Computer assisted design for the implantable left ventricular assist device (LVAD) blood pump using computational fluid dynamics (CFD) and computer-aided design and manufacturing (CAD/CAM)

Thrombus formation and hemolysis are critical issues in the design of a long-term implantable LVAS (left ventricular assist system). The fluid dynamic characteristics of the blood flow are one of the main factors that cause thrombus formation and hemolysis. In this study, we optimized blood chamber geometry, port design, and fluid dynamics in our implantable LVAS to ensure minimization of shear-stress-related blood damage. A blood pump chamber (stroke volume, 65 ml) and an inflow and outflow port were designed with three-dimensional CAD (computer-aided-design) software (Pro-Engineering version 20) and estimated by FEM (fine-element method) computational fluid dynamic (CFD) analysis (Ansys version 5.5). We adopted three-dimensional distribution of CFD results for qualitative evaluation, and we also tried to estimate the normalized index of hemolysis (NIH) and time-series change of hematocrit from the results of CFD analysis as quantitative index of optimization for geometry of the blood pump chamber. With the use of this design, the blood pump geometry was optimized as the decrease of NIH from 2.72 g/1001 in the first model to 0.098 g/1001 in the second model, corresponding to the decrease in shear stress. The hematocrit also improved from 0.7% in the first model to 11.5% in the second model 2 years after implantation of the pump. Areas where flow stagnation was observed in the first model were free of stagnation in the second model. The results show that computer-aided design of the blood pump contributes to optimizing a blood pump chamber for reducing thrombus formation and hemolysis, and also contributes to reducing cost and time in developing the implantable LVAS.     

A young girl with refractory intestinal Behçet’s disease: a case report and review of literatures on pediatric cases who received an anti-tumor necrosis factor agent

Behçet’s disease (BD) is a chronic, relapsing, multisystem inflammatory disorder classified as vasculitis and characterized by recurrent oral and genital ulcerations, uveitis, and protean clinical signs of skin, central nervous system, musculoskeletal, and gastrointestinal involvements. Among the protean manifestations due to BD, intestinal BD is often intractable, but effective treatment for intestinal BD has not been fully established. Tumor necrosis factor (TNF)-α plays a central role in inflammation in BD patients; however, there are very few reports on the successful treatment of pediatric-onset cases of intestinal BD using anti-TNF-α agents. We report the case of a 6-year-old Japanese girl with refractory intestinal BD who was successfully treated with multidrug therapy including etanercept (ETN). Also, we performed a review of literatures on pediatric cases who received an anti-TNF-α agent. To our knowledge, this is the youngest patient with intestinal BD who was successfully treated using ETN. Although further studies are needed to determine the efficacy and safety of anti-TNF-α agents in the treatment for pediatric-onset BD, we believe that even in very young patients with refractory BD, an anti-TNF-α agent may be beneficial.     

Immunohistochemical and Immunocytochemical Localization of Amylase in Rat Parotid Glands and von Ebner's Glands by Ion Etching-Immunoscanning Electron Microscopy

The distribution of amylase in rat parotid glands and von Ebner's glands was examined using ion etching-immunoscanning electron microscopy, which enables both light and electron microscopic observations of identical semi-thin resin sections immunolabeled with anti-α-amylase and immunogold in association with silver enhancement. At the light microscopic level, most acinar secretory granules (SG) and striated duct secretions of parotid glands were strongly stained dark brown. In von Ebner's glands, acinar SG and duct secretions were weakly to strongly stained light to dark brown. At the electron microscopic level, labeling was observed as bright gold-silver particles. The labeling intensity of acinar SG of parotid glands was higher than that of von Ebner's glands. In parotid glands, weak labeling of SG in transitional cells between acini and intercalated ducts, very weak labeling of SG in intercalated ducts, and strong labeling of striated duct secretions were observed. In von Ebner's glands, the secretions and some SG of interlobular ducts were strongly labeled compared to those of intralobular ducts and SG of acini. Less amylase was synthesized in von Ebner's acini compared to parotid acini, whereas von Ebner's ducts may secrete significantly more amylase to modify saliva than parotid ducts.     

Multicenter,retrospective, observational study for the Treatment Pattern of systemic corticoSTERoids for relapse of non-infectious uveitis accompanying Vogt-Koyanagi-Harada disease or sarcoidosis

Japanese Journal of Ophthalmology - Non-infectious uveitis associated with Vogt-Koyanagi-Harada (VKH) disease or sarcoidosis is commonly treated with systemic corticosteroids (SCS). We assessed the...     

Case report of traumatic hemorrhage from the anterior choroidal artery

Traumatic hemorrhage from the anterior choroidal artery is very rare. A 74-year-old male was admitted to our hospital immediately after a traffic accident. CT on admission showed right intracerebral hematomas in the posterior limb of the internal capsule and the upper part of the right cerebral peduncle. Neurological examination revealed that the patient had left hemiparesis and transient mute, pseudobulbar sign and peduncular hallucination. The absence of hypertensive asymptomatic microbleeds in other basal ganglia supported the verdict of traumatic injury of the anterior choroidal artery. The tear mechanism of the anterior choroidal artery might have been caused by an impact to the parietal region directed toward the tentorium.     

The value of multidetector row computed tomography in the diagnosis of traumatic clivus epidural hematoma in children: a three-year experience

BACKGROUND: Clivus epidural hematoma (CEH) is reported to be extremely rare. However, we consider that CEH may not be as rare as commonly thought, and that it may often go unrecognized because of diagnostic problems. The aim of this study was to evaluate the value of multidetector row computed tomography (MDCT) in the diagnosis of CEH. METHODS: Twenty-seven children aged less than 16 years who had experienced traffic crashes or falls were retrospectively evaluated with MDCT including sagittal reconstruction of the cervical spine. RESULTS: Sagittal reconstructed images showed definitive findings of CEH in 3 (13%) of the 24 traffic-crash patients. CONCLUSION: MDCT can show definitive findings of CEH, and diagnostic problems can be solved through the utilization of MDCT. We consider that CEH may be more common than previously thought.     

Induction of mitochondria-dependent apoptosis through the inhibition of mevalonate pathway in human breast cancer cells by YM529, a new third generation bisphosphonate

YM529, a new third generation bisphosphonate, induced apoptosis of a human breast cancer cell line, MX-1. Cytotoxic activity of YM529 was more potent than that of incadronate. YM529 activated caspase-9, but not caspase-8, and induced the release of cytochrome c into cytosol. YM529 increased Bax expression and decreased Bcl-2 expression, while it did not induce caspase-8-dependent Bid truncation. Farnesyl pyrophosphate prevented YM529-mediated cytotoxicity. These results suggest that YM529 is a potent therapeutic agent for human breast cancers, activating the mitochondria-dependent apoptotic pathway through the inhibition of protein farnesylation.     

Melanoma Differentiation-Associated Gene 5 Regulates the Expression of a Chemokine CXCL10 in Human Mesangial Cells: Implications for Chronic Inflammatory Renal Diseases

Mesangial cells play an important role in inflammatory reactions in kidney. Although viral infections often trigger the worsening of chronic inflammatory renal diseases, the mechanisms are largely unknown. Melanoma differentiation-associated gene 5 (MDA5) is a member of RNA helicase family with a conserved Asp-Glu-x-His (DExH) box. In the present study, we examined the effect of polyinosinic-polycytidylic acid (poly IC), an authentic double-stranded RNA (dsRNA) that mimics viral dsRNAs, on MDA5 expression using primary culture of human mesangial cells. The cells were simply treated or transfected with poly IC; the former procedure is a model of cells exposed to viral dsRNA released from dying cells, and the latter is a model of entry of RNA virus into the cytoplasm. Expression levels of MDA5 mRNA in mesangial cells were increased about 70-100 fold in response to either treatment or transfection with poly IC. MDA5 protein expression was significantly induced as well. RNA interference experiments revealed that poly IC treatment induced MDA5 expression via Toll-like receptor 3 (TLR3) and interferon (IFN)-β, and that poly IC trasnfection induced MDA5 expression via another DExH box RNA helicase, retinoic acid-inducible gene-I (RIG-I), and IFN-β. Moreover, MDA5 induced by poly IC, in turn, increased the expression of a chemokine CXCL10. In addition, immunohistochemical staining demonstrated a high level of MDA5 expression in glomeruli, mainly in mesangial cells, of patients with severe lupus nephritis or proteinuric IgA nephropathy. MDA5 may be involved not only in physiological antiviral reactions but also in chronic inflammation in glomerular mesangial cells.