Pregnancy-related conditions and premature coronary heart disease in adult offspring.

Objective: To investigate the association between complications during pregnancy and premature coronary heart disease in adult offspring. Methods: We conducted a population-based case-control study of 153 Indonesian patients with a first acute coronary syndrome (ACS) (age ≤55 years) and 153 age-matched and sex-matched controls. Data on complications during pregnancy (high blood pressure, preterm delivery) and maternal infections in pregnancy were obtained, together with sociodemographic data, clinical profiles, laboratory measurements and adulthood cardiovascular disease (CVD) risk factors at hospital admission or enrolment. Conditional logistic regression was performed to assess the association between overall pregnancy complications, and specific groupings of complications and premature ACS. Results: Pregnancy-related hypertension and infection were more common in mothers of cases than controls. Pregnancy complications were associated with premature offspring ACS (OR 2.9, 95% CI 1.4 to 6.0, p=0.004), and the association persisted in fully adjusted analyses (ORadjusted 4.5, 1.1 to 18.1, p=0.036). In subgroup analyses, pregnancy-related high blood pressure (ORadjusted 5.0, 1.0 to 24.7, p=0.050) and maternal infections (ORadjusted 5.2, 1.1 to 24.2, p=0.035) were associated with offspring ACS. Conclusions: Offspring of mothers with complications during pregnancy have an increased risk for premature ACS in adulthood, which may be of particular relevance in populations in transition, where the incidence of both pregnancy-related morbidity and CVD are high

Biomedical applications of photo- and sono-activated Rose Bengal:a review

\u3cp\u3eObjective: The aim of this review is to discuss and compare the extensive range of biomedical applications of photo- and sono-activated Rose Bengal (RB). Background data: RB is a xanthene dye that due to its interesting photo- and sono-sensitive properties is gaining attention in the scientific field. Methods: This study is a literature review using the database PubMed. Results: As a photosensitizer, RB converts the triplet oxygen molecule into reactive oxygen species after irradiation with green light (532 nm). This mechanism allows for the use of photo-activated RB in photochemical tissue bonding, photodynamic therapy, antimicrobial therapy and cancer treatment, photothrombotic animal models, and other applications, including tissue engineering and treatment of tauopathies. As a sono-sensitive compound, RB is applied for sonodynamic therapy, cancer treatment, and antimicrobial therapy. Conclusions: This review outlines the versatility and effectiveness of photo- and sono-activated RB in numerous biomedical applications.\u3c/p\u3

Development of an ex vivo aneurysm model for vascular device testing

\u3cp\u3eAn ex vivo aneurysm model that closely resembles the in vivo situation can provide an important tool for testing therapies. The model should mimic a variety of conditions, such as in vivo hemodynamics and native arterial structure and characteristics, avoiding animal experimentation.  Therefore, the aim of this study is to develop an ex vivo aneurysm model by vessel wall stiffening to be used to assess treatment strategies. Porcine carotid arteries from slaughterhouse animals were used to evaluate the acute effect of different concentrations of Rose Bengal on distensibility. This sono-sensitive compound was activated by several ultrasound frequencies, resulting in stiffening of the treated arteries of which the most effective combination was selected. In a pulsatile ex vivo vascular bioreactor treated and control porcine carotid arteries were subjected to physiological conditions for 10 days. During culture, hemodynamics showed increased mean pressure and decreased pulsatility in treated arteries compared to controls. Change in vessel morphology and significant increase of distal diameter was observed in the treated arteries but not in the controls. Histology of treated arteries revealed dissection-like lesions distally and aneurysm-like structure proximally. Finally, a stent graft was deployed in one treated artery and cultured demonstrating the feasibility of testing endovascular devices in the model. In conclusion, we developed an ex vivo model reproducing the onset of aneurysm formation. This could represent a promising tool for early stage device testing thereby reducing the need for animal studies.\u3c/p\u3

Legal claims for malignant mesothelioma : dealing with all cases

Background: Apart of medical reasons, a definitive diagnosis of malignant mesothelioma may be required as a basis for a claim of financial compensation although a pathological source of conclusive evidence is missing. Clinical assessment of all available data is then the only option to come to a final conclusion. We evaluated the diagnostic work-up of a large cohort of Dutch patients who applied for financial compensation due to mesothelioma. We determined how often a pathological or clinical diagnosis can be made, and which factors are associated with making the final diagnosis malignant mesothelioma. Methods: A flow diagram of the diagnostic work-up was constructed for patients that applied to the Dutch institute for asbestos victims between 2005 and 2008 (N=1498). Both pathological and clinical factors that may influence the diagnostic outcome were assessed. Results: In 97 of the 1498 patients (6%) no pathologic diagnosis could be established because of an uncertain diagnosis (N=54), inadequate (N=22) or unavailable tumor samples (N=21). A final pathological diagnosis of malignant mesothelioma could most often be made when biopsy samples were available compared to those in whom only cytological material was available. In patients in who no conclusive diagnosis could be made, clinical assessment was performed. Eighty percent of patients (66/83) who were clinically assessed were considered to have mesothelioma. None of the clinical features analyzed were strongly associated with a confirmed diagnosis of malignant mesothelioma. Discussion: Our study shows that only in a small number of the patients who applied no pathologic diagnosis could be obtained. Based on judgment of clinical experts in the majority of these cases a near to certain diagnosis could be made. Moreover, it is reasonable to obtain biopsy material from patients to increase the chance to obtain a confirmed diagnosis. Therefore, it is important to refer patients early for diagnostic procedures. (C) 2013 Elsevier Ireland Ltd. All rights reserved

Influence of dilated cardiomyopathy and a left ventricular assist device on vortex dynamics in the left ventricle

Together with new developments in mechanical cardiac support, the analysis of vortex dynamics in the left ventricle has become an increasingly important topic in literature. The aim of this study was to develop a method to investigate the influence of a left ventricular assist device (LVAD) on vortex dynamics in a failing ventricle. An axisymmetric fluid dynamics model of the left ventricle was developed and coupled to a lumped parameter model of the circulation. Simulations were performed for healthy conditions and dilated cardiomyopathy(DCM). Vortex structures in these simulations were analyzed by means of automated detection. Results show that the strength of the leading vortex ring is lower in a DCM ventricle than in a healthy ventricle. The LVAD further influences the maximum strength of the vortex and also causes the vortex to disappear earlier in time with increasing LVAD flows. Understanding these phenomena by means of the method proposed in this study will contribute to enhanced diagnostics and monitoring during cardiac support

Continuous-flow cardiac assistance : effects on aortic valve function in a mock loop

Background As the use of left ventricular assist devices (LVADs) to treat end-stage heart failure has become more widespread, leaflet fusion—with resul-tant aortic regurgitation—has been observed more frequently. To quantitatively assess the effects of nonpulsatile flow on aortic valve function, we tested a continuous-flow LVAD in a mock circulatory system (MCS) with an interposed valve. Materials and Methods To mimic the hemodynamic characteristics of LVAD patients, we utilized an MCS in which a Jarvik 2000 LVAD was positioned at the base of a servomotor-operated piston pump (left ventricular chamber). We operated the LVAD at 8000 to 12,000 rpm, changing the speed in 1000-rpm increments. At each speed, we first varied the outflow resistance at a constant stroke volume, then varied the stroke volume at a constant outflow resistance. We measured the left ventricular pressure, aortic pressure, pump flow, and total flow, and used these values to compute the change, if any, in the aortic duty cycle (aortic valve open time) and transvalvular aortic pressure loads. Results Validation of the MCS was demonstrated by the simulation of physiologic pressure and flow waveforms. At increasing LVAD speeds, the mean aortic pressure load steadily increased, while the aortic duty cycle steadily decreased. Changes were consistent for each MCS experimental setting, despite variations in stroke volume and outflow resistance. Conclusions Increased LVAD flow results in an impaired aortic valve-open time due to a pressure overload above the aortic valve. Such an overload may initiate structural changes, causing aortic leaflet fusion and/or regurgitation. Key Words: left ventricular assist device; continuous flow; aortic valve; moc

Attenuated cardiac function degradation in ex vivo pig hearts

\u3cp\u3eIsolated hearts offer the opportunity to evaluate heart function, treatments, and diagnostic tools without in vivo factor interference. However, the early loss of cardiac function and edema occur over time and do limit the duration of the experiment. This research focuses on delaying these limitations using optimal blood control. This study examines whether blood conditioning by means of the combination of blood predilution and hemodialysis can significantly reduce cardiac function degradation. Slaughterhouse porcine hearts were revived in the PhysioHeart™ platform to restore physiological cardiac performance. Twelve hearts were divided into a control group and a dialysis group; in the latter group, hemodialysis was attached to the blood reservoir. Cardiac hemodynamics and blood parameters were recorded and evaluated. Blood conditioning significantly reduced the loss of cardiac pump function (control group vs dialysis group, −14.9 ± 6.3%/h vs −9.7 ± 2.7%/h) and loss of cardiac output (control group vs dialysis group, −11.8 ± 3.4%/h vs −5.9 ± 2.0%/h). Hemodialysis resulted in physiological and stable blood parameters, whereas in the control group ions reached pathological values, while interstitial edema still occurred. The combination of blood predilution and hemodialysis significantly attenuated ex vivo cardiac function degradation and delayed the loss of cardiac hemodynamics. We hypothesized that besides electrolyte and metabolic control, the hemodialysis-accompanied increase in hematocrit resulted in improved oxygen transport. This could have temporarily compensated the deleterious effect of an increased oxygen-diffusion distance due to edema in the dialysis group and resulted in less progression of cell decay. Clinically validated measures delaying edema might improve the effectiveness of the PhysioHeart™ platform.\u3c/p\u3

A model to predict patient temperature during cardiac surgery

A core temperature drop after cardiac surgery slows down the patient's recuperation process. In order to minimize the amount of the so-called afterdrop, more knowledge is needed about the impaired thermoregulatory system during anesthesia and the effect of different protocols on temperature distribution. Therefore, a computer model has been developed that describes heat transfer during cardiac surgery. The model consists of three parts: (1) a passive part, which gives a simplified description of the human geometry and the passive heat transfer processes, (2) an active part that takes into account the thermoregulatory system as a function of the amount of anesthesia and (3) submodels, through which it is possible to adjust the boundary conditions. The validity of the new model was tested by comparing the model results to the measurement results of three surgical procedures. A good resemblance was found between simulation results and the experiments. Next, a model application was shown. A parameter study was performed to study the effect of different temperature protocols on afterdrop. It was shown that the effectiveness of forced-air heating is larger than the benefits resulting from increased environmental temperature or usage of a circulating water mattress. Ultimately, the model could be used to develop a monitoring decision system that advises clinicians what temperature protocol will be best for the patient

Fibrotic aortic valve disease after radiotherapy:an immunohistochemical study in breast cancer and lymphoma patients

\u3cp\u3eBACKGROUND: Radiation-associated aortic valve (AV) stenosis is frequently seen as a late sequela after thoracic radiotherapy (RT). Although the clinical relationship between thoracic radiotherapy and valvular dysfunction has been established, the process leading to accelerated aortic valve stenosis remains unclear. The aim of this study was to determine whether increased inflammatory cell infiltration, fibrosis, and calcification is present in aortic valves after radiotherapy at the time of aortic valve replacement.\u3c/p\u3e\u3cp\u3eMETHODS: Stenotic aortic valve specimens from 43 patients were obtained after surgical aortic valve replacement. A total 28 patients had previously undergone radiotherapy for breast cancer or malignant lymphoma. A total 15 patients were included as control. The valve leaflets were assessed by (immuno)histochemistry for inflammatory cell composition (CD3, CD20, CD68, and CD163) and extracellular matrix changes (collagen and calcification).\u3c/p\u3e\u3cp\u3eRESULTS: Aortic valve cell density after radiotherapy for lymphoma was markedly decreased when compared with other groups. Irradiated aortic valve show similar (low) degrees of late T and B lymphocyte infiltration as control valves, whereas macrophage marker CD68 was decreased after radiotherapy for breast cancer. Collagen content was increased following radiotherapy. Aortic valves of patients with lymphoma contained significantly less calcified tissue when compared with the other groups.\u3c/p\u3e\u3cp\u3eCONCLUSION: High-dose radiation at a young age (patients with lymphoma) results in cell loss and premature fibrotic aortic valve stenosis as opposed to the degenerative calcific stenosis observed in patients with breast cancer. Our findings suggest a possible dose-dependent effect of radiotherapy on aortic valve fibrosis. The active presence of inflammatory cells may be limited to the acute phase after radiotherapy.\u3c/p\u3