Deairing Techniques for Double‐Ended Centrifugal Total Artificial Heart Implantation

The unique device architecture of the Cleveland Clinic continuous‐flow total artificial heart (CFTAH) requires dedicated and specific air‐removal techniques during device implantation in vivo. These procedures comprise special surgical techniques and intraoperative manipulations, as well as engineering design changes and optimizations to the device itself. The current study evaluated the optimal air‐removal techniques during the Cleveland Clinic double‐ended centrifugal CFTAH in vivo implants (n = 17). Techniques and pump design iterations consisted of developing a priming method for the device and the use of built‐in deairing ports in the early cases (n = 5). In the remaining cases (n = 12), deairing ports were not used. Dedicated air‐removal ports were not considered an essential design requirement, and such ports may represent an additional risk for pump thrombosis. Careful passive deairing was found to be an effective measure with a centrifugal pump of this design. In this report, the techniques and design changes that were made during this CFTAH development program to enable effective residual air removal and prevention of air embolism during in vivo device implantation are explained.     

Single synchronous delivery of FK506-loaded polymeric microspheres with pancreatic islets for the successful treatment of streptozocin-induced diabetes in mice

Immune rejection after transplantation is common, which leads to prompt failure of the graft. Therefore, to prolong the survival time of the graft, immunosuppressive therapy is the norm. Here, we report a robust immune protection protocol using FK506-loaded microspheres (FK506_M) in injectable hydrogel. Pancreatic islets were codelivered with the FK506_M into the subcutaneous space of streptozocin-induced diabetic mice. The islets codelivered with 10?mg/kg FK506_M maintained normal blood glucose levels during the study period (survival rate: 60%). However, transplantation of islets and FK506_M at different sites hardly controlled the blood glucose level (survival rate: 20%). Immunohistochemical analysis revealed an intact morphology of the islets transplanted with FK506_M. In addition, minimal number of immune cells invaded inside the gel of the islet-FK506_M group. The single injection of FK506_M into the local microenvironment effectively inhibited immune rejection and prolonged the survival time of transplanted islets in a xenograft model.     

Women and STD. A tangled web

There has been an increase in the incidence of sexually transmitted diseases (STDs) in India in recent years. Indian women, however, are embarassed to seek medical help for the treatment of such diseases. Because of this and the lack of an adequate number of trained and sympathetic medical professionals--especially women gynecologists--diagnoses of STDs are being missed. Women are receiving improper or inadequate treatment, especially in light of the fact that STDs spread through organisms that may be highly resistant to commonly used antibiotics. The unavailability of proper medical equipment for gynecological examinations and inadequate budget allocations for appropriate drugs compound the problem. In addition, management of traditional STDs is being overshadowed by acquired immunodeficiency syndrome, particularly following reports on Indian women being exposed to an AIDS-tainted vaccine. The increased fear of AIDS may lead to diversion of funding from traditional STD programs. Better management of STDs, however, can be accomplished through sex education and greater national awareness.     

The application of inertial measurements unit for the clinical evaluation and assessment of gait events

Foot drop is one of the common gait abnormalities which are difficult to detect, diagnose and evaluate. While various gait monitoring systems are available, many are computationally expensive and difficult to implement outside laboratory environments. This study introduces an in-house designed system based on inertial measurement units to capture the gait symptoms, specifically in the case of foot drop symptoms. The system specification and communication results, as well as filtering methods are discussed. Also, the pitch angle of thigh, shank and foot from a subject with no reported foot problem have been compared (gathered from identical equipment under similar conditions) to the same angle from a foot drop subject.     

Characterization of breast cancers and therapy response by MRS and quantitative gene expression profiling in the choline pathway

Tumor choline metabolites have potential for use as diagnostic indicators of breast cancer phenotype and can be non‐invasively monitored in vivo by MRS. Extract studies have determined that the principle diagnostic component of these peaks is phosphocholine (PCho), the biosynthetic precursor to the membrane phospholipid, phosphatidylcholine (PtdCho). The ability to resolve and quantify PCho in vivo would improve the accuracy of this putative diagnostic tool. In addition, determining the biochemical mechanisms underlying these metabolic perturbations will improve the understanding of breast cancer and may suggest potential molecular targets for drug development. Reported herein is the in vivo resolution and quantification of PCho and glycerophosphocholine (GPC) in breast cancer xenografts in SCID mice via image‐guided ³¹P MRS, localized to a single voxel. Tumor metabolites are also detected using ex vivo extracts and high‐resolution NMR spectroscopy and are quantified in the metastatic tumor line, MDA‐mb‐231. Also reported is the quantification of cytosolic and lipid metabolites in breast cells of differing cancer phenotype, and the identification of metabolites that differ among these cell lines. In cell extracts, PCho and the PtdCho breakdown products, lysophosphatidylcholine, GPC and glycerol 3‐phosphate, are all raised in breast cancer lines relative to an immortalized non‐malignant line. These metabolic differences are in direct agreement with differences in expression of genes encoding enzymes in the choline metabolic pathway. Results of this study are consistent with previous studies, which have concluded that increased choline uptake, increased choline kinase activity, and increased phosholipase‐mediated turnover of PtdCho contribute to the observed increase in PCho in breast cancer. In addition, this study presents evidence suggesting a specific role for phospholipase A₂‐mediated PtdCho catabolism. Gene expression changes following taxane therapy are also reported and are consistent with previously reported changes in choline metabolites after the same therapy in the same tumor model. Copyright © 2008 John Wiley & Sons, Ltd.     

The role of surgical simulation and the learning curve in robot-assisted surgery

New surgical teaching methods are continuously being developed to overcome the learning curves of new advanced surgical procedures. The learning curve is recognized in most minimally invasive and robot-assisted surgery. The development of complex skills-training models and simulators, although in its infancy, has started to facilitate the transfer of these skills to novice surgeons without increasing the risk to patients’ safety. Robotic surgery, whether in the specialties of urology, general surgery, or cardiac surgery, has become the ideal platform to integrate simulators for teaching purposes. Its different interface requires the surgeon to acquire more advanced skills compared with conventional open or laparoscopic surgery. However, simulators can allow the naïve surgeon to develop these skills and pass the learning curve without the medico–legal implications of surgical training, limitations in trainee working hours, and ethical considerations of learning basic skills on humans.     

The effect of ibuprofen on bleeding during periodontal surgery.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications for both medical and dental ailments. These drugs have been shown to increase bleeding during surgeries, which may prompt practitioners to discontinue their use before surgical procedures. The aim of the present study is to assess the effect of a common NSAID, ibuprofen, on bleeding during periodontal surgery. MATERIALS AND METHODS: The study group consisted of 10 patients who were scheduled to undergo periodontal surgery of similar type, complexity, and duration. Each subject acted as control as well as case group. The case group consisted of 10 surgeries in which patients were administered ibuprofen prior to surgery, whereas ibuprofen was not administered in control group. Bleeding time was measured at first visit and prior to first and second surgeries. The volume of blood loss during each surgery was measured by subtracting the amount of water used for irrigation from the total volume of fluid collected in the portable aspirator at the end of the surgery. RESULTS: The result showed a statistically significant (P < 0.05) increase in intraoperative bleeding during periodontal surgery when ibuprofen was preadministered. In addition, there was statistically significant (P < 0.05) increase in bleeding time. CONCLUSION: Ibuprofen taken prior to periodontal surgery increases intraoperative bleeding and should be administered cautiously before periodontal surgeries.