Impact of Recovery from Acute Kidney Injury After Aortic Arch Repair.

BACKGROUND: The impact of recovery from acute kidney injury (AKI) after open thoracic aortic surgery on follow-up outcomes is unclear. METHODS: This retrospective study included 214 patients who underwent aortic arch surgery requiring hypothermic circulatory arrest between 2007 and 2019. Patients who required preoperative renal replacement therapy and patients who died within 7 postoperative days were excluded. The incidence of recovery from AKI was examined. Renal outcomes were compared among patients with no AKI (Group N), recovery from AKI (Group R), and persistent AKI (Group P). RESULTS: Preoperative kidney function was similar among the 3 groups. Among the 115 patients who developed postoperative AKI, 80.9% recovered from AKI at discharge. The 5-year cumulative mortality rate was 18.0%, 24.5%, and 68.4% in Group N, R, and P, respectively (P < .001, Group R vs Group P). The 5-year cumulative incidence of renal replacement therapy dependency was 0.0%, 5.4%, and 22.7%, respectively (P = .04, Group N vs Group R; P = .01, Group R vs Group P). The medians (interquartile range) of estimated glomerular filtration rate (mL/min/1.73 m2) 2 years after surgery were 65.2 (50.4-80.2), 54.3 (41.4-65.9), and 56.9 (40.2-67.5), respectively (P = .03, Group N vs Group R). CONCLUSIONS: The majority of patients recovered from AKI after thoracic aortic repair by discharge. However, the prolonged impact of AKI recovery on kidney function was observed during the follow-up period. Diligent follow-up after discharge is warranted for early identification of patients at high risk of kidney disease progression.

Phyto-Fenton remediation of a dichloro-diphenyl-trichloroethane contaminated site in Ha Tinh Province, Vietnam.

A field trial was conducted at a site in Cam Binh commune, Ha Tinh province, Vietnam, highly contaminated with organo-pesticides. The phyto-Fenton process was applied to remove pesticide residues in soils. In addition to magnetite (Fe3O4) materials added to the soils, fertilizers and elicitors for oxidative burst were also added in the different experimental treatments. Dichloro-diphenyl-trichloroethane (DDT) and isomers were removed in all experimental lots. The removal efficiency was highest in lot B1, a site where only iron materials were added. The removal efficiency and the final content of DDTs in B1 were 98.4% and 0.009 mg kg-1, respectively. In the presence of elicitors, the conversion of DDT to dichloro-diphenyl-dichloroethylene was more favorable. Analysis of soil properties indicated that the phyto-Fenton process can occur at neutral soil pH, and when there are only small changes in soil organic carbon content and cation exchange capacities. Shifts in the composition of the microbial communities were observed. Further studies on the interactions between materials added to soil, plants, and the soil microbiome are needed to understand the mechanism of action of the phyto-Fenton process during soil remediation.

Accelerated remediation of organochlorine pesticide-contaminated soils with phyto-Fenton approach: a field study.

Phytoremediation and advanced oxidation processes are among the most promising techniques for removing organic pollutants from soils. A field trial was performed for six months to evaluate the effect of nano-Fe3O4 on the degradation of organochlorine pesticide residues including Lindane, p,p'-dichlorodiphenyltrichloroethane (DDT), p,p'-dichlorodiphenyldichloroethylene (DDE), and p,p'-dichlorodiphenyldichloroethane (DDD) in pesticide-contaminated soils in the presence of vetiver in Bac Giang province, Vietnam. Vetiver was planted in three zones with different nano-Fe3O4 concentrations. Soil samples from each zone were periodically collected to determine the remaining concentrations of selected organochlorine pesticides via gas chromatography-electron capture detector. Results indicated that the total DDT concentrations in the examined soil were 1.9-13 times higher than the permissible threshold level (10 µg g-1) established by the national technical regulation on pesticide residues in soil. The (p,p'-DDE + p,p'-DDD)/p,p'-DDT ratios ranged from 13.5 to 114, indicating the absence of recent inputs of technical DDTs at the study area. DDT dechlorination mainly occurred under aerobic pathways to form DDE. Furthermore, DDE degradation in soil was adequately described by the pseudo-first-order kinetics model (R2 > 0.892). In the presence of vetiver, the rate constants of DDE degradation were 0.264, 0.350, and 0.434 month-1 with 0, 25, and 100 mg kg-1 of added nano-Fe3O4, respectively, indicating that the degradation of DDE correlated positively with Fe3O4 concentration in the soil. Additionally, the presence of vetiver and nano-Fe3O4 in the soil increased DDT removal rates, which might be linked to the involvement of Fenton/Fenton-like reactions.

Thrombocytopenia recovered by surgical resection of a myxoma.

Myxoma is the most common primary cardiac neoplasm, and causes a variety of symptoms, including hematological disorder. An 82-year-old man with anorexia was diagnosed with a gastrointestinal stromal tumor. Computed tomography and echocardiography showed a 2-cm tumor in the left atrium. The patient had a history of lung and skin sarcoidosis, and interstitial pneumonia. Laboratory examination showed thrombocytopenia with a platelet count of 23 × 103/µL and elevation of IgA and platelet-associated IgG (PAIgG). We suspected that the thrombocytopenia was caused by the left atrial tumor. He successfully underwent resection of the tumor with cardiopulmonary bypass. The platelet count increased to 166 × 103/µL after surgery. Pathological examination showed Alcian blue staining of the extracellular and intracellular matrix, suggesting a mucopolysaccharide matrix. Immunohistochemical examination of the tumor revealed expression of CD31, CD34, and calretinin, which was consistent with a myxoma. The PAIgG level decreased to the normal range at 36 days postoperatively. Thrombocytopenia is a relatively rare finding in patients with myxomas. However, in addition to mobility of the mass, thrombocytopenia should be kept in mind as an indication for surgery. .

Surgical repair of unroofed coronary sinus with severe mitral regurgitation in an elderly patient.

An unroofed coronary sinus (URCS) is a rare anomaly that produces communication between the left atrium (LA) and the coronary sinus (CS), resulting in a left-to-right shunt. Due to the lack of symptoms and particular anatomical characteristics, this disease is difficult to diagnose, and prone to be overlooked. An 85-year-old man was admitted to our hospital because of anorexia and shortness of breath. On physical examination, a systolic murmur was heard at the apex, and pitting edema was present in both legs. Transthoracic echocardiography showed severe regurgitation of the mitral valve and tricuspid valve. Transesophageal echocardiography confirmed a shunt between the LA and the CS. Because of uncontrolled heart failure, we performed surgical repair 50 days after admission. Under cardiopulmonary bypass and heart arrest, the URCS was detected in the LA and directly sutured. Repair of the mitral and tricuspid valves and the Maze procedure were also performed. The patient had a good postoperative course, and has been doing well for 2 years. Transesophageal echocardiography is helpful for diagnosis of URCS. Mitral regurgitation might raise the left atrial pressure and result in increase in shunt flow, causing left and right heart failure in elderly patients. .

Acute Exposure to 17α-Ethinylestradiol Alters Aggressive Behavior of Mosquitofish (Gambusia affinis) Toward Japanese Medaka (Oryzias latipes).

Behavior of the mosquitofish (Gambusia affinis) toward the Japanese medaka (Oryzias latipes) was tested under exposure to environmental 17α-ethinylestradiol (EE2), a synthetic derivative of natural estrogen, estradiol. The mosquitofish were exposed to EE2 at different concentrations-0, 0.5, 5.0, and 50.0 ng/L-for 2 days, before their behavioral changes toward the medaka were observed. Results indicate that female mosquitofish became more aggressive at the high level of EE2 (50 ng/L), in terms of how persistently they attempted to approach the medaka. The males showed increased aggressive behavior toward the medaka, by significantly increasing the number and persistence of approach attempts at the low (0.5 and 5 ng/L) levels of EE2. At the highest EE2 concentration (50 ng/L), however, the number of attempts decreased, while the persistence increased in the males showing the same pattern as in the females. All behavioral changes were reversed once EE2 was removed from the environment.

Identification and application of Phyto-Fenton reactions.

The formation of hydroxyl radicals (•OHs) by aquatic plants was investigated using electron-spin-resonance (ESR) spectroscopy and fluorescence microscopy. ESR observations, using 5- (diethoxyphosphoryl)-5-methyl-pyrroline N-oxide as a trapping agent, indicated that the signals produced by aquatic plants ground with ferrous iron ions are almost identical to those produced by Fenton's reagent. In addition, fluorescence was observed in the oxidized form of aminophenyl fluorescein in the presence of ferrous ions as well as any particles of colloidal ferrihydrite, magnetite, and ferric-ion-exchanged zeolite, while no fluorescence appeared in the absence of these iron compounds. Moreover, fluorescence-microscopy observations demonstrated that fluorescence mainly occurs on the surface of aquatic plants at neutral pH in the presence of the latter three solid iron compounds, implying the occurrence of heterogeneous phyto-Fenton reactions utilizing endogenous hydrogen peroxide (H2O2) in the aquatic plants. Furthermore, batch treatments of the pollutant 17α-ethinylestradiol (EE2), using colloidal ferrihydrite iron, indicated the feasible removal of EE2 with enhanced performance, lower-or apparently no-consumption of endogenous H2O2, and no significant stress to the aquatic plants. We concluded that the treatment of environmental pollutants through •OH formations via heterogeneous phyto-Fenton reactions should be a feasible alternative to conventional wastewater and water-treatment processes.

Continuous treatments of estrogens through polymerization and regeneration of electrolytic cells.

This study proposes a novel electrolytic method for simultaneous removal of trace estrogens and regeneration of electrolytic cells for long-term wastewater treatment. Continuous treatments of estrogens estrone (E1), 17ß-estradiol (E2) and 17α-ethinyl estradiol (EE2) were theoretically and experimentally studied using an electrolytic reactor equipped with a multi-packed granular glassy carbon electrode reactor. Experimental results demonstrated that E1, E2 and EE2 were effectively removed through electro-polymerization on the granular glassy carbon (and Pt/Ti) anode counter. Polymer formed during continuous treatment was quickly decomposed and electrodes were regenerated completely by ˙OH radicals produced through the reduction of ozone. Calculated overall energy consumptions were less than 10 Wh/m(3), demonstrating extremely low energy consumptions. In addition, a mathematical model developed based on the limiting mass transfer rate and post-regeneration could represent general trends in time series data observed in experiments.

Removal of estrogens by electrochemical oxidation process.

Treatments of estrogens such as Estrone (E1), Estradiol (E2) and Ethinylestradiol (EE2) were conducted using an electrolytic reactor equipped with multi-packed granular glassy carbon electrodes. Experimental results showed that E1, E2 and EE2 were oxidized in the range of 0.45-0.85 V and were removed through electro-polymerization. Observed data from continuous experiments were in good agreement with calculated results by a mathematical model constructed based on mass transfer limitation. In continuous treatment of trace estrogens (1 µg/L), 98% of E1, E2 and EE2 were stably removed. At high loading rate (100 µg/L), removal efficiency of E1 was kept around 74%-88% for 21 days, but removal efficiency reduced due to passivation of electrodes. However, removal efficiency was recovered after electrochemical regeneration of electrodes in presence of ozone. Electric energy consumption was observed in the range of 1-2 Wh/m(3). From these results, we concluded that the present electrochemical process would be an alternative removal of estrogens.

Pharmacokinetics and safety of the sesame lignans, sesamin and episesamin, in healthy subjects.

A single-blind, placebo-controlled, parallel-group and multiple oral dose study was conducted in 48 healthy subjects to investigate the pharmacokinetics and safety of multiple oral doses of sesame lignans (sesamin and episesamin). Subjects were randomly divided into two groups. Each subject was administered 50 mg of sesame lignans (sesamin/episesamin=1/1) or placebo once daily for 28 days. The pharmacokinetics of the sesame lignans were investigated using 10 of the 24 subjects in the sesame lignans group. No serious adverse events were observed in this study. Sesamin was absorbed with a peak plasma concentration at 5.0 h. The plasma concentration of the main metabolite, SC-1, reached a peak at 5.0 h and decreased rapidly with a terminal half-life of 2.4 h. Episesamin was also absorbed with a peak plasma concentration at 5.0 h and decreased with a terminal half-life of 7.1 h. The plasma concentration of the main metabolite, EC-1, reached a peak at 5.0 h and decreased rapidly with a terminal half-life of 3.4 h. The plasma concentrations of sesamin and episesamin reached a steady state by day 7. Sesame lignans were confirmed to be safe and tolerable in healthy subjects. The results of the pharmacokinetic study demonstrate that no accumulation was observed following multiple 50 mg doses of sesame lignans.

Biological Fenton's oxidation of pentachlorophenol by aquatic plants.

This study proposes a new treatment method to decompose persistent chemicals such as pentachlorophenol (PCP) in water, utilizing hydrogen peroxide present in aquatic plants to proceed the biological Fenton reaction. PCP was not effectively removed by aquatic plants. However, by adding 2.8 mM of Fe(2+), there was a rapid removal of PCP while at the same time consumption of endogenous hydrogen peroxide occurred. It was observed the increase of chloride ions formation in water-confirming the complete degradation of PCP. These results demonstrated that PCP was oxidized through a biological Fenton reaction, and hydrogen peroxide in aquatic plants was a key endogenous substance in treatment of refractory toxic pollutants.

Arachidonate-enriched triglyceride oil does not promote tumor development in a rat medium-term multi-organ carcinogenesis model.

The modifying potential on tumor development of arachidonate-enriched triglyceride oil (ARA-oil) containing approximately 40% arachidonic acid was investigated in a medium-term multi-organ carcinogenesis bioassay using male and female F344 rats. The animals were sequentially given five carcinogens with different target sites in the first 4 weeks, and then administered ARA-oil for 24 weeks at dietary levels of 0% (control), 1.25%, 2.5% or 5.0%. No statistically significant differences in incidences and multiplicities of hyperplastic and neoplastic lesions were showed in the large intestine in either sex. In the liver, kidney, and lung in both sexes, and the mammary gland and uterus in females, tumor promoting potential was not evident with ARA-oil treatment. ARA-oil did not affect the quantitative data for glutathione S-transferase placental form positive foci of the liver. Increased induction of hyperplastic or neoplastic lesions in the urinary bladder and thyroid in ARA-oil-treated groups was without dose dependence. In addition, a second experiment with ARA-oil only administration for 8-week revealed no effects on cellular proliferation in the urinary bladder or thyroid in either sex. These results indicate that ARA-oil has no tumor promoting potential in any organs or tissues initiated with the five carcinogens applied in the present study.

Supplementation of arachidonic acid-enriched oil increases arachidonic acid contents in plasma phospholipids, but does not increase their metabolites and clinical parameters in Japanese healthy elderly individuals: a randomized controlled study.

BACKGROUND: The importance of arachidonic acid (ARA) among the elderly has recently gained increased attention. The effects of ARA supplementation in the elderly are not fully understood, although ARA is considered to be associated with various diseases. We investigate whether ARA supplementation to Japanese elderly subjects affects clinical parameters involved in cardiovascular, inflammatory, and allergic diseases. We also examine the levels of ARA metabolites such as prostanoids during intervention. METHODS: We conducted a randomized, double-blind and placebo-controlled parallel group intervention trial. ARA-enriched oil (240 or 720 mg ARA per day) or placebo was administered to Japanese healthy men and women aged 55-70 years for 4 weeks followed by a 4-week washout period. The fatty acid contents of plasma phospholipids, clinical parameters, and ARA metabolites were determined at baseline, 2, 4, and 8 weeks. RESULTS: The ARA content in plasma phospholipids in the ARA-administrated groups increased dose-dependently and was almost the same at 2 weeks and at 4 weeks. The elevated ARA content decreased to nearly baseline during a 4-week washout period. During the supplementation and washout periods, no changes were observed in eicosapentaenoic acid and docosahexaenoic acid contents. There were no changes in clinical blood parameters related to cardiovascular, inflammatory and allergic diseases. ARA supplementation did not alter the level of ARA metabolites such as urinary 11-dehydro thromboxane B2, 2,3-dinor-6-keto prostaglandin (PG) F1α and 9,15-dioxo-11α-hydroxy-13,14-dihydro-2,3,4,5-tetranor-prostan-1,20-dioic acid (tetranor-PGEM), and plasma PGE2 and lipoxin A4. ARA in plasma phospholipids was not correlated with ARA metabolite levels in the blood or urine. CONCLUSION: These results indicate that ARA supplementation, even at a relatively high dose, does not increase ARA metabolites, and suggest that it does not induce cardiovascular, inflammatory or allergic diseases in Japanese elderly individuals.

Genotoxicity evaluation of sesamin and episesamin.

Sesamin is a major lignan that is present in sesame seeds and oil. Sesamin is partially converted to its stereoisomer, episesamin, during the refining process of non-roasted sesame seed oil. We evaluated the genotoxicity of these substances through the following tests: a bacterial reverse mutation assay (Ames test), a chromosomal aberration test in cultured Chinese hamster lung cells (CHL/IU), a bone marrow micronucleus (MN) test in Crlj:CD1 (ICR) mice, and a comet assay using the liver of Sprague-Dawley (SD) rats. Episesamin showed negative results in the Ames test with and without S9 mix, in the in vitro chromosomal aberration test with and without S9 mix, and in the in vivo comet assay. Sesamin showed negative results in the Ames test with and without S9 mix. In the in vitro chromosomal aberration test, sesamin did not induce chromosomal aberrations in the absence of S9 mix, but induced structural abnormalities at cytotoxic concentrations in the presence of S9 mix. Oral administration of sesamin at doses up to 2.0g/kg did not cause a significant increase in either the percentage of micronucleated polychromatic erythrocytes in the in vivo bone marrow MN test or in the % DNA in the comet tails in the in vivo comet assay of liver cells. These findings indicate that sesamin does not damage DNA in vivo and that sesamin and episesamin have no genotoxic activity.

Pulmonary artery obstruction due to a metastatic malignant phyllodes tumor of the breast.

A 65-year-old woman with a 9-year surgical history of a left breast phyllodes tumor was admitted with progressive chest pain on effort. Computed tomography showed severe stenosis of the main pulmonary artery, with the mass originating from the ventricular septum. We planned to resect the tumor the next day. However, the next morning a pulmonary artery embolism occurred, and she developed dyspnea and lost consciousness. After carrying out cardiopulmonary resuscitation, we performed a life-saving operation. We successfully resected the huge tumor as far as possible from the right ventricle via a right atrial (RA)-tomy. However, her consciousness did not improve to better than Glasgow Coma Scale grade 7. She died from suffocation caused by metastasis invading her airway despite undergoing tracheotomy on the 77 th postoperative day.

Long-term survival after coronary arterial grafts in patients with end-stage renal disease.

BACKGROUND: Bilateral internal thoracic artery (BITA) grafting is known to improve the long-term survival after coronary artery bypass grafting (CABG). However, there are few reports regarding the efficacy of BITA grafting in end-stage renal disease (ESRD) patients. This study investigates the potential benefits of BITA grafting in ESRD patients. METHODS: One hundred thirty ESRD patients dependent on chronic hemodialysis underwent isolated CABG in the Kumamoto Central Hospital from 1988 to 2009. The early results and long-term outcomes in 49 patients using BITA (BITA group) were compared with 81 patients using a single ITA (SITA group). The mean follow-up time was 5.2 +/- 3.8 years. RESULTS: The mortality rate was 4.9% for the SITA group and 4.1% for the BITA group (p = 0.8215). No differences were seen for the incidence of mediastinitis or a rethoracotomy for bleeding. The 3-year, 5-year, 7-year, and 10-year survival rates in the SITA group were 79.6%, 62.5%, 43.6%, and 22.6%, respectively. The corresponding survival rates in the BITA group were 76.0%, 61.9%, 58.8%, and 33.2%, respectively. There were no statistical differences in survival (p = 0.1636), freedom from cardiac death (p = 0.3205), or freedom from cardiac events (p = 0.4071). In ESRD patients without diabetes mellitus, BITA grafting improves the outcomes concerning cardiac events (p = 0.0143). CONCLUSIONS: After a long-term follow-up, CABG with BITA grafts showed no advantages in the long-term outcomes among ESRD patients. However, for ESRD patients without diabetes mellitus, BITA grafting may provide more promising long-term outcomes.

Novel wrapping technique with insertion of fat tissue for hemostasis in aortic surgery.

The standard techniques and prosthetic materials for graft replacement in aortic surgery have been dramatically improved. However, persistent oozing and bleeding during aortic surgery sometimes occur and lead to life-threatening problems because of severe coagulopathy, which results from induced hypothermia, long cardiopulmonary bypass time, or fragile aortic walls by acute aortic dissection. Although various techniques and devices for reduction of bleeding have been already documented, these techniques are not always perfect and are sometimes complex. A new wrapping technique with insertion of fat tissue, as described in this report, is simple and provides a perfect hemostasis.

Controlled release of matrix metalloproteinase 1 with or without skeletal myoblasts transplantation improves cardiac function of rat hearts with chronic myocardial infarction.

Skeletal myoblast transplantation has been applied clinically for severe ischemic cardiomyopathy. Matrix metalloproteinase 1 (MMP-1) reduces fibrosis and prevents the progress of heart failure. We hypothesized that MMP-1 administration to the infarct area enhances the efficacy of skeletal myoblast transplantation. The controlled release of MMP-1 improved cardiac functions of rats with chronic myocardiac infarction with or without transplantation of skeletal myoblasts. Improvement in cardiac function and small fibrotic area inside the infarcted area were observed compared with those of myoblast transplantation. In conclusion, controlled release of MMP-1 was effective in cardioprotection in postmyocardial infarction although the combination with cell transplantation showed the similar effect.

Delivery route in bone marrow cell transplantation should be optimized according to the etiology of heart disease.

BACKGROUND: Recent studies have revealed that bone marrow cell (BMC) transplantation is effective not only for myocardial infarction (MI), but also for dilated cardiomyopathy (DCM). However, the method of administering donor cells remains unknown, and may differ between MI and DCM. In the present study, intramyocardial (IM) injection and intravenous (IV) delivery of BMC were compared in each etiological model. METHODS AND RESULTS: MI was induced in 72 mice and DCM in another 36 mice by doxorubicin. BMCs were administered IV or IM in an acute MI (AMI), old MI (OMI) or DCM model. In the AMI model, left ventricular (LV) remodeling was reduced in both the IM- and IV-groups, but only in the IM-group in the OMI model. In the DCM model, the LV dimension of the IV-group was smaller than that of the IM-group. Histological examination showed that green fluorescent protein (GFP) cells were equally distributed in the infarct area of the IV- and IM-groups in AMI, and in the IM-group in the OMI model. In the DCM model, GFP cells were diffusely scattered throughout the ventricular wall in the IV-group, but were confined to the injection site in the IM-group. CONCLUSIONS: In OMI, IM delivery of BMCs was more effective than IV; however, IV delivery was superior in DCM. Delivery route should be selected according to the etiology of heart disease to optimize the efficacy of BMC transplantation.

Beta-adrenergic stimulation does not activate Na+/Ca2+ exchange current in guinea pig, mouse, and rat ventricular myocytes.

The effect of beta-adrenergic stimulation on cardiac Na(+)/Ca(2+) exchange has been controversial. To clarify the effect, we measured Na(+)/Ca(2+) exchange current (I(NCX)) in voltage-clamped guinea pig, mouse, and rat ventricular cells. When I(NCX) was defined as a 5 mM Ni(2+)-sensitive current in guinea pig ventricular myocytes, 1 microM isoproterenol apparently augmented I(NCX) by approximately 32%. However, this increase was probably due to contamination of the cAMP-dependent Cl(-) current (CFTR-Cl(-) current, I(CFTR-Cl)), because Ni(2+) inhibited the activation of I(CFTR-Cl) by 1 microM isoproterenol with a half-maximum concentration of 0.5 mM under conditions where I(NCX) was suppressed. Five or ten millimolar Ni(2+) did not inhibit I(CFTR-Cl) activated by 10 microM forskolin, an activator of adenylate cyclase, suggesting that Ni(2+) acted upstream of adenylate cyclase in the beta-adrenergic signaling pathway. Furthermore, in a low-extracellular Cl(-) bath solution, 1 microM isoproterenol did not significantly alter the amplitude of Ni(2+)-sensitive I(NCX) at +50 mV, which is close to the reversal potential of I(CFTR-Cl). No change in I(NCX) amplitude was induced by 10 microM forskolin. When I(NCX) was activated by extracellular Ca(2+), it was not significantly affected by 1 microM isoproterenol in guinea pig, mouse, or rat ventricular cells. We concluded that beta-adrenergic stimulation does not have significant effects on I(NCX) in guinea pig, mouse, or rat ventricular myocytes.