Impact of surgically placed radiopaque markers during aortic root surgery on facilitating secondary diagnostic and therapeutic interventions

BACKGROUND

Implantation of radiopaque markers during aortic root surgery might possibly facilitate upcoming coronary angiography or transcatheter aortic valve implantation. Aim of this study was to report the impact of surgically placed radiopaque markers on procedural characteristics and on angiographic outcomes.

METHODS

We retrospectively analyzed baseline characteristics, preoperative and postoperative data as well as procedural findings. In addition, a subgroup analysis of all patients who underwent coronary angiography after aortic root surgery was performed to report radiation time and contrast media used.

RESULTS

A total of 469 patients underwent aortic root surgery between January 2008 and April 2020. Patients were divided into two groups: group w/ markers (n = 182) and group w/o markers (n = 287). A propensity score matching was performed resulting in a total of 28 patients w/ markers and 28 patients w/o markers. Aortic cross-clamp time did not differ statistically significantly between the group w/o markers and the group w/ markers (124.0 [96.0-150.0] versus 123.0 [110.0-149.0] min, p = 0.09). There was no increased probability for requirement of postoperative angiography in the group w/o markers compared to the group w/ markers (11.8% versus 15.4%, p = 0.27). There was no statistically significant difference in the radiation time 5.5 [3-6.5] versus 5 [2.5-7.5] min, p = 0.62) nor in the amount of contrast media used (85 [77.5-100] versus 80 [60-90] ml, p = 0.07).

CONCLUSIONS

Surgically placed radiopaque markers during aortic root surgery do not increase operative risk and have the potential for facilitating secondary diagnostic and therapeutic interventions.

The David procedure for quadricuspid aortic valve repair

Quadricuspid aortic valves are rare but may result in significant aortic regurgitation requiring surgery. To date, valve-sparing root replacement is frequently done in patients with bi- and tricuspid aortic valve pathologies with preserved cusp tissue. Nevertheless, little is known about quadricuspid repair, especially in regard to the optimal surgical technique for long-term durability. We hereby provide a surgical guide to valve-sparing aortic root replacement using the David technique in a young patient with severe aortic regurgitation.

Recurrent Cardiac Constriction after Implantation of an Expanded Polytetrafluoroethylene Surgical Membrane

One of the challenges compounding the complexity of reoperative cardiac surgery is the surgical adhesion, which can be responsible for adverse intraoperative events. Implantation of a substitute neo-pericardium has become a frequently used solution, with currently rising numbers of reoperations. We report the case of a 38-year-old man who developed recurrent delayed cardiac constriction following the implantation of an expanded polytetrafluoroethylene neo-pericardium. Careful preoperative planning is recommended to plan the optimal method of pericardioplasty, taking into account the pros and cons of each available material.

German Aortic Root Repair Registry - Insights from the First 400 Consecutive Patients

BACKGROUND

The objective was to provide initial data from our prospective valve-sparing aortic root replacement (V-SARR) registry and reasons for conversion to prosthetic replacement (AVR).

METHODS

Six centers established an intention-to-treat-design V-SARR-registry (German Aortic Root Repair Registry, GEARR, first-patient-in 10/2016) with main inclusion criterion "scheduled for V-SARR as Plan A". Clinical information, operative details, intraoperative valve/root measurements and clinical/TTE follow-up-data are documented.

RESULTS

Of a total of n=449, we report data on n=401 patients (81% male, mean age 51±14y). N=350 underwent V-SARR as scheduled (Group A, "David"-variants I 55%, III 2%, IV 13%, V 24%, V- Stanford 2%, Yacoub-Remodeling 2%), n=51 were converted to AVR (Group B). Median follow-up was 11 months (0-2.6y), cumulative follow-up 279 patient-years. In Group B there were less connective tissue disorders (6vs16%), fewer patients had LVEF>50% (60%vs90%), more had bicuspid aortic valves (BAV,45%vs28%), fewer patients had preoperative non/trace AR (2%vs20%). Fewer individuals in Group B had rare types of BAV (fused N/L, R/N, 10%vs30%) and more had unbalanced roots (56%vs40%). Immediate-postoperative AR was none/trace in 79%, and mild in 20%. At 30 days the dpmean was 7±5mmHg. None of the patients died in hospital, two strokes occurred. One patient needed early AVR as re-do surgery.

CONCLUSIONS

Main factors causing surgeons to convert a planned V-SARR to AVR include asymmetry of aortic valve/root, severity of AR, safety-reasons (LVEF), and BAV, but not rare types of BAV. GEARR will help us identify the impact on long-term outcomes of pre- and postoperative valvular anatomy and various V-SARR types.

Direct Versus Side Graft Cannulation From the Right Axillary Artery in Thoracic Aortic Surgery

BACKGROUND

The axillary artery can be cannulated for antegrade cerebral perfusion directly or by employing a prosthetic vascular graft anastomosed to the artery.

METHODS

From 2008 until 2019, 688 patients underwent axillary artery cannulation. Of those, 287 underwent direct cannulation and 401 cannulation through a side graft. We identified risk factors for cannulation-related complications, and after propensity score matching, we compared the 2 matched cohorts' cannulation-related and postoperative outcomes.

RESULTS

A smaller axillary-artery diameter (odds ratio = 0.70; 95% confidence interval, 0.56-0.87) and emergency surgery (odds ratio = 2.23; 95% confidence interval, 1.27-3.92) were identified as risk factors for cannulation-associated complications. In the propensity score-matched cohorts (n = 266 in each), the number of patients experiencing cannulation-related complications was significantly higher in the direct cannulation group than in the side-graft group (n = 33 [12.4%] versus n = 15 [5.6%]; P = .01). The direct group's incidence of iatrogenic axillary artery dissection was significantly higher (n = 17 [6.4%] versus n = 4 [1.5%] P = .008); their incidence of postoperative stroke was also significantly higher (n = 39 [14.7%] versus n = 21 [7.9%]; P = .025). Patients cannulated with a side graft needed more transfusions of blood products (median [IQR]: 3.0 [1.0-6.0] versus 4.0 [2.0-7.0;] P = .009).

CONCLUSIONS

Cannulating the right axillary through a vascular prosthetic graft reduces cannulation-related complications such as iatrogenic axillary artery dissection and lowers stroke rates. To help prevent cannulation-related complications and stroke, we recommend the routine use of a side graft when cannulating the axillary artery.

Eigenschaften des Tropokollagen-Moleküls und deren Bedeutung für die Fibrillenbildung

Long-Spacing-Segmente enthalten im Gegensatz zu Fibrillen des nativen Typs kein oder nur sehr wenig Tyrosin.

Die nach „Anfärbung“ im Elektronenmikroskop sichtbare hochunterteilte Querstreifung entsteht bei Fibrillen und Segmenten nach dem gleichen Mechanismus.

Durch vergleichende Untersuchung der Querstreifungsmuster von mit Phosphorwolframsäure und mit Uranylacetat „angefärbten“ Segmenten wurden getrennte Anhäufungen von basischen und sauren Aminosäuren längs des Tropokollagen-Moleküls nachgewiesen und lokalisiert.

Die um ein Viertel ihrer Länge gegeneinander versetzte parallele Anordnung der Tropokollagen-Moleküle in den Fibrillen des nativen Typs und die antiparallele, mit den Enden ungefähr abschneidende Zusammenlagerung in den Fibrillen des Long-Spacing-Typs wurden durch graphische Addition entsprechend angeordnete Photometerkurven von Long-Spacing-Segmenten bewiesen.

Die seitliche Zusammenlagerung und die End-an-End-Verknüpfung der Tropokollagen-Moleküle sind auf elektrostatische Kräfte zurückzuführen.

Novel amplification unit at chromosome 3q25-q27 in human prostate cancer

BACKGROUND

In prostate carcinoma, amplification of the genes c-MYC, Her2/NEU, and the androgen receptor gene has been documented, with gene amplification being related to progressive tumor growth. Recently, using comparative genomic hybridization (CGH), we provided evidence for DNA copy number gains at chromosome 3q25-q26 in prostate cancer [Sattler et al.: Prostate 39:79-86, 1999].

METHODS

In this study, additional prostatic tumors were evaluated by CGH to determine the frequency of DNA overrepresentation at 3q. Comparative PCR and Southern blot analyses were applied to determine whether known genes are involved in DNA copy number gains.

RESULTS

By CGH, DNA copy number gains, all of which involved chromosome region 3q25-q26, were disclosed in 50% of the prostate tumors analyzed. There was no evidence for high-level amplification. The analysis of 12 genes from 3q25-q27 by comparative PCR revealed amplification in 6 (35.3%) of 17 tumors tested. Amplification was detected for the genes IL12A, MDS1, SLC2A2, and SOX2, with coamplification of three genes in two tumors. IL12A was amplified as single gene in three tumors and in a subline of the DU145 cell line, SLC2A2 in one tumor.

CONCLUSIONS

Our studies revealed a novel amplification unit at 3q25-q27 in prostate carcinoma, with the genes IL12A, MDS1, SLC2A2, and SOX2 being located within the amplification unit. A common region of amplification was evident spanning the IL12A gene locus at 3q25-q26.2. Possibly, IL12A indicates an adjacent, till now unidentified gene which is important in the development of prostate cancer.

Cardiac compliance in fetuses of diabetic women

OBJECTIVE

To examine possible changes in cardiac function in fetuses of pregestational diabetic mothers.

METHODS

We conducted a prospective longitudinal study of 31 women whose pregnancies were between 22 weeks' gestation and term, and who had pregestational diabetes. All diabetic women included in the study had glycosylated hemoglobin lower than 6.5%. All patients included in the study had an early ultrasound confirming gestational age. Doppler studies of the blood flow through the mitral and tricuspid valves were done every 4 weeks using a pulsed-wave Doppler ultrasound device with a 3.5- or 5-MHz transducer. The following indices were calculated from the flow velocity waveforms: the peak velocity during the rapid ventricular filling (E wave) and during the atrial systole (A wave), and the ratio between these velocities (E/A ratio); and the velocity time integral of the atrioventricular blood flow (this integral correlates with volume flow). A comparison between the Doppler indices obtained in fetuses of diabetic women and of normal women was made by using the Mann-Whitney test.

RESULTS

Each patient had four to five fetal echocardiographic examinations at 22, 26, 30, 34, and 38 weeks' gestation. The E/A ratio of the mitral and tricuspid valves did not increase in fetuses of diabetic women during the third trimester and was significantly higher in fetuses of nondiabetic women compared with fetuses of diabetic women at 34 and 38 weeks' gestation. The velocity time integral of the mitral and tricuspid valves multiplied by heart rate was higher, but not significantly, in fetuses of nondiabetic women compared with fetuses of diabetic women at 34 and 38 weeks' gestation. The E-wave of the mitral and tricuspid valves increased in both groups throughout gestation. The A-wave of the mitral and tricuspid valves increased only in fetuses of diabetic women throughout the third trimester and was significantly higher at 34 and 38 weeks' gestation compared with fetuses of nondiabetic women.

CONCLUSION

Differences in atrioventricular blood flow patterns between fetuses of diabetic women and normal fetuses do not necessarily result from differences in cardiac compliance.

Phylogeny and biogeography of Aralia sect. Aralia (Araliaceae)

Aralia sect. Aralia (Araliaceae) consists of approximately eight species disjunctly distributed in Asia and North America. Phylogenetic and biogeographic analyses were conducted using sequences of the internal transcribed spacer regions of the nuclear ribosomal DNA. Aralia racemosa from eastern North America was sister to A. californica from western North America. Aralia cordata from eastern Asia did not form a species-pair relationship with the eastern North American A. racemosa. The two subspecies of A. racemosa formed a monophyletic group. Biogeographic analyses showed a close area relationship between eastern North America and western North America. The Himalayas were cladistically basal and eastern Asia was placed between the Himalayas and North America. The biogeographic analysis supported the origin of the eastern Asian and eastern North American disjunct pattern in Aralia sect. Aralia via the Bering land bridges. Comparisons with results of phylogenetic analyses of other genera suggested that (1) the floristic connection between eastern North America and western North America may be stronger than previously thought; and (2) the biogeographic patterns in the Northern Hemisphere are complex. Furthermore, a lack of correlation between sequence divergence values and phylogenetic positions was observed, suggesting the importance of a phylogenetic framework in biogeographic analyses.

Glucose metabolism in the yeast Schwanniomyces castellii: role of phosphorylation site I and an alternative respiratory pathway

Glucose metabolism in a Crabtree-negative yeast, Schwanniomyces castellii, and a cytochrome b-deficient mutant of this strain was investigated in chemostat culture. The wild-type and mutant strains exhibited the same behavior. Oxidative metabolism was observed when the substrate uptake rate (qS) was low. Fermentative metabolites were excreted when the qS value was higher than 0.40 g.g-1.h-1, indicating the occurrence of a respirofermentative metabolism; however, the respiratory quotient (RQ) remained near 1. When fermentation occurred, the cytochrome pathway was repressed but not the salicylhydroxamic acid (SHAM)-sensitive pathway. The presence of an alternative SHAM-sensitive respiratory pathway and the presence of phosphorylation site I in all metabolic conditions explained the RQ value of 1 and accounted for high biomass yields in oxidative metabolism conditions (0.62 g.g-1 for the wild-type strain and 0.31 g.g-1 for the cytochrome b-deficient mutant strain).

The CYP2D6B allele is not overrepresented in a population of German patients with idiopathic Parkinson's disease

The frequency of the CYP2D6B allele of the gene for debrisoquine 4-hydroxylase was studied in 115 patients with sporadic idiopathic Parkinson's disease, 55 of their healthy siblings, 63 patients with familial Parkinson's disease, 55 unaffected relatives, and 92 patients with Alzheimer's disease and 73 age matched healthy controls. By contrast with several previous studies, no significant variation of allele frequencies could be found between any of the groups studied. The results argue against a significant role of the CYP2D6 gene in the aetiology of sporadic and familial idiopathic parkinsonism in this patient population.

A multidirectional sonographic approach to elevated amniotic alpha-fetoprotein or positive acetylcholinesterase

OBJECTIVE

To evaluate the combined transvaginal and transumbilical ultrasonographic approach in cases of elevated amniotic fluid (AF) alpha-fetoprotein (AFP) and/or acetylcholinesterase in the second trimester.

METHODS

Nine pregnant women with normal sonographic results were referred because of elevated AF AFP and/or acetylcholinesterase and screened using a transvaginal and transumbilical 6.5-MHz ultrasound transducer. All women were at 17-21 weeks' gestation. The fetal skull and the vertebral column were scanned in both perpendicular and tangential planes for maximal exploitation of the axial resolution of the transducer, in both directions and in two to three planes.

RESULTS

Despite increased AF AFP and/or present acetylcholinesterase, no fetal malformation was detected in any of the nine cases. Open neural tube defects were not detected by the diagnostic technique. All nine women were delivered of term healthy neonates without malformations.

CONCLUSION

Our preliminary data suggest that targeted sonographic screening combining transvaginal and transumbilical approaches may reliably rule out an open neural tube defect larger than 0.3 mm. This may influence the decision-making process when termination of pregnancy is considered in cases of high AF AFP and/or positive acetylcholinesterase.

Immunonephelometric determination of the C4b-binding protein

A fully mechanised immunonephelometric method for the rapid and specific determination of C4b-binding protein (C4b-BP) in citrated plasma is described. The method utilizes commercially available rabbit antiserum against human C4b-BP and a nephelometer analyser. A single determination can be performed within 6 min, requiring 80 microliters sample volume. The measuring range is about 10 to 200% of normal C4b-BP. Precision is characterized by intraassay coefficients of variation between 1.5% and 2.8%, and interassay coefficients of variation between 4.0% and 4.6% for the same C4b-BP concentrations. The nephelometry of C4b-BP was correlated with electroimmunodiffusion (Laurell technique; r = 0.863, y = 0.909x+7.091, n = 79). C4b-BP concentrations (143%, 96-223%; median and 2.5th-97.5th percentile) from 83 subjects with increased inflammation markers C-reactive protein (> 10 mg/l), and fibrinogen (> 4.5 g/l) showing significantly higher C4b-BP concentrations compared to 151 obviously healthy subjects (97%, 68-141%; p < 0.001). In contrast to 81 patients with therapeutic heparinisation (90%, 60-131%) significant decreased concentrations were found in 90 subjects under oral anticoagulant therapy (OAT) in the stable state (78%, 44-125%; p < 0.001). Depending on different INR levels (< 2.5, n = 40: 71%, 63-85%; > 2.5, n = 50: 81%, 68-92%; median and 25th-75th percentile) no significant differences of C4b-BP concentrations could be measured.

Quality videotapes with the help of a computer

The last few years have seen a tremendous growth in videocassette usage, not only for entertainment, but also as a viable teaching method. Most homes in American now have at least one VCR. At Ozarka Vo Tech in Melbourne, AR, educators recognize the educational value of videotapes and have combined efforts to produce several quality computer-generated videotapes. With funding from projects, P189-01 A Competency-Based, Computer-Assisted, And Computer-Managed Model LPN Program, and the PI 2B061 Comprehensive Learning Lab, educators have been able to produce teacher-made videotapes to augment the different educational programs at our school. This article describes the method used, equipment needed, and general hints for improving the quality of teacher-made videotapes.

First- and second-trimester diagnosis of fetal ocular defects and associated anomalies: report of eight cases

Ocular cataract, hypertelorism, hypotelorism, anophthalmos, and microphthalmos are rare malformations commonly associated with other fetal anomalies. Previously, ocular malformations were detected only after mid-gestation. Transvaginal sonography allows the detection of many structural fetal anomalies. We describe the case reports of eight ocular anomalies among 1600 fetal screenings by transvaginal sonography at 12-18 weeks' gestation. Severe cataract was correctly diagnosed by transvaginal sonography. However, transvaginal sonography failed to detect moderate cataract in a case of repeat cataract in a subsequent gestation. Anophthalmia may sometimes be secondary to a degenerative process in middle and late pregnancy. In five of the eight described cases, the eye malformations were associated with defects of the central nervous system.

Comparisons of Lasker's coefficient of relationship in a Venezuelan town in two different periods

A formula for the standard error of Lasker's coefficient of relationship Ri derived from isonymy is proposed, and used to test for differences in relationship in two groups of pairs of spouses from the town of Quibor in Venezuela sampled one century apart. From analysis of the relationship, it was possible to attribute population growth also to immigration. Further, the study of the values of Ri showed that the surnames belonging to the male line are more frequent and stable in this population, which is characterized by a predominantly agricultural activity. From the analysis of the coefficients of relationship, the population of Quibor is also classified as patrilocal.

The molecular through ecological genetics of abnormal abdomen. II. Ribosomal DNA polymorphism is associated with the abnormal abdomen syndrome in Drosophila mercatorum

Restriction endonuclease cleavage analyses of cloned and genomic DNA samples indicate that the structure of the DNA encoding the large cytoplasmic RNAs (rDNAs) is altered in Drosophila mercatorum lines which exhibit an abnormal abdomen (aa) phenotype. In a majority of the rDNA repeat units from aa flies, the 28S coding sequence is interrupted by a large [5-6 kilobase pairs (kbp)] insert. A subclone containing this inserted DNA (ins 3) hybridizes primarily to rDNA-containing sequences in in situ and genomic blot hybridization experiments. Additionally, genomic nitrocellulose blot hybridization analyses show that ins- containing rDNA repeat units are clustered in a spontaneously arising aa mutant. This rDNA alteration in D. mercatorum flies with the aa phenotype more closely resembles the bobbed (bb) defect of D. hydei than the bb defect of D. melanogaster, which involves alterations in rDNA copy number. By analogy with the other Drosophila systems, we propose that the altered D. mercatorum rDNA repeat units are defective in rRNA production at a critical stage. The lowered levels of rRNA ultimately would limit the concentration of ribosomes needed to produce large quantities of a protein (in these cases, juvenile hormone esterase) needed for normal development.

Hyperfibrinolysis and hypercholesterolaemia in salt-intoxication in pigs

Non-acute salt-intoxication in pigs leads to hyperfibrinolysis and a continuous rise in cholesterol due to an increase in the LDL fraction. Morphologically, spherical microthrombi, vascular wall infiltration and changes to organs have been found, as have also been described in shock or stress situations.

Molecular evidence for genetic exchanges among ribosomal genes on nonhomologous chromosomes in man and apes

We have found that human and ape ribosomal genes undergo concerted evolution involving genetic exchanges among nucleolus organizers on nonhomologous chromosomes. This conclusion is based upon restriction enzyme analysis of the ribosomal gene families in man and five ape species. Certain structural features were found to differ among (but not within) species even though the ribosomal genes have a multichromosomal distribution. Genetic exchanges among nucleolus organizer regions may be related to the well-known phenomenon of acrocentric chromosome associations observed in man and apes. Length variation in a region of the nontranscribed spacer was found in both chimpanzee species we examined. The nature of this length variation was found to be identical to that previously described in man. The origin of the length variation and its polymorphism within these three species might be explained by unequal alignment and unequal cross-over among the ribosomal genes. An especially surprising finding was a nucleotide sequence polymorphism present in each individual human and ape we examined. Some ribosomal genes of each individual have a HindII site in the 28S gene about 800 base pairs from the EcoRI site in this gene. The remaining 28S genes lack this HindII site. The presence of this polymorphism within individuals of every species we examined suggests that it has been maintained by natural selection.

[Laboratory procedures in adenoviruses. IV. The influence of antiglobulin and complement on neutralization and hemagglutination-inhibition (author's transl)]

The neutralization of adenovirus 3,7, and 19 by rabbit antisera is enhanced by additional application of antirabbit globulin. All sera investigated, obtained early or late after the start of immunization, showed two- to sixfold titer rises. Complement also enhances the neutralization; the titer is raised to a greater extent in early than in late sera. To achieve maximal effects, antiglobulin and complement had to be used in fairly high concentration (ca. 10%). In hemagglutination-inhibition the same set of sera showed a titer increase mediated by anti-rabbit globulin (mostly by the factor 2 to 4), while complement was without influence. The neutralization titer of human sera from patients with adenovirus infections, as opposed to the rabbit antisera, was only slightly increased by addition of anti-human globulin or complement. These reagents had likewise negligible influence on the hemagglutination-inhibition of adenovirus 8 by human sera.