techniques. Zva was determined as (systolic arterial pressure+mean gradient)/stroke volume index. Energy loss index was calculated as (aortic area×aortic valve area)/([aortic area - aortic valve area]×body surface area). The stroke work loss was obtained as (mean gradient×100/[systolic arterial pressure+mean gradient]). The ratio of stroke volume index to pulse pressure was used to measure systemic arterial compliance. Zva, energy loss index, stroke work loss, and systemic arterial compliance were assessed before and 15 minutes after cardiopulmonary bypass. Systemic and pulmonary hemodynamics (invasive catheters) were similar after versus before AVR. Aortic valve area increased significantly (p<0.05) with AVR (0.92±0.26 cm(2) to 1.94±0.35 cm(2)), concomitant with decreases in peak and mean gradients (60±17 mmHg to 15±8 mmHg and 38±11 mmHg to 8±5 mmHg, respectively) and peak blood flow velocity (3.9±0.5 m·s(-1) to 1.9±0.5 m·s(-1)). AVR reduced Zva (4.6±1.0 mmHg·mL(-1)·m(-2) to 3.5±0.3 mmHg·mL(-1)·m(-2)) and improved energy loss index (0.55±0.16 cm(2)·m(-2) to 1.58±0.48 cm(2)·m(-2)) concomitant with a decline in stroke work loss (25%±6% to 7%±4%), but systemic arterial compliance remained unchanged (0.63±0.13 compared with 0.70±0.12 mL·mmHg(-1)·m(-2)).The current results showed that AVR acutely reduced Zva, improved energy loss index, and decreased stroke work loss, but did not affect systemic arterial compliance in elderly men with degenerative calcific trileaflet AS.
- Delivery of an enzyme-IGFII fusion protein to the mouse brain is therapeutic for mucopolysaccharidosis type IIIB. [JOURNAL ARTICLE]
- Proc Natl Acad Sci U S A 2014 Sep 29.
Mucopolysaccharidosis type IIIB (MPS IIIB, Sanfilippo syndrome type B) is a lysosomal storage disease characterized by profound intellectual disability, dementia, and a lifespan of about two decades. The cause is mutation in the gene encoding α-N-acetylglucosaminidase (NAGLU), deficiency of NAGLU, and accumulation of heparan sulfate. Impediments to enzyme replacement therapy are the absence of mannose 6-phosphate on recombinant human NAGLU and the blood-brain barrier. To overcome the first impediment, a fusion protein of recombinant NAGLU and a fragment of insulin-like growth factor II (IGFII) was prepared for endocytosis by the mannose 6-phosphate/IGFII receptor. To bypass the blood-brain barrier, the fusion protein ("enzyme") in artificial cerebrospinal fluid ("vehicle") was administered intracerebroventricularly to the brain of adult MPS IIIB mice, four times over 2 wk. The brains were analyzed 1-28 d later and compared with brains of MPS IIIB mice that received vehicle alone or control (heterozygous) mice that received vehicle. There was marked uptake of the administered enzyme in many parts of the brain, where it persisted with a half-life of approximately 10 d. Heparan sulfate, and especially disease-specific heparan sulfate, was reduced to control level. A number of secondary accumulations in neurons [β-hexosaminidase, LAMP1(lysosome-associated membrane protein 1), SCMAS (subunit c of mitochondrial ATP synthase), glypican 5, β-amyloid, P-tau] were reduced almost to control level. CD68, a microglial protein, was reduced halfway. A large amount of enzyme also appeared in liver cells, where it reduced heparan sulfate and β-hexosaminidase accumulation to control levels. These results suggest the feasibility of enzyme replacement therapy for MPS IIIB.
- Hemodynamic Study with Duplex Ultrasonography on Combined (Direct/Indirect) Revascularization in Adult Moyamoya Disease. [JOURNAL ARTICLE]
- J Stroke Cerebrovasc Dis 2014 Sep 26.
To evaluate the hemodynamic changes by duplex ultrasonography in adult moyamoya disease (MMD) patients who underwent combined direct and indirect revascularization surgery.Seventeen adult patients underwent direct and indirect revascularization surgery in our hospital. Hemodynamic parameters, peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI), were determined by color Doppler at the baseline, 2 weeks, and 6 months after bypass.Both the PSV and EDV of direct bypass were lower at 6 months after surgery compared with those at 2 weeks postoperatively. The EDV of indirect revascularization surgery of the maxillary artery (MA) at 6 months after surgery was higher and the RI of the MA lower compared with the baseline levels. Decreased PSV and EDV in the bypass vessel did not significantly correlate with increased EDV or decreased RI of the MA.Duplex ultrasonography is a reliable, noninvasive tool to assess hemodynamic changes and evaluate the therapeutic performance of combined bypass surgery in adult MMD.
- [Endoprosthetic repair of abdominal aortic aneurysm complicated by rupture into the vena cava inferior with formation of an aortocaval fistula.] [JOURNAL ARTICLE]
- Angiol Sosud Khir 2014; 20(3):149-153.
The article deals with is a case report of successful endovascular treatment of a patient with a saccular aneurysm of the infrarenal portion of the abdominal aorta complicated by its rupture into the inferior vena cava with formation of an aortocaval fistula. The patient underwent endoprosthetic repair of the abdominal aorta with the unilateral stent graft Endurant II 32x14-117 mm ("Medtronic") and cross-over femorofemoral bypass. The postoperative period was complicated by acute cardiac insufficiency and pulmonary oedema. After the appropriate intensive therapy lung oedema subsided, the events of cardiac insufficiency disappeared, and haemodynamics stabilized. According to the findings of the control multispiral computed tomography, the fistula does not function, there are no signs of the stent graft's dislocation or endoleak, with the cross-over femorofemoral bypass patent. The patient was discharged in a satisfactory condition.
- [Choosing the method of reconstructive operation in patients with atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia.] [JOURNAL ARTICLE]
- Angiol Sosud Khir 2014; 20(3):135-140.
Presented herein are remote results of surgical treatment of 101 patients with atherosclerotic occlusion of the femoral-popliteal-tibial segment in the stage of critical ischaemia. The choice of the reconstructive operation was made based on the developed criteria. Femoral-popliteal shunting into the isolated segment of the reversed great saphenous vein was performed in 48 (47.52%) patients, and 53 (52.48%) patients underwent distal femoraltibial bypass grafting according to the in situ technique. The five-year patency of the graft in these groups was identical, amounting to 54.17 and 58.49%, respectively. In order to predict the duration of bypass graft patency in the isolated segment of the popliteal artery we worked out criteria of competence of the collateral blood flow. We also defined more exactly the indications for applying a relieving arteriovenous fistula in distal femorotibial shunting. When deciding upon a method of operative treatment, preference is given to shunting into the isolated popliteal artery in sufficient collateral blood flow.
- [Efficacy of various types of femoropopliteal crural bypass grafting.] [JOURNAL ARTICLE]
- Angiol Sosud Khir 2014; 20(3):129-133.
Over the period from 1997 to 2007 a total of 132 patients presenting with chronic lower-limb ischaemia underwent reconstructive bypass grafting operations performed at the Department of Cardiovascular Surgery of the Murmansk Regional Clinical Hospital named after P.A. Bayandin. Depending on the method of formation of the distal anastomosis the patients were subdivided into two groups: Group I with endarterectomy in the zone of the distal anastomosis, including 39 patients, and Group II without endarterectomy, comprising 93 patients. As the plastic material for bypass grafting we used autoveins in the "reverse" and "in situ" positions, allografts made of polytetrafluoroethylene (PTFE) or woven fabric, combined grafts. In the both groups prevailing were patients with critical ischaemia of the lower limbs. Thus, 20 (51.3%) patients had degree III ischaemia in Group One and 60 (64.5%) patients in Group Two, and 18 (46.2%) patients had ischaemia degree IV and 20 (21.5%), respectively. In order to evaluate the state of the distal bed we calculated the average score according to the Rutherford classification (Rutherford, et al., 1997), which amounted to 7.56 ±1.5 and 6.2±1.43 for Group I and II, respectively. The best patency and limb salvage rate were observed in autovenous bypass grafting according to the "in situ" technique without endarterectomy. Thus, the cumulative patency amounted to 21% and limb salvage to 29.4% after 5 years.
- The cellular and proteomic response of primary and immortalized murine Kupffer cells following immune stimulation diverges from that of monocyte-derived macrophages. [JOURNAL ARTICLE]
- Proteomics 2014 Sep 30.
Kupffer cells are the first line of defense in the liver against pathogens, yet several microbes successfully target the liver, bypass immune surveillance, and effectively develop in this tissue. Our current, albeit poor, understanding of Kupffer cell-pathogen interactions has been largely achieved through the study of primary cells, requiring isolation from a large numbers of animals. To facilitate the study of Kupffer cell biology, an immortalized rat Kupffer cell line, RKC1, was developed. We performed a comparative global proteomic analysis of RKC1 and primary rat Kupffer cells (PRKC) to characterize their respective responses to lipopolysaccharide (LPS)-mediated immune stimulation. We identified patent differences in the proteomic response profile of RKC1 and PRKC to LPS. We observed that PRKC upregulated more immune function pathways and exhibited marked changes in cellular morphology following stimulation. We consequently analyzed the cytoskeletal signaling pathways of these cells in light of the fact that macrophages are known to induce cytoskeletal changes in response to pathogens. Our findings suggest that Kupffer cells respond differently to inflammatory stimulus than do monocyte-derived macrophages, and such data may provide insight into how pathogens, such as the malaria parasite, may have evolved mechanisms of liver entry through Kupffer cells without detection. This article is protected by copyright. All rights reserved.
- Off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel disease and enlarged ventricles. [Journal Article]
- Ann Saudi Med 2014 May-Jun; 34(3):222-8.
Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles.Prospective randomized trial of patients treated at The First Affiliated Hospital, China Medical University, over a 3-year period (2007-2010).A total of 102 patients with triple-vessel disease and enlarged ventricles (end-diastolic dimension >=6.0 cm) were randomized to OPCAB or ONCAB between July 2007 and December 2010. The in-hospital out.comes were analyzed. The study included a mid-term follow-up, with a mean follow-up time of 49.40 (12.88 months).No significant differences were recorded in the baseline clinical characteristics of ONCAB and OPCAB groups. A statistical difference was found between the two groups at the time of extubation, intensive care unit stay, hospital stay, blood requirements, incidence of intra-aortic balloon pump support, pulmonary complications, stroke, reoperation for bleeding, and inotropic requirements > 24 hours (P < .05). The number of anastomoses performed per patient, the incidence of postoperative ventricular arrhythmia, myocardial infarction, new-onset atrial fibrillation, hemodialysis, infective complications, recurrent angina, and percutaneous reintervention were similar between the 2 groups (P > .05). The left ventricular end-diastolic dimension was sig.nificantly smaller at 6 months' follow-up in the 2 groups than it was before operation ( < .05). No differences in hospital mortality and mid-term mortality between OPCAB and ONCAB groups were found. During the follow-up, no patient in either group had undergone repeat coronary artery bypass grafting.No differences in early and mid-term mortality were found between OPCAB and ONCAB in patients with triple-vessel disease and enlarged ventricles. However, OPCAB seems to have a beneficial effect on postoperative complications.
- RANWAR: Rank-Based Weighted Association Rule Mining from Gene Expression and Methylation Data. [JOURNAL ARTICLE]
- IEEE Trans Nanobioscience 2014 Sep 23.
Ranking of association rules is currently an interesting topic in data mining and bioinformatics. The huge number of evolved rules of items (or, genes) by association rule mining (ARM) algorithms makes confusion to the decision maker. In this article, we propose a weighted rule-mining technique (say, RANWAR or rank-based weighted association rule-mining) to rank the rules using two novel rule-interestingness measures, viz., rank-based weighted condensed support (wcs) and weighted condensed confidence (wcc) measures to bypass the problem. These measures are basically depended on the rank of items (genes). Using the rank, we assign weight to each item. RANWAR generates much less number of frequent itemsets than the state-of-the-art association rule mining algorithms. Thus, it saves time of execution of the algorithm. We run RANWAR on gene expression and methylation datasets. The genes of the top rules are biologically validated by Gene Ontologies (GOs) and KEGG pathway analyses. Many top ranked rules extracted from RANWAR that hold poor ranks in traditional Apriori, are highly biologically significant to the related diseases. Finally, the top rules evolved from RANWAR, that are not in Apriori, are reported.
- Efficacy and safety of perioperative sodium bicarbonate therapy for cardiac surgery-associated acute kidney injury: a meta-analysis. [JOURNAL ARTICLE]
- J Cardiovasc Pharmacol 2014 Sep 26.
Urinary alkalinization with sodium bicarbonate infusion can theoretically protect against the mechanisms of acute kidney injury. Controversy exists regarding whether sodium bicarbonate infusion can reduce the incidence of acute kidney injury from cardiac surgery. A meta-analysis was conducted to show the efficacy and safety of perioperative sodium bicarbonate use for preventing AKI in patients undergoing cardiac surgery.PubMed, CBM, EMBASE, CENTRAL and Cochrane renal group specialized register were searched for pertinent studies.Randomized controlled trails and prospective observational cohort studies that compared sodium bicarbonate with sodium chloride or blank control in cardiac surgery with cardiopulmonary bypass were included. Exclusion criteria were duplicate publications, non-adult studies, oral administration of sodium bicarbonate, retrospective analyses, and studies with small sample size (n<50) or with no data on AKI.Study endpoints, study design, population, operation information, and sodium bicarbonate doses were extracted.Data from 1673 patients in 5 randomized trials and 1 prospective observational cohort study were analyzed. The analysis showed that sodium bicarbonate did not reduce the incidence of postoperative AKI and the need for renal replacement therapy. Postoperative ventilation time, hospital length of stay, hospital death, and mortality within 90 days had no statistical difference between two groups. Time in ICU was even slightly longer in the experimental group.Urinary alkalinization using sodium bicarbonate infusion failed to reduce the incidence rate of AKI or other outcomes in patients undergoing cardiac surgery. This intervention might even prolong ICU stay.