Effect of atherothrombotic aorta on outcomes of total aortic arch replacement

ObjectiveThe effect of an atherothrombotic aorta on the short- and long-term outcomes of total aortic arch replacement, including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome.MethodsA group of 179 consecutive patients undergoing total aortic arch replacement were studied. An atherothrombotic aorta was present in 34 patients (19%), more than moderate leukoaraiosis in 71 (39.7%), and significant extracranial carotid artery stenosis in 27 (15.1%). In-hospital deaths occurred in 2 patients, 1 (2.9%) of 34 patients with and 1 (0.7%) of 145 patients without an atherothrombotic aorta (P = .26). Permanent neurologic deficits occurred in 4 (2.2%) and transient neurologic deficits in 17 (9.5%) patients. Multivariate analysis demonstrated that the risk factors for transient neurologic deficits were an atherothrombotic aorta (odds ratio, 4.4), extracranial carotid artery stenosis (odds ratio, 5.5), moderate/severe leukoaraiosis (odds ratio, 3.6), and cardiopulmonary bypass time (odds ratio, 1.02). To calculate the probability of transient neurologic deficits, the following equation was derived: probability of transient neurologic deficits = {1 + exp [7.276 − 1.489 (atherothrombotic aorta) − 1.285 (leukoaraiosis) − 1.701 (extracranial carotid artery stenosis) − 0.017 (cardiopulmonary bypass time)]}−1. An exponential increase occurred in the probability of transient neurologic deficits with presence of an atherothrombotic aorta and other risk factors in relation to the cardiopulmonary bypass time. Survival at 3 years after surgery was significantly reduced in patients with vs without an atherothrombotic aorta (75.0% ± 8.8% vs 89.2% ± 3.1%, P = .01).ConclusionsPatients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short- and long-term outcomes, including transient neurologic deficits

Outcome of elective total aortic arch replacement in patients with non–dialysis-dependent renal insufficiency stratified by estimated glomerular filtration rate

ObjectiveLittle is known about the impact of preoperative renal function stratified by estimated glomerular filtration rate (eGFR) on outcomes of total aortic arch replacement (TAR). The current study addressed this issue and identified a cutoff value of eGFR for the requirement of postoperative renal replacement therapy.MethodsFrom January 2000 to May 2011, 229 consecutive patients who did not require preoperative hemodialysis were retrospectively studied after elective TAR. Patients were grouped into the following categories: those with normal renal function (eGFR >90 mL/min/1.73 m2; n = 11) and those with mild (eGFR, 60-90 mL/min/1.73 m2; n = 86), moderate (eGFR, 30-59 mL/min/1.73 m2; n = 111), or severe (eGFR <30 mL/min/1.73 m2; n = 21) renal dysfunction. Linear trend tests demonstrated that the lower categories of eGFR were associated with a higher age, hypertension, coronary artery disease, peripheral arterial disease, and a higher EuroSCORE II.ResultsThe overall hospital mortality was 2.2%. A lower categories of eGFR were an independent risk factor for hospital mortality (odds ratio, 0.91; P = .002) and postoperative renal replacement therapy (odds ratio, 0.94; P < .002). A cutoff value for the requirement of postoperative renal replacement therapy was 26.0 mL/min/1.73 m2. Patients in the lower categories of eGFR had significantly higher hospital mortality (P = .03) and more morbidities, such as renal replacement therapy (P < .01), postoperative permanent neurologic deficits (P = .013), and prolonged mechanical ventilatory support (P < .01). Midterm survival and freedom from major adverse cerebrocardiovascular events were worse across the levels of the lower categories of eGFR.ConclusionsPreoperative eGFR is a strong predictor of short- and midterm outcomes in contemporary TAR

IPC2008-64281 NEAR NEUTRAL pH SCC OF GRADE X80 LINEPIPE STEELS UNDER CYCLIC LOADING

ABSTRACT Susceptibility to stress corrosion cracking (SCC) of Grade X80 linepipe steels, which were produced by recent TMCP (Thermo-Mechanical Controlled Processing) technique, controlled rolling (CR) followed by accelerated cooling process (ACC), in near neutral pH conditions was investigated, and cracking behavior was compared with conventional Grade X65 linepipe. Longitudinal strip specimens with small surface notches were cyclically loaded in the NS4 solution with cathodic polarization of -1000mV vs. SCE. No significant difference in susceptibility to SCC was found between Grades X80 and X65 linepipes, both produced by TMCP process, even under higher stress condition for X80 linepipe steel. Hydrogen permeation test reviled the strong effect of hydrogen for the cracking under the SCC test condition. Transgranular cracking and quasi-cleavage fracture were observed as an evidence of the effect of both corrosion and hydrogen embrittlement on near neutral pH SCC

The RECK tumor-suppressor protein binds and stabilizes ADAMTS10

The tumor suppressor protein RECK has been implicated in the regulation of matrix metalloproteinases (MMPs), NOTCH-signaling and WNT7-signaling. It remains unclear, however, how broad the spectrum of RECK targets extends. To find novel RECK binding partners, we took the unbiased approach of yeast two-hybrid screening. This approach detected ADAMTS10 as a RECK-interactor. ADAMTS10 has been characterized as a metalloproteinase involved in fibrillin-rich microfibril biogenesis, and its mutations have been implicated in the connective tissue disorder Weill-Marchesani syndrome. Experiments in vitro using recombinant proteins expressed in mammalian cells indicated that RECK indeed binds ADAMTS10 directly, that RECK protects ADAMTS10 from fragmentation following chemical activation and that ADAMTS10 interferes with the activity of RECK to inhibit MT1-MMP. In cultured cells, RECK increases the amount of ADAMTS10 associated with the cells. Hence, the present study has uncovered novel interactions between two molecules of known clinical importance, RECK and ADAMTS10

Provisory Map showing the Horizontal Displacements of the Primary Triangulation Points in Kwanto Districts, observed after the Great Earythquake of Sept. 1, 1923

After the great earthquake of Sept. 1, 1923, the Land Survey Department of the Army carried out the revision of the triangulation of the disturbed region, in order to investigate the horizontal displacements of the triangulation points. The work was executed during 1924-25. The provisory results of reductions are shown in the annexed Plate (PL. LXV)

The Change of Elevation of Land caused by the Great Earthquake of September 1st. 1923

Just after the great earthquake of September 1st. 1923, the Land Survey Department of the Army commenced at once the revision of precise levelling in order to investigate into the change of elevation caused by the earthquake. Nextly, during the period from 1924 to 1926, the Department carried out the revision of triangulations covering the whole disturbed regions. The work executed during the period from September 1923 to the end of 1925 covered nearly one half of the whole area, the survey for the remaining part being still in progress. The annexed Plate shows the change of the elevation so far measured

Comparison of the Results of the First and Second Precise Levellings in the Region Disturbed by the Tango Earthquake

The result of the first levelling carried out immediately after the earthquake has already been reported in Vol. 3. of this Bulletin. The levelling was resumed for the second time along the same route, in order to detect any further change in the vertical displacement. The results of comparison of the results of the first and second levellings are here given in the synoptic map reproduced in the annexed Plate (PL. LIII). The time and duration of the field work for the two levellings are as follows: The first levelling: April 13-June 24, 1927. The second levelling: June 17-August 24, 1927.丹後震災後直ちに行ひたる水準測量の成果は既に彙報第三号に報告したり。其後更に引続き同一経路に就き第二回の検測を行ひたる成果を第一回の成果と比較し、第一回第二回検測成果の差を求めたるものを別紙要図に図示し参考に供す。第ー図並第二図検測作業の期間下の如し。第一回:昭和二年四月十三日より六月十六日迄 第二回:昭和三年六月十七日より八月二四日迄