Comparison of pulsatile with nonpulsatile mechanical support in a porcine model of profound cardiogenic shock

The aim of this study was to examine whether pulsatility by intraaortic balloon counterpulsation (IABP) is an important adjunct to the treatment of profound cardiogenic shock (CS) with a widely used, nonpulsatile centrifugal pump (CP). In each of 18 anesthetized, open chest pigs, the outflow cannula of the CP was inserted in the aortic arch through the right external carotid artery, and the inflow cannula of the CP was placed in the left atrium. A 40 cc IABP was subsequently placed in the descending aorta through the left external carotid artery. CS was induced by occlusion of coronary arteries and the infusion of propranolol and crystalloid fluid. Mean aortic pressure, pulse pressure, aortic end diastolic pressure, left ventricular end diastolic pressure, right atrial pressure, and heart rate were monitored. Cardiac output and left anterior descending artery flow were measured with a transit time ultrasound flowmeter. During profound CS, life sustaining hemodynamics were maintained only with the support of the assist devices. Hemodynamic support with the CP was associated with a nearly nonpulsatile flow and a pulse pressure of 7 +/- 4 mm Hg, which increased to 33 +/- 10 mm Hg (p = 0.000) after combining the CP with the IABP. Compared with the hemodynamic support offered by the CP alone, addition of the IABP increased mean aortic pressure from 40 +/- 15 to 50 +/- 16 mm Hg (p = 0.000), cardiac output from 810 +/- 194 to 1,200 +/- 234 ml/min (p = 0.003), and left anterior descending artery flow from 26 +/- 10 to 39 +/- 14 ml/min (p = 0.001). In profound CS, mechanical support provided by a continuous flow CP is enhanced by the added pulsatility of the IABP.     

No effect of stem cell mobilization with GM-CSF on infarct size and left ventricular function in experimental acute myocardial infarction

Abstract. Objectives: To evaluate the effect of bone marrowpluripotent stem cell mobilization with granulocyte-monocyte colony stimulating factor (GMCSF) on infarct size and left ventricular function, in the setting of acute myocardial infarction, with a protocol easily applicable in clinical practice. Methods: Ten pigs underwent left thoracotomy and left anterior descending coronary artery occlusion for 1 h, followed by reperfusion. After 50 min of arterial occlusion, the animals were randomly divided between treatment with placebo (Group 1) and subcutaneous GM-CSF (Group 2). The thoracotomy was closed and the animals recovered. In Group 2, GM-CSF, 20 µg/kg, was administered daily, 5 days/week, for 3 weeks. Echocardiograms were obtained at 5 and 28 days after acute myocardial infarction. At 30 days, infarct size, expressed as a percentage of the whole left ventricular mass, was measured. Results: The white blood cell count increased from 13000 ± 3338/µl to 28700 ± 4916/µl (p = 0.001) in the GM-CSF-treated group. Infarct size was 7.8 ± 6.1% in Group 1 vs 7.5 ± 7.7% in Group 2 (ns). Similarly, no significant difference was observed between the 2 study groups in any of the echocardiographic measurements made at 28 days. Conclusions: Subcutaneous GMCSF administered during the early post acute myocardial infarction period neither decreased infarct size nor improved left ventricular function. Other protocols for mobilization of stem cells and their concentration in the injured area should be developed to combine efficacy and clinical applicability.     

Superior Performance of a Paraaortic Counterpulsation Device Compared to the Intraaortic Balloon Pump

The purpose of this study was to compare the hemodynamic effectiveness of a 30-ml stroke volume paraaortic counterpulsation device (PACD), presenting the advantages of ease of implantation and driving by a standard intraaortic balloon pump (IABP) console (Datascope 96, Datascope Corp., Montvale, NJ, USA) to that of a 40-ml IABP, in the setting of experimental heart failure. In an acute heart failure model, the IABP was placed in the descending aorta and the PACD in the ascending aorta of eight pigs. Both devices were driven by the same system, and hemodynamic measurements were obtained with and without mechanical assistance. The two pumps significantly reduced the systolic and end-diastolic aortic pressures, but the PACD reduced the latter more effectively (42.6 ± 18.1% vs 11.0 ± 9.9%, p = 0.0001). Both pumps provided significant aortic diastolic augmentation, but the counterpulsation wave of the PACD was significantly greater (augmentation of 44.8 ± 22.2% vs 37.6 ± 15.6%, p = 0.031). Both lowered the end-diastolic left ventricular pressure with a trend toward PACD superiority (24.2 ± 13.7% vs 19.7 ± 13.5%, p = 0.064). It is concluded that the PACD, even with smaller stroke volume, is more effective than the IABP. The simplicity of its implantation, together with the ability of the standard IABP consoles to control its function, make it a promising device for mechanical assistance of the failing heart.     

Molecular characterization of high-risk humanpapillomavirus genotypes in women with or without cervical lesions at VIA/VILI in Kara,Togo

BackgroundPersistent infection with high-risk (HR) papillomavirus (HPV) genotypes plays a central role in the pathogenesis of invasive cervical cancer.ObjectivesThis study aimed to determine the prevalence and distribution of HR-HPV among women with or without cervical lesions at VIA/VILI in Togo.MethodsCervical samples were collected from 238 women with or without cervical lesions at VIA / VILI and[c3] DNA [c4]was extracted and analyzed by real-time multiplex PCR. Logistic regression analysis was used to determined risk factors associated with HPV infection.inPietro Annigoni Biomolecular Research Center (CERBA / LABIOGENE) in Burkina Faso.ResultsThe age of the women ranged from 17 to 61 years old, and most were married (73.5%). The prevalence of HRHPV was 35.71% and this was higher in the age range 35–39 years. The six most common genotypes were HPV 31 (18.7%), HPV 52 (13.82%), HPV 68 (13.01%), HPV 66 (9.76%), HPV 58 (8.13%) and HPV 56 (8.13%). Genotypes HPV 18 (4.07%) and HPV 16 (0.81%) were less frequent.[c5] Married or living with a partner was associated with HPV infection (OR=2,17, IC [1.20–3.91], p<0,009).ConclusionThis study allowed characterizing for the first time in Togo, HR-HPV genotypes. This will help mapping-HR-HPV genotypes circulating in West Africa.