Increased numbers of pre-operative circulating monocytes predict risk of developing cardiac surgery-associated acute kidney injury in conditions requiring cardio pulmonary bypass.

BACKGROUND: Evaluating patients' risk for acute kidney injury (AKI) is crucial for positive outcomes following cardiac surgery. Our aims were first to select candidate risk factors from pre- or intra-operative real-world parameters collected from routine medical care and then evaluate potential associations between those parameters and risk of onset of post-operative cardiac surgery-associated AKI (CSA-AKI). METHOD: We conducted two cohort studies in Japan. The first was a single-center prospective cohort study (n = 145) to assess potential association between 115 clinical parameters collected from routine medical care and CSA-AKI (≥ Stage1) risk in the population of patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB). To select candidate risk factors, we employed random forest analysis and applied survival analyses to evaluate association strength. In a second retrospective cohort study, we targeted patients undergoing cardiac surgery with CPB (n = 619) and evaluated potential positive associations between CSA-AKI incidence and risk factors suggested by the first cohort study. RESULTS: Variable selection analysis revealed that parameters in clinical categories such as circulating inflammatory cells, CPB-related parameters, ventilation, or aging were potential CSA-AKI risk factors. Survival analyses revealed that increased counts of pre-operative circulating monocytes and neutrophils were associated with CSA-AKI incidence. Finally, in the second cohort study, we found that increased pre-operative circulating monocyte counts were associated with increased CSA-AKI incidence. CONCLUSIONS: Circulating monocyte counts in the pre-operative state are associated with increased risk of CSA-AKI development. This finding may be useful in stratifying patients for risk of developing CSA-AKI in routine clinical practice.

[Thoracic Endovascular Aortic Repair( TEVAR) Deployed into the False Lumen:Report of a Case].

A 73-year-old man had Stanford type B acute aortic dissection 11 years before. He had underwent thoracoabdominal aortic replacement due to thoracoabdominal aneurysm nine years before and hemiarch aortic replacement due to Stanford type A acute aortic dissection four years before. We performed surgery because the dissecting aortic aneurysm in the distal arch has enlarged. We selected thoracic endovascular aortic repair( TEVAR) because of reoperation, but the true lumen of the descending aorta was highly narrowed, we had to deploy stent-grafts into the false lumen. Since the proximal and distal parts of endovascular thoracic stent-grafts were deployed into the previously implanted Dacron grafts, we could deploy them without vascular injury. If both proximal and distal parts of stent-grafts can be deployed into vascular prosthesis, deploying the stent-grafts into the false lumen may be a feasible option.

[Left Atrial Myxoma with Coronary Artery-left Atrial Fistula:Report of a Case].

A 76-year-old woman underwent screening echocardiography. A cardiac mass was detected in the left atrium. It was located at the atrial septum, and was around 3 cm in size. Its surface was smooth and there was cystic cavity inside. Coronary angiography revealed rich blood flow from bilateral coronary arteries to the mass and massive shunt to the left atrium, which formed a fistulous connection. We performed tumor resection under cardiopulmonary bypass. Postoperative course was uneventful. Histopathologically, the tumor was myxoma. Cardiac myxoma is the most common primary cardiac tumor, but myxoma exhibiting coronary artery-left atrial fistula is fairly uncommon.

Data from expressed sequence tags from the organs and embryos of parthenogenetic Haemaphysalis longicornis.

OBJECTIVES: Haemaphysalis longicornis is the most important tick species in Japan and has a wide range of vector capacity. Due to its veterinary and medical importance, this tick species has been used as a model for tick/vector biological studies. To identify the key molecules associated with physiological processes during blood feeding and embryogenesis, full-length cDNA libraries were constructed using the fat body, hemocytes-containing hemolymph, midgut, ovary and salivary glands of fed females and embryos of the laboratory colony of parthenogenetic H. longicornis. The sequences of cDNA from the salivary glands had been already released. However, the related information is still poor, and the other expressed sequence tags have not yet been deposited. DATA DESCRIPTION: A total of 39,113 expressed sequence tags were obtained and deposited at the DNA DataBank of Japan. There were 7745 sequences from embryos, 7385 from the fat body, 8303 from the hemolymph including hemocytes, 7385 from the midgut, and 8295 from the ovary. The data, including expressed sequence tags from the salivary glands was summarized into Microsoft Excel files. Sharing this data resource with the tick research community will be valuable for the identification of novel genes and advance the progress of tick research.

[Cardiac Tamponade due to a Ruptured Giant Coronary Artery Aneurysm].

We report a case of a ruptured coronary artery aneurysm. An 87-year-old woman suffered from cardiac tamponade due to a ruptured coronary artery aneurysm. Coronary angiography showed a giant coronary aneurysm without coronary artery fistula. Emergency surgery was performed through median sternotomy. We performed aneurysmectomy and ligation of the perfusion arteries under cardiopulmonary bypass. The patient's postoperative course was uneventful. We also reviewed nine cases of ruptured coronary artery aneurysm without coronary artery fistula in Japan. The disease is a rare clinical state and considered to be an indication for emergency surgery.

Development of caseous calcification of mitral annulus after initiation of hemodialysis therapy.

We here present a 59-year-old man who had undergone peritoneal dialysis (PD) for 7 years and hemodialysis for the following 6 years in the Japanese Red Cross Kumamoto Hospital. Six years after commencing PD, transthoracic echocardiography showed a highly echoic mass with a transverse diameter of almost 15 mm in the posterior mitral leaflet. Because the mass increased from 2 years after initiation of hemodialysis, reaching over 25 mm by 6 years after commencing hemodialysis, tumor resection and mitral valve replacement were performed. When the surface of the mass was incised, white opalescent liquid drained out of the mass and histological examination showed multiple calcified nodules and granulation tissue, resulting in diagnosis of a caseous calcification of mitral annulus. .

Released washed platelet concentrates are effective and safe in patients with a history of transfusion reactions.

BACKGROUND: Plasma removal by washing is an effective approach to prevent transfusion reactions by platelet concentrates (PCs). Recently, washed PCs were released by the Japanese Red Cross Society (JRCS). MATERIALS AND METHODS: This retrospective multicenter study evaluated the efficacy and safety of released washed PCs (RWPCs) between September 2016 and January 2017 in Japan. The RWPCs were prepared by washing leukoreduced apheresis PCs with the platelet additive solution, BRS-A, using automated cell processors. RESULTS: Clinical data were obtained from 91 patients and 1210 RWPC transfusions at 50 institutions. The median number of RWPC transfusions per patient was 8 (range, 1-91). RWPCs were used in 94.5% of the patients with a history of recurrent or severe transfusion reactions for preventing such reactions. Responses of RWPCs were evaluated as complete response (91.6%), partial response (8.2%), no-change (0.2%), and progression (0%) and overall response was equal across subgroups divided by patients' profiles. The median corrected count increment (CCI) at 1 and 24 h post-transfusion were 13.5 (range, 1.9-35.4) × 109/L and 3.5 (range, -13 to 53.6) × 109/L, respectively, and median CCI at 24 h was 5.5 (range, -13 to 53.6) × 109/L in patients without risk factors associated with platelet transfusion refractoriness. Transfusion reactions to RWPCs were observed in only nine transfusions (0.7%), all of which were mild allergic reactions. CONCLUSION: This study demonstrated that RWPCs were effective and safe in patients with a history of transfusion reactions. Further prospective studies on efficacy together with cost-benefit analysis in RWPCs are needed.

Efficacy of Direct Oral Anticoagulant into the Care of Venous Thromboembolism Related to Kumamoto Earthquake.

Kumamoto was hit by a series of strong earthquakes beginning on April 14, 2016. We treated many deep vein thrombosis (DVT) patients and pulmonary thrombosis (PTE) patients. We came up with a strategy for diagnosis and therapy of venous thromboembolism (VTE). For VTE patients, we prescribed anticoagulant drugs, mainly direct oral anticoagulant (DOAC). To evaluate the validity and safety of the medical strategy for VTE in disasters, we investigated the prognosis of VTE patients at 4 months after the initial quake. In the two months following the initial quake we attended to 43 VTE patients, 11 PTE patients (including 9 patients with both DVT and PTE) and 32 DVT patients. We prescribed DOAC to 34 patients and Warfarin to 4 patients. Based on the survey at 4 months after the first tremblor, the period of anticoagulation therapy was 95.0±17.2 days for PTE and 57.1±36.5 days for DVT and 12 patients were continuing to take anticoagulant drugs. There were no recurrent VTE or bleeding events. DOAC therapy of VTE is therefore considered effective and safe in the event of a natural disaster. (This is a translation of J Jpn Coll Angiol 2017; 57: 33-40.).

[Surgical Treatment for Anomalous Aortic Origin of Coronary Arteries].

Anomalous aortic origin of coronary arteries is rare. We report 3 cases of surgical treatment for anomalous aortic origin of coronary arteries. Case 1 was a 38-year-old man who was saved by the use of an automated external defibrillator from cardiopulmonary arrest while exercising. The coronary angiogram showed the right coronary artery arising from the left coronary sinus of Valsalva and being located between the aorta and the pulmonary trunk. He underwent coronary artery bypass grafting (CABG) using the right internal thoracic artery with ligation of proximal part of right coronary artery to prevent sudden death. Case 2 was a 76-year-old woman with the left coronary artery arising from the right coronary sinus of Valsalva and proximal left anterior descending coronary artery stenosis. She underwent CABG. Case 3 was a 58-year-old man with severe aortic valve regurgitation. He underwent aortic valve replacement. During weaning from cardiopulmonary bypass, the electrocardiogram revealed ST-segment elevation. Transesophageal echocardiography showed intramural segment of the left coronary artery and obstruction of the left coronary blood flow. Repair was accomplished by unroofing the intramural segment. All the cases were successfully treated by surgical treatment.

[Giant Left Atrium with Mitral Regurgitation in Williams Syndrome: Report of a Case].

A 43-year-old woman with a history of mitral regurgitation and Williams syndrome was admitted for the treatment of congestive heart failure. A computed tomography scan showed a giant left atrium. No other cardiac abnormalities were observed. She received mitral valve replacement with a mechanical valve prosthesis and underwent left atrium volume reduction with a suture technique and modified Maze procedure. After the operation, the cardiac rhythm returned to sinus rhythm and chest radiography showed normal cardiothoracic ratio. Congestive heart failure did not recur.

A new method for protection from shower embolism during TEVAR on a shaggy aorta.

The case of a patient with a thoracoabdominal aortic aneurysm accompanied by a shaggy aorta, in whom embolism was prevented by a graft used in debranching and placement of an extracorporeal shunt during thoracic endovascular aortic repair, called the "block and trap method", is presented. Two-staged operations were performed using Y graft replacement, debranching bypass, and thoracic endovascular aortic repair during which a temporary shunt line with a blood filter was made involving the femoral artery and vein. The method of trapping emboli in a filter in an external shunt appears effective.

Passenger lymphocyte syndrome with hemophagocytic syndrome after peripheral blood stem-cell transplantation from an HLA-matched full biological sibling: case report.

Massive hemolysis due to passenger lymphocyte syndrome (PLS) is rare after peripheral blood stem-cell (PBSC) transplantation with a minor ABO mismatch. We present, in a 16-year-old boy (group A Rh+), PLS with hemophagocytic syndrome (HPS) after PBSC transplantation from his HLA (human leukocyte antigens)-matched biological sister (group O Rh+). Mild-to-moderate hemolysis was evident from day +11 to day +15 after transplantation. HPS was diagnosed by bone marrow examination on day +16, while antibodies against the recipient's red blood cell antigens were detected on days +15 and +27. This hemolysis may have been due to PLS with HPS. Therefore, measurement of antibodies may provide a useful hallmark of immune hemolysis.

Molecular characterization and comparative study of 6 salivary gland metalloproteases from the hard tick, Haemaphysalis longicornis.

Six genes encoding metalloproteases were identified from the salivary gland of the hard tick, Haemaphysalis longicornis. Comparative analyses have shown the evolutionary distinct and different mRNA expression patterns of each gene during blood feeding. The proteins are synthesized as proenzymes with a prodomain and a metalloprotease/cysteine-rich domain of the reprolysin family. Within the active site, amino acid substitutions were observed. The recombinant Escherichia coli expression of one gene, hlESTMP1, was performed. The immunoblot analysis and indirect fluorescent assay using anti-hlESTMP1 suggested that this protein is mainly expressed in the cytoplasm of the salivary glands and only the mature form of 34 kDa was detectable. The proenzyme expressed by baculovirus was processed into a mature domain, suggesting that proenzyme activation possibly occurs through a pro-protein convertase dependent pathway. The presence of these diverse enzymes might contribute to the greater functional complexity of bioactive molecules in tick saliva to facilitate blood feeding.

Identification of genes encoding cement-like antigens expressed in the salivary glands of Haemaphysalis longicornis.

A cDNA expression library from the salivary glands of hard tick, Haemaphysalis longicornis, was constructed. Immunoscreening was performed using sera of the rabbit repeatedly infested with ticks and seventeen positive clones were obtained. A BLASTP search suggested that 8 sequences matched with that of hypothetical H. longicornis sequence and one clone encoded HL35 antigen U from the same tick species. Eight of 17 gave no match to any sequence reported in the database. The proteins expected from these novel sequences possess common characteristics with cement proteins which assist ticks in their attachment to the host during blood feeding. The expression of these genes in salivary glands was confirmed by RT-PCR. Four of the 8 sequences showed to be upregulated upon blood feeding. These immunodominant antigens are of particular interest as candidates for future cement protein based-tick vaccine.

Tick troponin I-like molecule is a potent inhibitor for angiogenesis.

This is the first report identifying the anti-angiogenesis saliva molecule of the ixodid tick. In our previous study, we identified a troponin I-like molecule (HLTnI) of the ixodid hard tick Haemaphysalis longicornis, a vector for various pathogens. To investigate its potential inhibitory effects for angiogenesis, we expressed and purified recombinant HLTnI in Escherichia coli. In a vascular endothelial growth factor (VEGF) competitive angiogenesis assay, the recombinant HLTnI significantly inhibited the capillary formation of human vascular endothelial cells (HUVEC) in vitro. The inhibition was dose-dependent with an IC(50) of 18.95 nM. These results indicated that HLTnI is a potent angiogenesis inhibitor.

The use of a recombinant baculovirus expressing a chitinase from the hard tick Haemaphysalis longicornis and its potential application as a bioacaricide for tick control.

Baculoviruses are specific insect pathogens used as selective biological insecticides on lepidopteran insects. We have tested a recombinant baculovirus expressing a chitinase gene for its efficacy as a tick bioacaricide. The recombinant Autographa californica multiple nuclear polyhedrosis virus expressing a chitinase enzyme (AcMNPV-CHT1) from the hard tick, Haemaphysalis longicornis, was constructed and found to have a novel bioacaricidal effect against ticks. The recombinant baculovirus was used to express the chitinase enzyme in Spodoptera frugiperda (Sf9) insect cells. Topical application of the supernatant harvested from the insect cell culture was found to cause mortality in nymphal ticks of H. longicornis. High temperature (>30 degrees C) and infrared radiation affected the chitinase enzyme activity and recombinant baculovirus infectivity by reducing the speed of tick killing by 60%. A mixture of recombinant virus and chitinase was found to kill ticks faster (p < 0.01) than pure chitinase and recombinant virus alone. Thus, the recombinant virus showed a synergistic effect with the foreign chitinase gene. In order to reduce the excessive use and cost of acaricides, it was found that a mixture of recombinant virus and flumethrin could halve the dose of the chemical acaricide used. These findings are important for the safe use of the recombinant virus expressing chitinase as a bioacaricide against ticks.

Characterization of Haemaphysalis longicornis recombinant cement-like antigens and preliminary study of their vaccination effects.

Two genes encoding immunodominant antigens, hlim2 and hlim3, were obtained from a salivary gland cDNA library of the hard tick, Haemaphysalis longicornis. The recombinant proteins were expressed in Escherichia coli as the GST fusion protein and used for immunization. We observed that the attachment rate of nymphal ticks fed on mice immunized with GST-hlim3 was significantly lower than that in the control group during the initial days of feeding. However, immunization with GST-hlim3 did not affect the engorgement rate of the ticks. In sharp contrast, GST-hlim2 did not influence the attachment rate and feeding period of ticks but had a significant reduction in the engorgement body weight. These data highlight the suitability of the 2 recombinant cement-like proteins for use in a cocktail vaccine.