The latest wire technique for chronic total occlusion.

If patency is restored after chronic total occlusion (CTO), it can be maintained over the long term by implanting drug-eluting stents. The cause of unsuccessful percutaneous coronary intervention is usually failure of the wire to cross the site of CTO. The objective of this article is to describe the latest wire techniques for CTO. As for wire selection, CTO should generally be treated with hard-tipped spring wires, preferably Conquest Pro series (Asahi Intec). According to the penetrating strategy, the course of a blood vessel with CTO is established preoperatively and the wire is advanced based on the imaging data with minimum rotation (a torque of +/- 90 degrees or less). If the operator encounters divergence between the preoperative CTO image and the actual course of the coronary artery, the parallel wire technique should be used. With this method, a wire which enters the subintimal space is left there, and a second wire is inserted along it to find a new channel. When this technique is successful, the following findings are often noted: 1) the second wire crosses over the first one in the CTO; 2) the second wire shows more acute curve than the first wire; 3) the second wire penetrates the lesion from the outer curvature of the coronary artery and then is advanced along the same curvature of the vessel. Indeed, the second wire should be operated intentionally to achieve these findings so that the probability of success increases and the duration of the procedure is shortened.     

Hypoxia-induced upregulation of CD11b expression in granulocytes

The aim of this study is to evaluate leukocyte-endothelial adhesion during ischemia/reperfusion injury. Polymorphonuclear neutrophils (PMN) were isolated from healthy volunteers and incubated in the presence of 2% O₂ (hypoxia) or 21% O₂ (normoxia) at 37°C for two hours. In some experiments, whole blood was subjected to hypoxia or normoxia prior to PMN isolation. Flowcytometric analysis and adhesion assays were carried out using these PMN. Moreover, adhesion assay was carried out using PMN, prepared from the patients who underwent infrarenal aortic aneurysmectomy with aortic clamping at various time points as an in vivo model of ischemial reperfusion injury. Flowcytometric analysis revealed an increased expression of CD11b in PMN subjected to hypoxia compared with those subjected to normoxia prior to isolation. Interestingly, these phenomena were not observed with PMN isolated prior to being subjected with hypoxia. Enzyme-linked immunosorbent assay (ELISA) using serum prepared from whole blood subjected to hypoxia revealed elevated levels of tumor necrosis factor (TNF)- compared with those subjected to normoxia. PMN obtained during aneurysmectomy exhibited an increased adhesion to activated human umbilical vein endothelial cells (HUVEC), compared with those taken from the same patients prior to the operation. In contrast, PMN prepared after aortic clamp, exhibited a significant reduced adhesion to activated HUVEC. Hypoxic condition, induced CD11b expression on PMN in vitro. PMN subjected to hypoxic condition in vivo exhibited an increased adhesion to activated endothelium. Elevated level of serum TNF- may be involved in this phenomenon.     

Initial perfusate purification during subnormothermic machine perfusion for porcine liver donated after cardiac death

Journal of Artificial Organs - Improvement of machine perfusion (MP) technologies is required to enhance organ quality for donor after cardiac death (DCD) grafts. Installing a dialyzer or a filter...     

Interleukin-6 and tumor necrosis factor-alpha in patients with obstructive sleep apnea-hypopnea syndrome

BACKGROUND: In previous studies, significantly elevated levels of vascular endothelial growth factor (VEGF) have been reported in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS). On the other hand, plasma tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) have been significantly higher in mild sleep apneics than in normal controls. However, this study included a small number of patients and milder cases of OSAHS. OBJECTIVES AND METHODS: To assess the involvement of IL-6 and TNF-alpha in VEGF increases in patients with severe OSAHS, serum levels of IL-6 and TNF-alpha were determined in patients with severe OSAHS (n=110) and compared to those of controls (n=45) using an enzyme-linked immunosorbent assay. RESULTS: No significant increase in IL-6 or TNF-alpha was detected in the present study cohort. However, the body mass index was significantly correlated with the severity of the apnea-hypopnea index. CONCLUSIONS: These data suggest that the elevation in VEGF is not directly related to IL-6 or TNF-alpha levels. However, the question of whether VEGF is the cause or the result of OSAHS remains to be determined. Further studies are needed to clarify the role of IL-6 and TNF-alpha in the pathogenesis of OSAHS, in which obesity should be entered as an independent factor.     

Effects of indigo carmine intravenous injection on oxygen reserve index (ORi™) measurement

To retrospectively investigate the effects of indigo carmine intravenous injection on oxygen reserve index (ORi?) in 20 patients who underwent elective gynecologic surgery under general anesthesia. The study subjects were patients who underwent elective gynecologic surgery under general anesthesia between April 2016 and January 2017, and were administered a 5-ml intravenous injection of 0.4% indigo carmine for clinical purposes during surgery with ORi monitoring. Changes in ORi within 20 min after indigo carmine injection were observed. A relevant decrease in ORi was defined as ≥?10% reduction in ORi from pre-injection level. ORi rapidly decreased after indigo carmine intravenous injection in all patients. In 10 of 19 patients, ORi decreased to 0 after indigo carmine injection. The median lowest value of ORi was 0 (range 0–0.16) and the median time to reach the lowest value of ORi was 2 min (range 1–4 min) after injection. ORi values returned to pre-injection levels within 20 min in 13 of 19 patients, and the median time to return to pre-injection levels was 10 min (range 6–16 min) after injection. During ORi monitoring it is necessary to consider the rapid reduction in ORi after intravenous injection of indigo carmine.     

Caffeine rapidly decreases potassium conductance of dissociated outer hair cells of guinea-pig cochlea

The effects of caffeine on the outer hair cells (OHCs) freshly dissociated from guinea-pig cochlea were investigated with the whole-cell patch-clamp technique, in both the conventional and the nystatin perforated patch-clamp configurations under voltage-clamp condition. Application of caffeine (> 1 mM for 10–30 s) induced an inward current (I_caffeine) with decrease of conductance in a dose-dependent manner at a holding potential (V_H) of −60 mV. The reversal potential ofI_caffeine (E_caffeine) was close to the K⁺ equilibrium potential. TheI_caffeine was not affected by Ca²⁺-free external solution. The internal perfusion of the Ca²⁺ chelator BAPTA had no effect onI_caffeine. TheI_caffeine was not modulated by the external application of H-8 or staurosporine and by the internal perfusion of GDP-βS. The amplitude ofI_caffeine was the largest at the basal region of OHCs when caffeine was locally applied by the ‘puffer’ method. These results suggest that caffeine induces a decrease in membrane potassium conductance of the OHCs mainly at the basal region without mediating the intracellular signaling pathway.     

Orientation of human glioblastoma cells embedded in type I collagen,caused by exposure to a 10 T static magnetic field

We investigated the preferred orientation of human glioblastoma cells (A172) following exposure to static magnetic fields (SMF) at 10 Tesla in the presence or absence of collagen. A172 cells embedded in collagen gel were oriented perpendicular to the direction of the SMF. A172 cells cultured in the absence of collagen did not exhibit any specific orientation pattern after 7 days of exposure to the SMF. Thus we succeeded in evoking the magnetic orientation of human glioblastoma cells by exposure to the SMF. Our results suggest that the orientation of glioblastoma cell processes may be due to the arrangement of microtubules under the influence of magnetically oriented collagen fiber.     

Chromosomal numerical abnormalities in early stage lung adenocarcinoma

Chromosomal numerical abnormalities (CNA) are ubiquitous in human cancers. However, the question of when a CNA occurs in the course of tumor generation and progression, is controversial. Recent radiological scrutiny has enabled the identification of small peripheral lesions in the lung. A chromosome-wide investigation encompassing almost all the chromosomal centromeres was performed using modified fluorescence in situ hybridization on the archived pathological samples of 16 atypical adenomatous hyperplasia (AAH) and 30 lung adenocarcioma (AdCa) specimens including those smaller than 1 cm in size. The prevalence of the gain was more extensive in male than in female patients, and in non-smokers than in smokers. It tended to be greater in poorly differentiated AdCa, in moderately differentiated AdCa, and in well-differentiated AdCa cases, in that order. Most AAH had non-specific gains affecting all the examined chromosomes. The prevalence of the gain differed significantly between AAH and bronchioloalveolar carcinoma (BAC) 1 cm. It is proposed that the CNA is a distinct phenomenon occurring in the early or premalignant stage of lung AdCa, and that the CNA itself may not be a sequel in the carcinogenetic process, but a driving factor in carcinogenesis.