Coronary artery bypass grafting (CABG) induces pro-inflammatory and immunomodulatory phenotype of platelets in the absence of a pro-aggregatory state.

BACKGROUND: Coronary artery bypass grafting (CABG) is considered the choice treatment for patients suffering from coronary artery disease (CAD). In the inflammatory milieu of cardiopulmonary bypass (CPB), systemic inflammatory response syndrome (SIRS) can induce a platelet pro-inflammatory state which could exacerbate post-CABG inflammatory status while affecting hemostatic function in patients. Therefore, focusing on platelets, the study presented here attempted to evaluate the pro-inflammatory and immunomodulatory profile of platelets as well as pro-aggregatory status during CABG. METHODS: Platelets from patients undergoing CABG were subjected to flowcytometry analysis to evaluate P-selectin and CD40L expressions and PAC-1 binding in five intervals of 24 h before surgery, immediately, 2 h, 24 h, and one week after surgery. Moreover, intra-platelet TGF-ß1 was also examined with western blotting. RESULTS: Data showed increases of P-selectin and CD40L expressions in patients, with the meaningful loss of platelet contents of TGF-ß1 after CABG (p < 0.001), where the changes tended to recover by day 7 of surgery while remaining above baseline (p < 0.001). Meanwhile, no significant change in PAC-1 binding capacity was shown. CONCLUSION: The study presented here suggests that although the release of pro-inflammatory substances from platelets during CABG supports the post-operative inflammatory state, platelets are not pro-aggregatory enough to enhance thrombotic events after surgery. Whilst these observations could be due to successful medical interventions to optimize hemostasis during and after surgery, post-CABG reversal of anticoagulant by protamine is considered as another factor that may also have contributed to preventing pro-aggregatory but not pro-inflammatory and immunomodulatory functions of platelets.

Stable CAD patients show higher levels of platelet-borne TGF-ß1 associated with a superior pro-inflammatory state than the pro-aggregatory status; Evidence highlighting the importance of platelet-derived TGF-ß1 in atherosclerosis.

Activated platelets are involved in the atherogenic stage of atherosclerosis, while they can also progress it to atherothrombosis which may cause an ischemic state and organ failure. In general, coronary artery disease (CAD) is considered as common and severe clinical consequence of atherosclerosis, manifesting as a chronic inflammatory condition with the release of platelet mediators, among which the importance of platelet-borne TGF-ß1 is not yet well understood. Hence, for the first time, this study aimed to examine platelet level of TGF-ß1 (latent/mature) in CAD-patients and its association with the expression of platelet pro-inflammatory molecules. Platelet from stable CAD-patients candidate for CABG and healthy controls were subjected to flowcytometry analysis to evaluate P-selectin and CD40L expressions and PAC-1 binding. Platelet-borne and soluble TGF-ß1, both mature/active and latent forms were also examined with western blotting. Higher expression levels of P-selectin and CD40L in patients with CAD than in controls were associated with comparable levels of PAC-1 binding in both groups. Platelet TGF-ß1 levels were also significantly higher in patients, while their platelets showed clear bands of mature TGF-ß1 that were barely visible in healthy individuals. Soluble TGF-ß1 was also higher in patients. Significant correlations between mature/active TGF-ß1 and platelet pro-inflammatory markers (P-selectin and CD40L) as well as common indicators of inflammation (CRP and ESR) were observed in CAD patients. In this study, given the insignificant changes in pro-aggregatory potentials in stable CAD, the pro-inflammatory state of platelets may be more involved in disease development and progression. Direct correlations between active platelet-borne TGF-ß1 and pro-inflammatory markers with its presence in CAD-patients, which was almost absent in the platelets of healthy individuals, may also underscore the significant contribution of platelet-borne TGF-ß1 to the pathogenesis of the disease.

Dual-Source Dual-Energy CT-Scan Confirms the Diagnosis of Ancient Hydatid Cysts Recovered from a Late Roman Burial in Amiens, France.

Background: Two calcified objects recovered from an adolescent in a burial site in Amiens, France, have been previously identified as hydatid cysts using thin-section petrography. The importance of ancient hydatidosis besides the value of these unique archeological excavated materials encouraged the authors to look at this attractive subject more interdisciplinary by implementing medical radiology. Methods: In the current experiment, which has been carried out in the Radiology Department, Tehran Heart Center (THC), Tehran, Iran, the conventional and dual-energy dual-source Tomography, X-Ray Computed-scan was used in studying the remaining structures of the two calcified masses. The imaging procedure was carried out based on X-Ray attenuation by two different tube voltages. Results: A high concentration of calcium sediment in the cyst walls was revealed in Hounsfield units, the measuring of the elements in CT. Taking advantage of implementing this imaging technique the oxalate calcium was also shown as the dominant component of the samples. The results were all in favor of diagnosing hydatid cysts. Conclusion: The achieved pictorial results in the present paper have highlighted the important role of CT scan as a noninvasive confirming technique in paleopathological investigations. Using Dual-source dual-energy CT-scan in reconfirming these previously identified hydatid cysts, is an encouraging message towards the necessity of sequential studies on invaluable biological excavated pieces.

Reducing state attenuates ectodomain shedding of GPVI while restoring adhesion capacities of stored platelets: evidence addressing the controversy around the effects of redox condition on thrombosis.

Thrombosis involves different stages including platelet adhesion to the site of injury, aggregatory events governed by integrin activation, pro-inflammatory responses recruiting leukocytes and finally, pro-coagulant activity which results in fibrin generation and clot formation. As important signaling agents, reactive oxygen species (ROS) reduce thrombus volume and growth, however given such a multistage mechanism, it is not well-elucidated how ROS inhibition modulates thrombosis. PRP-platelet concentrates (PCs) were either treated with ROS-reducing agents (1 mM NAC or 30 µM NOX inhibitor, VAS2870) or kept untreated during storage. Shedding and expression of platelet adhesion receptors in presence of inhibitors, agonists and CCCP (as controls) were analyzed by flow cytometery and western blot respectively. Besides above parameters, platelet adhesion to collagen in stored platelets was examined in presence of ROS inhibitors using fluorescence-microscopy. Highest levels of adhesion receptors shedding were achieved by ionophore and CCCP while collagen induces much more GPVI shedding than that of GPIbα. ROS inhibition reduced receptors shedding from day 3 of storage while enhanced their expressions. ROS inhibition not only did not reduce platelet adhesion capacity but it also enhanced platelets adhesion (in presence of NAC) or spreading (in presence of VAS2870) in 5 days-stored PCs. While reducing state significantly inhibits platelet aggregation and thrombus growth, our results indicated that as a first stage of thrombosis, platelet adhesion is resistance to such inhibitory effects. These findings highlight the fact that integrin-dependent platelet activation is much more vulnerable to the inhibition of ROS generation than GPVI-dependent platelet adhesion. Presumably, inhibition of platelet activating signals by ROS inhibitors preserves platelet adhesiveness to collagen due to lessening GPVI shedding.

Anti-Acanthamoeba Effects of Silver and Gold Nanoparticles and Contact Lenses Disinfection Solutions.

BACKGROUND: This study aimed to investigate the anti-Acanthamoeba effects of the most used marketed disinfecting solutions in Iran. Moreover, the efficacy of some nano-compounds was tested against pathogenic Acanthamoeba. METHODS: The present study was conducted in the School of Public Health, Tehran University of Medical sciences, Tehran, Iran during 2015-2016. Cysts of Acanthamoeba T4 genotype (7 × 104 /ml) mixed at the equal volume with contact lens solutions including Opti-free, Ginza, ReNu, Maxima, Light, and Cyclean for the recommended time by the manufacturers. Nano-silver and nano-gold compounds were also treated with the amoebae. Chlorhexidine 0.02% and normal saline were used as positive and negative controls, respectively. Dead and alive amoebae were determined using vital stain and suspension was cultured in non-nutrient agar. The entire process was repeated at least three times. RESULTS: In none of the solutions in the manufacturer's brochure recommended time, full cytotoxic effect was observed on the cysts of Acanthamoeba. Opti free express solution destroyed the cysts after 6 days. Nanosilver and nano-gold compounds showed no cytotoxic effect on the cysts of Acanthamoeba. CONCLUSION: None of the Nanoparticles compounds as well as contact lenses disinfecting solutions which studied was effective on Acanthamoeba cysts in the manufacturer's brochure recommended time. However, continuing study on Nano-silver and Nano-gold compounds to find effective ingredients against Acanthamoeba are highly recommended.

Human spiruridiasis due to Physaloptera spp. (Nematoda: Physalopteridae) in a grave of the Shahr-e Sukhteh archeological site of the Bronze Age (2800-2500 BC) in Iran.

Evidence of rare human helminthiasis in paleoparasitological records is scarce. we report here the finding of Physaloptera spp. eggs in a soil sample collected in the pelvic and sacrum bones area of a skeleton excavated from a grave of Shahr-e Sukhteh archeological site dating back to the Bronze Age. The site is located in southeastern Iran and has attracted the attention of numerous archeological teams owing to its vast expanse and diverse archeological findings since 1997. The spirurid nematodes Physaloptera spp. are rarely the cause of human helminthiasis nowadays, but this infection might not have been so rare in ancient populations such as those in the Shahr-e Sukhteh. Out of 320 skeletons analyzed in this study, only one parasitized individual was detected. This surprising result led us to suspect the role of nematophagous fungi and other taphonomic processes in possible false-negative results. This is the first paleoparasitological study on human remains in this archeological site and the first record of ancient human physalopterosis in the Middle East.

Impact of metabolic syndrome on mortality and morbidity after coronary artery bypass grafting surgery.

BACKGROUND: The prevalence of Metabolic syndrome (MetS) has been increased in Asian countries. It represents a cluster of cardiovascular risk factors including obesity, insulin resistance, lipid abnormality and hypertension. OBJECTIVES: The purpose of this study was to assess the association between MetS and outcome in patients undergoing coronary artery bypass grafting surgery (CABG). PATIENTS AND METHODS: This prospective study was performed on patients scheduled for coronary artery bypass grafting surgery (CABG). All the patients were followed up in hospital and three months afterward. Patients were excluded if they were younger than 18 years or had severe comorbidities, a history of valvular heart disease, and low ejection fraction. RESULTS: A total of 235 patients (135 women) with a mean age of 59 ± 9.3 years were included. MetS was more prevalent in women (P < 0.001). The most prevalent complications were bleeding [20 (8.5%)] and dysrhythmia [18 (7.7%)]. At three months follow-up, the frequency rates of readmission [24 (10.2%)] and mediastinitis [9 (3.8%)] were higher than other complications. Diabetes and MetS were risk factors for a long ICU stay (> 5 days) and atelectasia (P < 0.05). Significant associations were observed between diabetes and pulmonary embolism (P = 0.025) and mediastinitis (P = 0.051). CONCLUSIONS: Identification of MetS before CABG can predict the surgery outcome. Patients with MetS have increased risks for longer ICU stay and atelectasia.

A Review of Myiasis in Iran and a New Nosocomial Case from Tehran, Iran.

BACKGROUND: Due to various climatic conditions in different parts of Iran, presenting of various kinds of human myiasis is expected. Despite of a few case series, most papers related to myiasis are case reports originated from various parts of Iran. This study discusses on different clinical features of myiasis in Iran and description of one case from Tehran as a representative to nosocomial infection in Iran. METHODS: The information needed for this descriptive study was derived mainly from the digital library of Tehran University of Medical Sciences. The larvae have been identified with observing on posterior spiracles, spines of their body and anal tubercles. RESULTS: Total number of reported myiasis cases from Iran is 77 which can be categorized clinically as furuncular, wound, ophthalmic, auricular, nasopharyngeal, oral, intestinal and genitourinary. Based on parasitological features, all myiasis agents in Iran are belonging to Calliphoridae, Sarcophagidae, Oestridae and Syrphidae flies. The case which is reporting in this paper can be mentioned as representative of nosocomial myiasis which it seems to be underreported because of some medicolegal reasons. CONCLUSION: Low number of investigations on various aspects of human myiasis, as well as incuriosity to report of the cases in disease reporting system of health minister, made the myiasis as a neglected disease.

The Effects of Positive Airway Pressure Ventilation during Cardiopulmonary Bypass on Pulmonary Function Following Open Heart Surgery.

BACKGROUND: Intrapulmonary shunt as a result of atelectasis following cardiac surgeries is an important and common postoperative complication that results into pulmonary dysfunction typically lasting more than a week following surgery. Different methods have been provided to prevent these complications. OBJECTIVES: In order to prevent postoperative pulmonary complications, investigation of the effectiveness of continuous positive airway pressure (CPAP) and intermittent mandatory ventilation (IMV) during cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass grafting (CABG). MATERIALS AND METHODS: In this prospective interventional study, 300 patients, candidate for elective CABG (On-Pump), were randomly allocated to 3 groups: A, B, C. Group A (CPAP) patients received CPAP at 10 cm H2O during CPB. Group B (IMV) patients received IMV with a tidal volume of 2 cc/kg and respiratory rate of 15/min and group C (control) patients did not receive any type of ventilation during CPB. Other procedures were similar between groups. Arterial blood samples were taken at 8 moments and arterial blood gas (ABG) analysis were compared between groups. Chest x-rays after CABG were also evaluated with respect to atelectasis. RESULTS: The demographic data were similar in between three groups. Graft number, pump time and preoperative ABGs were not significantly different. Postoperative PaO2 were significantly higher in the CPAP and IMV groups and (A-a) DO2 were significantly lower in these two groups, compared to the control group. CONCLUSIONS: In the present study, applying positive airway pressure methods (CPAP or IMV) during CPB was associated with better postoperative ABG measurements and (A-a) DO2.

Right atrial chemodectoma with atypical chest pain: a 6-year surgical follow-up.

Paragangliomas are rare neoplasms of neural crest origin and arise from the chromaffin (pheochromocytomas) or chemoreceptor (chemodectomas) tissues. Patients with cardiac chemodectomas, hormonally inactive paragangliomas, may have chest pain or various obstructive or compressive symptoms, depending on the location of the tumor. We report the case of a right atrial chemodectoma causing atypical chest pain. The tumor was discovered at transthoracic echocardiography. Coronary angiography showed a vascular tumor fed by a branch of the circumflex artery. En bloc tumor resection was carried out under cardiopulmonary bypass, with an uneventful surgical course. After 6 years of follow-up, the patient remains asymptomatic and disease-free.

Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVES: The present study was aimed to identify the preoperative, intraoperative, and postoperative predictors of AF in a pure cohort of the patients with coronary artery disease who underwent CABG surgery. METHODS: Between November 2005 and May 2006, 302 consecutive patients were included in this prospective study. All the relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in the included patients and they were also monitored for development of post-CABG AF. RESULTS: Postoperative AF occurred in 46 (15%) of patients. By univariate analysis, older age, P-wave abnormality in ECG, presence of mitral regurgitation, larger left atrium (LA), left main coronary artery involvement, failure to graft right coronary artery (RCA), and adrenergic use in ICU were significantly associated with occurrence of post-CABG AF (all P< 0.05). However, in the logistic regression model, age (OR: 1.067, 95%CI: 1.02-1.116, P=0.005), LA dimension (OR: 1.102, 95%CI: 1.017-1.1936, P=0.017), P-wave morphology (OR: 12.07, 95%CI: 3.35-48.22, P=0.0001), failure to graft RCA (OR: 3.57, 95%CI: 1.20-10.64, P=0.022), and postoperative adrenergic use (OR: 0.35, 95%CI: 0.13-0.93, P=0.036) remained independently predictive of postoperative AF. CONCLUSION: The present study suggested that age, P-wave morphology, LA dimension, failure to graft right coronary artery, and postoperative adrenergic use were independent predictors of post-CABG AF. Therefore, clinical data, ECG and echocardiography may be useful in preoperative risk stratification of the surgical patients for the occurrence of post-CABG AF.