Hybrid braided 3-D scaffold for bioartificial liver assist devices

Three-dimensional ex vivo hepatocyte culture is a tissue-engineering approach to improve the treatment of liver disease. The extracorporeal bioartificial liver (BAL) assists devices that are used in patients until they either recover or receive a liver transplant. The 3-D scaffold plays a key role in the design of bioreactor that is the most important component of the BAL. Presently available 3-D scaffolds used in BAL have shown good performance. However, existing scaffolds are considered to be less than ideal in terms of high-density cultures of hepatocytes maintaining long-term metabolic functions. This study aims to develop a 3-D hybrid scaffold for a BAL support system that would facilitate high-density hepatocyte anchorage with long-term metabolic functions. The scaffolds were fabricated by interlacing polyethylene terephthalate (PET) fibers onto the polysulfone hollow fibers utilizing a modern microbraiding technique. Scaffolds with various pore sizes and porosities were developed by varying braiding angle which was controlled by the gear ratio of the microbraiding machine. The morphological characteristics (pore size and porosity) of the scaffolds were found to be regulated by the gear ratio. Smaller braiding angle yields larger pore and higher porosity. On the other hand, a larger braiding angle causes smaller pore and lower porosity. In hepatocyte culture it was investigated how the morphological characteristics (pore size and porosity) of scaffolds influenced the cell anchorage and metabolic functions. Scaffolds with larger pores and higher porosity resulted in more cell anchorage and higher cellular functions, like albumin and urea secretion, compared to that of smaller pores and lower porosity.     

The mendosal suture of the occipital bone: occurrence in Indian population,embryology and clinical significance

The Occipital occipital bone is ontogenetically and functionally unique when compared to the other bones of the skull in humans and other mammalian cousins. The Occipital occipital bone develops from six ossification centers; any defect in the ossification process will give rise to mendosal suture (accessory suture) and conditions like posterior plagiocephaly. There is a paucity of literature regarding the mendosal suture and further more, its report in Indian population is not known. The present study was conducted to find out the occurrence of mendosal suture in the Indian dry skulls. Fifteen specimens (3%) were found to have these sutures out of five hundred500 skulls examined. Nine (3.1%) samples are of male skulls out of two hundred ninety (290) and six (2.85%) samples are that of female skulls out of two hundred ten210. The mendosal suture ran close to the superior nuchal line in all specimens and traveled medially from the lambdoidal suture. The length of the sutures ranged from 0.8 cm to 2.6 cm (1.88 cm) on the right side and 1.4 cm to 2.9 cm (1.94 cm) on the left side respectively in male skulls; and 0.7 cm to 2.8 cm (1.55 cm) on the right side and 1 cm to 2.4 cm (1.42 cm) on the left side, respectively, in female skulls. The origin of mendosal suture from the lambdoidal suture was 5.7 cm to –6.3 cm (5.98 cm) from the tip of the mastoid process on the right side and 5.6 to –6.3 cm (6 cm) on the left side, respectively, in male skulls; and 5.4 cm to –5.8 cm (5.58 cm) on the right side and 5.4 cm to –5.6 cm on the left side respectively in female skulls. The occurrence and clinical significance of the present study is discussed.     

Brugada syndrome and its relevance in the perioperative period

Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.     

Perioperative atrial fibrillation: A systematic review of evolving therapeutic options in pharmacologic and procedural management

Given the high incidence of atrial fibrillation (AF) in the surgical population and the associated morbidity, physicians managing these complicated patients in the perioperative period need to be aware of the new and emerging trends in its therapy. The cornerstones of AF management have always been rate/rhythm control as well as anticoagulation. Restoration of sinus rhythm remains the fundamental philosophy as it maintains the atrial contribution to cardiac output and improves ventricular function. The recent years have seen a dramatic increase in the number of randomized AF trials that have made significant advances to our understanding of both pharmacologic and procedural management, from the introduction of the new generation of oral anticoagulants (NOAC''s) to catheter approaches for AF ablation. This paper will summarize the newest data that will affect the perioperative management of these patients.     

The increasing importance of percutaneous mechanical circulatory assist device therapy in heart failure management

Introduction:

Advances in medical and surgical care have made it possible for an increasing number of patients with Congenital Heart disease (CHD) to live into adulthood. Transposition of the great vessels (TGV) is the most common cyanotic congenital cardiac disease where the right ventricle serves as systemic ventricle. It is not uncommon for these patients to have systemic ventricular failure requiring transplantation.

Study Design:

Hemodynamic decompensation in these patients can be swift and difficult to manage. Increasingly percutaneous LVAD''s such as the Impella (Abiomed, Mass, USA) are gaining popularity in these situations owing to their relative ease of placement, both in and outside of the operating room.

Conclusion:

In this paper we demonstrate that Impella (IMP) CP placement through the axillary artery approach shows to be suitable option for short term cardiac support and improvement of end organ perfusion in anticipation of cardiac transplantation.     

Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management

Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\l ”1). Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.     

Limited granulomatosis with polyangiitis in an adolescent with Crohn's disease on infliximab therapy: cause or coincidence?

Pulmonary involvement in Crohn's disease (CD) may precede the development of intestinal inflammation, but in most cases occurs during the course of treatment, either as an extra‐intestinal manifestation, because of secondary infections, or as a side effect of the therapy itself. This case highlights the differential diagnosis and work up for multiple pulmonary nodules that developed in a patient with CD who had been in remission on infliximab therapy. Even though infectious causes, such as Mycobacteria and Fungi, account for majority of these cases, the possibility of non‐infectious conditions such as autoimmune disorders should also be considered.     

The year in Cardiothoracic and Vascular Anesthesia: selected highlights from 2011

There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiority over medical management and its equivalency to surgical valve replacement in high-risk patients. This transformational technology represents a major leadership opportunity for the cardiac anesthesiologist. Minimally invasive valve surgery has shown effectiveness in high-risk patients. Radial access is equivalent to femoral access for percutaneous coronary intervention in acute coronary syndromes but significantly reduces the risk of local vascular complications. Recent trials have further clarified the roles of medical therapy, percutaneous coronary intervention, and coronary artery bypass surgery in patients with significant coronary artery disease and left ventricular dysfunction. The past year has witnessed major advances in cardiovascular practice with new drugs, new devices, and new guidelines. The coming year most likely will advance these achievements to enhance the care of patients.     

Elimination of Lymphatic Filariasis: Mass Drug Administration in Endemic Areas of (Bidar District) Karnataka-2008

Background:

Lymphatic Filariasis is a mosquito transmitted disease, caused by parasitic worm Wuchereria bancrofti. Global Programme for Elimination of Lymphatic Filariasis was established in early 2000. The strategy recommended by the World Health Organization is annual Mass Drug Administration (MDA) of single-dose of Diethylcarbamazine 6 mg/kg (DEC), distributed to inhabitants of Filariasis endemic areas, excluding children below 2 years of age, pregnant women, and seriously ill persons, and Morbidity Management. The health system distributes the drugs by a door-to-door strategy.

Objective:

To assess the coverage and compliance of MDA in Bidar district during the campaign in November 2008.

Materials and Methods:

Cross-sectional population-based house-to-house visit. Outcome is assessed as actual coverage and compliance, in Percentage and proportions.

Results:

Eight clusters, total eligible population of 1 131 individuals were interviewed. The coverage rate was 78% with variation across different areas. The compliance with drug ingestion was 68%.

Conclusion:

The effective coverage was below the target (85%). Side effects of DEC were minimum, the overall coverage was better in rural areas compared with urban areas.