Vitrification and nanocrystallization of pure liquid Ni studied using molecular-dynamics simulation

Structural variation, vitrification, and crystallization processes in liquid nickel are simulated on continuous cooling and isothermal holding using a classical molecular-dynamics computer simulation procedure with an embedded-atom method potential at constant pressure. Structural changes are monitored with direct structure observation in the simulation cells, as well as by pair distribution and radial distribution functions created using the atomic coordinates. A cluster analysis is also performed. The crystallization kinetics is analyzed under isothermal conditions by monitoring density and energy variation as a function of time. As a result, a time-temperature-transformation diagram can be constructed over a wide temperature range.

Right Heart Function during Left Ventricular Assistance in an Open-Chest Porcine Model of Acute Right Heart Failure

Changes in the right ventricular function measured with a thermodilution ejection fraction catheter have been recorded in open-chest normal pigs and pigs with acute right heart failure (RVF) undergoing left ventricular assistance with a pneumatic-sactype device (LVAD). To produce acute right heart failure, 5 pigs underwent ligation of the right ventricular free wall coronary arteries. Compared with normal pigs, cardiac output in ligated pigs fell by 21% (7.5 ± 0.5 vs 9.5 ± 1.2 L/min; p < 0.05) and the right ventricular end diastolic pressure rose (11.4 ± 2.6 vs 5.7 ± 3.6 vs mmHg: p <0.05). With the left ventricular assist device connected, the right atrial pressure was increased to 3, 5, 7, 10 and 12 mmHg by volume loading while maintaining the haematocrit at 35 ± 6%. The right ventricular stroke work index (RVSWI) increased with volume loading in normal pigs. In RVF pigs, RVSWI increased significantly with the LVAD (59.2 ± 5.8 vs 23.5 ± 7.8 mmHg ml/min/kg, p<0.01), approaching that of normal pigs (62.3 ± 4.8 mmHg ml/min/kg). Similar changes were observed in the cardiac output and right ventricular stroke volume. These results show that, in this model of open-chest, mild, acute right heart failure, left ventricular assistance allows right ventricular function to return to normal, despite volume overloading, by decreasing right ventricular after load and increasing right ventricular compliance

Phase I-II study of irinotecan (CPT-11) plus nedaplatin (254-S) with recombinant human granulocyte colony-stimulating factor support in patients with advanced or recurrent cervical cancer

Combination chemotherapy with irinotecan (CPT-11) and platinum compounds is effective for treating cervical cancer. Nedaplatin (254-S) is a new cisplatin analogue that achieves a high response rate (53%) in patients with primary cervical cancer. We performed a phase I-II study of combination chemotherapy with CPT-11 plus 254-S for advanced or recurrent cervical cancer. The inclusion criteria were stage IV disease or recurrence. CPT-11 and 254-S were administered intravenously on day 1, while rhG-CSF (50 microg) was given on days 3-12. This regimen was repeated after 4 weeks. Dose escalation was carried out in tandem (CPT-11/254-S: 50/70, 50/80, and 60/80 mg m(-2)). A total of 27 patients (stage IV=seven, recurrence=20) were enrolled. The phase I study enrolled eight patients. At dose levels 1 and 2, no dose-limiting toxicities were observed. At dose level 3, the first two patients developed DLTs. The maximum tolerated dose of CPT-11 and 254-S was 60 and 80 mg m(-2), respectively, and the recommended doses were 50 and 80 mg m(-2). Grade 3/4 haematologic toxicity occurred in 67% in phase II study, but there were no grade 3 non-haematologic toxicities except for nausea or lethargy. In all 27 patients, there were two complete responses (7%) and 14 Partial responses (52%), for an overall response rate of 59% (95% confidence interval: 39-78%). Among the 12 responders with recurrent disease, the median time to progression and median survival were 161 days (range: 61-711 days) and 415 days (range: 74-801 days). This new regimen is promising for cervical cancer.

Occurrence of conjunctivitis, sinusitis and upper region tracheitis in Japanese quail (Coturnix coturnix japonica), possibly caused by Mycoplasma gallisepticum accompanied by Cryptosporidium sp. infection

On a farm raising approximately 75,000 Japanese quail (Coturnix coturnix japonica) for egg production, the diseased quail showed clinical signs of swelling of the head, nasal discharge, increased lacrimation, and decreased egg production. The flock experienced a mortality rate of 5.7% per day. Macroscopic observation revealed large, gelatinous masses of caseous exudate in the sinuses, egg peritonitis, and airsacculitis. Microscopically, non-purulent or purulent inflammation accompanied by lymphoid hyperplastic tissue with germinal centers was observed in the oculofacial respiratory mucosa. The developing stage of the lesions was abscess formation. In the investigation of pathogens, antigens to Mycoplasma gallisepticum and Pasteurella multocida serotype D were immunolabeled on and demonstrated in the mucosal membranes. In addition, P. multocida, Escherichia coli, Staphylococcus sp., and Streptococcus sp. were isolated from the infraorbital sinuses, and Mycoplasma isolated from a diseased bird was confirmed as M. gallisepticum by polymerase chain reaction (PCR). Furthermore, Cryptosporidium sp. was frequently found in the brush border. Serological, bacteriological and PCR examinations, some with negative outcomes, were carried out concerning microbes that are known to cause swollen heads in birds (Haemophilus paragallinarum, Newcastle disease virus and turkey rhinotracheitis virus). The average concentration of ammonia fumes in the cages was 30.6 parts/106, which suggests that the high levels of ammonia fumes promoted infection and multiplication of M. gallisepticum in the quail, and that the clinical disease then worsened due to mixed infection with M. gallisepticum and Cryptosporidium sp. or other bacteria.

Usefulness of positron emission tomography for diagnosis of malignancy in a calcified lesion: a case report

When calcified lesions in the liver or spleen are found during follow-up of patients who have undergone debulking surgery and chemotherapy for advanced ovarian carcinoma, it is very difficult to differentiate recurrent cancer from secondary change after chemotherapy. We present here a patient in whom calcified lesions in the liver and spleen were diagnosed as malignancy on the basis of a preoperative PET study. Malignancy was confirmed by histologic examination after surgery.

Interleukin-11 enhances cell survival of decidualized normal human endometrial stromal cells

High expression of interleukin-11 (IL-11) and the IL-11 receptor alpha chain in developing decidual cells in mice has been reported, and mice lacking IL-11 receptor expression have been reported to show impaired implantation owing to defective decidualization. However, the direct effect of IL-11 on endometrial stromal cells has not been studied. In this study, we examined the direct effects of IL-11 on normal human endometrial stromal cells using an in vitro decidualization assay system. IL-11 enhanced cell viability and prolactin secretion of 8-Br-cAMP-induced decidualized cells but not of non-stimulated stromal cells. IL-11 dose-dependently enhanced the viability of stromal cells co-stimulated with 8-Br-cAMP and IL-11 without any significant effect on prolactin secretion from the cells. The extracellular matrix did not affect the effect of IL-11 on the viability of 8-Br-cAMP-stimulated stromal cells. These results indicate that IL-11 enhances the viability of 8-Br-cAMP-stimulated stromal cells and of decidualized stromal cells, and that the cell survival signals generated by IL-11 are independent of those generated by the extracellular matrix. IL-11 produced locally in decidual tissues may enhance the viability of decidualized stromal cells and possibly protect against cell damage during embryo implantation and trophoblastic invasion.

Positron emission tomography using 2-[(18)F] fluoro-2-deoxy-D-glucose in the diagnosis of uterine leiomyosarcoma: a case report

The preoperative diagnosis of uterine leiomyosarcoma (LMS) is very difficult. Magnetic resonance (MR) imaging is usually used for it; however, precise diagnosis by MR imaging is limited to typical LMS with coagulative tumor cell necrosis. We presented a case of LMS that was diagnosed preoperatively by positron emission tomography (PET) using 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG).

Positron emission tomography with (18)F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging

OBJECTIVE

The effectiveness of positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) for diagnosis of uterine sarcoma was evaluated in comparison to the effectiveness of magnetic resonance (MR) imaging and power Doppler imaging.

METHOD

The cases of five Osaka City University Hospital patients diagnosed with uterine sarcoma based on histopathological examination, in whom FDG-PET, MR imaging, and power Doppler imaging studies had been performed preoperatively, were reviewed. A comparative study of the usefulness of these three imaging modalities for diagnosis of sarcoma was conducted. Tumors comprised three leiomyosarcomas, one endometrial stromal sarcoma, and one carcinosarcoma.

RESULTS

FDG-PET examinations were 100% positive for the five sarcomas; MR imagings were 80% positive (four of five cases), and US was 40% positive (two of five cases). The mean standardized uptake value of the sarcomas was 4.5 +/- 1.3.

CONCLUSION

The sarcoma lesions were clearly imaged by FDG-PET. FDG-PET may be a most useful diagnostic method for uterine sarcoma.

Effect of adjuvant chemotherapy using pirarubicin, cisplatin, and etoposide (PEP) for stage IVB endometrial carcinoma: a case report

Prognosis of patients with stage IVB endometrial adenocarcinoma is quite poor. Combination therapy of radiation with surgery or chemotherapy is a common therapy for advanced endometrial cancers. However, radiation therapy is effective only for localized cancer, and the chemotherapeutic effect on stage IVB endometrial cancers is very low. We present a patient with stage IVB endometrial adenocarcinoma, whose tumor was not resected completely at the first surgery. She showed a remarkable response to a PEP (pirarubicin, etoposide, cisplatin) regimen and has survived without disease over 8 years. This case suggests that reduction surgery following PEP therapy is a new therapeutic modality for stage IVB endometrial carcinoma.

Effect of variation in systemic blood flow on plasma TNF-alpha in a pig model with left ventricular assist device

Tumor necrosis factor-alpha (TNF-alpha) release has been implicated in a sepsis-like syndrome following cardiopulmonary bypass (CPB). This also may be important in patients who have had a left ventricular assist device (LVAD) implanted. This report investigates the effect of reducing systemic blood flow on hemodynamic response, mixed venous oxygen saturation (SvO(2)), and the release of TNF-alpha. LVADs were implanted in 9 pigs. The aorta was clamped, and thus the LVAD flow represented the entire systemic blood flow. Plasma TNF-alpha in the femoral artery (FA) and superior mesenteric vein (SMV) was measured at baseline and following systemic blood flow changes. Simultaneously, hemodynamic parameters and oxygen saturation in the pulmonary artery (SvO(2)) were measured. Following reductions in systemic blood flow, plasma TNF-alpha increased gradually to a maximum level at a systemic blood flow of 20%. There was no significant difference between TNF-alpha levels in the SMV and the FA. There was a significant (p < 0.05) correlation between cardiac index, stroke volume index, and TNF-alpha. The SvO(2) decreased significantly (p < 0.05) at a systemic blood flow of 30 and 20%. A rise in TNF-alpha occurred when the SvO(2) was less than 75%. The data demonstrate that a reduction in systemic blood flow causes an increase in plasma TNF-alpha. This can lead to the development of a sepsis-like syndrome in a group of patients who already are hemodynamically compromised. While weaning short-term LVAD support, rapid diminution of the cardiac output and the pump flow must be avoided.

Comparison of Salmonella isolation rates in different types of egg-layer hen houses in Chiba, Japan

This study investigated the differences in Salmonella isolation rates in environmental samples taken from several types of hen houses in Chiba, Japan. In addition, for the detailed epidemiologic survey, environmental samples, hens, and rodents were collected from Salmonella-contaminated windowless houses on three farms. As a result, Salmonella was isolated from four (80%) of five farms with windowless hen houses; Salmonella enteritidis was isolated from a single windowless house. In contrast, only one serotype of Salmonella was isolated from 1 (6.7%) of 15 farms with open hen houses. In the S. enteritidis-contaminated windowless hen house, the isolation rates of S. enteritidis as compared with the other serotypes were 90.9% of environments, 94.1% of hens, and 86.4% of roof rats (Rattus rattus) that resided in the environments. In reference to the phage type (PT) of these isolates, PT1 was detected in environments and roof rats, and PT9 was detected in both these samples and in hens. Thus, the Salmonella isolation rate in hen houses seems to be associated with whether the premises are windowless or open. Moreover, roof rats appear to be the most important vectors in the spread of S. enteritidis in the windowless hen house because the S. enteritidis PTs coincide with each other.

Intestinal tissue oxygenation and tumor necrosis factor-alpha release during systemic blood flow changes in pigs with left ventricular assist devices

We previously demonstrated that tumor necrosis factor-alpha (TNF-alpha) increased following a reduction in systemic blood flow to 60% or less of the original cardiac output using a left ventricular assist device (LVAD). The aim of this study was to investigate the effect of reducing systemic blood flow on tissue oxygenation in the gastrointestinal tract (GIT) and the consequences of this on TNF-alpha release. LVADs were implanted in 9 pigs. The aorta was clamped, and thus the LVAD flow represented the entire systemic blood flow. Plasma TNF-alpha of the superior mesenteric vein was measured at baseline and during systemic blood flow changes. Simultaneously, pH, lactate, oxygen delivery index (DO(2)I), oxygen consumption index (VO(2)I), and oxygen extraction (O(2)ER) in the GIT were measured. The pH decreased and the lactate level increased significantly (p < 0.05) at a systemic blood flow of 50% or less. The VO(2)I was positively correlated with DO(2)I. The O(2)ER increased significantly (p < 0.05) with reductions in systemic blood flow to 30% or less. There was a significant (p < 0.01) correlation between TNF-alpha and O(2)ER at levels higher than 55%. These data demonstrate that the GIT oxygenation is inadequate with a reduction in systemic blood flow to 50% and that GIT oxygenation becomes critical at a reduction of 30%. During LVAD weaning, careful attention must be given to the GIT. The pH and lactate may be good markers of the adequacy of tissue oxygenation in the GIT.

Production and physiological function of granulocyte colony-stimulating factor in non-pregnant human endometrial stromal cells

Effects of granulocyte colony-stimulating factor (G-CSF) on proliferation and differentiation of normal human endometrial stromal cells were investigated in an in vitro decidualization culture of stromal cells. Unstimulated stromal cells secreted little prolactin and G-CSF, whereas 8-Br-cAMP-stimulated stromal cells secreted higher levels. There was no relationship, however, between the levels of prolactin and G-CSF secreted from the stimulated cells. Detectable levels of prolactin secretion were not found in two of six stromal cell cultures stimulated with 8-Br-cAMP; however, these two culture supernatants contained high concentrations of G-CSF. Co-stimulation of the stromal cells with 8-Br-cAMP and G-CSF enhanced prolactin secretion from the stimulated cells in a G-CSF concentration-dependent manner without any change in viable cell numbers. However, G-CSF did not affect prolactin secretion or viable cell numbers of 8-Br-cAMP-stimulated decidualized cells. These results indicate that G-CSF enhances cAMP-mediated decidualization of human endometrial stromal cells in an autocrine or paracrine fashion.

The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in the diagnosis of recurrence and lymph node metastasis of cervical cancer

The usefulness of positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-PET) in diagnosing recurrence and lymph node metastasis of uterine cervical cancer was evaluated as a preliminary study. The FDG uptake of 13 cervical cancer patients, including 4 patients with recurrence, was evaluated. The FDG uptake of the cervices of 5 patients who underwent PET studies for non-cervical tumors were used as control. In 2 patients who had undergone radical hysterectomy, we compared the diagnosis of lymph node metastasis based on FDG-PET and magnetic resonance imaging. The FDG uptake in the 9 primary cervical cancers was greater than that in normal cervices (p=0.025). Examination of the 4 recurrent tumors revealed a higher FDG uptake than that in normal cervices (p=0.0022). Metastatic lesions in lymph nodes showed an accumulation of FDG on the PET scan. In conclusion, FDG-PET may be an effective diagnostic tool for detecting recurrence and lymph node metastasis of uterine cervical cancers.

Sonographic characteristics of massive ovarian edema

Massive ovarian edema (MOE) is a very rare disease characterized by a tumor-like enlargement of the ovary. The ultrasound findings have been reported as a solid tumor-like mass or as a solid mass containing a cystic component. Recent reports using magnetic resonance imaging of MOE have demonstrated that multiple ovarian follicles situated around the periphery of the cortex of the enlarged ovary is the most important diagnostic indicator of MOE. This finding was first demonstrated by ultrasound in the case we present here. Thus we suggest that the ultrasound detection of multiple peripheral ovarian follicles in a solid ovarian tumor-like mass may make the preoperative diagnosis of MOE possible by ultrasound alone.

Combined diagnostic imaging of uterine carcinosarcoma: A case report

The diagnostic imaging characteristics of uterine carcinosarcoma have not been established because the tumor is very rare. We studied magnetic resonance (MR) imaging, power Doppler ultrasonography, and positron emission tomography (PET) in one such carcinosarcoma to define its imaging characteristics. On T1-weighted MR images, the tumor mass in the uterus was low-signal intensity and had a slight inhomogeneous appearance. On T2-weighted images, it had a heterogeneous appearance and was of medium- or high-signal intensity; marked flow void was apparent from the myometrium to the tumor mass. The MR flow void was also detected by power Doppler ultrasonography. Increased glucose metabolism was detected on PET images, suggesting a malignant tumor in the endometrial cavity. Combined diagnostic images with MR, power Doppler ultrasonography, and PET is recommended as the diagnostic method for uterine carcinosarcoma.

Postoperative adjuvant chemotherapy with cisplatin, etoposide, and pirarubicin for endometrial carcinoma patients with lymph node metastasis: A pilot study

We evaluated the effects of a combined chemotherapy regimen on endometrial carcinoma in 14 patients with lymph node metastasis. After surgery, the patients were treated with 3 cycles of chemotherapy (PVP regimen) every 4 weeks. The PVP regimen consisted of 75 mg/m2 cisplatin on day 1, 40 mg/m2 pirarubicin (P) on day 1, and 75 mg/m2 etoposide (VP-16: V) on days 2, 3 and 4. The effect of adjuvant chemotherapy was evaluated based on progression-free survival (PFS), overall survival (OS), and adverse effects. The 5-year PFS rate was 52% [95% confidence interval (CI), 10-94%], and the 5-year OS rate was 50% (95% CI, 16-84%). The major toxicity was myelosuppression. One hundred percent of patients had neutropenia above grade 3, but all recovered from myelosuppression. PVP therapy may be an effective adjuvant therapy for endometrial carcinoma patients with lymph node metastasis used as an alternative to radiation therapy.

In vitro decidualization activity assay of human endometrial stromal cells

To address the need for a simple and reliable system for evaluating the effects of bioactive substances on decidualization of endometrial stromal cells, we designed and tested an assay for measuring decidualization activity. With our assay, it is easy to examine the effects of various bioactive substances on endometrial stromal decidualization. For example, as shown in this study, it is now clear that neither RANTES nor gonadotropin releasing hormone agonist has any effect on endometrial stromal decidualization. Our simple assay has also made it possible to evaluate individual stromal decidualization activities and the regulation of decidualization.

Successful preoperative diagnosis of massive ovarian edema aided by comparative imaging study using magnetic resonance and ultrasound

Massive ovarian edema (MOE) is a rare disease. Therefore, preoperative diagnostic method of massive ovarian edema (MOE) has not been established. We have succeeded in making a preoperative diagnosis of MOE aided by ultrasonogram and magnetic resonance imaging (MRI) and the patient's ovaries were preserved. Characteristics and proposed diagnostic imaging criteria for MOE are discussed.

Early diagnosis and evaluation of therapy in postoperative recurrent cervical cancers by positron emission tomography

Positron emission tomography (PET) using 2-[18F]fluoro-2 deoxy-D-glucose (FDG) was performed on two uterine cervical cancer patients in whom recurrent tumors, one pelvic and the other at the vaginal wall had not been precisely diagnosed using the usual imaging examinations. One recurrence was confirmed by the acccumulation of FDG to the pelvic mass as detected by magnetic resonance imaging (MRI). During chemotherapy, changes in FDG-PET findings were detected earlier than those in MRI. In the other, PET detected a recurrent tumor that could not be found by MRI, and was also useful for evaluating chemotherapeutic effects. These cases suggest that PET with FDG can be a useful examination not only for diagnosing recurrent cervical cancer after radical hysterectomy, especially pelvic recurrence, but also for evaluating chemotherapeutic effects on recurrent cancers.

Enhanced Fas/CD95-mediated apoptosis by epidermal growth factor in human endometrial epithelial cells

Epidermal growth factor (EGF) has been reported to regulate apoptosis in various cell lineages. Throughout the menstrual cycle overexpression of the EGF receptor in the secretory epithelium and constitutive expression of EGF in all types of endometrial cells were identified by immunohistochemical study of normal human endometrial tissues. However, it is not known whether EGF also regulates endometrial apoptosis. This study examined the regulatory functions of EGF in endometrial apoptosis by using a human endometrial epithelial cell line HHUA which is susceptible to Fas-mediated apoptosis. Although EGF alone did not affect the cell growth of HHUA, EGF pretreatment of HHUA enhanced Fas-mediated growth suppression and Fas-mediated DNA fragmentation in the cells. Flowcytometric analyses demonstrated that EGF did not induce Fas expression on the cell surface while expressions of the EGF receptor were down-regulated. These results suggest that EGF may enhance apoptotic susceptibility of the endometrial epithelium, especially in the secretory epithelium.

Remarkable suppressive effect of consecutive low-dose cisplatin therapy on advanced ovarian clear cell adenocarcinoma

Ovarian clear cell adenocarcinoma (OCCA) is known to be less responsive to cisplatin and most other anti-cancer drugs and to have a poorer prognosis than other ovarian cancers. We report a rare case of stage IIIc OCCA in a patient who has been treated postoperatively with cisplatin alone and continues to survive after 7.5 years. In this case, 25 mg/m2/day of cisplatin was administered for 5 consecutive days every 4 weeks. After remission, intermittent administration of cisplatin every 3 to 4 months was performed 8 times. This case suggests that induction and intermittent chemotherapy using consecutive low-dose cisplatin administration may be a useful treatment for OCCA.

Increased natural killer cell activities in patients treated with gonadotropin releasing hormone agonist

Natural killer (NK) cell activity in patients treated with gonadotropin-releasing hormone agonists (GnRH-a) was studied. The subjects were 8 patients with endometriosis (6 with ovarian endometrial cyst, 2 with adenomyosis) and 3 patients with uterine leiomyoma. Changes in serum estradiol (E2) concentration and NK cell activity in peripheral blood were analyzed before and after GnRH-a treatment (buserelin 900 microg/day for 4-5 months). NK cell activity was determined by 51Cr release assay and E2 by radioimmunoassay. NK cell activity before GnRH-a treatment was 37.7 +/- 19.0%, and after therapy activity increased significantly to 50. 8 +/- 18.2%. However, no significant correlation between the increase in NK cell activity and the decrease in E2 concentration was found. Results indicate that the standard GnRH-a treatment for endometriosis and uterine leiomyoma might increase NK cell activity. The etiology of the increase of NK activity with GnRH-a treatment is likely related to factors other than E2 concentration.

[Renal, intestinal and whole body metabolic changes in pig LVAD model]

We investigated renal, intestinal, and whole body metabolic changes in response to variations in Left Ventricle Assist Device (LVAD) flow and inspired oxygen concentration (FiO2). Left ventricular assist devices were implanted in 10 adult pigs (weight, 55 +/- 1.76 kg). Renal vein (RV), superior mesenteric vein (SMV), and pulmonary artery (PA) blood oxygen saturation and lactate concentration were measured and used as tissue perfusion markers. These measurements were made before and after changes in LVAD flow or FiO2. Oxygen saturation in PA, SMV, and RV decreased significantly after a reduction in LVAD flow (p = 0.05), with a greater reduction in SMV than in the PA and RV (p < 0.05 at LVAD flow 3.5 l/min; p < 0.01 at LVAD flow 2.0 and 1.0 l/min). The lactate concentration in the PA and SMV increased significantly (p < 0.01) with decreased flow, with a greater increase in the SMV than in the PA (p < 0.05). whereas it remained unchanged in the RV. Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in FiO2 (p < 0.05). Lactate concentration in the PA, SMV, and RV increased significantly at FiO2 of 0.10 (p < 0.05). Lactate concentration in the PA and SMV was significantly higher than that in the RV at FiO2 of 0.10 (p < 0.01). The results show that the gastrointestinal tract is at high risk during low perfusion or low FiO2, whereas in the kidneys metabolic function appears to be less disturbed. In clinical practice, this emphasizes the need to ensure adequate blood flow and respiratory function, especially after extubation, in patients with implanted LVAD. This might avoid intestinal ischemia and subsequent endotoxemia.

Surface Modification of Conventional Polymers by Depositing Plasma Polymers of Trimethylsilane and of Trimethylsilane + O2

The dynamic wetting properties of TMS (trimethylsilane) and TMS + O2 plasma-deposited films on ten low energy conventional polymers were investigated using the Wilhelmy balance method. Plasma deposition resulted in wetting properties that were independent of the underlying polymer substrate for the majority of polymers studied. TMS plasma modification resulted in virtually the same degree of hydrophobicity with an average cosine of the dynamic advancing contact angle from the first immersion, cos &theta;D,a,1 = -0.381 (&theta;D,a,1 = 112 +/- 3.6), for eight of the ten polymers. PTFE and UHMWPE were slightly more hydrophobic after TMS plasma treatment with an average cos &theta;D,a,1 = -0.785 (&theta;D,a,1 = 141 +/- 4.2). TMS + O2 plasma modification resulted in high wettability of all polymers with an average cos &theta;D,a,1 = 0.654 (&theta;D,a,1 = 49.2 +/- 11.7). Dynamic hysteresis, mainly a result of the change in meniscus shape during immersion and emersion, and intrinsic hysteresis, due to the extent of surface configuration change, were both found to vary according to the size of the polymer plate. In general, dynamic hysteresis can be quite large for more hydrophobic TMS treated polymers and considerably smaller for highly hydrophilic TMS + O2 treated polymers. The extent of intrinsic hysteresis of only TMS treated polymers was found to be independent of the underlying polymers within the time-scale of wetting. TMS + O2 plasma treatment resulted in wide variations in intrinsic hysteresis probably due to substrate specific etching of oxygen plasma species. The wettability of the untreated and TMS and TMS + O2 treated polymers, indicated by the static "advancing" contact angles from the sessile droplet method and dynamic "advancing" and "receding" contact angles from the Wilhelmy balance method, were found to conform well to the correlation, cos &theta;S = (cos &theta;D,a,1 + cos &theta;D,r,1)/2. Copyright 1999 Academic Press.

Surface Modification of Conventional Polymers by Depositing Plasma Polymers of Trimethylsilane and of Trimethylsilane + O2

The static wetting properties of TMS (trimethylsilane) and TMS + O2 plasma deposited films on eleven low energy conventional polymers were investigated using the sessile droplet method. The static advancing contact angle is an excellent indication of the change in surface state properties from plasma surface modification. However, traditional contact angle measuring techniques possess a methodological limitation, which can leave a water droplet on the substrate surface for up to 3 min before a measurement is obtained. The static "advancing" contact angles of different size water droplets on teflon and nylon surfaces were observed to change significantly in 2 min while equilibrating with the surface and surroundings. A new quick image-capturing device enables static contact angle measurement 2 to 4 s after contact with the substrate. This technique virtually eliminates the time dependent effects of evaporation and surface state change, which are believed to be responsible for the change in static advancing contact angles. Furthermore, static contact angles independent of droplet volume and contact time may be taken as a surface characteristic property, which is denoted as the intrinsic static contact angle, &theta;S. The static "advancing" contact angle, measured in this fashion, indicated that the wetting properties of TMS and TMS + O2 plasma polymer deposition on 10 conventional polymers were modified virtually independent of the underlying substrate. The average advancing contact angles on TMS and TMS + O2 modified polymers are &theta;S = 94 +/- 2.2 (cos &theta;S = -0.0645) and &theta;S = 32 +/- 6.9 (cos &theta;S = 0.8452), respectively. Copyright 1999 Academic Press.

Identification of the granulocyte colony-stimulating factor (G-CSF) producing cell population in human decidua and its biological action on trophoblast cell

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic factor, which induces differentiation and proliferation of immature granulocytes. During pregnancy, decidual tissue produces G-CSF and the receptor for G-CSF is expressed on chorionic villous tissues. This study attempted to determine the cell population responsible for G-CSF production in decidual tissue and the influence of G-CSF on trophoblasts. Immunostaining and in situ hybridization showed that both the decidual cells and macrophages in the decidual tissue were sources of G-CSF. With 50 micrograms of G-CSF, the [3H] thymidine uptake was 11,100 +/- 2,200 DPM and the control uptake was 7,970 +/- 1,820 DPM. G-CSF induced proliferation of trophoblasts 1.4-fold higher than that of control. It is concluded that the decidual cells and macrophages were sources of G-CSF in the decidual tissue, and G-CSF promoted trophoblast cell proliferation.

Enhancement of apoptotic susceptibility in human endometrial epithelial cell line HHUA by transforming growth factor-beta 1

Although reports have been published on the generation of transforming growth factor-beta 1 (TGF-beta 1) and expression of TGF-beta receptors in human endometrial tissues, the biological functions of endometrial TGF-beta 1 have remained unclear. In this study, the effects of TGF-beta 1 on endometrial apoptosis were examined by using an endometrial epithelial cell line HHUA which is susceptible to Fas-mediated apoptosis. TGF-beta 1 alone did not affect the cell growth of HHUA, but pretreatment of HHUA with TGF-beta 1 enhanced Fas-mediated growth suppression and DNA fragmentation of the cells. Flow cytometric analyses showed that TGF-beta 1 did not affect Fas expression on the cell surface. These findings lead to the conclusion that TGF-beta 1 enhances susceptibility to Fas-mediated apoptosis in the endometrial epithelial cell. Modulation of Fas-mediated endometrial apoptosis by TGF-beta 1 may thus be a tissue-specific effect which is distinct from other TGF-beta 1 effects on Fas-mediated apoptosis in activated T-cells and rheumatoid synovial cells. The biological functions of endometrial TGF-beta 1 and endometrial apoptosis are also discussed.

Pregnancy and neonatal outcomes in unexplained recurrent/habitual aborters treated by allogenic leukocyte immunization

Allogenic leukocyte immunization is a common treatment of unexplained recurrent abortions, whose immunological side effects have hardly been reported. In this study, pregnancy and neonatal outcomes of unexplained recurrent/habitual aborters, who were treated by their husbands' leukocyte immunization, are reviewed. Seventy-seven patients were treated by their husbands' leukocyte immunization at the Infertility Cline of Osaka City University Hospital from 1985 to 1995. Among the 63 pregnancies after the immunizations, 47 cases succeeded in livebirths. Ten of the 47 cases were delivered by cesarean sections. There found no possible relationship between their operative indications and leukocyte immunizations in the 10 cases. As for pregnancy complications, two patients showed liver dysfunction. However we did not find any specific side effects in the pregnancy complications. There was no specific fetal/neonatal complications to the immunotherapy but a case of neonatal thrombocytopenia caused by maternal anti-HLA IgGs.

The gastrointestinal tract: an underestimated organ as demonstrated in an experimental LVAD pig model

BACKGROUND

Although hemodynamic stability and renal function are important and are monitored closely in patients with implanted left ventricular assist devices (LVAD), the gastrointestinal tract may be underestimated in the early postoperative period with regard to adequate perfusion. We investigated renal, intestinal, and whole body metabolic changes in response to variations in LVAD flow and inspired oxygen concentration (FiO2).

METHODS

Left ventricular assist devices were implanted in 10 adult pigs (weight, 55 +/- 1.76 kg). Renal vein (RV), superior mesenteric vein (SMV), and pulmonary artery (PA) blood oxygen saturation and lactate concentration were measured and used as tissue perfusion markers. These measurements were made at baseline and after changes in LVAD flow or FiO2.

RESULTS

Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in LVAD flow (P < 0.05), with a greater reduction in the SMV than in the PA and RV (p < 0.05 at LVAD flow 3.5L/min; p < 0.01 at LVAD flow 2.0 and 1.0 L/min). The lactate concentration in the PA and SMV increased significantly (p < 0.01) with decreased flow, with a greater increase in the SMV than in the PA (p< 0.05), whereas it remained unchanged in the RV. Oxygen saturation in the PA, SMV, and RV decreased significantly after a reduction in FiO2 (p < 0.05). Lactate concentration in the PA, SMV, and RV increased significantly at FiO2 of 0.10 (p < 0.05). Lactate concentration in the PA and SMV was significantly higher than that in the RV at Fi)2 of 0.10 (p < 0.01).

CONCLUSIONS

The results show that the gastrointestinal tract is at high risk during low perfusion or low FiO2, whereas the kidneys' metabolic function appears to be less disturbed. In clinical practice, this emphasizes the need to ensure adequate blood flow and respiratory function, especially after extubation, in patients with implanted LVAD. This might avoid intestinal ischemia and subsequent endotoxemia. Gastrointestinal tonometry may help in the assessment of intestinal perfusion.

A right ventricular hemopump restores right ventricular function with pulmonary artery banding

We investigated the ability of the Hemopump to support the right ventricle during acute, partial, pulmonary artery obstruction. In 6 pigs, a 14 Fr size Hemopump was placed through the pulmonary artery into the right ventricle. Control measurements were made. A band around the pulmonary artery proximal to the outflow port of the Hemopump was tightened, and measurements were repeated with the Hemopump at minimum and then maximum speed. With banding, right ventricular stroke volume and output decreased (43 [SD, 7] to 28 [SD, 8] ml, p < 0.001; 4.9 [SD, 0.8] to 3.7 [SD, 1.0] L/min, p < 0.01 respectively), but they were restored with the Hemopump (38 [SD, 5] ml and 4.5 [SD, 0.6] L/min; both p = NS vs control). Increases in right ventricular peak systolic (28 [SD, 10] to 42 [SD, 17] mm Hg; p < 0.01) and end-diastolic pressure (2 [SD, 1] to 12 [SD, 6] mm Hg; p < 0.02) were reversed by the Hemopump (29 [SD, 8] and 4 [SD, 2] mm Hg; both p = NS vs control). Right ventricular pressure rate product almost doubled with banding (3,199 [SD, 1,252] to 5,962 [SD, 2,796] mm Hg; p < 0.01), but it decreased with the Hemopump (3,368 [SD, 767] mm Hg; p = NS vs control). With acute partial pulmonary artery banding, a right ventricular Hemopump restores output from and offloads the right ventricle.

Direct mechanical assistance of the right ventricle with the Hemopump in a porcine model

In 6 pigs, a 14F Hemopump was placed through the pulmonary artery into the right ventricle. The pulmonary artery was banded proximal to the outflow port of the Hemopump, and tightening the band increased right ventricular peak systolic pressure by 50%. There were significant falls in right ventricular stroke volume (from 43 +/- 7.3 mL [+/- the standard deviation] to 27 +/- 8.0 mL; p < 0.001) and cardiac output (from 4.94 +/- 0.76 L/min to 3.70 +/- 0.95 L/min; p < 0.01) and increases in right ventricular peak systolic pressure (from 28 +/- 9.7 mm Hg to 42 +/- 17.1 mm Hg; p < 0.01) and end-diastolic pressure (from 2 +/- 0.8 mm Hg to 12 +/- 6.4 mm Hg; p < 0.02). Mean aortic pressure fell (from 65 +/- 29.9 mm Hg to 61 +/- 9.6 mm Hg; p < 0.01), but systemic vascular resistance was unchanged, thus indicating a fall in left ventricular output reflected by a decrease in mixed venous oxygen saturation (from 60% +/- 8.9% to 47% +/- 7.6%; p < 0.01). After 15 minutes with the Hemopump at maximum speed, these variables returned to control levels (stroke volume, 38 +/- 4.5 mL; cardiac output, 4.50 +/- 0.63 L/min; right ventricular peak systolic pressure, 29 +/- 8.3 mm Hg; right ventricular end-diastolic pressure, 4 +/- 2.0 mm Hg; mean aortic pressure, 72 +/- 10.4 mm Hg; mixed venous oxygen saturation, 56% +/- 4.6% [all, p = not significant versus controls]).(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma granulocyte colony stimulating factor concentrations in pregnant women

We measured the plasma granulocyte colony stimulating factor (G-CSF) concentrations in pregnant women to evaluate the association between G-CSF and increased neutrophil counts that has been observed during pregnancy. We examined 96 pregnant and 10 nonpregnant women. The G-CSF concentrations were assayed using a sandwich enzyme immunoassay. The G-CSF concentrations in pregnant women were significantly higher at all times than those of nonpregnant women. The G-CSF concentrations were also significantly higher during than before labor. The plasma G-CSF concentrations were positively correlated with the neutrophil counts during the 3rd trimester only. In conclusion, increased G-CSF concentrations may be related to the increases in neutrophil counts in pregnant women, especially during the 3rd trimester.

[A case of dissecting aortic aneurysm and presence of anti-Jr(a) antibody]

A 66-year-old woman was diagnosed as a DeBakey type II dissecting aortic aneurysm with angiography and CT. Antibody screening revealed circulating anti-Jr(a) antibody. Preoperatively, erythropoietin was administered twice a week. Over 24 days, a total of 1200 ml of her blood was removed and stored for autologous transfusion. The dissecting ascending aorta was replaced with the aid of cardiopulmonary bypass. The post operative course was uneventful. By using erythropoietin, pre-donated autologous blood, cell saver, aprotinin and transfusion of fresh autologous blood, it was possible to perform cardiovascular surgery on this patient who had an abnormal antibody. This patient is the first case of repair or dissecting aortic aneurysm with anti-Jr(a) antibody in Japan.

Use of the Nippon-Zeon pneumatic ventricular assist device as a bridge to cardiac transplantation

The Nippon-Zeon (NZ) ventricular assist device is a sac type, air driven, heterotopic, external pump. Its performance has been evaluated in Japan as a bridge to myocardial recovery. Few data are available on the device as a bridge to heart transplantation. Since 1991, 10 patients (9 men) were bridged to heart transplantation with NZ, all in biventricular support. The mean age was 39 +/- 13 years (range, 21-60 years), mean body weight was 75 +/- 13 kg (range, 51-95 kg). Five patients had a dilated cardiopathy, and five were ischemic (three acute myocardial infarctions). Despite maximal inotropic support, including enoximone in seven, epinephrine in three, and intraaortic balloon pumping in one, eight patients were anuric, three were in acute hepatic failure, and three were intubated. Preoperative hemodynamic and biologic values were: cardiac index, 1.57 +/- 0.4 l/min/m2; pulmonary capillary wedge pressure, 34 +/- 5 mmHg; creatinine, 200 +/- 80 mumol/l; blood urea nitrogen, 17.5 +/- 8 mmol/l; total bilirubin 36 +/- 6 mumol/l; aspartate aminotransferase, 1,000 +/- 2,000 IU/l. In all patients, a biventricular assist device was implanted without the use of cardiopulmonary bypass. Improvement occurred immediately in all but one. Mean left ventricular flow was 4.5 +/- 0.8 l/min. Anticoagulation was maintained with intravenous heparin. Recently for bleeding was required in one case (10%), and two patients had positive blood cultures that were successfully treated. There was no mechanical failure. Hemolysis was not significant (lactate dehydrogenase, 378 +/- 50 IU/l; plasma-free hemoglobin below 10 mg/dl). Each device was free of thrombi and deposits at time of explantation. One patient died while on assist. Nine patients (90%) were transplanted after 11 +/- 8 days (range, 1-32 days). Three died early after transplantation, one of graft failure, two of sepsis. Six patients (66%) could be discharged. The follow-up ranges from 7 to 28 months. NZ is a simple, reliable, pneumatic device driven by a light, silent console; it can be rapidly implanted without cardiopulmonary bypass in patients in desperate condition who are awaiting cardiac transplantation. The difficulty of patient rehabilitation while using this device should limit the duration of support to weeks to allow the patient to be in optimal condition for heart transplantation.

Clinical application of evoked spinal cord potentials elicited by direct stimulation of the cord during temporary occlusion of the thoracic aorta

Evoked spinal cord potentials elicited by direct stimulation of the cord were used to monitor spinal cord ischemia in 68 patients undergoing temporary occlusion of the thoracic aorta (29 thoracic nondissecting aortic aneurysms, 9 nondissecting thoracoabdominal aneurysms, and 30 dissecting aneurysms). "Immediate" postoperative paraplegia developed in three patients and "immediate" paraparesis developed in one, whereas "delayed" paraplegia developed in two others. During aortic crossclamping, four response patterns of the spinal cord potentials were obtained: (1) no change (n = 53), (2) change with return (n = 10), (3) change with inconsistent return (n = 2), and (4) change without return (n = 3). Neurologic complications occurred in 2%, 0%, 100% of these groups, respectively. Delayed paraplegia developed on the second postoperative day in only one patient with a false-negative result, and the potentials correlated well with this patient's clinical neurologic recovery. The aortic crossclamp time was significantly longer in the patients with "change with inconsistent return" and "change without return" than in the other two groups (p < 0.01). Femoral artery pressure and the cardiopulmonary bypass flow rate were also significantly lower in these groups than in the other two groups (p < 0.02 and p < 0.01, respectively). We conclude that intraoperative monitoring of direct spinal cord responses is useful for the early detection of spinal cord ischemia for assessing the efficacy of surgical countermeasures.

Right heart function during left ventricular assistance in an open-chest porcine model of acute right heart failure

Changes in the right ventricular function measured with a thermodilution ejection fraction catheter have been recorded in open-chest normal pigs and pigs with acute right heart failure (RVF) undergoing left ventricular assistance with a pneumatic-sac-type device (LVAD). To produce acute right heart failure, 5 pigs underwent ligation of the right ventricular free wall coronary arteries. Compared with normal pigs, cardiac output in ligated pigs fell by 21% (7.5 +/- 0.5 vs 9.5 +/- 1.2 L/min; p < 0.05) and the right ventricular end diastolic pressure rose (11.4 +/- 2.6 vs 5.7 +/- 3.6 vs mmHg: p < 0.05). With the left ventricular assist device connected, the right atrial pressure was increased to 3, 5, 7, 10 and 12 mmHg by volume loading while maintaining the haematocrit at 35 +/- 6%. The right ventricular stroke work index (RVSWI) increased with volume loading in normal pigs. In RVF pigs, RVSWI increased significantly with the LVAD (59.2 +/- 5.8 vs 23.5 +/- 7.8 mmHg ml/min/kg, p < 0.01), approaching that of normal pigs (62.3 +/- 4.8 mmHg ml/min/kg). Similar changes were observed in the cardiac output and right ventricular stroke volume. These results show that, in this model of open-chest, mild, acute right heart failure, left ventricular assistance allows right ventricular function to return to normal, despite volume overloading, by decreasing right ventricular after load and increasing right ventricular compliance.

[Correlation of myocardial temperature, intramyocardial pH, and myocardial electrical activity during hyperkalemic hypothermic cardioplegic arrest to functional recovery after reperfusion]

We estimated the correlation of myocardial temperature, intramyocardial pH, and myocardial electrical activity (MEA) during hyperkalemic hypothermic cardioplegic arrest to functional recovery after reperfusion to assess those parameters as intra-operative on-line assessment of myocardial preservation during cardiac operation. Twenty dogs underwent cardiopulmonary bypass at 30 degrees C. Cardiac function was evaluated before and after two hours ascending aortic cross-clamping. The dogs were divided into four groups according to cardiac preservation methods employed. Group I (n = 6): 4 degrees C hyperkalemic crystalloid cardioplegic solution was delivered antegradely through the aorta every 30 minutes without topical cooling. Group II (n = 4): total volume of cardioplegic solution same as Group I was delivered only once without topical cooling. Group III (n = 5): cardioplegic solution same as Group I with lidocaine (100 mg/l) was delivered every 30 minutes without topical cooling. Group IV (n = 5): cardioplegic solution same as Group I was delivered every 30 minutes with topical cooling. Hearts at less than 8 degrees C during aortic cross-clamping (Group I) revealed better functional recovery (72 +/- 21%) than those over 15 degrees C (Group II-IV, 28 +/- 30%). There was no significant correlation between intramyocardial pH changes during aortic cross-clamping and functional recovery after reperfusion (R = -.2257). During aortic cross-clamping, the occurrence of MEA which was obtained directly from the electrode inserted into left ventricular anterior free wall (direct MEA) was observed in all cases. However the myocardial activities which were identified by direct MEA were not necessarily observed visually or by routine electrocardiogram.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical aspects of automatic implantable cardioverter defibrillator (AICD) in patients with life-threatening ventricular tachyarrhythmias]

Implantations of automatic implantable cardioverter defibrillator were performed in five patients with life-threatening ventricular tachyarrhythmias. Preoperative diagnoses of arrhythmias were sustained ventricular tachycardia (VT) in two cases, ventricular fibrillation (VF) in two cases and sustained VT+VF in one case. Four of five cases had basic diseases respectively (broad anterior myocardial infarction, dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy), and the other case was idiopathic. Preoperative CTR were 43-65% (mean 57.4%) and left ventricular ejection fraction were 26-76% (mean 51.2%). Implantation of AICD was indicated for patients who survived circulatory arrest or life-threatening VT. Median sternotomy (3) or left antero-lateral thoracotomy (2) were performed for implantation of large-small patch electrodes for defibrillation. AICD generators were implanted in the pocket under abdominal rectal muscle in all cases. Postoperatively myocardial insufficiency, pericarditis, pleuritis occurred in three cases respectively. In the follow-up periods (2-25 months, mean 13 months), AICD worked effectively in two patients with spontaneous VT (6 months, 1 year after operation) and no cardiac death was experienced. We concluded that AICD system is effective for the life-threatening ventricular tachyarrhythmias, although the further estimation in longer follow-up periods are warranted.