Study transport of hesperidin based on the DPPC lipid model and the BSA transport model

Hesperidin (HE), a significant flavonoid polyphenolic compound present in citrus plants, exhibits diverse pharmacological effects. Considering the crucial involvement of biological membranes and transporter proteins in the transportation and biological processes of HE, it becomes essential to comprehend the potential mechanisms through which HE interacts with membranes and transporter proteins. In order to simulate the process of active molecule transport, a cell membrane model consisting of 1,2-dipalmitoyl-n-glycero-3-phosphatidylcholine (DPPC) and a transporter protein model of bovine serum albumin (BSA) were employed for investigation. The present study aimed to investigate the mechanism of action of hesperidin (HE) in DPPC and BSA using fluorescence quenching, Fourier transform infrared spectroscopy (FTIR), and differential scanning calorimetry (DSC). The localization and interaction of HE within liposomes were also elucidated. Furthermore, the binding of BSA and HE was analyzed through UV/Vis absorption spectroscopy, fluorescence spectroscopy, infrared spectroscopy, and computational biology techniques. Computational biology analysis revealed that the binding between HE and BSA primarily occurred via hydrogen bonding and hydrophobic interactions. This study aimed to investigate the role and mechanism of HE in the DPPC cell membrane model and the BSA transporter protein model, thereby offering novel insights into the action of HE in DPPC and BSA.

Complexation study of syringaldehyde complexed with serum albumin

As a major flavonoid polyphenolic compound in the stem of Hibiscus taiwanensis, syringaldehyde (SA) has numerous pharmacological effects. Nevertheless, owing to its less in-depth study, its application is limited. Within this work, the interactions between serum albumin and SA were elucidated by multispectral studies. The results of ultraviolet/visible absorption spectroscopy suggest that the conformation of serum albumin can be altered by binding with SA. Fluorescence spectroscopy indicates that SA forms complexes with serum albumin, quenching its fluorescence. This suggests that the fluorescent residues of serum albumin are situated at or near the binding site. Additionally, FT-IR results confirm that SA alters the secondary structure of BSA, specifically affecting the positions of both amide I and amide II bands. Via the computational biology analyses, it was confirmed that SA binds at the active site of serum albumin and nine residues form hydrophobic interactions. In addition, the cytotoxicity of SA to BRL-3A cells was also studied, and SA had almost no toxicity to the growth of BRL-3A cells. The complex has a higher α-amylase inhibition capacity than SA alone. To sum up, this work reveals that the interaction of SA with BSA induces a conformational alteration in BSA. It also proved that SA inhibits α-amylase more significantly and has great potential in hypoglycemia.

Strategic management to optimize response to cardiac resynchronization therapy registry

Background

Cardiac resynchronization therapy (CRT) is guideline-recommended for the treatment of symptomatic heart failure (HF) in patients (pts) with reduced LVEF and prolonged QRS. Clinical trials report Clinical Composite Score (CCS) response rates from 60 to 75%. However, patients with common comorbidities, such as atrial fibrillation, are often under-represented in clinical trials. The Strategic MAnagement to optimize response to cardiac Resynchronization Therapy (SMART) Registry (NCT03075215) was designed to examine outcomes in CRT patients in the real world.

Methods

The SMART Registry was a global, multicenter, prospective, clinical registry that enrolled subjects undergoing a de novo CRT-D implant or upgrade from pacemaker to CRT-D using a quadripolar LV lead. CCS was assessed at 12 months post-implant.

Results

For study design and CCS outcomes see Figure 1. CCS at 12 months showed that 58.8% of pts improved and 20.1% stabilized. Of the 21.1% of pts that worsened, 8.4% were due to death, 7.8% non-fatal heart failure event, and 5% worsening of NYHA or patient global assessment. Notably, this registry had a high prevalence of pts with NYHA I/II (51%), Non-LBBB (50%), AF (37%), diabetes (35%), and bradycardia (31%) at baseline. Age (>65), diabetes, ischemia, non-LBBB, atrial fibrillation (AF) and renal dysfunction correlated with worsened CCS outcomes. NYHA III/IV patients had significantly higher HF hospitalization (HFH) rates than NYHA I/II (P-value <0.001) (Figure 2a) and patients with AF had higher HFH rates than those without (P-value <0.001) (Figure 2b). Similar effects of NYHA score and AF were seen on mortality. The use of ACE/ARB, or ARNI, and MRA correlated with better outcomes, whereas diuretics and anticoagulants correlated with poorer outcomes.

Conclusions

In this large registry, clinical outcomes across important sub-populations are in line with expectations, with older age, ischemia, renal dysfunction, AF, non-LBBB, and diabetes associated with a lower likelihood of response to CRT. By including these patients, this study provides a clearer picture of the effectiveness of CRT in the real world. Future studies should examine optimization approaches to facilitate CRT effectiveness in these under studied patient populations.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This registry was funded by Boston Scientific (BSC)

Acrylamide induces ferroptosis in HSC-T6 cells by causing antioxidant imbalance of the XCT-GSH-GPX4 signaling and mitochondrial dysfunction

Acrylamide (AA) is a heat-induced food contaminant, mainly metabolized by the liver. Increasing evidences have proved that ferroptosis is linked to the pathogenesis of liver disease. In the current study, the underlying mechanism of AA-induced rat hepatic stellate (HSC-T6) cells ferroptosis was investigated by detecting changes in iron levels, expressions of ferroptosis-related proteins and indicators of mitochondrial dysfunction. The results showed that AA treatment led to iron levels increased and expressions of long-chain acyl-CoA synthase 4 (ACSL4), cyclooxygenase 2 (COX2) and ferritin heavy chain 1 (FTH1) proteins in HSC-T6 cells were all altered. Treatment with the ferroptosis inhibitor ferrostatin-1 (Fer-1) markedly reversed the impact of AA, suggesting that AA induced ferroptosis in HSC-T6 cells. Mechanistically, AA induced the onset of ferroptosis by affecting XCT-GSH-GPX4 antioxidant signaling. Moreover, AA created a peroxidative environment for ferroptosis by inducing oxidative stress in HSC-T6 cells through mitochondrial dysfunction, as evidenced by increased mitochondrial ROS (mtROS) release, mitochondrial membrane potential (MMP) depolarization, and decreased mitochondrial ATP. Our results indicated that AA resulted in mitochondrial dysfunction and ferroptosis, and dysregulation of XCT-GSH-GPX4 antioxidant signaling was a key factor in AA-induced ferroptosis.

Derivates variation of phenylalanine as a model disinfection by-product precursor during long term chlorination and chloramination

Dissolved nitrogenous organic matter in water can contain precursors of disinfection by-products (DBPs), especially nitrogenous DBPs (N-DBPs). Amino acids are ubiquitous as dissolved nitrogenous organic matter in source water and can pass through drinking water treatment processes to react with disinfectants in finished water and in the distribution system. Phenylalanine (Phe) was selected as a model amino acid precursor to investigate its derived DBPs and their variations during a chlorination regime that simulated water distribution with residue chlorine. The 7-day DBPs formation potential (DBPsFP) test with chlorine revealed chlorination by-products of phenylalanine including trihalomethanes (THMs), haloacetic acids (HAAs), haloacetonitriles (HANs), and halonitromethanes (HNMs), but not trichloronitromethane (TCNM) which was a significant N-DBP detected during the first 48 h of chlorine contact. The formation of most carbonaceous DBPs (C-DBPs) increased with chlorination time; however N-DBPs and non-chlorinated byproducts of phenylacetonitrile and phenylacetaldehyde reached their highest concentration after 2 h of reaction, and then gradually decreased until below detection after 7 days. The chlorination influencing factors indicated that light enhanced the peak yield of DBPs; the pH value showed different influences associated with corresponding DBPs; and the presence of bromide ions (Br^-) generated a variety of bromine-containing DBPs. The DBPsFP test with chloramine reduced C-DBPs generation to about 1/3 of the level observed for chlorine disinfection and caused an increase in dichloroacetonitrile. Surveillance of DBPs during drinking water distribution to consumers should consider the varying contact times with disinfectants to accurately profile the types and concentrations of C-DBPs and N-DBPs present in drinking water.

One step bioconversion of waste precious metals into Serratia biofilm-immobilized catalyst for Cr(VI) reduction

OBJECTIVES

For reduction of Cr(VI) the Pd-catalyst is excellent but costly. The objectives were to prove the robustness of a Serratia biofilm as a support for biogenic Pd-nanoparticles and to fabricate effective catalyst from precious metal waste.

RESULTS

Nanoparticles (NPs) of palladium were immobilized on polyurethane reticulated foam and polypropylene supports via adhesive biofilm of a Serratia sp. The biofilm adhesion and cohesion strength were unaffected by palladization and catalytic biofilm integrity was also shown by magnetic resonance imaging. Biofilm-Pd and mixed precious metals on biofilm (biofilm-PM) reduced 5 mM Cr(VI) to Cr(III) when immobilized in a flow-through column reactor, at respective flow rates of 9 and 6 ml/h. The lower activity of the latter was attributed to fewer, larger, metal deposits on the bacteria. Activity was lost in each case at pH 7 but was restored by washing with 5 mM citrate solution or by exposure of columns to solution at pH 2, suggesting fouling by Cr(III) hydroxide product at neutral pH.

CONCLUSION

A 'one pot' conversion of precious metal waste into new catalyst for waste decontamination was shown in a continuous flow system based on the use of Serratia biofilm to manufacture and support catalytic Pd-nanoparticles.

An effect comparison between Furlow double opposing Z-plasty and two-flap palatoplasty on velopharyngeal closure

The aim of this study was to compare velopharyngeal closure between patients who underwent Furlow palatoplasty and two-flap palatoplasty. A retrospective review of 88 patients with incomplete palate cleft was performed. 48 patients (17 males; 31 females) aged 2-28 years received Furlow palatoplasty. 40 patients (17 males; 23 females) aged 2-21 years received two-flap palatoplasty. Velopharyngeal function was categorized as adequate, marginal or inadequate. Complications associated with the operation were documented. Statistically significant differences were not found amongst sex distribution, age at operation, follow-up time, and preoperative speech intelligibility. After primary repairs using Furlow and two-flap palatoplasty, the surgeon's incidence of postoperative palatal fistula was 0%. The complications were not significantly different between the two groups. The authors achieved the lowest reported incidence of postoperative palatal fistulas in primary Furlow palatoplasty. The outcomes of the velopharyngeal closure were better in patients who received Furlow palatoplasty (P<0.05). Furlow palatoplasty was more effective than two-flap palatoplasty in obtaining perfect velopharyngeal closure. A probable explanation may be that Furlow palatoplasty can reposition and overlap the divergent palatal muscle and lengthen the soft palate.

Uptake of Sr2+ and Co2+ into biogenic hydroxyapatite: implications for biomineral ion exchange synthesis

Biomineral hydroxyapatite (Bio-HAp) produced by Serratia sp. has the potential to be a suitable material for the remediation of metal contaminated waters and as a radionuclide waste storage material. Varying the Bio-HAp manufacturing method was found to influence hydroxyapatite (HAp) properties and consequently the uptake of Sr(2+) and Co(2+). All the Bio-HAp tested in this study were more efficient than the commercially available hydroxyapatite (Com-HAp) for Sr(2+) and Co(2+) uptake. For Bio-HAp the uptake for Sr(2+) and Co(2+) ranged from 24 to 39 and 29 to 78 mmol per 100 g, respectively. Whereas, the uptake of Sr(2+) and Co(2+) by Com-HAp ranged from 3 to 11 and 4 to 18 mmol per 100 g, respectively. Properties that increased metal uptake were smaller crystallite size (<40 nm) and higher surface area (>70 m(2) g(-1)). Organic content which influences the structure (e.g., crystallite arrangement, size and surface area) and composition of Bio-HAp was also found to be important in Sr(2+) and Co(2+) uptake. Overall, Bio-HAp shows promise for the remediation of aqueous metal waste especially since Bio-HAp can be synthesized for optimal metal uptake properties.

Investigation of internal pollutant loading for a tide-influenced waterbody

Based on laboratory experiments and field investigations, the relationship between internal pollutant release intensity and water velocity was determined for Neijiang, a representative waterbody. A two-dimension, unsteady hydrodynamic water quality model coupled with internal pollutant release was established and validated to assess Neijiang in different, typical years and at different tidal cycles. The internal-to-external pollutant loading ratio (IEPLR) was proposed in this paper for the first time to identify the temporal distribution of the effect induced by internal pollutant loading on the water environment. It was found that the annual internally released amounts of total nitrogen, total phosphorous, and chemical oxygen demand (COD) in the high-water year (1998) was 484.0 Mg, 405.3 Mg, and 1928.3 Mg, respectively, which was 27% greater than levels found in the typical-water year (2001) and the dry-water year (2004). Internal pollutant loading in the three typical years showed marked temporal variation; the high-water year displayed the most asymmetrical distribution. Internally released total nitrogen, total phosphorus, and COD during the tidal cycle of flood season was 1.374 Mg, 1.059 Mg, and 4.456 Mg, respectively, which was approximately 55.9% higher than dry season. External pollutant loading on Neijiang was the significant factor influencing water quality because the mean IEPLRs in the three typical years and the tidal cycles were less than one. However, because of the enhanced intensity of internal pollutant release, there were still 124 d in 1998, 22 d in 2001, and 38 d in 2004 when IEPLRs were greater than one; during these days a sudden algae bloom or water quality saltation might occur in Neijiang.

Biomineralization: linking the fossil record to the production of high value functional materials

The microbial cell offers a highly efficient template for the formation of nanoparticles with interesting properties including high catalytic, magnetic and light-emitting activities. Thus biomineralization products are not only important in global biogeochemical cycles, but they also have considerable commercial potential, offering new methods for material synthesis that eliminate toxic organic solvents and minimize expensive high-temperature and pressure processing steps. In this review we describe a range of bacterial processes that can be harnessed to make precious metal catalysts from waste streams, ferrite spinels for biomedicine and catalysis, metal phosphates for environmental remediation and biomedical applications, and biogenic selenides for a range of optical devices. Recent molecular-scale studies have shown that the structure and properties of bionanominerals can be fine-tuned by subtle manipulations to the starting materials and to the genetic makeup of the cell. This review is dedicated to the late Terry Beveridge who contributed much to the field of biomineralization, and provided early models to rationalize the mechanisms of biomineral synthesis, including those of geological and commercial potential.

From bio-mineralisation to fuel cells: biomanufacture of Pt and Pd nanocrystals for fuel cell electrode catalyst

Biosynthesis of nano-scale platinum and palladium was achieved via enzymatically-mediated deposition of metal ions from solution. The bio-accumulated Pt(0) and Pd(0) crystals were dried, applied onto carbon paper and tested as anodes in a polymer electrolyte membrane (PEM) fuel cell for power production. Up to 100% and 81% of the maximum power generation was achieved by the bio-Pt and bio-Pd catalysts, respectively, compared to commercial fuel cell grade Pt catalyst. Hence, biomineralisation could pave the way for economical production of fuel cell catalysts since previous studies have shown that precious metals can be biorecovered from wastes into catalytically active bionanomaterials.

Applications of bacterial hydrogenases in waste decontamination, manufacture of novel bionanocatalysts and in sustainable energy

Bacterial hydrogenases have been harnessed to the removal of heavy metals from solution by reduction to less soluble metal species. For Pd(II), its bioreduction results in the deposition of cell-bound Pd(0)-nanoparticles that are ferromagnetic and have a high catalytic activity. Hydrogenases can also be used synthetically in the production of hydrogen from sugary wastes through breakdown of formate produced by fermentation. The Bio-H2 produced can be used to power an electrical device using a fuel cell to provide clean electricity. Production of hydrogen from confectionery wastes by one organism (Escherichia coli) can be used as the electron donor for the production of Bio-Pd0 from soluble Pd(II) by a second organism. The resulting Bio-Pd0 can then be used as a bioinorganic catalyst in the remediation of Cr(VI)-contaminated solutions or polychlorinated biphenyls at the expense of Bio-H2, as a hydrogenation catalyst for industry or as a component of a fuel cell electrode.

Synthesis of nanophase hydroxyapatite by a Serratia sp. from waste-water containing inorganic phosphate

Synthesis of nanophase hydroxyapatite (HA) on a bacterial surface was achieved at the expense of CaCl2 and inorganic phosphate (Pi). After initial nucleation, calcium was precipitated on and around the cells as calcium phosphate at the expense of inorganic phosphate in the challenge solution, with no precipitation in cell-free controls. HA was also biomanufactured using inorganic phosphate ions scavenged from a phosphate-containing waste-water. With additional Ca2+, the concentration of phosphate was decreased from 0.27 (approximately 25 ppm) to approximately 0.02 m (approximately 2 ppm) in the waste-water. Crystals of calcium phosphate manufactured by the cells were located by scanning electron microscopy (SEM) and identified as HA by X-ray powder diffraction, with an average crystal size calculated as approximately 25 nm. Possible application of bioHA as a biomaterial and implications for one-step 'waste-into product' are discussed.

A novel electrobiotechnology for the recovery of precious metals from spent automotive catalysts

Platinum group metals are routinely used in automotive catalysts but recycle technology lags behind demand. There is no available 'dean technology' and leach solutions (e.g. aqua regia) to solubilise the metals from scrap are highly aggressive. A microwave-assisted leaching method was developed which gave 80% metals recovery, with the leach time reduced from 2 h to 15 min using 50% (aq.) diluted aqua regia to give potentially a more biocompatible leachate. Desulfovibrio desulfuricans reduces soluble platinum group metals to cell-bound insoluble base metals (e.g. Pd(II) --> Pd(0)). For use, biofilm was immobilised on a Pd-23% Ag solid alloy membrane which delivered H. to the cells via an electrochemical chamber at the back-side. The biomass-coated Pd-Ag alloy electrode was used in a flow-through reactor for recovery of Pd, Pt and Rh from aqua regia leachates (pH 2.5) of spent automotive catalysts with up to 90% efficiency at a flow residence time of 15 minutes. Free cells did not reduce platinum group metals from the leachates but the electrobioreactor did so using biofilm-cells pre-loaded with Pd(0). Reactors lacking biomass or reactors with heat-killed biofilm removed less platinum group metals, via electrochemically-synthesised H. reductant alone. The use of an active biofilm layer in a flow-through electrobioreactor provides a simple, dean and rapid potential recycle technology.

Acetabular revision with impacted freeze-dried cancellous bone chips and a cemented cup: a report of 7 cases at 5 to 9 years' follow-up

The long-term results of bone impaction grafting with fresh-frozen femoral head allografts and a cemented cup are favorable. Because of intermittent shortage of fresh-frozen femoral heads at our local bone bank, we used processed freeze-dried bone in 7 acetabular revisions operated between 1989 and 1994. All 7 consecutive patients were followed annually. At final review (March 2000), 1 patient had died after 8.5 years of follow-up of a cause not related to the surgery. In 1 hip, a rerevision was performed for septic loosening 5 years after the previous septic loosening. Radiographically the freeze-dried allografts seemed to incorporate in all cases but the reinfected one; progressive radiolucent lines were not seen, although 1 case had a stable line in 1 zone. The overall survival rate for the 7 acetabular reconstructions at an average follow-up of 7 years (range, 5-9 years) was 86%. At midterm follow-up, there was no aseptic loosening. In this limited case report, the results at midterm for freeze-dried allograft bone chips in acetabular reconstructions are acceptable.

A new and reliable method of individual ventricular capture identification during biventricular pacing threshold testing

Biventricular (BV) pacing for the treatment of heart failure is in clinical investigation. In the absence of independent outputs for separate pacing of each ventricle, a method is needed to determine the respective LV versus RV thresholds. A technique was developed and validated to distinguish BV capture from LV or RV capture from a multilead surface ECG. The QRS axes were determined at the time of implant by comparing multilead surface ECGs during BV, RV, and LV pacing in 63 patients (42 men, age 63 +/- 12 years) who received pacemakers or ICDs capable of BV pacing. Differences between BV and LV, and between BV and RV axes were examined to determine which ECG leads best indicate a change from BV to univentricular capture. The axis shift from BV to RV pacing was positive while the axis shift from BV to LV pacing was negative. The morphology change associated with LV versus RV capture is best examined in the ECG lead that is perpendicular to the axis shift. A change from BV to LV capture was best identified as increasing positivity of the QRS in lead III, while a change from BV to RV capture was best recognized as increasing positivity of the QRS in lead I. When performing a BV pacing threshold test, mean QRS vector changes derived from standard ECG can be used to distinguish LV or RV capture from BV capture.

Impact of biventricular pacing on mortality in a randomized crossover study of patients with heart failure and ventricular arrhythmias

Biventricular (BV) pacing is under clinical investigation for the treatment of heart failure. Its impact on mortality is unknown. Patients with heart failure and ventricular tachyarrhythmias received an implantable cardioverter defibrillator with BV pacing capability. Patients were randomized 1:1 to BV pacing or no pacing, then crossed over to the alternate mode after 3 months. All-cause mortality was measured in each arm up to the point of crossover. Fifteen of 222 patients died between implant and crossover. Five patients died while programmed to BV pacing and 19 died while programmed to no pacing. Survival in the BV pacing arm was 93 +/- 4% versus 86 +/- 6% in the no pacing arm (P = 0.18). In a patient population with symptomatic heart failure and ventricular arrhythmias, BV pacing does not appear to be associated with excess mortality. Larger and longer studies will be needed to determine if BV pacing confers a survival benefit.

Performance of a new steroid-eluting coronary sinus lead designed for left ventricular pacing

The Ventak CHF/CONTAK CD Biventricular Pacing Study is a prospective randomized trial to examine the safety and efficacy of biventricular (BV) pacing in patients with standard indications for an ICD, symptomatic heart failure, a LVEF < or = 0.35, and a QRS > or = 120 ms. Patients underwent implantation of a BV pacing and sensing system with backup defibrillation capability, which includes a steroid-eluting coronary venous lead that is advanced into the coronary venous vasculature by over-the-wire techniques. LV pacing threshold, BV impedance, and BV R wave amplitude were measured in 58 consecutive patients. Using a percutaneous over-the-wire insertion technique, steroid-eluting coronary venous leads were associated with satisfactory mean LV pacing threshold, BV impedance, and BV R wave amplitude acutely up to 4 months after implantation. Pacing threshold stabilized 2 weeks after lead implantation and sensing threshold remained stable from the time of implant.

A comparison of psychological functioning in women at different stages of in vitro fertilization treatment using the mean affect adjective check list

PURPOSE

The objectives were to identify the stage/s of IVF treatment where a woman is most vulnerable to psychological stress, and to assess the Mean Affect Adjective Check List (MAACL) as a measure of psychological functioning during IVF treatment, which has hitherto not been reported.

METHODS

Thirty-seven women undergoing IVF treatment according to the long protocol of controlled ovarian stimulation completed the MAACL questionnaire at the following stages: (a) before treatment (visit 1), (b) before embryo transfer (visit 2), and (c) before pregnancy test (visit 3).

RESULTS

Apart from anxiety scores for visit 2, the hostility, depression, and state anxiety scores for visit 3 were higher than the corresponding scores for visits 1 and 2 (P < 0.001). Anxiety scores for visits 2 and 3 were similar.

CONCLUSIONS

Psychological counseling should be targeted at women after embryo transfer and leading up to the pregnancy test. The MAACL is a useful method for measuring psychological stress in women during IVF treatment.

Efficacy of biventricular sensing and treatment of ventricular arrhythmias

While much is known concerning the hemodynamic effects of biventricular (BV) pacing, little has been reported concerning the efficacy of BV sensing and pacing in the detection and treatment of ventricular tachyarrhythmias. Two hundred nineteen heart failure (HF) patients with VT or VF and a QRS > or = 120 ms during sinus rhythm received an ICD capable of BV pacing and sensing. Detection times of induced VF and success rates for terminating induced VT were measured. The ICD system used a left ventricular epicardial lead implanted via thoracotomy (52 patients) or a specially designed percutaneous, over-the-wire lead inserted in the coronary venous system. VF detection times and VT termination rates by antitachycardia pacing (ATP) were compared with those measured in a population of recipients of ICD using a RV lead alone. Median induced VF detection times were comparable (2.0-s BV vs 1.8-s RV). Termination of induced VT on the first attempt was comparable with BV pacing (87.4%) versus RV pacing (89.6%). The time to detect induced VF was not different with ICDs using BV sensing versus conventional ICDs using RV sensing alone. Similarly, the rates of successful termination of induced VT by ATP with BV or RV pacing were comparable.

Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators

OBJECTIVES

We sought to test the postulate that biventricular pacing diminishes the need for appropriate tachycardia therapy. We reviewed the frequency of therapy in patients, serving as their own controls, who were enrolled in the Ventak CHF (congestive heart failure) biventricular pacing study.

BACKGROUND

It is well established that both acute and chronic CHF contribute to the need for tachyarrhythmia therapy in recipients of an automatic implantable cardioverter defibrillator (ICD). Synchronized biventricular (BV) pacing is a new and promising therapy for symptomatic improvement of CHF in selected patients (low ejection fraction, intraventricular conduction delay). We postulate that this pacing therapy will diminish the need for tachyarrhythmia therapy.

METHODS

Participants in the Ventak CHF trial received a triple-chamber biventricular ICD with a transvenous right ventricular lead and a left ventricular (LV) lead placed via thoracotomy. Of 54 patients enrolled in the Ventak CHF trial, 32 could be analyzed, with each completing three blinded months programmed to BV VDD pacing and a second randomly assigned three-month period of no pacing.

RESULTS

Of the 32 patients, 13 (41%) received appropriate therapy for a ventricular tachyarrhythmia at least once in the six-month monitoring period postimplant. Five patients (16%) had at least one tachyarrhythmic episode while programmed to BV pacing, whereas 11 (34%) had at least one episode while programmed to no pacing. Three patients (9%) received therapy in both pacing periods, two with BV pacing only. The decrease in necessary tachycardia therapy during the BV pacing period was statistically significant (p = 0.035).

CONCLUSIONS

In patients with standard ICD indications who also have CHF, LV dysfunction, and an intraventricular conduction delay, ICD therapy is less common with BV pacing. The mechanism for this improvement is unclear but may be related to hemodynamic improvement in CHF. Although BV pacing does not obviate the need for an ICD, it does diminish the need for appropriate tachyarrhythmia therapy in selected patients.

[Tumour suppressor p53 gene sequence mutations in pleomorphic adenoma of salivary gland]

OBJECTIVE

To detect p53 exon 7 and 8 mutation and to study genesis and biological characteristics of pleomorphic adenoma of salivary galand.

METHODS

Polymerase chain reaction- single-strand conformational polymorphism (PCR-SSCP) and DNA sequencing analysis were used.

RESULTS

PCR-SSCP analysis showed that in 11 patients with positive SSCP, 7 showed abnormal exon 7 and 3 abnormal exon 8. Comparison of SSCP results with DNA sequencing showed that patients all patients with p53 exon 7 and 8 mutations were SSCP positive. Exon 7 mutation pattern was point mutation(T-->C). Exon 8 mutation pattern included base substitution (point mutation) (C-->A) and frame-shiftmutation (base insertion and base loss).

CONCLUSIONS

Polycodon and poly-pattern mutations appeared in p53 exon 7 and 8. Pleomorphic adenoma of salivary galand was similar to malignant tumor in p53 gene mutation. Poly-codon mutation could occur in the same case.

[p53 gene mutation determined by single-strand conformational polymorphism and DNA sequencing analysis in pleomorphic adenoma of salivary gland]

OBJECTIVE

To detect p53 exon 6 mutation pattern in pleomorphic adenoma of salivary gland.

METHODS

Single-strand conformational polymorphism (SSCP) and DNA sequecing were used.

RESULTS

SSCP analysis showed that 6 of 11 cases with SSCP positive were exon 6 abnormal. Comparison of the SSCP results with DNA sequecing, 4 cases with p53 exon 6 mutations were SSCP positive. Mutation pattern included base substitution (point mutation, G-->T, T-->G) and frame-shift mutation (base insertion and base loss).

CONCLUSION

Poly-codon and poly-pattern mutations appeared in p53 exon 6. PCR-SSCP was a convenient method to detecte gene mutation.

Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group

BACKGROUND

The purpose of this study was to evaluate the safety and efficacy of a temperature-controlled radiofrequency catheter ablation system.

METHODS AND RESULTS

The patient population included 1050 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia (AVNRT), an accessory pathway (AP), or the atrioventricular junction (AVJ). Ablation was successful in 996 patients. The probability of success was highest among patients who had undergone ablation of the AVJ, lowest in patients who had undergone ablation of an AP, and in between for patients who had undergone ablation of AVNRT. A major complication occurred in 32 patients. Four variables predicted ablation success (AVJ, AVNRT, or left free wall AP ablation and an experienced center). Four factors predicted arrhythmia recurrence (right free wall, posteroseptal, septal, and multiple APs). Two variables predicted development of a complication (structural heart disease and the presence of multiple targets), and 3 variables predicted an increased risk of death (heart disease, lower ejection fraction, and AVJ ablation).

CONCLUSIONS

These findings may serve as a guide to clinicians considering therapeutic options in patients who are candidates for ablation.

Effect of catheter tip length and position on lesion volume in temperature controlled RF ablation in canine tricuspid valve annulus

BACKGROUND

Radiofrequency (RF) energy has been delivered to the tricuspid valve annulus (TVA) in humans with both 4 mm and 8 mm long catheter tip electrodes to treat atrial flutter. However, lesion volume with temperature controlled RF delivery systems has not been previously characterized.

METHODS

In 10 anesthetized canines, a single pulse of temperature controlled RF energy at a 70 degrees C set point, 30 second duration was delivered with either a 7 Fr/4 mm tip or a 7 Fr/8 mm tip electrode in a position both anterolateral and posteroseptal to the tricuspid valve annulus (TVA). Surface echocardiogram was obtained prior and after ablation. The animals were sacrificed after ablation and the lesions underwent gross and histological examination.

RESULTS

Lesion size, tip temperature and power were related to tip electrode surface area (SA). Eight mm tips (SA = 59 mm2) tended to create significantly larger lesions than 4 mm tips (SA = 29 mm2). Median lesion volume was 22 vs. 1.5 mm3, respectively. Eight mm tips were also associated with higher power requirements and lower temperatures than 4 mm tips. Posteroseptal TVA lesions tended to be larger than anterolateral lesions. No significant complications were noted.

CONCLUSIONS

Using temperature controlled RF ablation, large lesions may be safely created on the canine TVA using 7 Fr catheters with 8 mm long tips.

Predictors of fluoroscopy time and estimated radiation exposure during radiofrequency catheter ablation procedures

The objective of this study was to identify factors that predict fluoroscopy duration and radiation exposure during catheter ablation procedures. The patient population included 859 patients who participated in the Atakr Ablation System clinical trial at 1 of 9 centers (398 male and 461 female patients, aged 36 +/- 21 years). Each patient underwent catheter ablation of an accessory pathway, the atrioventricular junction, or atrioventricular nodal reentrant tachycardia using standard techniques. The duration of fluoroscopy was 53 +/- 50 minutes. Factors identified as independent predictors of fluoroscopy duration included patient age and sex, the success or failure of the ablation procedure, and the institution at which the ablation was performed. Catheter ablation in adults required longer fluoroscopy exposure than it did in children. Men required longer durations of fluoroscopy exposure than did women. The mean estimated "entrance" radiation dose was 1.3 +/- 1.3 Sv. The dose needed to cause radiation skin injury was exceeded during 22% of procedures. The overall mean effective absorbed dose from catheter ablation procedures was 0.025 Sv for female patients and 0.017 Sv for male patients. This degree of radiation exposure would result in an estimated 1,400 excess fatal malignancies in female patients and 2,600 excess fatal malignancies in male patients per 1 million patients.

Temperature controlled RF ablation in canine ventricle and coronary sinus using 7 Fr or 5 Fr ablation electrodes

The safety and lesion volume of temperature controlled radiofrequency ablation (TCRFA) in the right ventricle (RV), left ventricle (LV), and coronary sinus (CS) comparing long 5 Fr to standard tip electrodes have not been previously reported. In 10 canines, TCRFA was delivered at a 70 degrees C set point for 30 seconds. Lateral and septal RV lesions were made with either a 5 Fr/5 mm or 7 Fr/4 mm tip. Lateral and septal LV lesions were made with either a 5 Fr/7 mm or 7 Fr/4 mm tip. Proximal and distal CS lesions were made with either a 7 Fr/4 mm, 5 Fr/5 mm or 5 Fr/7 mm tip. Gross and histologic examination of the lesions was completed. Lesion size, tip temperature and power required are related to electrode surface area (SA) when ablating in the RV, LV or CS. 5 Fr/7 mm tips (SA = 36 mm2) tended to create larger lesions than 7 Fr/4 mm tips (SA = 29 mm2) in the LV. 7 Fr4 mm tips tended to create larger lesions than 5 Fr/5 mm tips (SA = 26 mm2) in the RV. 7 Fr/4 LV lesions exceeded 7 Fr/4 mm RV lesions due to thicker LV walls. In the CS, 5 Fr/7 mm tips tended to create the largest lesions. In the RV, LV and CS, tips with larger SA tended to have lower temperatures and require higher power. No high temperature or high impedance shut-downs were observed. In conclusion, varying 5 Fr tip length can safely produce larger or smaller lesions compared to those created with 7 Fr/4 mm tips.

Cardiac applications of video assisted thoracic surgery

As experience with video assisted thoracic surgery (VATS) has grown, cardiac applications of VATS are being explored. Simple cardiac procedures including pericardiectomy and epicardial pacemaker lead placement are readily accomplished by VATS. More complex cardiac procedures are being investigated both in the laboratory and in the clinical arena. Totally endoscopic coronary artery bypass grafting has been successfully performed in the animal model. Modification of existing instrumentation and techniques has had an enabling benefit. The human experience consists of predominantly a video assisted minithoracotomy approach with some successful promise. More advanced procedures including minimally invasive valve replacement are also being explored.

Minimally invasive thoracoscopically assisted coronary artery bypass surgery

OBJECTIVE

Minimally invasive techniques have been widely used in other surgical fields including video-assisted thoracic surgery (VATS) in thoracic surgery. These concepts are now being applied to cardiac surgery. The opportunities to make cardiac surgery less invasive include elimination of the median sternotomy incision, elimination of cardiopulmonary bypass and no manipulation of the aorta.

MATERIALS AND METHODS

From January 1992 through September 1996, various aspects of minimally invasive cardiac surgery have been examined in the inanimate endoscopic trainer, animal model, human cadaver and in human clinical studies. Techniques of endoscopic sutured anastomosis as well as alternatives to suturing were first perfected in the inanimate trainer. Twenty animals then underwent endoscopic coronary artery bypass using the left internal mammary artery to the left anterior descending with circulatory support from an axial flow pump. Fifty eight minimally invasive coronary artery bypass procedures have been performed in humans using thoracoscopic assistance for internal mammary artery harvest.

RESULTS

One hundred fifty endoscopic coronary anastomoses were performed in the inanimate trainer with the endoscopic suturing technique being the preferred method. Time required to perform an anastomosis decreased from greater than 60 min to a mean of 20 min as technique and instruments were developed. In animals, methods of access as well as enabling surgical instruments to allow crossclamp of the aorta and performance of the anastomosis were developed. Fifty-eight humans underwent coronary artery bypass using the left internal mammary artery placed to the left anterior descending under direct vision through a limited anterior thoracotomy on a beating heart. The procedure was successful in 52 patients with conversions required in six patients. Techniques were developed for immobilization for performance of the anastomosis.

DISCUSSION

The ability to perform an endoscopic anastomosis still remains the rate limiting step for totally endoscopic coronary artery bypass surgery. The present MIDCAB (minimally invasive direct coronary artery bypass grafting) procedure is a significant advance in cardiac surgery, but still has limitations that make performance of an exact anastomosis still somewhat difficult and applicable only to single-vessel disease. Present efforts are directed toward extending the MIDCAB procedure by various immobilization and circulatory support devices and combining the MIDCAB procedure with catheter techniques for treating more advanced disease.