Force-Induced Alignment of Nanofibrillated Bacterial Cellulose for the Enhancement of Cellulose Composite Macrofibers.

Bacterial cellulose, as an important renewable bioresource, exhibits excellent mechanical properties along with intrinsic biodegradability. It is expected to replace non-degradable plastics and reduce severe environmental pollution. In this study, using dry jet-wet spinning and stretching methods, we fabricate cellulose composite macrofibers using nanofibrillated bacterial cellulose (BCNFs) which were obtained by agitated fermentation. Ionic liquid (IL) was used as a solvent to perform wet spinning. In this process, force-induced alignment of BCNFs was applied to enhance the mechanical properties of the macrofibers. The results of scanning electron microscopy revealed the well-aligned structure of BCNF along the fiber axis. The fiber prepared with an extrusion rate of 30 m min-1 and a stretching ratio of 46% exhibited a strength of 174 MPa and a Young's modulus of 13.7 GPa. In addition, we investigated the co-spinning of carboxymethyl cellulose-containing BCNF with chitosan using IL as a "container", which indicated the compatibility of BCNFs with other polysaccharides. Recycling of the ionic liquid was also verified to validate the sustainability of our strategy. This study provides a scalable method to fabricate bacterial cellulose composite fibers, which can be applied in the textile or biomaterial industries with further functionalization.

[Aortic Root Partial Reconstruction Combined with Intraoperative Aortic Dissection:Report of a Case].

A 73-year-old woman with Valsalva aneurysm and mitral regurgitation was introduced to our department. We performed combined operation including aortic root partial repair and mitral valve repair. After wenning from cardiopulmonary bypass, intraoperative aortic dissection was confirmed by transesophageal echocardiography from the ascending aorta to the descending aorta, entry was near to proximal anastomosis line of the ascending aorta. To avoid heart failure, the ascending aorta wrapping by prothesis graft was performed to protect from urgent rupture postoperative at first stage. According to contrast computed tomography (CT) findings, location of entry was correspond with aortic clamping. We performed partial aortic replacement including innominate artery reconstruction for her at fourth day postoperative for treating aortic dissection at second stage. Postoperative course was uneventful.

Resection of left atrial appendage aneurysm and full maze procedure as curative management for stroke recurrence.

Left atrial appendage aneurysm (LAAA) is a rare congenital heart anomaly that frequently becomes apparent after middle age. We report a case of LAAA in a 63-year-old woman with stroke. After stabilization of ischemic cerebral stroke, the patient underwent left atrial appendectomy with full maze procedure and tricuspid annuloplasty under cardiac arrest with cardiopulmonary bypasss. She has been living a healthy life without anticoagulants postoperatively. Resection and the full-maze procedure is an efficacious and durable procedure for LAAA with chronic atrial fibrillation.

[Valve Replacement for Tricuspid Regurgitation with Congenitally Corrected Transposition of the Great Arteries].

Congenitally corrected transposition of the great arteries accounts for less than 1% of congenital heart diseases, and is defined as ventriculoarterial and atrioventricular discordance. We report a case of a 56-year-old woman complaining of persistent cough, who was diagnosed with congenitally corrected transposition of the great arteries and dextrocardia. Moderate regurgitation of the systemic tricuspid valve was revealed. The surgeon was positioned on the left side of the patient, and performed tricuspid valve replacement through the left atrium. Furthermore, mitral valve annuloplasty, atrial septal defect closure, and myocardial electrode implantation were performed. The postoperative course was uneventful.

Rate of Stenotic Bicuspid Aortic Valve Aortic Dilatation After Aortic Valve Replacement, Calculated Using a 3-Dimensional Reconstruction Tool.

BACKGROUND: Progression of asymmetric dilated aorta associated with bicuspid aortic valve (BAV) is difficult to evaluate conventionally. The aim of the study was to calculate the rate of progression of the dilated BAV aorta after aortic valve replacement (AVR) using a 3-dimensional (3-D) reconstruction tool.Methods and Results:Fourteen stenotic BAV and 14 stenotic tricuspid aortic valve (TAV) patients with mildly dilated ascending aorta were reviewed. A patient-specific 3-D aortic model was reconstructed from preoperative and postoperative computed tomography data (BAV, 2.5±1.9 years after AVR; TAV, 2.2±1.8 years after AVR). Aortic diameter, including the longest and shortest, was measured on the maximum perpendicular cross-section tangential to the 3-D centerline of the reconstructed model. The longest diameter was defined as that passing through the distal point of the greater curvature of the aorta. The shortest diameter was defined as perpendicular to the longest. The progression rates were compared between the BAV and TAV groups. The progression rate of ascending aortic diameter was greater for BAV (longest diameter, 1.02±1.03 vs. -0.075±0.78 mm/year, P<0.001; shortest diameter, 0.41±0.62 vs. -0.016±0.59 mm/year, P=0.003). The longest diameter of the proximal arch also grew more rapidly in the BAV group (P<0.001). CONCLUSIONS: Ascending aortic dilatation with stenotic BAV progresses after AVR at a maximum rate of 1.02±1.03 mm/year. Expansion toward the greater curvature frequently progresses to the proximal arch.

Cannulation needle-induced anterior wall tenting of internal jugular vein causing posterior wall penetration.

Unintentional posterior venous wall penetration during internal jugular vein (IJV) cannulation may cause critical arterial injuries in spite of ultrasound guidance. We aimed to evaluate whether small venous diameter and anterior venous wall tenting by a needle would be associated with posterior venous wall penetration, and to seek factors related to the venous wall tenting. We conducted a retrospective review in patients who underwent IJV cannulation. Using an ultrasound view obtained when puncturing, venous diameter, venous wall thickness, anterior venous wall tenting length, and needle angle were measured, and posterior venous wall penetration was determined. Eleven cannulations in 56 patients were assigned to posterior venous wall penetration. Small venous diameter (p = 0.004), and long anterior venous wall tenting (p = 0.007) were associated with posterior venous wall penetration. The longer anterior venous tenting would be expected with reducing needle angle (p = 0.004) or increasing anterior venous wall thickness (p = 0.006). In conclusion, small IJV and anterior venous wall tenting lead to posterior venous wall penetration. Anterior venous wall tenting is longer with reducing needle angle, or increasing the anterior venous wall thickness.

Cardiac stab injury by a bodkin.

A 46-year-old male had a cardiac stab injury resulting in cardiac tamponade as a result of a suicide attempt using a bodkin, a sharply pointed instrument for making holes. The patient was transferred to our hospital about 12 hours after the injury. Pericardiotomy at the emergency operation revealed the penetration of the right ventricle and the hole was repaired following removal of the bodkin. Postoperative course was uneventful.

Aortic valve perforation due to latent infective endocarditis.

A 64-year-old man underwent aortic valve replacement for aortic regurgitation. The aortic valve was perforated in the noncoronary cusp. Pathological findings showed that the perforation probably occurred due to infective endocarditis. However, the patient had no obvious inflammatory signs preoperatively, to suggest latent infective endocarditis.

Remarkable improvement of hemodynamics by continuous hemodiafiltration in patients after operation for thoracic aortic dissection.

Severe circulatory failure after cardiovascular surgery is occasionally difficult to treat and the mortality risk is high. Systemic inflammatory response syndrome (SIRS) is one of the complications resulting in circulatory failure and, continuous hemodiafiltration (CHDF) seems to be a potentially effective treatment to improve the critical condition by removing proinflammatory cytokines. We present two recent cases of SIRS with critical circulatory failure which were successfully treated by CHDF after operation for thoracic aortic dissection.