Mini-sternotomy for aortic valve replacement reduces the length of stay in the cardiac intensive care unit: meta-analysis of randomised controlled trials

Background Mini-sternotomy for isolated aortic valve replacement aims to reduce operative trauma hastening recovery and improving the cosmetic outcome of cardiac surgery. The short-term clinical benefits from the mini-sternotomy are presumed to arise because the incision is less extensive and the lower half of the chest cage remains intact. The basic conduct of virtually all other aspects of the aortic valve replacement procedure remains the same. Therefore, similar long-term outcomes are to be expected. Objectives To conduct a meta-analysis of the only available randomised controlled trials (RCT) in the published English literature. Data sources Electronic search for relevant publications in MEDLINE, EMBASE and CENTRAL databases were performed. Four studies met the criteria. Study eligibility criteria RCT comparing minimally invasive (inverted C or L (J)-shaped) hemi-sternotomy versus conventional sternotomy for adults undergoing isolated aortic valve replacement using standard cardiopulmonary bypass technique. Methods Outcome measures were the length of positive pressure ventilation, blood loss, intensive care unit (ICU) and hospital stay. Results The length of ICU stay was significantly shorter by 0.57 days in favour of the mini-sternotomy group (CI −0.95 to −0.2; p=0.003). There was no advantage in terms of duration of ventilation (CI −3.48 to 0.36; p=0.11). However, there was some evidence to suggest a reduction in blood loss and the length of stay in hospital in the mini-sternotomy group. This did not prove to be statistically significant (154.17 ml reduction (CI −324.51 to 16.17; p=0.08) and 2.03 days less (CI −4.12 to 0.05; p=0.06), respectively). Limitations This study includes a relatively small number of subjects (n=220) and outcome variables. The risk of bias was not assessed during this meta-analysis. Conclusion Mini-sternotomy for isolated aortic valve replacement significantly reduces the length of stay in the cardiac ICU. Other short-term benefits may include a reduction in blood loss or the length of hospital stay

Selective incorporation of iododeoxyuridine into DNA of hepatic metastases versus normal human liver

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109868/1/cptclpt1988166.pd

The Effects of Polysorbate 80 on the Fat Emulsion in Ice Cream Mix: Evidence from Transmission Electron Microscopy Studies

Emulsifiers are used in ice cream to produce a dry, smooth textured product with desireable melting properties. They function by promoting a partial destabilization of the fat emulsion. Polyoxythylene sorbitan monooleate is used very commonly in the ice cream industry for this purpose. The objective of this research was to examine by transmission electron microscopy the differences in the fat globules in typical ice cream mix emulsions prepared with and without 0.08% polyoxyethylene sorbitan monooleate. Ice cream mix was combined 3:1 with a 2% solultion of ultralow gelling temperature agarose at 20 degrees C, fixed with 4% glutaraldehyde, postfixed with 1% OsO4 in imidazole/phosphate buffer, embedded in Spurr resin and thin-sectioned for viewing. The emulsifier reduced the number of casein micelles adsorbed to the fat globules as determined by both TEM and quantification of membrane protein with Kjeldahl analyses. The fat/Serum interfacial tension was also significantly reduced by the presence of emulsifier in the mix. The data suggest that emulsifiers promote fat destabilization through reduction of membrane protein, based on their ability to reduce the fat serum interfacial tension. In the presence of crystallized fat, the emulsion then becomes less stable to shear forces during the whipping and freezing of ice cream

Changes in the Ultrastructure of Emulsions as a Result of Electron Microscopy Preparation Procedures

Various methods of preparing emulsions for electron microscopy were examined with peanut oil/protein and ice cream mix emulsions. For transmission electron microscopy {TEM) , fresh peanut oil/bovine serum albumin emulsions were mixed with 2% agar , fixed in phosphate-buffered (pH 7 . 0) 4% glutaraldehyde solution and postfixed in phosphate-buffered (pH ? . 0) 1% osmium tetroxide alternatively , the glutaraldehyde- fixed samples were briefly rinsed in acetone prior to postfixation . Both preparations yielded satisfactory fat globule preservation. Similar emulsions were prepared on loops and suspended over vapors of 25% gJ nt.RrBl r\u27lehyr\u27le Rnc\u27l 1% oRmi urn tetroxide . This preparation resulted in angular fat globules surrounded by a heavy protein precipitate. Ice cream mix emulsions were prepared for TEM study by mixing with 4% agar , mixing with 2% agarose or using agar tubes. After fixation in phosphate- buffered 4% glutaraldehyde (pH 7 .0) solution , the samples were postfixed in either phosphate/imidazole buffe red (pH 7 . 0) or phosphate- buffered (pH 7 .0) 1% osmium tetroxide . ~lixing with 2% agarose and postfixing in imidazole/phosphate buffered osmium tetroxide yielded the best results . A clearly visible fat membrane and well-delineated fat crystals were observed. Scanning electron microscope (SEM) studies o!\u27 peanut oil/casein emulsions mixed with 4% agar yielded good results whereas in ice cream mix emul s i ons , the results were inconclusive

Sodium Transport in Capillaries Isolated from Rat Brain

Brain capillary endothelial cells form a bloodbrain barrier (BBB) that appears to play a role in fluid and ion homeostasis in brain. One important transport system that may be involved in this regulatory function is the Na + ,K + -ATPase that was previously demonstrated to be present in isolated brain capillaries. The goal of the present study was to identify additional Na + transport systems in brain capillaries that might contribute to BBB function. Microvessels were isolated from rat brains and 22 Na + uptake by and efflux from the cells were studied. Total 22 Na + uptake was increased and the rate of 22 Na + efflux was decreased by ouabain, confirming the presence of Na + ,K + -ATPase in capillary cells. After inhibition of Na + ,K + -ATPase activity, another saturable Na + transport mechanism became apparent. Capillary uptake of 22 Na + was stimulated by an elevated concentration of Na + or H + inside the cells and inhibited by extracellular Na + , H + , Li + , and NH 4 + . Amiloride inhibited 22 Na + uptake with a K i between 10 −5 and 10 −6 M but there was no effect of 1 mM furosemide on 22 Na + uptake by the isolated microvessels. These results indicate the presence in brain capillaries of a transport system capable of mediating Na + / Na + and Na + /H + exchange. As a similar transport system does not appear to be present on the luminal membrane of the brain capillary endothelial cell, it is proposed that Na + /H + exchange occurs primarily across the antiluminal membrane.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66187/1/j.1471-4159.1983.tb09065.x.pd

Radiation Therapy in Addition to Gross Total Resection of Retroperitoneal Sarcoma Results in Prolonged Survival: Results from a Single Institutional Study

Purpose. Typical treatment of retroperitoneal sarcomas (RPSs) is surgery with or without radiation therapy for localized disease. With surgery alone, local failure rates are as high as 90%; this led to radiation therapy playing an important role in the treatment of RPSs. Methods. Thirty-one patients with retroperitoneal sarcoma treated with gross total resection and radiation therapy make up this retrospective analysis. Nineteen were treated preoperatively and 12 postoperatively (median dose, 59.4 Gy)—sixteen also received intraoperative radiation therapy (IORT) (median dose, 11 Gy). Patients were followed with stringent regimens, including frequent CT scans of the chest, abdomen, and pelvis. Results. With a median follow-up of 19 months (range 1–66 months), the 2-year overall survival (OS) rate is 70% (median, 52 months). The 2-year locoregional control (LRC) rate is 77% (median, 61.6 months). The 2-year distant disease free survival (DDFS) rate is 70% (median not reached). There were no differences in radiation-related acute and late toxicities among patients treated pre- versus postoperatively, whether with or without IORT. Conclusions. Compared to surgery alone, neoadjuvant or adjuvant radiation therapy offers patients with RPS an excellent chance for long-term LRC, DDS, and OS. The integration of modern treatment planning for external beam radiation therapy and IORT allows for higher doses to be delivered with acceptable toxicities

Cadherin–catenin expression in primary colorectal cancer: a survival analysis

Both cell adhesion and cell signalling events are mediated by components of the cadherin-catenin complex. Loss of expression of the components of this complex have been shown to correlate with invasive behaviour in many tumour types although their exact role in colorectal cancer remains unclear. Immunohistochemical analysis of the expression of components of the cadherin-catenin complex in colorectal cancers from 60 patients was undertaken. Loss of memberanous expression of E-cadherin, alpha-catenin and beta-catenin was demonstrated in 52%, 85% and 40% of tumours respectively. Focal nuclear expression of beta-catenin ( 75% of tumour cells per section) was seen in 11 (18%) tumours. Loss of membranous alpha-catenin expression significantly correlated with tumour de-differentiation (P = 0.009). There was a trend towards an association between advanced tumour stage and loss of membranous expression of alpha-catenin or beta-catenin, although these associations were not statistically significant. Univariate analysis revealed that advanced Dukes' stage, tumour de-differentiation, loss of membranous beta-catenin expression, cytoplasmic beta-catenin expression and widespread nuclear expression of beta-catenin all correlated with short survival following apparently curative resection of the primary tumour. However, only Dukes' stage (P = 0.002), tumour grade (P = 0.02) and widespread nuclear expression of beta-catenin (P = 0.002) were independent predictors of short survival. Disturbed growth signalling events in colorectal tumours are thought to result in nuclear accumulation of beta-catenin. Consequently, tumours with widespread nuclear expression of beta-catenin are likely to have severely abnormal growth characteristics, and which therefore might be predictive of short survival in these patients

Response of human HT-29 colorectal tumor cells to extended exposure to bromodeoxyuridine

Effects of the extended exposure of a human colorectal tumor-cell line (HT-29) to bromodeoxyuridine (BrdUrd) were studied in anticipation of the clinical use of that agent to treat colorectal cancer, particularly as a regionally delivered radiosensitizer. We found that 72-h exposure to a concentration of BrdUrd that is estimated to be locally maintained in the liver (100 μ M ) was significantly cytotoxic with a 3-log reduction in survival. As measured by GC/MS-SIM method, incorporation of BrdUrd into DNA followed an unexpected time course in that continuous exposure to 10 μ M BrdUrd resulted in maximal incorporation at 3 days, after which the extent of incorporated analog fell significantly (despite daily changes of the medium). This finding was apparently due to a greater rate of loss of BrdUrd from the medium at later time points. Flow cytometric analysis using an anti-BrdUrd antibody (IU-4) revealed that antibody binding also peaked and fell off with time. However, at exposure times of >24 h, the timing and extent of this decline were significantly different than had been indicated by the GC/MS method. These results indicate that the quantitative relationship between antibody staining and BrdUrd incorporation changes as drug-exposure time increases and that quantitative studies of anti-BrdUrd antibody binding must be interpreted with caution, especially when extended drug-treatment protocols have been used.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46921/1/280_2004_Article_BF00694337.pd

Note on the special fillet fatty acid composition of the dwarf carp (Cyprinus carpio carpio) living in thermal Lake Hévíz, Hungary

Fatty acid (FA) composition of the fillet and the intestinal content of dwarf common carp (Cyprinus carpio carpio) living in Lake Hévíz was determined in wintertime collected samples and results were compared to widespread literature data on carp. Fillet FA profile of the thermally adapted (28 oC) Hévíz dwarf carps differed from profiles originated from divergent culture and feeding conditions in the overall level of saturation. Fillet myristic acid proportions largely exceeded all literature data in spite of poor dietary supply. Fillet fatty acid results indicate the effects of thermal adaptation (high saturation level) and the correlative effects of feed components rich in omega-3 fatty acids, with special respect to docosahexaenoic acid. With the application of discriminant factor analysis the Hévíz sample was accurately differentiated from the literature data on carp fillet fatty acid profile, mostly based on C14:0, C18:1 n9, C18:2 n6, C20:1 n9 and C20:4 n6 FAs. In summary, fillet FA profile suggested thermal adaptation, location specificity and the ingestion of algal and bacterial material