Use of the Mechanical Dilator Sheath for Removal of Endocardial Leads: A Single Center Experience

Background: Due to an increasing number of cardiac device implantations, the number of leads that need to be extracted because of infection or lead failure is consistently rising. We present our experience in percutaneous lead removal in a single tertiary center. Methods: From December 2009 to August 2010, 12 patients underwent percutaneous lead extraction procedure by the Evolution (TM) mechanical dilator sheath (Cook Medical Inc., Bloomington, IN, USA) system after failure of manual traction and a locking stylet. Results: Ages of the patients ranged between 7 and 86 years (mean age was 58 +/- 12 years). Mean implantation time was 73 months (range between 12 and 244 months). Ten patients had one lead; only two patients had two leads. Indications for lead removal were: lead endocarditis in five patients, local (pocket) infection in four patients, and lead failure in three patients. All leads were successfully removed by using the device, except one lead which was one of the two leads in a patient with dual chamber pacemaker implanted 10 years ago. In three patients, same venous accesses (sheath of extraction system) were used to implant a new lead after removal of damaged leads without a new venous puncture. In only one patient, significant hematoma was found after the intervention and treated conservatively. No other significant complications were encountered in any patients. Conclusions: Damaged or infected leads can safely and relatively easily be extracted by using this new percutaneous extraction technique. (PACE 2012; 15

Network models for understanding boron-induced transcriptomics changes within HepG2 cell line

Boron has crucial roles in plant growth and survival; also, it is suggested as an essential trace element forhuman physiology. Accumulating evidence show beneficial effects of boron for human health. Along withits benefits to bone and brain health, many findings support the anti-carcinogenic role of dietary boron.Although biochemical significance of boron is evident, relatively few studies focus on boron-inducedbiological processes and mechanisms at the molecular level.In this work, we aim to reveal the boron-induced molecular mechanisms in detail, and our preliminaryfindings of network modelling studies is presented. HepG2 cell line is treated with boric acid (BA) at halfmaximalinhibitory concentration (IC50) for 24 hours. Differential gene expression profile relative to nontreatedHepG2 cells is investigated with microarray technology. Gene expression changes in HepG2 cellscultured with different chemicals are also obtained by re-analysis of published data, and integrated withgene expression changes due to boric acid treatment. Integrated gene expression data is used forreconstructing a weighted gene co-expression network to investigate the bioactivity of boric acid in acomparative manner. As a second approach, a regulatory network is build using boric acid induced geneexpression data with motif knowledge and known physical interactions among transcription factors.84At half-maximal inhibitory concentration, boric acid treatment lead to a massive down-regulation ofgenes which take part in in cell-cycle progression and various metabolic processes. Few genes involved inapoptosis and cytokine-cytokine receptor interaction pathway had elevated levels of expression in thepresence of boric acid exposure. Comparative network analysis indicated the induction of manyfunctional gene groups, which appear to be specifically associated with boric acid treatment. Regulatorynetwork revealed transcription factor-gene interactions, which will help us to exploit the effectedregulatory mechanisms at transcriptomics level in the presence of highly concentrated boron.According to our results, a group of genes involved in lipid metabolism might be particularly meaningfulsince latest research suggest potential therapeutic activity of boron in lipid dysregulation disorders likefatty liver disease and obesityThese genes were down-regulated in boric acid treated cells and formed aboric acid associated subnetwork contrasting with the carcinogenic chemical induced profile. In thefuture we plan to validate the key proteins in the regulatory network in cell culture. Moreover, we aim torecapitulate the microarray experiments and carry out subsequent network modelling at lowerconcentrations of boric acid to study the boric acid related network patterns in a concentrationdependent manner

Changes in gene profile of human hepatocellular carcinoma cell line (HepG2) induced by boric acid at half mazimal inhibitory concentration (IC50).

Boron is an essential micronutrient for many biological processes in plants and animals. In humans, adverse health outcomes are reported for both boron deprivation and excessive boron intake. Humans might get exposed to high doses of boron by consuming boron containing products or by working at boron enriched workplaces. In this study, the aim is to find out about the cytotoxicity mechanisms of boric acid, the most abundant form of boron containing compounds in human blood, on human hepatocellular carcinoma (HepG2) cell line. XTT cell proliferation assay was carried out to assess the effect of boric acid treatment at varying concentrations on the viability of HepG2 cells and to determine the half maximal inhibitory concentration (IC50) of boric acid. Comet assay and microarray experiments were performed at IC50 concentration to examine boric acid induced DNA damage and changes in gene expression profile. Boric acid inhibited cell growth in a dose dependent manner with an IC50 value of 24 mM. Microarray analysis revealed a total of 785 gene as differentially regulated in response to boric acid treatment. Analyses of differentially expressed transcripts for enriched gene ontologies and pathways using Database for Annotation, Visualization and Integrated Discovery (DAVID) Functional Annotation Tool suggest cell cycle arrest at mitotic phase and controlled cell death as potential mechanisms of inhibited cell growth. Our overall findings suggest, at IC50 concentration boric acid might be inhibiting DNA replication and possibly interfering with lipid and amino acid metabolism

In vitro effects of boric acid on human liver hepatoma cell line (HepG2) at the half-maximal inhibitory concentration

Boron is a prominent part of the human diet and one of the essential trace elements for humans. Dietary boron is mostly transformed into boric acid within the body and has been associated with desirable health outcomes. Non-dietary resources of boron, such as boron-based drugs and occupational exposure, might lead to excessive boron levels in the blood and provoke health adversities. The liver might be particularly sensitive to boron intake with ample evidence suggesting a relation between boron and liver function, although the underlying molecular processes remain largely unknown

Hoarseness Secondary to Cardiovascular Disease: Cardiovocal Sydrome in a Patient With Pulmonary Artery Aneurysm and Giant Atria

Cardiovocal syndrome or Ortner syndrome is the hoarseness secondary to recurrent laryngeal nerve palsy due to compression enlarged cardiovascular structures. Dilated left atrium with mitral valve disease is a well-known cause for this rare syndrome; however several cardiovascular conditions also contribute to the pathogenesis. Data suggest that, recurrent laryngeal nerve seems to be compressed in the window between enlarged hypertensive pulmonary artery, aorta and ligamentum arteriosum not solely by enlarged left atrium. In this context, we presented a case of cardiovocal syndrome in a patient with pulmonary artery aneurysm, giant atria and corrected atrial septal defect. The patient was admitted for gradual hoarseness for two years and laryngoscopy revealed left vocal cord paralysis. Cardiovascular examination with transthoracic echocardiography showed pulmonary artery aneurysm with giant atria which is compatible with cardiovocal syndrome