Circulating endothelial cells demonstrate an attenuation of endothelial damage by minimizing the extracorporeal circulation

ObjectiveDetachment of endothelial cells may represent serious injury of the endothelium after cardiopulmonary bypass. We investigated whether the extent of endothelial injury is related to the type of cardiopulmonary bypass system used (conventional or minimized) and determined circulating endothelial cells as well as von Willebrand factor and soluble thrombomodulin.MethodsTwenty patients scheduled for elective coronary bypass grafting were randomly assigned to either the minimal extracorporeal circulation system or the standard cardiopulmonary bypass. Ten healthy volunteers served as controls. Circulating endothelial cells per milliliter of full blood were perioperatively determined by immunomagnetic cell separation technique. Endothelial plasma markers were measured by enzyme-linked immunosorbent assay.ResultsPreoperative circulating endothelial cell numbers did not differ between the experimental groups, but were significantly higher than in the healthy controls (18.6 ± 5.6 vs 7.2 ± 3.8, P < .001). At 6 hours, circulating endothelial cell numbers increased significantly compared with baseline in both experimental groups and peaked at 12 hours after cardiopulmonary bypass initiation, each time with significantly lower values in the minimal extracorporeal circulation group (6 hours: 44.0 ± 9.9 vs 29.6 ± 9.8, P = .007; 12 hours: 48.1 ± 6.8 vs 31.8 ± 7.1, P < .001). Likewise, von Willebrand factor and soluble thrombomodulin postoperatively increased in both groups with a tendency toward lower levels in the minimal extracorporeal circulation group. Although circulating endothelial cells gradually declined, continually with lower numbers in the minimal extracorporeal circulation group, the endothelial plasma markers remained elevated during observation time.ConclusionsCirculating endothelial cells represent a novel marker of the intrinsic endothelial damage caused by cardiopulmonary bypass. Its analysis facilitates the evaluation of cardiopulmonary bypass modifications as the minimal extracorporeal circulation system could be proven to be less injurious to endothelium and myocardium

Indication for percutaneous aortic valve implantation

The incidence of valvular aortic stenosis has increased over the past decades due to improved life expectancy. Surgical aortic valve replacement is currently the only treatment option for severe symptomatic aortic stenosis that has been shown to improve survival. However, up to one third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to high comorbidities resulting in a higher operative mortality rate. In the past such patients could only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement with the goal of offering a therapeutic solution for patients who are unfit for surgical therapy. Currently there are two catheter-based treatment systems in clinical application (the Edwards SAPIEN aortic valve and the CoreValve ReValving System), utilizing either a balloon-expandable or a self-expanding stent platform, respectively

A versatile fluorescence lifetime imaging system for scanning large areas with high time and spatial resolution

"Published in SPIE Proceedings Vol. 9286"We present a flexible fluorescence lifetime imaging device which can be employed to scan large sample areas with a spatial resolution adjustable from many micrometers down to sub-micrometers and a temporal resolution of 20 picoseconds. Several different applications of the system will be presented including protein microarrays analysis, the scanning of historical samples, evaluation of solar cell surfaces and nanocrystalline organic crystals embedded in electrospun polymeric nanofibers. Energy transfer processes within semiconductor quantum dot superstructures as well as between dye probes and graphene layers were also investigated.This work was financially supported by the European Regional Development Fund (ERDF) through Programa Operacional Factores de Competitividade (COMPETE: FCOMP-01-0124-FEDER-014628) and the Portuguese Fundacao para a Ciencia e Tecnologia (FCT) through the projects "Functional structuring, inter-particle interaction and energy transfer in ensembles of nanocrystal dots" (PTDC/FIS/113199/2009), Ultra-fast spectroscopy on the dynamics and relaxation of Dirac electrons in graphene" (PTDC/FIS/101434/ 2008) and "Low dimensional nanostructures for nonlinear optical applications" PTDC/CTmNAN/114269/2009

Polyethylenimine-mediated gene delivery into human bone marrow mesenchymal stem cells from patients

Transplantation of mesenchymal stem cells (MSCs) derived from adult bone marrow has been proposed as a potential therapeutic approach for post-infarction left ventricular (LV) dysfunction. However, age-related functional decline of stem cells has restricted their clinical benefits after transplantation into the infarcted myocardium. The limitations imposed on patient cells could be addressed by genetic modification of stem cells. This study was designed to improve our understanding of genetic modification of human bone marrow derived mesenchymal stem cells (hMSCs) by polyethylenimine (PEI, branched with Mw 25 kD), one of non-viral vectors that show promise in stem cell genetic modification, in the context of cardiac regeneration for patients. We optimized the PEI-mediated reporter gene transfection into hMSCs, evaluated whether transfection efficiency is associated with gender or age of the cell donors, analysed the influence of cell cycle on transfection and investigated the transfer of therapeutic vascular endothelial growth factor gene (VEGF). hMSCs were isolated from patients with cardiovascular disease aged from 41 to 85 years. Optimization of gene delivery to hMSCs was carried out based on the particle size of the PEI/DNA complexes, N/P ratio of complexes, DNA dosage and cell viability. The highest efficiency with the cell viability near 60% was achieved at N/P ratio 2 and 6.0 μg DNA/cm 2. The average transfection efficiency for all tested samples, middle-age group (&lt;65 years), old-age group (&gt;65 years), female group and male group was 4.32%, 3.85%, 4.52%, 4.14% and 4.38%, respectively. The transfection efficiency did not show any correlation either with the age or the gender of the donors. Statistically, there were two subpopulations in the donors; and transfection efficiency in each subpopulation was linearly related to the cell percentage in S phase. No significant phenotypic differences were observed between these two subpopulations. Furthermore, PEI-mediated therapeutic gene VEGF transfer could significantly enhance the expression level.DFG/SFB/Transregio 37BMBF/0313191German Helmholtz AssociationDFG/0402710Ministry of Education/0312138 AMinistry of Economy (Mecklenburg-West Pommerania)/V220-630-08-TFMVF/S-035Marie Curie International Research Staff Exchange Scheme (IRSES, FP7-PEOPLE-2009-IRSES)Reference and Translation Center for Cardiac Stem Cell Therapy (RTC

Effect of closed minimized cardiopulmonary bypass on cerebral tissue oxygenation and microembolization

ObjectiveCoronary artery bypass grafting with cardiopulmonary bypass carries a risk for neurologic complications because of cerebral hypoperfusion and microembolization. The basic goals of a novel closed minimized extracorporeal circulation are to prevent excessive hemodilution and to avoid blood-air interface. The aim of this prospective randomized study was to determine the effect of using the minimized extracorporeal circulation system compared with open conventional extracorporeal circulation on cerebral tissue oxygenation and microembolization.MethodsForty patients undergoing coronary artery bypass grafting (20 in each group) were continuously monitored for changes in cerebral oxygenated hemoglobin and tissue oxygenation index by using near-infrared spectroscopy. Total microembolic count and gaseous embolic count in both median cerebral arteries were monitored with multifrequency transcranial Doppler instrumentation.ResultsIn the conventional extracorporeal circulation group there was a highly significant reduction in both cerebral oxygenated hemoglobin and tissue oxygenation index from the start to the end of cardiopulmonary bypass (P < .01). The rate of decrease in cerebral oxygenated hemoglobin after aortic cannulation was faster in the conventional extracorporeal circulation group (F test = 9.03, P < .001). No significant changes with respect to cerebral oxygenated hemoglobin or tissue oxygenation index occurred in the minimized extracorporeal circulation group, except at the beginning of rewarming (P < .01). Total embolic count, as well as gaseous embolic count, in the left and right median cerebral arteries was significantly lower in the minimized extracorporeal circulation group (all P < .05). Postoperative bleeding was greater (P < .05) and the transfusion rate was higher (P < .05) in the conventional extracorporeal circulation group.ConclusionsUse of closed minimized cardiopulmonary bypass compared with conventional open cardiopulmonary bypass preserves cerebral tissue oxygenation and reduces cerebral microembolization

Организация работ по локализации и ликвидации аварийного разлива нефти и нефтепродуктов на водной поверхности

Объектом исследования являются методы локализации и ликвидации разливов нефти на водной поверхности. Цель работы – провести анализ существующих методов и тактических мероприятий по локализации и ликвидации разливов нефти на водной поверхности. В процессе исследования проводился анализ имеющихся данных, на основе которых были выделение наиболее эффективные методы локализации и ликвидации разливов нефти на водной поверхности. Проведен расчет объема вытекшей нефти и количества сорбента, требуемого для ликвидации разлива. В результате исследования было выявлено, что наиболее эффективным способом локализации разливов на водной поверхности являются боны с различными механизмами их установки, а наиболее эффективными методами ликвидации – использование скиммеров и сорбентов.Объектом исследования являются методы локализации и ликвидации разливов нефти на водной поверхности. Цель работы – провести анализ существующих методов и тактических мероприятий по локализации и ликвидации разливов нефти на водной поверхности. В процессе исследования проводился анализ имеющихся данных, на основе которых были выделение наиболее эффективные методы локализации и ликвидации разливов нефти на водной поверхности. Проведен расчет объема вытекшей нефти и количества сорбента, требуемого для ликвидации разлива. В результате исследования было выявлено, что наиболее эффективным способом локализации разливов на водной поверхности являются боны с различными механизмами их установки, а наиболее эффективными методами ликвидации – использование скиммеров и сорбентов

Effect of acute kidney injury requiring extended dialysis on 28 day and 1 year survival of patients undergoing interventional lung assist membrane ventilator treatment

<p>Abstract</p> <p>Background</p> <p>Extracorporeal lung assist devices are increasingly used in the intensive care unit setting to improve extracorporeal gas exchange mainly in patients with acute respiratory distress syndrome. ARDS is frequently accompanied by acute kidney injury; however it is so far unknown how the combination of these two conditions affects long term survival of critically ill patients.</p> <p>Methods</p> <p>In a retrospective analysis of a tertiary care hospital we evaluated all patients undergoing interventional lung assist (iLA) treatment between January 1^st2005 and December 31^st2009. Data from all 61 patients (31 F/30 M), median age 40 (28 to 52) years were obtained by chart review. Follow up data up to one year were obtained.</p> <p>Results</p> <p>Of the 61 patients undergoing iLA membrane ventilator treatment 21 patients had acute kidney injury network (AKIN) stage 3 and were treated by extended dialysis (ED). Twenty-eight day survival of all patients was 33%. While patients without ED showed a 28 day survival of 40%, the survival of patients with ED was only 19%. Patients on ED were not different in respect to age, weight, Horowitz index and underlying disease.</p> <p>Conclusions</p> <p>AKI requiring ED therapy in patients undergoing iLA treatment increases mortality in ICU patients. Patients in whom iLA was placed as a bridge to lung transplantation and that were successfully transplanted showed the best outcome. Future studies have to clarify whether it is possible to identify patients that truly benefit from the combination of these two extracorporeal treatment methods.</p

Optimal Management of the Patient with an Episode of Atrial Fibrillation In and Out of the Hospital

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75668/1/j.1540-8167.1999.tb00696.x.pd

Coronary artery surgery: cardiotomy suction or cell salvage?

Coronary artery bypass grafting (CABG) today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery