Technique for Adaptation of Konno Aortoventriculoplasty in Patient-Prosthesis Mismatch.

The patient-prosthesis mismatch has been reported as an important cause of adverse outcome following aortic valve replacement. The relief of patient-prosthesis mismatch generally requires a reoperation of comprehensive nature, which necessitates an extensive aortic root enlargement. The Konno aortoventriculoplasty represents an efficient treatment option, as this technique provides both extreme root enlargement and relief of the frequently associated subvalvular obstruction. However, the application and conduct of the procedure may somewhat differ from the pediatric Konno procedures.This article describes our surgical technique adaptation in Konno-aortoventriculoplasty for adult patient-prosthesis mismatch cases, highlighting the differing points from the pediatric-Konno.

Rerouting anomalous coronary artery origin in aortopulmonary window in newborn.

Coronary artery anomalies may accompany the aortopulmonary window and, if not noticed, may cause catastrophic consequences. The repair of the aortopulmonary window is quite straightforward; however, establishing a normal coronary pattern may challenge the repair. When the anomalous origin of the coronary artery is on the defect rim, right at the location where sutures are to be placed, it may interfere with proper suture placement. A technique to overcome such a technical obstacle and reroute the anomalous right coronary in such cases is described.

Predictive Gene Signature for Pyrazolopyrimidine Derivative c-Src Inhibitor 10a Sensitivity in Melanoma Cells.

Melanoma is a highly aggressive cancer with poor prognosis. Although more than 80% of melanomas harbor an activating mutation in genes within the MAPK pathway, which are mutually exclusive, usefulness of therapies targeting MAPK pathway are impeded by innate and/or acquired resistance in most patients. In this study, using melanoma cells, we report the efficacy of a recently developed pyrazolo[3,4-d]pyrimidine derived c-Src inhibitor 10a and identify a molecular signature which is predictive of 10a chemosensitivity. We show that the expression of TMED7, PLOD2, XRCC5, and NSUN5 are candidate biomarkers for 10a sensitivity. Although an undifferentiated/mesenchymal/invasive status of melanoma cells is associated with resistance to 10a, we show here for the first time that melanoma cells can be sensitized to 10a via treatment with valproic acid, a histone deacetylase inhibitor.

Recombinant adiponectin inhibits inflammation processes via NF-kB pathway in acute pancreatitis.

PURPOSE:   Adiponectin is a protein stemming from adipose tissue and having strong anti-inflammatory properties. We aimed to assess the damage diminishing effects of recombinant adiponectin  (rAD) through NF-kB in the experimental acute pancreatitis  (AP) model. MATERIALS AND METHODS:   Acute pancreatitis was created by applying 50 µg/kg dose of intraperitoneal cerulean. The rats were randomised and divided into 3 groups as control, AP and rAD groups. Moreover, the rats in each group were divided into two sub-groups as 24th and 48th hour subgroups. rAD was injected in the study group intraperitoneally. Tissue and blood samples were taken after 24 and 48 hours. Histopathological assessment and NF-kB activity were investigated in pancreatic tissue. RESULTS:   Serum TNF-a, IL-1b and IL-6 levels were found to be statistically significant in the AP group compared to the rAD group in the 24th and 48th hour  (p < 0.05). Similarly, NF-kB activity was also found to be significant in the AP group both in the 24th and 48th hour  (p < 0.05). There were significant differences in the AP and the rAD groups histopathologically in terms of edema, inflammation, vacuolisation and necrosis  (p < 0.001). CONCLUSION:   rAD has significantly reduced NF-kB activity, cytokine levels and tissue damage  (Tab. 1, Fig. 1, Ref. 51).

Phenotype-based variation as a biomarker of sensitivity to molecularly targeted therapy in melanoma.

Transcriptomic phenotypes defined for melanoma have been reported to correlate with sensitivity to various drugs. In this study, we aimed to define a minimal signature that could be used to distinguish melanoma sub-types in vitro, and to determine suitable drugs by which these sub-types can be targeted. By using primary melanoma cell lines, as well as commercially available melanoma cell lines, we find that the evaluation of MLANA and INHBA expression is as capable as one based on a combined analysis performed with genes for stemness, EMT and invasion/proliferation, in identifying melanoma subtypes that differ in their sensitivity to molecularly targeted drugs. Using this approach, we find that 75% of melanoma cell lines can be treated with either the MEK inhibitor AZD6244 or the HSP90 inhibitor 17AAG.

Intraoperative ultrasound control of surgical margins during partial nephrectomy.

AIMS: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. SUBJECTS AND METHODS: This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. RESULTS: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. CONCLUSIONS: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

Mitral Patient-Prosthesis Mismatch Predicts Suboptimal Hemodynamic Recovery after Mitral Valve Replacement.

BACKGROUND: A possible relationship between an obstructive prosthesis and suboptimal hemodynamic recovery, as reflected by unsatisfactory regression in systolic pulmonary artery pressure (sPAP) and functional tricuspid regurgitation (FTR) following mitral valve replacement (MVR), was investigated. A delineating effective orifice area index (EOAI) value was sought in order to define a patient-prosthesis mismatch. METHODS: A total of 128 patients undergoing isolated mechanical MVR were followed up for a mean of 46 ± 9 months. Patients were allocated to two groups. Group I comprised 83 patients (65%) exhibiting a satisfactory (≥30%) regression in sPAP and FTR, while group II comprised 45 patients with a <30% (suboptimal) decrease in these parameters. A cutoff value for the prosthetic mitral valve in-vivo EAOI was explored as a predictor of postoperative hemodynamic recovery. RESULTS: The mean in-vivo EOAI differed significantly between the groups (1.23 cm2/m2 in group I versus 1.11 cm2/m2 in group II; p <0.0001). The consequent receiver operating characteristic curve analysis revealed an EOAI of 1.19 cm2/m2 as the cut-off value, below which a suboptimal postoperative regression in pulmonary hypertension and FTR is predicted. CONCLUSIONS: An in-vivo EOAI <1.19 cm2/m2 strongly suggests a suboptimal hemodynamic recovery following MVR with the bileaflet mechanical prosthesis used in the present study. Although no direct relationship between prosthesis size and in vivo EOAI was demonstrated, the logical approach is to implant a prosthesis of the largest possible size.

Recommendations for Valve Replacement in Ischemic Mitral Regurgitation with Compromised Ventricle.

The unique features of ischemic mitral regurgitation may necessitate attention to certain points during mitral valve replacement (MVR). A few simple but practical recommendations are offered for concomitant or isolated MVR in this high-risk population which is often burdened by an extremely limited myocardial reserve.

A new technique for the surgical repair of double cleft earlobe: modified Millard's rotation-advancement flap.

The double cleft earlobe is a rare earlobe deformation. The most common causes of cleft earlobe are earring or piercing tear injuries and trauma. In this study, the cases of five patients (all women) attending the clinic between 2010 and 2013 suffering from a unilateral traumatic complete double earlobe cleft as a result of an earring injury were evaluated. The principles of Millard's cleft lip repair were applied during the repair of these double cleft earlobe deformities. This adaptation of Millard's technique to repair double earlobe clefts with a non-straight closure appears to give satisfactory results.

Remote Targets for Right Coronary Artery Bypass: Distal Trunk or Posterior Descending Artery Grafting.

BACKGROUND: Choosing a good anastomotic site is crucial during surgical revascularization of the right coronary artery (RCA) system. In many instances of distal and/or sequential main trunk disease, either the right posterior descending coronary artery (RPDA) or distal part of the right main coronary artery (DRCA) is preferred as the target vessel. In this article, the saphenous vein graft (SVG) patency is compared between these two main targets in the long term. MATERIALS AND METHODS: Postoperative control coronary angiograms were obtained and assessed from 452 patients undergoing conventional on-pump coronary artery bypass grafting with either a DRCA (n = 305) or a RPDA graft (n = 147) after an average postoperative period of 5.8 ± 4.3 years (range: 2 months-20 years; a total of 2,627 patient-years). RESULTS: The overall graft patency was 60%. The 15-year patency rate was better for the DRCA grafts than that for the RPDA grafts (32 ± 5% vs. 19 ± 6%, respectively; p = 0.001), irrespective of target vessel caliber. Other factors adversely influencing the long-term graft patency were poor target vessel quality (p = 0.002) and hypercholesterolemia (p = 0.01). On the other hand, target vessel diameter, diabetes mellitus, hypertension, chronic renal insufficiency, obesity, peripheral arterial disease, or SVG quality were not associated with poor long-term graft patency in these patients having distal-type RCA disease. CONCLUSIONS: In the presence of distal and/or sequential right coronary disease, DRCA may be the target vessel of choice for bypass grafting, rather than the RPDA, mainly for better long-term SVG patency rates in this location.

The effects of Hypericum perforatum on hepatic ischemia- -reperfusion injury in rats.

BACKGROUND: Ischemia-reperfusion injury (IR) is associated with a high morbidity and mortality. Several agents have been used to protect the liver after IR. We aimed to investigated the effects of the Hypericum perforatum on IR of the liver. METHODS: A total of 62 wistar-albino male rats in 4 groups were used. Sham group (n: 8). Control group (IR, n: 18) was underwent partially liver ischemia and reperfusion (IR). Carboxymethyl cellulose group (CMC n: 18) was given 0.5 % carboxymethyl cellulose before IR for a week. Hypericum perforatum group (HP, n:18) was given 0.5 % carboxymethyl cellulose supplemental the extract of Hypericum perforatum before IR for a week. Blood and liver samples were obtained before ischemia, and 1, 2, 4 hours after the reperfusion. AST, ALT, LDH, TNF-α, IL-6, MDA and advanced oxidation protein products(AOPP) levels were determined in blood samples. Histological evaluation and tissue MDA, AOPP levels were determined. RESULTS: Blood levels of ALT, TNF-α, IL-6 and MDA were significantly low in HP group compared with IR and CMC groups (p < 0.05). There was no difference between the liver injury scrores of IR and CMC groups (p > 0.05). CONCLUSION: [corrected] These results indicate that H. perforatum can protect the liver against IR. As antioxidative agent, Hypericum perforatum has both local and systemic protective effects in ischemia reperfusion injury (Tab. 1, Fig. 4, Ref. 31).

Aortoventriculoplasty for correction of patient-prosthesis mismatch examples.

OBJECTIVE: Patient-prosthesis mismatch is often considered as an important cause of adverse outcome following aortic valve replacement. A small annulus represents a challenge for the surgeon; yet can be best managed at the initial operation using relatively simple techniques, as later-on correction is often far more challenging. Corrective reoperations necessitate drastic root enlargement, along with the relief of subvalvular muscular obstruction. PATIENTS AND METHODS: The Konno-type aorto-ventriculoplasty is preferred in the present case series in order to achieve a radical aortic annulus enlargement in difficult reoperation settings and to address the accompanying subvalvular obstruction due to muscular hypertrophy simultaneously as well, with the septal patch included in the technique. RESULTS: This approach provides satisfactory relief of the obstruction at both valvular and subvalvular level and the benefits are immediately evident, as symptoms abruptly end in all cases. CONCLUSION: Long-term outcome is also excellent in both clinical and haemodynamic terms, as reflected by the significant left ventricle mass regression, absence of symptoms and improved quality of life.