Two-stage hybrid surgical repair for aortic arch pathology with a shaggy aorta: a case report.

BACKGROUND: The surgical treatment strategy for aortic arch pathology with a shaggy aorta must be determined on a case-by-case basis because of the risk of catastrophic complications, such as brain infarction and spinal cord injury. CASE PRESENTATION: This report describes the surgical case of two saccular aneurysms of the arch and abdominal aorta associated with a shaggy aorta in a 63-year-old man who underwent total arch replacement and secondary thoracic endovascular aortic repair. Considering the risk of embolization during endovascular therapy, graft replacement for the abdominal aortic aneurysm was initially performed. On postoperative day 28, total arch replacement with the conventional elephant trunk was performed using the functional brain isolation technique, which involves manipulating places far from the atherosclerotic burden, such as arterial inflow for cardiopulmonary bypass and unclamping of neck vessels. On postoperative day 7 after total arch replacement, thoracic endovascular aortic repair was performed across the conventional elephant trunk in the nondiseased descending aorta. No postoperative complications, such as cerebrovascular failure, paraplegia, or embolization to abdominal viscera or lower extremities, occurred. The patient remained asymptomatic. CONCLUSIONS: The present case suggests that total arch replacement with the conventional elephant trunk and secondary thoracic endovascular aortic repair may be an effective alternative for aortic arch pathology with a shaggy aorta. The strategy for surgical treatment in patients with aortic arch pathologies with a shaggy aorta must be judged on a case-by-case basis, considering patient characteristics, comorbidities, and preoperative evaluation using transesophageal echocardiography and computed tomography angiography, to eliminate potential determinants of intraoperative stroke.

Self-Sufficient Production of Lunar Regolith Gravels on the Moon by Ultrarapid Microwave Sintering.

A sintered lunar regolith is expected to be used to construct buildings, roads, and landing pads for spacecrafts on the Moon. Here, we demonstrate that focused microwave heating is effective for the rapid solidification of the lunar regolith simulant to obtain regolith gravel without any microwave susceptor. The conventional multimode microwave oven cannot heat lunar regolith simulants and requires microwave susceptors such as silicon carbide (SiC) and thermal insulators because of its low dielectric loss. We achieved rapid microwave heating of a lunar regolith simulant without using a susceptor or thermal insulator by forming an intense microwave electric field using a cavity resonator and a semiconductor microwave oscillator. Focused microwaves at 2.45 GHz produced the gravel-shaped and solidified lunar regolith at 300 °C lower temperature than a conventional electrical furnace, where more than 1050 °C temperature was required to sinter the lunar regolith simulant. In addition, we produced larger gravel of the lunar regolith simulant using 915 MHz. The intense electric field generated by the single-mode resonator promoted the solidification of the lunar regolith simulant without any additional substances. This process enables the local production of structured lunar regoliths on the Moon without the transport of any materials from the Earth.

Mitral valve replacement using a collar-reinforced mitral prosthesis for severe mitral annular calcification, which secures implantation in both the supra-annular and intra-atrial positions: a case report.

BACKGROUND: Appropriate management of mitral annular calcification associated with mitral valve surgery must be determined on a case-by-case basis. However, an established procedure remains uncertain. CASE PRESENTATION: This report describes a surgical case of severe mitral and aortic valve stenosis associated with severe mitral annular calcification in a 71-year-old woman who underwent mitral valve replacement with a collar-reinforced mitral prosthesis. The patient underwent surgical repair after the treatment for heart failure. As the present patient was deemed to be at high risk for conventional mitral valve replacement, we applied a composite prosthetic valve that was enlarged circumferentially on the ventricular side of the prosthesis with a bovine pericardial patch. First, the solid calcium bar was left untouched and only the friable calcified mass that was easily scattered was removed. Subsequently, the prosthesis was secured by two mattress sutures placed in the intra-atrial position at the region of the extended calcified myocardium. Additionally, ten mattress sutures were placed in the supra-annular position at the other regions capable of passing stitches from the ventricular side to the atrial side. Finally, a 1.5 cm wide trimmed bovine pericardial collar was sutured circumferentially from the annulus to the atrial wall using running 4-0 polypropylene for reinforcement. Although temporary hemodialysis was performed for acute renal failure, the patient remained asymptomatic. CONCLUSIONS: The present case suggests that mitral valve replacement using a collar-reinforced mitral prosthesis may be an effective technique for severe mitral annular calcification. To avoid catastrophic complications associated with treatment for severely calcified annulus, it is crucial to make a prudent preoperative decision regarding the surgical strategy under circumstances where conventional mitral valve replacement is impossible.

Novel technique of repairing right partial anomalous pulmonary venous connection with intact atrial septum using in situ interatrial septum as a flap in a 68-year-old-woman: a case report.

BACKGROUND: Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown. CASE PRESENTATION: This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic. CONCLUSIONS: The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.

Rapidly vanishing left atrial dissection following mitral valve replacement: a case report.

BACKGROUND: Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. non-surgical) for left atrial dissection has not been fully established yet. CASE PRESENTATION: Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the non-surgical treatment of left atrial dissection. CONCLUSIONS: It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.

Surgical Treatment for Kommerell's Diverticulum Associated with a Right-Sided Aortic Arch and an Aberrant Left Subclavian Artery: Endovascular or Hybrid.

A right-sided aortic arch, associated with an aberrant left subclavian artery and a Kommerell's diverticulum, is a rare congenital anomaly. Case 1: A 53-year-old man, complaining of dysphasia, underwent a two-stage hybrid operation. Total arch replacement with the reconstruction of supra-aortic vessels was performed via a median sternotomy. Thoracic endovascular aortic repair was subsequently completed with the femoral approach. Case 2: A 81-year-old man, complaining of syncope and dizziness, underwent thoracic endovascular aortic repair after endovascular aneurysm repair for a common iliac artery aneurysm. Treatment strategies for Kommerell's diverticulum should be individually determined depending on the clinical situation and anatomical features.

Antegrade thoracic endovascular aortic repair using an ascending aortofemoral through-and-through wire technique for a severely tortuous aorta associated with rickets.

BACKGROUND: Severe aortic tortuosity of the access route often prevents successful complete exclusion of an aneurysm in thoracic endovascular aortic repair (TEVAR). CASE PRESENTATION: We performed antegrade TEVAR on a 79-year-old man with right hemiparesis. We deployed the stent graft from the ascending aorta with a tube graft conduit to treat a descending thoracic aortic aneurysm associated with rickets and multiple comorbidities. Although the application of a ministernotomy diminished the potential advantages of endovascular treatment in view of less invasive surgery, antegrade TEVAR using an ascending aortofemoral through-and-through wire technique was a good option in this patient because a conventional retrograde approach was not feasible due to his severely tortuous aorta. CONCLUSIONS: To avoid device-related complications, it is crucial to make a prudent preoperative decision on a patient-by-patient basis, taking into account the appropriate access site, adjuvant guidewire technique, and adjunctive surgical interventions.

Open Surgery for Giant Bilateral Internal Iliac Artery Aneurysms with Compression of Neighboring Abdominal Structures: A Case Report.

We describe a patient with successfully treated giant bilateral internal iliac artery aneurysms that were associated with acute renal failure secondary to bilateral hydronephrosis, lumbosacral plexopathy, and ileus. After hemodialysis for 1 month, the patient underwent graft replacement of the abdominal aorta and iliac arteries, including complete obliteration of the internal iliac artery branches, reconstruction of the inferior mesenteric artery, and ureterolysis. Weaning from hemodialysis was achieved and postoperative renal function improved. Although the patient had serious preoperative co-morbidities, emergency traditional open surgery should be the gold standard for securely releasing compression of the neighboring organs instead of endovascular treatment.

Structure of the RsbX phosphatase involved in the general stress response of Bacillus subtilis.

In the general stress response of Bacillus subtilis, which is governed by the sigma factor σ(B), stress signalling is relayed by a cascade of Rsb proteins that regulate σ(B) activity. RsbX, a PPM II phosphatase, halts the response by dephosphorylating the stressosome composed of RsbR and RsbS. The crystal structure of RsbX reveals a reorganization of the catalytic centre, with the second Mn(2+) ion uniquely coordinated by Gly47 O from the ß4-α1 loop instead of a water molecule as in PPM I phosphatases. An extra helical turn of α1 tilts the loop towards the metal-binding site, and the ß2-ß3 loop swings outwards to accommodate this tilting. The residues critical for this defining feature of the PPM II phosphatases are highly conserved. Formation of the catalytic centre is metal-specific, as crystallization with Mg(2+) ions resulted in a shift of the ß4-α1 loop that led to loss of the second ion. RsbX also lacks the flap subdomain characteristic of PPM I phosphatases. On the basis of a stressosome model, the activity of RsbX towards RsbR-P and RsbS-P may be influenced by the different accessibilities of their phosphorylation sites.

Delayed visceral and spinal cord malperfusion after axillo-bifemoral bypass for complicated acute type B aortic dissection.

We describe a successfully treated case of acute type B aortic dissection complicated with lower extremity, visceral, and spinal cord malperfusion. To restore perfusion to both lower extremities, we performed an emergency right axillo-bifemoral bypass. Furthermore, we performed total arch replacement, including primary entry closure, because of delayed visceral organ ischemia. Unexpectedly, delayed paraplegia occurred after hospital discharge; however, the patient recovered without any neurologic sequelae after early introduction of hyperbaric oxygen therapy. Because another episode of organ malperfusion in the long term cannot be anticipated, and even though the previous organ malperfusion episode was treated successfully, close observation is mandatory for detecting clinical manifestations in combination with the availability of imaging modalities.

Simultaneous surgery for patent ductus arteriosus associated with papillary fibroelastoma.

We describe a case of patent ductus arteriosus (PDA) in a 76-year-old woman with a history of stroke, atrial fibrillation, and chronic obstructive pulmonary disease. Cranial diffusion-weighted imaging (DWI) performed for preoperative assessment showed a hyperintense lesion in the left cerebellum. Preoperative transesophageal echocardiography (TEE) demonstrated two highly mobile masses approximately 5 mm in diameter adherent to the left and non-coronary cusps of the aortic valve. We performed transpulmonary patch closure of PDA under hypothermic circulatory arrest. Subsequently, two frond-like masses were completely shaved off the cusps, preserving the native aortic leaflets. Pathological examination confirmed the diagnosis of papillary fibroelastoma (PFE). To our knowledge, this is the first report of PDA associated with PFE. Perioperative use of TEE is an effective tool for management of cardiovascular patients with suspected cardiogenic embolism.

Humidity control and hydrophilic glue coating applied to mounted protein crystals improves X-ray diffraction experiments.

Protein crystals are fragile, and it is sometimes difficult to find conditions suitable for handling and cryocooling the crystals before conducting X-ray diffraction experiments. To overcome this issue, a protein crystal-mounting method has been developed that involves a water-soluble polymer and controlled humid air that can adjust the moisture content of a mounted crystal. By coating crystals with polymer glue and exposing them to controlled humid air, the crystals were stable at room temperature and were cryocooled under optimized humidity. Moreover, the glue-coated crystals reproducibly showed gradual transformations of their lattice constants in response to a change in humidity; thus, using this method, a series of isomorphous crystals can be prepared. This technique is valuable when working on fragile protein crystals, including membrane proteins, and will also be useful for multi-crystal data collection.

Crystallization and preliminary X-ray analysis of isopentenyl diphosphate isomerase from Methanocaldococcus jannaschii.

Type 2 isopentenyl diphosphate isomerase (IDI-2) is a flavoprotein. Recently, flavin has been proposed to play a role as a general acid-base catalyst with no redox role during the enzyme reaction. To clarify the detailed enzyme reaction mechanism of IDI-2 and the unusual role of flavin, structural analysis of IDI-2 from Methanocaldococcus jannaschii (MjIDI) was performed. Recombinant MjIDI was crystallized at 293 K using calcium acetate as a precipitant. The diffraction of the crystal extended to 2.08 Šresolution at 100 K. The crystal belonged to the tetragonal space group I422, with unit-cell parameters a=126.46, c=120.03 Å. The presence of one monomer per asymmetric unit gives a crystal volume per protein weight (VM) of 3.0 Å3 Da(-1) and a solvent constant of 59.0% by volume.

Histomorphometric Evaluation of Cartilage Degradation using Rabbit Articular Chondrocytes Cultured in Alginate Beads - Effects of Hyaluronan.

OBJECTIVE: A 3-dimensional alginate bead culturing method using rabbit articular chondrocytes was studied for the screening of the effectiveness of drugs for articular diseases. DESIGN: The beads cultured with IL-1ß, TGF-ß, and Hyaluronan (HA) were evaluated histochemically with Alecian blue and immunohistochemically with CS-56 antibody. Chondrocytes in alginate beads were arbitrarily classified into four groups: 1) chodrocyte surrounded with cell-associated matrix (CAM) in which proteoglycan (PG) was positively stained (PG-possitive chondrocyte); 2) chondrocyte with PG-negative CAM; 3) PG-positive CAM alone, and 4) PG-negative CAM alone. Total sulfated GAG concentrations in the culture media were quantitated by dimethylmethylene blue (DMMB) assay. ProMMP-3, TIMP-1 and -2 concentrations in the culture media were determined by sandwich enzyme immunoassays. RESULTS: Significant increase of PG-nagative cells were immunohistochemically found by IL-1ß stimulation. The pretreatment with TGF-ß almost fully suppressed those increase of PG-negative cells by IL-1ß. Both GAG and proMMP-3 concentrations in the culture media were significantly increased after IL-1ß stimulation. There were no significant differences in both TIMP-1 and TIMP-2 concentrations in the culture media with or without IL-1ß stimulation. 800-kDa HA reduced significantly the number of PG-negative cells and proMMP-3 concentration in the culture media, but showed no effects on the concentrations of both TIMPs. CONCLUSIONS: Because this 3-dimensional chondrocyte culture in alginate beads is close to in vivo conditions, this method can be used for evaluation of the effectiveness of novel drugs for articular diseases.

[A rapidly progressed metastatic choroidal tumor from a hepatocellular carcinoma].

BACKGROUND: Metastatic choroidal tumor stemming from a hepatocellular carcinoma (HCC) is very rare. We report a case of a metastatic choroidal tumor stemming from a hepatocellular carcinoma. CASE: A 50-year-old man became aware of a visual field defect in his left eye starting 1 month previously. He had undergone surgery for HCC nine years before, and had received radiation therapy for lung and brain metastasis of HCC. Funduscopic examination revealed a red choroidal mass with subretinal bleeding. One month later, light perception of the left eye disappeared with rapid growth of the tumor and high intraocular pressure. Because the ocular pain was uncontrollable, enucleation of the left eyeball was performed. In histopathological examination, the choroidal tumor consisted of tumor cells showing characteristics of HCC such as intracytoplasmic glycogen granules, fatty degeneration, and necrosis of the tumor cells. CONCLUSION: The clinical characteristics of metastatic choroidal tumors from an HCC are a red appearance and rapid growth with retinal detachment and subretinal hemorrhage.

Functional analysis of type 1 isopentenyl diphosphate isomerase from Halobacterium sp. NRC-1.

Here we report the characterization of the type-1 isopentenyl diphosphate isomerase derived from Halobacterium sp. NRC-1. The expressed purified enzyme showed maximum isomerase activity in the presence of 1 M NaCl at 37 degrees C at pH 6.0. This type-1 enzyme appears to be the first for which the Co2+ ion is required for activity.

Cytotoxicity analysis of a novel titanium alloy in vitro: adhesion, spreading, and proliferation of human gingival fibroblasts.

A recently developed novel Ti-29Nb-13Ta-4.6Zr alloy (Ti-Ta) was investigated physically and chemically, and the results suggested it to be a possibly suitable dental material. In this study we analyzed the effects of the alloy, in comparison with those of other dental metals, on the adhesion, spreading, and proliferation of human gingival fibroblasts (Gin-1 cells) in vitro. The Gin-1 cells adhered and spread well on the Ti-Ta as well as on commercially pure titanium (Ti) and commercial Ti-6Al-7Nb alloy (Ti-Al), forming long processes showing a typical fibroblastic morphology that was close to that on glass. The proliferation of Gin-1 cells was significantly suppressed on Au-Pd-Ag alloy (Au-Pd) and commercially pure copper (Cu); however, the cells proliferated as well on Ti-Ta as they did on Ti, Ti-Al, and glass. Though most of the Gin-1 cells on Cu and about half of them on Au-Pd died after 1 day and 5 days of culture, respectively, the cells on Ti-Ta, Ti, Ti-Al and glass showed 100% viability even after 5 days of culture. These results suggest that the newly developed Ti-Ta alloy has biocompatibility as good as that of Ti and Ti-Al with respect to morphology and proliferation of Gin-1 cells in vitro.

Inhibition of type 2 isopentenyl diphosphate isomerase from Methanocaldococcus jannaschii by a mechanism-based inhibitor of type 1 isopentenyl diphosphate isomerase.

Type 2 isopentenyl diphosphate:dimethylallyl diphosphate isomerase (IDI-2, EC 5.3.3.2) is a flavoprotein, which requires FMN, NADPH, and Mg2+ for the activity to convert isopentenyl diphosphate to dimethylallyl diphosphate. For investigation of the reaction mechanism of IDI-2, 3,4-epoxy-3-methylbutyl diphosphate (EIPP), a mechanism-based inhibitor of type 1 IDI (IDI-1), was treated with the overexpressed IDI-2 (MjIDI) from methanogenic archaeon Methanocaldococcus jannaschii. EIPP showed the time- and concentration-dependent inhibition (KI; 56.5 mM, k(inact); 0.10 s(-1), k(inact)/KI; 1.76 s(-1)M(-1)) and the UV-vis spectrum of MjIDI after treatment with EIPP was apparently different from that of the untreated MjIDI. These results indicated that EIPP modified FMN through a covalent bond in the active site of MjIDI. The formed EIPP-FMN complex was separated from the reaction mixture and the spectrometric analysis of the complex suggested that the reduced form of FMN bound to EIPP at the N5 position. These results may suggest that the IDI-2 reaction is similar to IDI-1, which proceeds via carbocation-type intermediate.

Transpost: a novel approach to the display and transmission of 360 degrees-viewable 3D solid images.

Three-dimensional displays are drawing attention as next-generation devices. Some techniques which can reproduce three-dimensional images prepared in advance have already been developed. However, technology for the transmission of 3D moving pictures in real-time is yet to be achieved. In this paper, we present a novel method for 360-degrees viewable 3D displays and the Transpost system in which we implement the method. The basic concept of our system is to project multiple images of the object, taken from different angles, onto a spinning screen. The key to the method is projection of the images onto a directionally reflective screen with a limited viewing angle. The images are reconstructed to give the viewer a three-dimensional image of the object displayed on the screen. The display system can present images of computer-graphics pictures, live pictures, and movies. Furthermore, the reverse optical process of that in the display system can be used to record images of the subject from multiple directions. The images can then be transmitted to the display in real-time. We have developed prototypes of a 3D display and a 3D human-image transmission system. Our preliminary working prototypes demonstrate new possibilities of expression and forms of communication.

Oxybuprocaine induces a false-positive response in immunochromatographic SAS Adeno Test.

OBJECTIVE: To investigate whether a solution of oxybuprocaine hydrochloride, 0.4%, results in a false-positive response in an immunochromatographic SAS Adeno Test. DESIGN: Experimental study. CONTROLS: Physiologic saline and 2% lidocaine. TESTING: Each chemical (100 microl) was diluted in a transport medium. Five drops (200 microl) of the resultant solution were dispensed into the round sample well of a test device. Fifteen samples were tested in each group. MAIN OUTCOME MEASURES: Ten minutes after the start of the test, a colored line in the "specimen" portion of the test membrane was visually read as positive or negative by a masked technician. RESULTS: No positive reaction was observed in the control groups (physiologic saline and lidocaine). A false-positive reaction was observed in six samples (33.3%) in the oxybuprocaine group. The positive rate was significantly higher in the oxybuprocaine group compared with those in control groups (P = 0.0062, Fisher's extract probability test). CONCLUSIONS: Oxybuprocaine may induce a false-positive reaction in an immunochromatographic SAS Adeno Test. We recommend the use of lidocaine, instead of oxybuprocaine, for local anesthesia in taking eye swabs from patients with suspected adenovirus infection.