The beneficial effects of 18β-glycyrrhetinic acid following oxidative and neuronal damage in brain tissue caused by global cerebral ischemia/reperfusion in a C57BL/J6 mouse model

This study investigated the effects of 18β-glycyrrhetinic acid (GA) on neuronal damage in brain tissue caused by global cerebral ischemia/reperfusion (I/R) in C57BL/J6 mice. All subjects (n = 40) were equally divided into four groups: (1) sham-operated (SH), (2) I/R, (3) GA, and (4) GA+I/R. The SH group was used as a control. In the I/R group, the bilateral carotid arteries were clipped for 15 min, and the mice were treated with the vehicle for 10 days. In the GA group, mice were given GA (100 mg/kg) for 10 days following a median incision without carotid occlusion. In the GA+I/R group, the I/R model was applied to the mice exactly as in the I/R group, and they were then treated with the same dose of GA for 10 days. Cerebral I/R significantly induced oxidative stress via an increase in lipid peroxidaitons and a decrease in elements of the antioxidant defense systems. However, GA treatment was protective against the oxidative effects of I/R by inducing significant increases in antioxidant defense systems and a significant decrease of lipid peroxidations. Additionally, cerebral I/R increased the incidence of histopathological damage and apoptosis in brain tissue, but these neurodegenerative effects were eliminated by GA treatment. Therefore, the current study demonstrated that GA treatment effectively prevents oxidative and histological damage in the brain caused by global I/R. In this context, GA may be useful for the attenuation of the negative effects of global cerebral I/R and, in the future, it may be a viable and safe alternative treatment for ischemic stroke in humans.     

Plasma concentrations of soluble CD40 ligand in smokers with acute myocardial infarction: a pilot study

Coronary artery disease (CAD) is believed to be the single leading cause of death in both men and women in the world. Smoking is the most important risk factor for CAD. Smoking increases platelet aggregation and thrombus formation. CD40 ligand (CD40L) is a transmembrane glycoprotein derived from activated platelets. It participates in thrombus formation during the acute phase of acute myocardial infarction (MI). Elevation of CD40L identifies the patients who are at highest risk for cardiac events and who are likely to benefit from treatment with the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists. The purpose of this study was to evaluate levels of CD40L in smokers with acute MI. Fifty-seven patients with acute MI were enrolled in this study. Thirty-one smokers were compared with 26 non-smokers. Soluble CD40L level in the plasma was determined by a standard enzyme-linked immunosorbent assay. Circulating levels of CD40L were higher in the smokers’ group. Smokers with acute MI may have increased risk for thrombotic complications during acute MI, and optimal antiaggregant therapy should be administered.     

Delivery of gaseous microemboli with vacuum-assisted venous drainage during pulsatile and nonpulsatile perfusion in a simulated neonatal cardiopulmonary bypass model

This study investigated delivery of gaseous microemboli (GME) with vacuum-assisted venous drainage (VAVD) at various flow rates and perfusion modes in a simulated neonatal cardiopulmonary bypass (CPB) model. Four transducers (postpump, postoxygenator, postfilter, and venous line) of the emboli detection and classification (EDAC) quantifier were inserted into the CPB circuit to detect and classify GME. Four negative pressures (0, -15, -30, and -45 mm Hg), 3 flow rates (750, 1,000, and 1,250 ml/min), and 2 perfusion modes (pulsatile and nonpulsatile) were tested. After injecting 10 ml air into the venous line via an 18G needle, 2-minute segments of data were recorded simultaneously through 4 transducers. This entire process was repeated 6 times for each unique combination of pressure, flow rate, and perfusion mode, yielding a total of 144 experiments. Independent of perfusion mode and flow rate, the use of VAVD with higher negative pressures delivered significantly more GME at the postpump site. There was no difference in delivery at the postfilter site. The majority of GME were trapped by the Capiox Baby-RX hollow-fiber membrane oxygenator. Compared with nonpulsatile flow, pulsatile flow transferred more GME at the postpump site at all 3 flow rates. Our results suggest that VAVD with higher negative pressures, increased flow rates, and pulsatile flow could deliver more GME at the postpump site when a fixed volume air is introduced into the venous line. The Emboli Detection and Classification Quantifier is a sensitive tool for the detection and classification of GME as small as 10 microns in this simulated neonatal model.     

Gaseous microemboli detection in a simulated pediatric CPB circuit using a novel ultrasound system

The objective of this study was to evaluate the effect of flow rate and perfusion mode on the delivery of gaseous microemboli in a simulated pediatric cardiopulmonary bypass (CPB) circuit with an open arterial filter purge line using a novel ultrasound detection system. The circuit was primed with 450 ml fresh, heparinized bovine blood plus 200 ml Lactated Ringer's solution (total volume 650 ml, corrected Hct 25%). After the injection of 5 ml air into the venous line, an Emboli Detection and Classification (EDAC) Quantifier (Luna Innovations, Inc., Roanoke, VA) was used to simultaneously record microemboli counts at postpump, postoxygenator, and postarterial filter sites. Trials were conducted at four different flow rates (500, 750, 1,000, 1,250 ml/min) and two perfusion modes (pulsatile, nonpulsatile). Microemboli counts uniformly increased with increasing pump flow rates. In all trials, the majority of gaseous microemboli detected in the simulated pediatric CPB circuit were <20 microm in diameter. At the lowest flow rate tested (500 ml/min), all microemboli (>10 microm) were cleared from the circuit by the oxygenator and arterial filter. Clearance efficiency was decreased at higher flow rates (750-1,250 ml/min). Over 98% of microemboli detected at the postoxygenator site were <40 microm in diameter. In general, pulsatile flow delivered more microemboli to the circuit at postpump and postoxygenator sites than nonpulsatile flow. The results of this study confirmed that entrained air from the venous line could be delivered to the systemic circulation (as represented by our pediatric pseudo patient) at flow rates from 750 to 1,250 ml/min, despite the presence of an arterial filter and open arterial filter purge line. All of the microemboli distal to the arterial filter were smaller than the conventional detectable level of 40 microm.     

Decreased global field synchronization of multichannel frontal EEG measurements in obsessive-compulsive disorders

Global field synchronization (GFS) quantifies the synchronization level of brain oscillations. The GFS method has been introduced to measure functional synchronization of EEG data in the frequency domain. GFS also detects phase interactions between EEG signals acquired from all of the electrodes. If a considerable amount of local brain neurons has the same phase, these neurons appear to interact with each other. EEG data were received from 17 obsessive-compulsive disorder (OCD) patients and 17 healthy controls (HC). OCD effects on local and large-scale brain circuits were studied. Analysis of the GFS results showed significantly decreased values in the delta and full frequency bands. This research suggests that OCD causes synchronization disconnection in both the frontal and large-scale regions. This may be related to motivational, emotional and cognitive dysfunctions.     

Importance of TNF-related apoptosis-inducing ligand in pathogenesis of interstitial cystitis

Introduction  

Although interstitial cystitis is an inflammatory disease, its etiopathogenesis is not clearly understood. The objective of the present study is to investigate the distribution of TNF-related apoptosis-inducing ligand (TRAIL) and its receptors in bladder biopsy samples of patients diagnosed with interstitial cystitis and the role of TRAIL in the pathogenesis of interstitial cystitis.     

Precise quantification of pressure flow waveforms of a pulsatile ventricular assist device

Unreliable quantification of flow pulsatility has hampered many efforts to assess the importance of pulsatile perfusion. Generation of pulsatile flow depends upon an energy gradient. It is necessary to quantify pressure flow waveforms in terms of hemodynamic energy levels to make a valid comparison between perfusion modes during chronic support. The objective of this study was to quantify pressure flow waveforms in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) levels in an adult mock loop using a pulsatile ventricle assist system (VAD). A 70 cc Pierce-Donachy pneumatic pulsatile VAD was used with a Penn State adult mock loop. The pump flow rate was kept constant at 5 L/min with pump rates of 70 and 80 bpm and mean aortic pressures (MAP) of 80, 90, and 100 mm Hg, respectively. Pump flows were adjusted by varying the systolic pressure, systolic duration, and the diastolic vacuum of the pneumatic drive unit. The aortic pressure was adjusted by varying the systemic resistance of the mock loop EEP (mm Hg) = (integral of fpdf)/(integral of fdt) SHE (ergs/cm3) = 1,332 [((integral of fpdt)/(integral of fdt))--MAP] were calculated at each experimental stage. The difference between the EEP and the MAP is the extra energy generated by this device. This difference is approximately 10% in a normal human heart. The EEP levels were 88.3 +/- 0.9 mm Hg, 98.1 +/- 1.3 mm Hg, and 107.4 +/- 1.0 mm Hg with a pump rate of 70 bpm and an aortic pressure of 80 mm Hg, 90 mm Hg, and 100 mm Hg, respectively. Surplus hemodynamic energy in terms of ergs/cm3 was 11,039 +/- 1,236 ergs/cm3, 10,839 +/- 1,659 ergs/cm3, and 9,857 +/- 1,289 ergs/cm3, respectively. The percentage change from the mean aortic pressure to EEP was 10.4 +/- 1.2%, 9.0 +/- 1.4%, and 7.4 +/- 1.0% at the same experimental stages. Similar results were obtained when the pump rate was changed from 70 bpm to 80 bpm. The EEP and SHE formulas are adequate to quantify different levels of pulsatility for direct and meaningful comparisons. This particular pulsatile VAD system produces near physiologic hemodynamic energy levels at each experimental stage.     

Relationship between c-reactive protein to albumin ratio and coronary artery calcium score and CAD-RADS scores with coronary computed tomography angiography

Background/aimC-reactive protein (CRP) to albumin ratio (CAR) is predictive marker of systemic inflammatory state in atherosclerotic coronary diseases when compared to predictive value of these two markers separately. We aimed to evaluate the relationship between CAR and the coronary artery calcium (CAC) score, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score in patients’ unknown diagnosis of coronary artery disease (CAD) underwent coronary CTA (Computed Tomography Angiography) and were classified by CAD-RADS scores. Materials and methods A total of 187 patients consecutively referred for the evaluation of their chest pain underwent coronary CTA were included retrospectively. Results CRP, CAR, and CAD-RADS scores were higher in patients with CAC score > 400 than the other groups (p < 0.001). We found positive correlation between CAR and CAC score (r= 0.384, p < 0.001), and also there was a positive correlation between CAR and CAD-RADS score (r= 0.462, p < 0.001). Multivariate logistic regression analyses showed that low density lipoprotein cholesterol (LDL-C), CAD-RADS score, and CAR were independent predictors of CAC score (p < 0.05). Conclusion Higher CAR can be a predictive marker of atherosclerosis and CAD. CAR may be useful in the management of patients before invasive coronary angiography. Further studies are needed to clarify the pathophysiologic role of CAR in patients with atherosclerotic coronary heart diease.