Arterial revascularization with the right gastroepiploic artery and internal mammary arteries in 300 patients

From September 1989 to September 1992, the right gastroepiploic artery in combination with one or both internal mammary arteries was used as a graft in 300 patients who underwent coronary artery bypass grafting. The gastroepiploic artery was the primary choice in preference to the saphenous vein. The study comprised 263 men and 37 women, ranging in age from 31 to 77 years (median age 59 years). Thirty-nine patients (13%) underwent previous bypass procedures with autologous vein grafts. In 17 patients (5.7%) the gastroepiploic artery was used as a single graft. In 150 patients (50%) the gastroepiploic artery in conjunction with one internal mammary artery was used (in 6 patients combined with a vein graft). In 133 patients (44.3%) the gastroepiploic artery was used with both internal mammary arteries. Revascularization in nine patients (3%) was combined with another cardiac procedure; three aortic valve replacements, two mitral valve repairs, and four resections of a left ventricular aneurysm. Ten patients died in the hospital (3.3%; 70% confidence limits 2.3% to 4.8%); two of these patients had an infarction in the area revascularized by the gastroepiploic artery. At late follow-up, 0.5 to 39 months (mean 14 months) after the operation, we found no mortality. One patient with an occluded gastroepiploic artery graft underwent reoperation with the use of the right internal mammary artery. One patient underwent percutaneous transluminal coronary angioplasty of the right coronary artery after occlusion of the gastroepiploic artery. Elective recatheterization was done in 88 patients 1 to 25 months after operation (mean 10 months). Graft patency in gastroepiploic artery grafts increased steadily from 77% in the first semester of the study to 95% in the fourth semester and then equaled the patency of the internal mammary artery grafts (97%), which was almost constant during the whole period. We conclude that patency of the gastroepiploic artery was initially related to a ''learning curve'' but eventually equaled that of the internal mammary artery grafts. Furthermore, the gastroepiploic artery may well be the graft of choice in conjunction with the internal mammary arteries

Holographic Kondo Model in Various Dimensions

We study the addition of localised impurities to U(N) Supersymmetric Yang-Mills theories in (p+1)-dimensions by using the gauge/gravity correspondence. From the gravity side, the impurities are introduced by considering probe D(8-p)-branes extendingalong the time and radial directions and wrapping an (7-p)-dimensional submanifold of the internal (8-p)-sphere, so that the degrees of freedom are point-like from the gauge theory perspective. We analyse both the configuration in which the branes generate straight flux tubes -corresponding to actual single impurities - and the one in which connected flux tubes are created- corresponding to dimers. We discuss the thermodynamics of both the configurations and the related phase transition. In particular, the specific heat of the straight flux-tube configuration is negative for p<3, while it is never the case for the connected one. We study the stability of the system by looking at the impurity fluctuations. Finally, we characterise the theory by computing one- and two-point correlators of the gauge theory operators dual to the impurity fluctuations. Because of the underlying generalised conformal structure, such correlators can be expressed in terms of an effective coupling constant (which runs because of its dimensionality) and a generalised conformal dimension.Comment: 56 pages, 3 figures; v2: typos correcte

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

Location-Specific Epigenetic Regulation of the Metallothionein 3 Gene in Esophageal Adenocarcinomas

Metallothionein 3 (MT3) maintains intracellular metal homeostasis and protects against reactive oxygen species (ROS)-induced DNA damage. In this study, we investigated the epigenetic alterations and gene expression of the MT3 gene in esophageal adenocarcinomas (EACs).Using quantitative bisulfite pyrosequencing, we detected unique DNA methylation profiles in the MT3 promoter region. The CpG nucleotides from -372 to -306 from the transcription start site (TSS) were highly methylated in tumor (n = 64) and normal samples (n = 51), whereas CpG nucleotides closest to the TSS (-4 and +3) remained unmethylated in all normal and most tumor samples. Conversely, CpG nucleotides in two regions (from -139 to -49 and +296 to +344) were significantly hypermethylated in EACs as compared to normal samples [FDR<0.001, -log10(FDR)>3.0]. The DNA methylation levels from -127 to -8 CpG sites showed the strongest correlation with MT3 gene expression (r = -0.4, P<0.0001). Moreover, the DNA hypermethylation from -127 to -8 CpG sites significantly correlated with advanced tumor stages and lymph node metastasis (P = 0.005 and P = 0.0313, respectively). The ChIP analysis demonstrated a more repressive histone modification (H3K9me2) and less active histone modifications (H3K4me2, H3K9ace) in OE33 cells than in FLO-1 cells; concordant with the presence of higher DNA methylation levels and silencing of MT3 expression in OE33 as compared to FLO-1 cells. Treatment of OE33 cells with 5-Aza-deoxycitidine restored MT3 expression with demethylation of its promoter region and reversal of the histone modifications towards active histone marks.In summary, EACs are characterized by frequent epigenetic silencing of MT3. The choice of specific regions in the CpG island is a critical step in determining the functional role and prognostic value of DNA methylation in cancer cells

Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved

Neural Circuits Underlying Rodent Sociality: A Comparative Approach

All mammals begin life in social groups, but for some species, social relationships persist and develop throughout the course of an individual’s life. Research in multiple rodent species provides evidence of relatively conserved circuitry underlying social behaviors and processes such as social recognition and memory, social reward, and social approach/avoidance. Species exhibiting different complex social behaviors and social systems (such as social monogamy or familiarity preferences) can be characterized in part by when and how they display specific social behaviors. Prairie and meadow voles are closely related species that exhibit similarly selective peer preferences but different mating systems, aiding direct comparison of the mechanisms underlying affiliative behavior. This chapter draws on research in voles as well as other rodents to explore the mechanisms involved in individual social behavior processes, as well as specific complex social patterns. Contrasts between vole species exemplify how the laboratory study of diverse species improves our understanding of the mechanisms underlying social behavior. We identify several additional rodent species whose interesting social structures and available ecological and behavioral field data make them good candidates for study. New techniques and integration across laboratory and field settings will provide exciting opportunities for future mechanistic work in non-model species

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

OBJECTIVE: To identify possible avenues of sparing the internal mammary artery (IMA) for coronary artery bypass grafting (CABG) in women undergoing autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. BACKGROUND: Optimal autologous reconstruction of the breast and coronary artery bypass grafting (CABG) are often mutually exclusive as they both require utilisation of the IMA as the preferred arterial conduit. Given the prevalence of both breast cancer and coronary artery disease, this is an important issue for women's health as women with DIEP flap reconstructions and women at increased risk of developing coronary artery disease are potentially restricted from receiving this reconstructive option should the other condition arise. METHODS: The largest clinical and cadaveric anatomical study (n=315) to date was performed, investigating four solutions to this predicament by correlating the precise requirements of breast reconstruction and CABG against the anatomical features of the in situ IMAs. This information was supplemented by a thorough literature review. RESULTS: Minimum lengths of the left and right IMA needed for grafting to the left-anterior descending artery are 160.08 and 177.80 mm, respectively. Based on anatomical findings, the suitable options for anastomosis to each intercostals space are offered. In addition, 87-91% of patients have IMA perforator vessels to which DIEP flaps can be anastomosed in the first- and second-intercostal spaces. CONCLUSION: We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG

INTERRUPTION OF THE AORTIC-ARCH, DISTAL AORTOPULMONARY WINDOW, ARTERIAL DUCT AND AORTIC ORIGIN OF THE RIGHT PULMONARY-ARTERY IN A NEONATE - REPORT OF A CASE SUCCESSFULLY REPAIRED IN A ONE-STAGE OPERATION

The case of a 4-day-old male neonate with the rare combination of interruption of the aortic arch beyond the left subclavian artery, distal aortopulmonary window, persistent arterial duct and aortic origin of the right pulmonary artery is presented. Review of the literature reveals this patient to be the thirteenth reported case and the fifth case with succesful repair