Hyperspectral imaging of vascular anastomosis associated with blood flow and hemoglobin concentration

The feasibility of optical non-invasive evaluation of the graft function of vascular anastomosis was investigated in vitro using hyperspectral imaging (HSI) in the wavelength range from 500 to 600 nm. A Y-shaped vessel was made using porcine carotid arteries having an inner diameter of 3.5 to 4 mm. The graft vessel was anastomosed at a 45° angle with 8-0 polypropylene suture. Fresh porcine blood at an oxygen saturation of 100% was circulated in the specially designed circuit loop and through the graft or main vessel. The vessels were then irradiated with light, and the reflected light was captured with an HSI camera. The attenuation (A) image at each wavelength (λ) was obtained and the spectral A(λ) image was created. The spectral A(λ) image showed graft patency and changes in the hemoglobin concentration. The A(λ) decreased as the flow rate increased due to the orientation of the red blood cells. The experimental results indicated that imaging of the hemoglobin concentration without distortion from blood flow is possible using two wavelengths: 625 and 770 nm. This method is able to distinguish between the blood flow and changes in hemoglobin concentration. The multispectral and hyperspectral imaging method is useful for the non-invasive evaluation of graft function.

New generation extracorporeal membrane oxygenation with MedTech Mag-Lev, a single-use, magnetically levitated, centrifugal blood pump: preclinical evaluation in calves

We have evaluated the feasibility of a newly developed single-use, magnetically levitated centrifugal blood pump, MedTech Mag-Lev, in a 3-week extracorporeal membrane oxygenation (ECMO) study in calves against a Medtronic Bio-Pump BPX-80. A heparin- and silicone-coated polypropylene membrane oxygenator MERA NHP Excelung NSH-R was employed as an oxygenator. Six healthy male Holstein calves with body weights of about 100 kg were divided into two groups, four in the MedTech group and two in the Bio-Pump group. Under general anesthesia, the blood pump and oxygenator were inserted extracorporeally between the main pulmonary artery and the descending aorta via a fifth left thoracotomy. Postoperatively, both the pump and oxygen flow rates were controlled at 3 L/min. Heparin was continuously infused to maintain the activated clotting time at 200-240 s. All the MedTech ECMO calves completed the study duration. However, the Bio-Pump ECMO calves were terminated on postoperative days 7 and 10 because of severe hemolysis and thrombus formation. At the start of the MedTech ECMO, the pressure drop across the oxygenator was about 25 mm Hg with the pump operated at 2800 rpm and delivering 3 L/min flow. The PO2 of the oxygenator outlet was higher than 400 mm Hg with the PCO2 below 45 mm Hg. Hemolysis and thrombus were not seen in the MedTech ECMO circuits (plasma-free hemoglobin [PFH] < 5 mg/dL), while severe hemolysis (PFH > 20 mg/dL) and large thrombus were observed in the Bio-Pump ECMO circuits. Plasma leakage from the oxygenator did not occur in any ECMO circuits. Three-week cardiopulmonary support was performed successfully with the MedTech ECMO without circuit exchanges. The MedTech Mag-Lev could help extend the durability of ECMO circuits by the improved biocompatible performances.

Prevention of atrial fibrillation with ultra-low dose landiolol after off-pump coronary artery bypass grafting

PURPOSE

Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that is associated with an increased incidence of other complications. The goal of this prospective randomized study was to evaluate the effect of ultra-low dose landiolol hydrochloride for prevention of AF after off-pump coronary artery bypass grafting (CABG).

METHODS

The subjects were 47 patients who underwent isolated CABG and were randomly divided into those who received landiolol from ICU admission until the beginning of oral drug intake (Group L) and those administered diltiazem hydrochloride over the same period (Group D). The incidence of AF within one week after surgery was examined as the primary endpoint. Heart rate, blood pressure, cardiac output, and other hemodynamic parameters were used as secondary endpoints. The rates of adverse events were also recorded.

RESULTS

The incidences of AF in the first postoperative week were 4.8% and 27% in Groups L and D, respectively (p = 0.046). There were no differences in hemodynamic parameters between the Groups. In multivariate analysis, no factor emerged as a significant risk factor for postoperative AF. Two patients had adverse events of asthma and hypotension, respectively, in Group L.

CONCLUSION

Ultra-low dose landiolol is effective for preventing AF after CABG without worsening hemodynamics.

Alterations in red blood cell volume and hemoglobin concentration, viscoelastic properties, and mechanical fragility caused by continuous flow pumping in calves

In this study, we have analyzed the changes in mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and the dynamic deformability and mechanical fragility of red blood cells (RBCs) in five male Holstein calves (body weight: 95.6 ± 10.8 kg) whose circulation was partially supported with a novel magnetically levitated extracorporeal centrifugal blood pump MedTech Dispo. One hour after the pumping has started, the MCV increased and the MCHC decreased by 1.064 ± 0.006 and 0.906 ± 0.050 times, respectively, as compared with those of the prepumped blood (P < 0.05). The deformability index L/W, where L and W are the long and short axes of the two-dimensional RBC images, respectively, sheared by a cyclically reversing shear flow increased indicating that the RBCs pumped for 1 h exhibited more elastic characteristics (P < 0.05). In addition, when the pumped blood cells were sheared for 30 min with a uniform shear stress of 25.38 Pa, the hemolysis level decreased dramatically as compared with the control blood, as more fragile RBCs were destroyed by pumping, leaving behind less fragile RBCs. All these characteristics of the RBCs exposed to continuous flow resemble those of young RBCs having larger MCV, lower MCHC, higher elasticity, and lower fragility. In conclusion, during continuous flow pumping, the RBCs having relatively lower threshold for hemolysis to mechanical shear stress generated by continuous flow blood pump (CFBP) are destroyed first and removed from circulation in the early stage of application of CFBP, thus leaving behind less fragile and stronger RBCs.

Effect of different labio-lingual spaces in tray designs on the displacement of and pressure against a mobile tooth

The present study aimed to examine the effect of custom tray designs on the displacement of mobile tooth and local impression pressures during the impression procedure, using partially edentulous simulation models with six anterior teeth containing a mobile tooth prepared in previous studies. The custom trays were designed by altering the thickness of the respective spaces on the labial and lingual sides of the remaining tooth arch. In previous studies, the mobile tooth was displaced in the labial direction and local impression pressures of the mobile tooth were greater against the lingual side than the labial side for all custom tray designs. Furthermore, the custom trays perforated with holes on the lingual side were effective to reduce mobile tooth displacement, labial and lingual impression pressures against the mobile tooth, and the differences between them. Therefore, the present study was performed focusing on the labial and lingual thickness of spaces in custom tray designs. It was found that mobile tooth displacement, labial and lingual impression pressures against the mobile teeth and their differences were less in trays with spaces>3.0 mm thick on both the labial and lingual sides, but markedly greater in trays with a 1.5 mm-thick space on the labial side. These results indicate that the thickness of spaces on the labial side in the tray should not be reduced to prevent mobile tooth displacement.

Influence of lip support on the soft-tissue profile of complete denture wearers

Complete dentures change the soft-tissue profile, although the exact relationship remains unclear. This study examined the relationship between the presence and degree of lip support provided by dentures and the lateral views of the facial appearance of edentulous patients. The subjects were five edentulous patients (three men and two women). Their facial appearances with experimental record blocks, with and without their complete dentures, were measured using a three-dimensional laser measuring system. The experimental record block for each subject had different conditions in the anteroposterior direction anteriorly but the same vertical dimensions posteriorly. The lateral digital facial images were displayed on a computer monitor, and the linear and angular measurements were analysed using image analysis software. The nasolabial angle was smaller and the labial points projected more with excessive lip support versus with deficient support. Moreover, the counter of the nose was affected by the labial flange of the record base, particularly in the facial appearance of one subject with highly atrophic residual ridges. The lip support affected the lower facial soft-tissue profile, including the lower part of the nose; the nasolabial angle and positional relationship between the lips and Ricketts's esthetic plane (E plane) are useful indexes for examining lip support.

Dynamic viscoelastic properties of commercial glass-fibre reinforced resin used for crowns and bridges

In order to investigate the thermal stability, the physical and mechanical, and dynamic viscoelastic properties of glass-fibre reinforced composite materials were measured. The G' of the seven materials examined was within 5;20 +/- 14; 55 and 4;50-14; 35 GPa for dry and wet specimens in air at 37 degrees C, respectively, and decreased with increasing temperature. The G' values of dry specimens decreased by 7;74-15;4% when heated to 60 degrees C. The value of tan delta ranged from 0;0102 to 0;0295 and from 0.0181 to 0.0406 for dry and wet specimens in air at 37 degrees C, respectively. The coefficient of linear thermal expansion between 30 and 60 degrees C ranged from 0;557 to 3; 95 x 10-5/ degrees C. Moreover, the filler content ranged from 56; 36 to 88; 87 wt%. These results showed that the magnitudes of G', tan delta, and the coefficient of linear thermal expansion and water absorption depend on the inorganic filler or glass-fibre content; i.e. the amount of resin matrix. Moreover, for all the materials examined, the G' values were thermostable in the temperature range encountered in the oral cavity.

Immunolocalization of osteoclast differentiation factor in rat periodontium

The aim here was to observe the immunohistochemical localization of osteoclast differentiation factor (ODF)/receptor activator of NF kappa B ligand (RANKL) in the rat periodontium. Rat mandibles were demineralized and embedded in paraffin, and horizontal and frontal sections were prepared for immunohistochemical analysis. In horizontal sections, immunolocalization of RANKL was marked in the distal area of the periodontium of molars in which osteoclasts appeared, due to physiological tooth drift. In frontal sections, RANKL immunoreactivity was localized on spindle-shaped mesenchymal cells around blood vessels near the bone surface in the periodontium. In addition, immunoreaction for RANKL was detected on structures that appeared to be elongated cell processes near blood vessels in frontal sections. Immunohistochemical examination for the general antigen of nerve-specific protein suggested a similarity between these structures and nerve fibres.

Effects of oestrogen deficiency on osteoclastogenesis in the rat periodontium

This study was designed to investigate quantitative changes in osteoclast generation in rat periodontium following ovariectomy. Wistar rats, aged 9 weeks, were subjected to either ovariectomy (OVX) or sham surgery. Osmotic pumps were implanted in 24 rats and either 17beta-oestradiol or vehicle solution were infused continuously. The rats were assigned to one of the following groups: (1) OVX+vehicle; (2) sham+vehicle; or (3) OVX+ 17beta-oestradiol. On the days 7 and 14 after surgery, four rats in each group were killed. Mandibles were demineralized and embedded in paraffin. Frontal sections of alveolar bone in the region of the first molar were cut for enzyme histochemistry and immunohistochemistry. On day 7, there was no significant difference in the number of tartrate-resistant acid phosphatase (TRAP)-positive cells located on bone surfaces in either group. However, the number of TRAP-positive mononuclear cells that were separated from the bone surface was significantly higher in group 1 than in groups 2 and 3. On the day 14, the number of TRAP-positive cells in group 1, which were attached to the bone surface, was significantly higher than had been apparent on day 7. There were also significant increases in the number of nuclei of TRAP-positive cells attached to the bone in group 1 compared with groups 2 and 3 on day 14. These findings demonstrate that oestrogen deficiency induces of osteoclastogenesis in the rat periodontium and that quantitative changes in osteoclastogenesis could be prevented by E2 infusion.

The effect of oestrogen deficiency on the alveolar bone resorption caused by traumatic occlusion

This study, using 132 female rats, was designed to investigate whether oestrogen loss facilitates alveolar bone alterations induced by traumatic occlusion. Rats were ovariectomized (OVX) or underwent sham-operation (Sham). Seven days after surgery, half of the rats in each group were subjected to experimental traumatic occlusion (trauma), and the other half were left untreated. Thus, there were four groups: OVX+trauma, Sham+trauma, OVX, and Sham. Rats in each group were killed 1, 3, 5, 7, or 10 days after the introduction of occlusal trauma. The resected mandibles were processed without decalcification, and histomorphometric measurements were performed in the alveolar bone adjacent to the periodontal ligament of the first molar. The statistical assessment of the time- and group-specific differences by analysis of variance revealed significant differences between the OVX+trauma and Sham+trauma groups in the resorption parameters, but not in the formation parameters. The results show that the alveolar bone dynamics induced by traumatic occlusion are enhanced by oestrogen deficiency.

Impression pressures against teeth in a partially edentulous model with a mobile tooth: influence of impression tray design

The purpose of the present study was to examine the effect of custom tray designs on local pressures against teeth during the impression procedure. In a previous study, a partially edentulous simulation model with a mobile tooth was used, and the effect of custom tray designs on the displacement of the mobile tooth was examined during the impression procedure. Based on that study's results, we have assumed that the differences in impression pressures between the labial and the lingual sides of a mobile tooth could either cause or affect displacement. The present study was undertaken to determine the local impression pressures against each side of three anterior teeth, including one mobile tooth, using the same simulation model and the same custom trays as in the previous study. It was found that the local pressures exerted against teeth during the impression procedure were affected by the custom tray designs and varied according to the coronal shape, axis inclination and location of the teeth.

Malposition of the epiglottis after tracheal intubation via the intubating laryngeal mask

The intubating laryngeal mask has been reported to be a successful method of tracheal intubation although advancement of the tracheal tube via the laryngeal inlet into the trachea cannot be seen. Damage to the larynx or other tissues may occur during blind passage of a tracheal tube. We report a case in which the tracheal tube, advanced blindly, tucked the epiglottis into the laryngeal inlet, resulting in oedema of the epiglottis. This case illustrates the potential for airway obstruction after extubation when using the intubating laryngeal mask as a blind intubation guide.