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Objective: Mitral valve transcatheter edge-to-edge repair (TEER) is an effective therapeutic alternative to mitral valve surgery for high-risk surgical patients with mitral regurgitation (MR). The TEER route necessitates the use of the femoral vein approach. We present a case report of a patient with atrial functional MR (AFMR) and an indwelled inferior vena cava filter (IVCF) who underwent TEER using the MitraClip system (Abbott Vascular, Santa Clara, CA, USA). Case Presentation: A 78-year-old male with an IVCF experienced frequent hospitalization for heart failure (HF) due to severe AFMR despite receiving maximally tolerated doses of guideline-directed medical therapy. Treatment for AFMR was necessary to prevent HF-related hospitalization. Considering the patient's high surgical risk and frailty, a minimally invasive approach was favored. However, the presence of the indwelled IVCF obstructed the use of the femoral vein for the MitraClip approach. Computed tomography revealed that all IVCF struts had penetrated the inferior vena cava (IVC) wall. Our heart team determined that endovascular venoplasty or stenting to establish the MitraClip approach route posed a high risk of IVC rupture. Consequently, we initially performed surgical IVCF removal, followed by TEER using the MitraClip system via conventional femoral vein access after one month. Following the intervention therapies, the patient has remained free from HF-related rehospitalization for 2 years. Conclusion: Surgical IVCF removal emerges as a viable treatment option for establishing the MitraClip system access route. [ABSTRACT FROM AUTHOR]

Current trend of climate change and depletion of ozone layer may cause the amount of ultraviolet (UV) radiation in the atmosphere to increase and thus, affecting biodiversity and ecosystem. Plants are one of the most affected organisms due their need of sunlight to carry important process of photosynthesis and the presence of UV radiation may result in detrimental effects on them. However, with controlled amount of UV radiation exposure as abiotic stress condition, plants will be able to develop a plant defense chemical and present an alternative source of drug discovery as natural products. Plant secondary metabolites are important compounds largely used in pharmaceutical industry and commonly found in Brassicaceae family plants such as broccoli sprouts, red cabbage sprouts and kale sprouts. Previous studies suggested that Brassicaceae sprouts is a good source of phytochemicals and reported to exhibit bioactive properties including antioxidative and anti-inflammatory. In this study, an overview of the effect of UV-B radiation exposure as abiotic stress on the amount of Brassicaceae sprouts bioactive compound and antioxidant activities are presented and discussed. Brassicaceae sprouts are grown and exposed to UV-B radiation under different sets of time and fresh samples of the sprouts are extracted with ethanol before undergoing phytochemical analysis for total phenolic content and then proceed with DPPH assays to study its antioxidant activity. Results suggest that UV-B radiation causes increase in double in the amount of total phenolic content for red cabbage sprout from 0.33 to 0.63 mg gallic acid/g-1 and increase in the antioxidant activity of kale sprout from 0.74 to 0.80 mg Trolox/g-1 from Brassicaceae species at 5th-min of exposure. This study is important to understand the increment of UV radiation from ozone layer depletion for plants particularly from Brassicaceae family to adapt to these changes while applying them in different industries including agriculture and health for their bioactive compounds. [ABSTRACT FROM AUTHOR]

Left ventricular perforation is an uncommon complication in transcatheter aortic valve implantation (TAVI). And a case of left ventricular perforation associated with an aberrant right subclavian artery (ARSA) has rarely been reported. An 86-year-old female attended our hospital with symptomatic severe aortic stenosis. Because of the patient's advanced age, and that she was a long-term steroid user, we treated her using TAVI. Although the presence of ARSA was noted, the aortic arch was a smooth arc on images of computed tomography (CT) along the axis of the aortic arch. A trans-femoral TAVI was performed. When the TAVI device passed through the aortic arch, the angle of the delivery system suddenly changed, and the guidewire was pushed in, which caused left ventricular perforation. We had to open the chest and perform a repair procedure. There was an enlarged space at the ARSA origin in three-dimensional (3D) CT, and this space may have caused the unexpected guidewire movement. The TAVI device may move in unexpected ways in presence of ARSA. It is necessary to carefully evaluate the access route using 3D CT as part of the preoperative evaluation to determine the safest treatment strategy. [ABSTRACT FROM AUTHOR]

Background: A persistent left superior vena cava (PLSVC) is an anomaly of the thoracic venous system that flows into the right atrium via an enlarged coronary sinus. When performing pulmonary vein isolation and left atrial appendage closure, the PLSVC can interfere with the procedure. We have performed thoracoscopic surgery on such a patient and would like to share our experience. Case presentation: The patient is a 70-year-old male with a 1-year history of repeated tachycardia with chest discomfort due to paroxysmal atrial fibrillation. Contrast-enhanced computed tomography revealed the presence of a PLSVC that flows into the right atrium. The hepatic vein flows directly into the right atrium, whereas the inferior vena cava enters the thoracic cavity next to the descending aorta and flows into the parazygous vein and PLSVC. We performed thoracoscopic stapler closure of the left atrial appendage and epicardial clamp-isolation of the pulmonary veins and the PLSVC. There was concern that the PLSVC would interfere with the visual field needed to perform the procedure. We carefully removed the adhesions to the surrounding tissue and provided mobility to the PLSVC and expanded it ventrally. As a result, the procedure could be performed safely and without complications. Conclusions: Our results demonstrate that in cases where catheter ablation is difficult for anatomical reasons, thoracoscopic stapler closure of the LAA and epicardial clamp-isolation of pulmonary veins may be a viable option. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal stem cells (MSCs) repair injured tissue in a paracrine manner. To enhance their therapeutic properties, preconditioning with various factors has been researched. We have previously showed that MSCs cultured in serum-free medium (SF-MSCs) promote their immunosuppressive ability, thereby enhancing their anti-fibrotic effect. Here, we examined whether serum-free medium and hypoxic preconditioning synergistically enhance the therapeutic effects of MSCs on renal fibrosis in rats with ischemia-reperfusion injury (IRI). Methods: SF-MSCs were incubated under 1% O2 conditions (hypo-SF-MSCs) or 21% O2 conditions (normo-SF-MSCs) for 24 h before collection. After IRI procedure, hypo-SF-MSCs or normo-SF-MSCs were injected through the abdominal aorta. At 7 or 21 days post-injection, the rats were killed and their kidneys were collected to evaluate inflammation and fibrosis. In in vitro experiments, we investigated whether hypo-SF-MSCs enhanced secretion of anti-fibrotic humoral factors using transforming growth factor (TGF)-β1-stimulated HK-2 cells incubated with conditioned medium from hypo-SF-MSCs or normo-SF-MSCs. Results: Normo-SF-MSCs showed attenuation of senescence, which increased their proliferative capacity. Although no significant difference in cellular senescence was found between normo-SF-MSCs and hypo-SF-MSCs, hypo-SF-MSCs further increased their proliferative capacity compared with normo-SF-MSCs. Additionally, administration of hypo-SF-MSCs more strongly ameliorated renal fibrosis than that of normo-SF-MSCs. Moreover, although hypo-SF-MSCs strongly attenuated infiltration of inflammatory cells compared with the control rats, which were treated with PBS, this attenuation was almost equal between normo-SF-MSCs and hypo-SF-MSCs. In vitro experiments revealed that hypo-SF-MSCs more significantly inhibited transforming growth factor (TGF)-β/Smad signaling compared with normo-SF-MSCs. Moreover, hypoxic preconditioning increased hepatocyte growth factor (HGF) secretion even under serum-free conditions, whereas knockdown of HGF in hypo-SF-MSCs attenuated inhibition of TGF-β/Smad signaling. Conclusions: These results indicate that administration of ex vivo-expanded, hypoxia-preconditioned SF-MSCs may be a useful cell therapy to prevent renal fibrosis. [ABSTRACT FROM AUTHOR]

Introduction: Body temperature maintained during open distal anastomosis in patients who undergo aortic surgery has been showing an upward trend; however, a higher temperature may increase visceral organ and spinal cord injury. Distal perfusion may reduce abdominal organ injury, especially acute kidney injury (AKI). Methods: From 2009 to 2016, 56 patients who underwent ascending aortic and/or aortic arch surgery were enrolled. Open distal anastomosis was performed using one of three protection strategies: 1) systemic temperature of 25°C followed by selective cerebral perfusion (SCP) with lower body circulatory arrest (Group CA25, n=27); 2) systemic temperature of 28°C followed by SCP with lower body circulatory arrest (Group CA28, n=4); and 3) systemic temperature of 28°C followed by SCP with distal aortic perfusion (Group DP, n=25). Results: During the postoperative course, levels of blood urea nitrogen, creatinine, liver enzymes, lactate dehydrogenase and lactate in Groups CA28 and CA25 were significantly higher than those in Group DP. AKI defined by the AKI Network occurred in 28 cases (50%) and 3 cases required permanent hemodialysis. AKI was significantly higher in Groups CA25 and CA28 than in Group DP (p=0.026). Mid-term follow-up showed that patients who developed postoperative AKI were more likely to suffer from cardiovascular events. Conclusions: Distal perfusion during open distal anastomosis reduced kidney and liver injury after thoracic aortic surgery despite an increased body temperature of up to 28°C. This strategy may be useful to prevent AKI, liver dysfunction, the need for hemodialysis and multiple organ failure and could improve mid-term results. [ABSTRACT FROM AUTHOR]

Background: A common SCN5A polymorphism H558R (c.1673 A > G, rs1805124) improves sodium channel activity in mutated channels and known to be a genetic modifier of Brugada syndrome patients (BrS). We investigated clinical manifestations and underlying mechanisms of H558R in BrS. Methods and results: We genotyped H558R in 100 BrS (mean age 45 ± 14 years; 91 men) and 1875 controls (mean age 54 ± 18 years; 1546 men). We compared clinical parameters in BrS with and without H558R (H558R+ vs. H558Rgroup, N = 9 vs. 91). We also obtained right atrial sections from 30 patients during aortic aneurysm operations and compared SCN5A expression and methylation with or without H558R. H558R was less frequent in BrS than controls (9.0% vs. 19.2%, P = 0.028). The VF occurrence ratio was significantly lower (0% vs. 29.7%, P = 0.03) and spontaneous type 1 ECG was less observed in H558R+ than H558R- group (33.3% vs. 74.7%, P = 0.01). The SCN5A expression level was significantly higher and the methylation rate was significantly lower in sections with H558R (N = 10) than those without (0.98 ± 0.14 vs. 0.83 ± 0.19, P = 0.04; 0.7 ± 0.2% vs. 1.6 ± 0.1%, P = 0.004, respectively). In BrS with heterozygous H558R, the A allele mRNA expression was 1.38 fold higher than G allele expression. Conclusion: The SCN5A polymorphism H558R may be a modifier that protects against VF occurrence in BrS. The H558R decreased the SCN5A promoter methylation and increased the expression level in cardiac tissue. An allelic expression imbalance in BrS with a heterozygous H558R may also contribute to the protective effects in heterozygous mutations. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cerebral malperfusion for patients with acute type A aortic dissection (AAAD) remains an unsolved problem. The present study aimed to evaluate our management of cerebral perfusion and identify predictors of perioperative cerebral malperfusion in patients undergoing surgical repair of AAAD. METHODS: Between January 2004 and December 2015, 137 consecutive patients with AAAD underwent aortic replacement at Tsuchiya General Hospital. The status of the dissected supra-aortic branch vessels (SABVs) was classified as patent or thrombosis by preoperative computed tomographic angiography. Intraoperative cerebral perfusion was monitored by transcutaneous carotid echo and regional oxygen saturation. In cases with neurological symptoms or cerebral malperfusion, quick cerebral perfusion was immediately started using a quick cutdown technique. We assessed clinical outcomes, including mortality and complications, and analysed predictors of early mortality and cerebral malperfusion. RESULTS: The early mortality rate was 8.0%. Postoperative cerebral injury was observed in 4 patients (2.9%). Nineteen patients had perioperative cerebral malperfusion. There were no postoperative cerebral injuries in the patients in whom intraoperative cerebral malperfusion was corrected. Multivariable analysis revealed that preoperative shock (odds ratio [OR] 22.60, P < 0.0001) and extension of dissection to the abdominal aorta (OR 9.31, P = 0.0064) were significant risk factors for early mortality. Preoperative neurological symptoms (OR 12.40, P = 0.0006) and partial or complete thrombosis of the SABV (OR 64.10, P < 0.0001) were identified as independent predictors of perioperative cerebral malperfusion. CONCLUSIONS: Perioperative cerebral perfusion should be carefully managed, especially in the patients with preoperative neurological symptoms or partial or complete thrombosis of the SABV. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Spinal cord injury (SCI) after the frozen elephant trunk (FET) technique is more frequent than after endovascular aneurysm repair. This study aimed to identify risk factors of SCI after the FET technique. METHODS: We performed the FET technique for extended thoracic aortic disease in 224 patients (mean age, 72.1 ± 10.9 years) from September 1997 to December 2011. The patients included those with acute type A aortic dissection (n = 103), acute type B aortic dissection (n = 30), chronic type B aortic dissection (n = 11) and thoracic atherosclerotic aneurysm (n = 80). Cerebrospinal fluid drainage (CSFD) was preoperatively performed for 18 elective cases with a high risk of spinal cord ischaemia from January 2003. RESULTS: Postoperative SCI was present in 8 (3.5%), including complete paraplegia in 3, patients and transient or permanent paraparesis in 5 patients. CSFD was not a significant independent risk factor (P = 0.93) for SCI. Univariate logistic regression analysis identified pathology (P = 0.001), diabetes (P = 0.001), previous aortic operation (P = 0.003), atherosclerotic aorta (P = 0.003), distal position of the stent graft below the ninth thoracic vertebral level (Th9; P = 0.001) and low blood pressure after the operation (P = 0.009) as significant independent risk factors for SCI. Stepwise logistic regression analysis identified the distal position of the stent graft below Th9 (P = 0.003; odds ratio [OR], 15.167; 95% confidence interval [95% CI], 2.568-89.578), mean pressure <70 mmHg (P = 0.008; OR, 11.470; 95% CI, 1.920-68.546) and diabetes (P = 0.009; OR, 9.621; 95% CI, 1.779-52.032) as significant independent risk factors for SCI. CONCLUSIONS: There were multiple factors predicting the risk of SCI after the FET technique. Paraplegia may be prevented by avoiding deep insertion of the stent graft and by keeping blood pressure elevated after the operation. [ABSTRACT FROM AUTHOR]

Morphologies of cured epoxy/brominated‐phenoxy blends were observed by scanning transmission electron microscopy (STEM) and energy dispersive X‐ray fluorescence spectroscopy (EDX). When brominated‐phenoxy content was 30 wt %, cocontinuous phase structures between cured epoxy and brominated‐phenoxy were found. Since every loss tangent (tan δ) curve as a function of temperature on dynamic mechanical analysis (DMA) showed 2 peaks at 128°C and 155°C respectively, cured epoxy phases and brominated‐phenoxy phases were incompatible together and Tgs of cured epoxy phases were not decreased. Tensile strength and tensile elongation of the cured blends were increased together. T‐peel adhesion strength and the lap‐shear adhesion strength were also increased together. These phenomena could be due to the cocontinuous structures consisted by the rigid cured epoxy phases of thermosets and ductile the brominated‐phenoxy phases of thermoplastics. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 104: 1702–1713, 2007 [ABSTRACT FROM AUTHOR]

The pore size of voids in crazed polypropylene (PP) was controlled by Laplace-pressure. Void diameter decreased and dropped out at 100 degrees lower temperature from the melting point of PP. These crazed films are adequate to a battery separator for the application. In this work, we attempted to extend the craze phase for high porosity. New voids were generated and grown around existing voids, and the number of voids per unit area was increased while maintaining the average void diameter. Healing temperature of the crazed PP films by Laplace-pressure was 60 °C in air, however 110 °C–135 °C in electrolytic solutions of propylene carbonate, dimethyl sulfoxide, and diethyl carbonate. This craze healing temperature depended on the interfacial tension. [ABSTRACT FROM AUTHOR]

Analysis of genetic mutations is one of the most effective ways to investigate gene function. We now have methods that allow for mass production of mutant lines and cells in a variety of model species. Recently, large numbers of mutant lines have been generated by both ‘loss-of-function’ and ‘gain-of-function’ techniques. In parallel, phenotypic information covering various mutant resources has been acquired and released in web-based databases. As a result, significant progress in comprehensive pheno-type analysis is being made through the use of these tools. Arabidopsis and rice are two major model plant species in which genome sequencing projects have been completed. Arabidopsis is the most widely used experimental plant, with a large number of mutant resources and several examples of systematic phenotype analysis. Rice is a major crop species and is used as a model plant, with an increasing number of mutant resources. Other plant species are also being employed in functional genetics research. In this review, the present status of mutant resources for large-scale studies of gene function in plant research and the current perspective on using loss-of-function and gain-of-function mutants in phenome research will be discussed. [ABSTRACT FROM AUTHOR]