Influence of brain death and associated trauma on solid organ histological characteristics

PURPOSE: To evaluate histopathological alterations triggered by brain death and associated trauma on different solid organs in rats. METHODS: Male Wistar rats (n=37) were anesthetized with isoflurane, intubated and mechanically ventilated. A trepanation was performed and a balloon catheter inserted into intracraninal cavity and rapidly inflated with saline to induce brain death. After induction, rats were monitored for 30, 180, and 360 min for hemodynamic parameters and exsanguinated from abdominal aorta. Heart, lung, liver, and kidney were removed and fixed in paraffin to evaluation of histological alterations (H&E). Sham-operated rats were trepanned only and used as control group. RESULTS: Brain dead rats showed a hemodynamic instability with hypertensive episode in the first minute after the induction followed by hypotension for approximately 1 h. Histological analyses showed that brain death induces vascular congestion in heart (p<0.05), and lung (p<0.05); lung alveolar edema (p=0.001), kidney tubular edema (p<0.05); and leukocyte infiltration in liver (p<0.05). CONCLUSIONS: Brain death induces hemodynamic instability associated with vascular changes in solid organs and compromises most severely the lungs. However, brain death associated trauma triggers important pathophysiological alterations in these organs.

Nonlinear estimation of neural processing time from BOLD signal with application to decision-making

The extraction of information about neural activity timing from BOLD signal is a challenging task as the shape of the BOLD curve does not directly reflect the temporal characteristics of electrical activity of neurons. In this work, we introduce the concept of neural processing time (NPT) as a parameter of the biophysical model of the hemodynamic response function (HRF). Through this new concept we aim to infer more accurately the duration of neuronal response from the highly nonlinear BOLD effect. The face validity and applicability of the concept of NPT are evaluated through simulations and analysis of experimental time series. The results of both simulation and application were compared with summary measures of HRF shape. The experiment that was analyzed consisted of a decision-making paradigm with simultaneous emotional distracters. We hypothesize that the NPT in primary sensory areas, like the fusiform gyrus, is approximately the stimulus presentation duration. On the other hand, in areas related to processing of an emotional distracter, the NPT should depend on the experimental condition. As predicted, the NPT in fusiform gyrus is close to the stimulus duration and the NPT in dorsal anterior cingulate gyrus depends on the presence of an emotional distracter. Interestingly, the NPT in right but not left dorsal lateral prefrontal cortex depends on the stimulus emotional content. The summary measures of HRF obtained by a standard approach did not detect the variations observed in the NPT. Hum Brain Mapp, 2012. (C) 2010 Wiley Periodicals, Inc.

Protein Disulfide Isomerase Is Required for Platelet-derived Growth Factor-induced Vascular Smooth Muscle Cell Migration, Nox1 NADPH Oxidase Expression, and RhoGTPase Activation

Vascular Smooth Muscle Cell (VSMC) migration into vessel neointima is a therapeutic target for atherosclerosis and postinjury restenosis. Nox1 NADPH oxidase-derived oxidants synergize with growth factors to support VSMC migration. We previously described the interaction between NADPH oxidases and the endoplasmic reticulum redox chaperone protein disulfide isomerase (PDI) in many cell types. However, physiological implications, as well as mechanisms of such association, are yet unclear. We show here that platelet-derived growth factor (PDGF) promoted subcellular redistribution of PDI concomitant to Nox1-dependent reactive oxygen species production and that siRNA-mediated PDI silencing inhibited such reactive oxygen species production, while nearly totally suppressing the increase in Nox1 expression, with no change in Nox4. Furthermore, PDI silencing inhibited PDGF-induced VSMC migration assessed by distinct methods, whereas PDI overexpression increased spontaneous basal VSMC migration. To address possible mechanisms of PDI effects, we searched for PDI interactome by systems biology analysis of physical protein-protein interaction networks, which indicated convergence with small GTPases and their regulator RhoGDI. PDI silencing decreased PDGF-induced Rac1 and RhoA activities, without changing their expression. PDI co-immunoprecipitated with RhoGDI at base line, whereas such association was decreased after PDGF. Also, PDI co-immunoprecipitated with Rac1 and RhoA in a PDGF-independent way and displayed detectable spots of perinuclear co-localization with Rac1 and RhoGDI. Moreover, PDI silencing promoted strong cytoskeletal changes: disorganization of stress fibers, decreased number of focal adhesions, and reduced number of RhoGDI-containing vesicular recycling adhesion structures. Overall, these data suggest that PDI is required to support Nox1/redox and GTPase-dependent VSMC migration.

Paradoxical effects of brain death and associated trauma on rat mesenteric microcirculation: an intravital microscopic study

OBJECTIVE: Experimental findings support clinical evidence that brain death impairs the viability of organs for transplantation, triggering hemodynamic, hormonal, and inflammatory responses. However, several of these events could be consequences of brain death-associated trauma. This study investigated microcirculatory alterations and systemic inflammatory markers in brain-dead rats and the influence of the associated trauma. METHOD: Brain death was induced using intracranial balloon inflation; sham-operated rats were trepanned only. After 30 or 180 min, the mesenteric microcirculation was observed using intravital microscopy. The expression of P-selectin and ICAM-1 on the endothelium was evaluated using immunohistochemistry. The serum cytokine, chemokine, and corticosterone levels were quantified using enzyme-linked immunosorbent assays. White blood cell counts were also determined. RESULTS: Brain death resulted in a decrease in the mesenteric perfusion to 30%, a 2.6-fold increase in the expression of ICAM-1 and leukocyte migration at the mesentery, a 70% reduction in the serum corticosterone level and pronounced leukopenia. Similar increases in the cytokine and chemokine levels were seen in the both the experimental and control animals. CONCLUSION: The data presented in this study suggest that brain death itself induces hypoperfusion in the mesenteric microcirculation that is associated with a pronounced reduction in the endogenous corticosterone level, thereby leading to increased local inflammation and organ dysfunction. These events are paradoxically associated with induced leukopenia after brain damage.

A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia

Objective Severe pulmonary hypoplasia and pulmonary arterial hypertension are associated with reduced survival in congenital diaphragmatic hernia (CDH). We aimed to determine whether fetal endoscopic tracheal occlusion (FETO) improves survival in cases of severe isolated CDH. Methods Between May 2008 and July 2010, patients whose fetuses had severe isolated CDH (lung-to-head ratio < 1.0, liver herniation into the thoracic cavity and no other detectable anomalies) were assigned randomly to FETO or to no fetal intervention (controls). FETO was performed under maternal epidural anesthesia supplemented with fetal intramuscular anesthesia. Tracheal balloon placement was achieved with ultrasound guidance and fetoscopy between 26 and 30 weeks of gestation. All cases that underwent FETO were delivered by the EXIT procedure. Postnatal therapy was the same for both treated fetuses and controls. The primary outcome was survival to 6 months of age. Other maternal and neonatal outcomes were also evaluated. Results Twenty patients were enrolled randomly to FETO and 21 patients to standard postnatal management. The mean gestational age at randomization was similar in both groups (P = 0.83). Delivery occurred at 35.6 +/- 2.4 weeks in the FETO group and at 37.4 +/- 1.9 weeks in the controls (P < 0.01). In the intention-to-treat analysis, 10/20 (50.0%) infants in the FETO group survived, while 1/21 (4.8%) controls survived (relative risk (RR), 10.5 (95% CI, 1.5-74.7), P < 0.01). In the receivedtreatment analysis, 10/19 (52.6%) infants in the FETO group and 1/19 (5.3%) controls survived (RR, 10.0 (95% CI, 1.4-70.6) P < 0.01). Conclusion FETO improves neonatal survival in cases with isolated severe CDH. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Signal Transceiver Transit Times and Propagation Delay Corrections for Ranging and Georeferencing Applications

The accuracy of ranging measurements depends critically on the knowledge of time delays undergone by signals when retransmitted by a remote transponder and due to propagation effects. A new method determines these delays for every single pulsed signal transmission. It utilizes four ground-based reference stations, synchronized in time and installed at well-known geodesic coordinates and a repeater in space, carried by a satellite, balloon, aircraft, and so forth. Signal transmitted by one of the reference bases is retransmitted by the transponder, received back by the four bases, producing four ranging measurements which are processed to determine uniquely the time delays undergone in every retransmission process. A minimization function is derived comparing repeater's positions referred to at least two groups of three reference bases, providing the signal transit time at the repeater and propagation delays, providing the correct repeater position. The method is applicable to the transponder platform positioning and navigation, time synchronization of remote clocks, and location of targets. The algorithm has been demonstrated by simulations adopting a practical example with the transponder carried by an aircraft moving over bases on the ground.

Intervenção Coronariana Percutânea prévia como fator de risco para Revascularização Miocárdica

FUNDAMENTO: A Intervenção Coronariana Percutânea (ICP) vem aumentando na doença arterial coronariana crônica. Consequentemente, cada vez mais pacientes submetidos a Cirurgia de Revascularização Miocárdica (CRM) apresentam stent coronariano. OBJETIVO: Avaliar a influência do antecedente de stent coronariano na mortalidade hospitalar após CRM. MÉTODOS: Análise prospectiva com 1.099 pacientes consecutivos submetidos a CRM com circulação extracorpórea, entre maio/2007 e junho/2009. Pacientes sem ICP prévia (n = 938; 85,3%) foram comparados com pacientes com ICP prévia (n = 161; 14,6%), utilizando modelos de regressão logística e análise de pareamento de amostras. RESULTADOS: Ambos os grupos apresentavam semelhança em relação aos fatores de risco, exceto pela maior presença de pacientes com angina instável no grupo com ICP prévia (16,1% vs. 9,9%; p = 0,019). A mortalidade hospitalar após CRM foi maior entre os pacientes com ICP prévia (9,3% vs. 5,1%, p = 0,034), e foi semelhante à esperada em relação ao EuroSCORE e ao 2000 Bernstein-Parsonnet score. Na análise com regressão logística multivariada a ICP prévia emergiu como fator de risco independente para mortalidade hospitalar pós-operatória (odds ratio 1,94; IC 95% 1,02-3,68; p = 0,044) tão forte quanto diabetes (odds ratio 1,86; IC 95% 1,07-3,24; p = 0,028). Após o pareamento dos grupos, a mortalidade hospitalar continuou sendo maior entre os pacientes com ICP prévia, com odds ratio 3,46 ; IC 95% 1,10-10,93; p = 0,034. CONCLUSÃO: A ICP prévia em pacientes com doença coronariana multiarterial é fator de risco independente para mortalidade hospitalar após CRM. Tal fato deve ser considerado quando a ICP for indicada como alternativa inicial em pacientes com doença arterial coronariana mais avançada. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0)

Astroparticle physics with nuclear track detectors

This thesis is mainly about the search for exotic heavy particles -Intermediate Mass Magnetic Monopoles, Nuclearites and Q-balls with the SLIM experiment at the Chacaltaya High Altitude Laboratory (5230 m, Bolivia), establishing upper limits (90% CL) in the absence of candidates, which are among the best if not the only one for all three kind of particles. A preliminary study of the background induced by cosmic neutron in CR39 at the SLIM site, using Monte Carlo simulations. The measurement of the elemental abundance of the primary cosmic ray with the CAKE experiment on board of a stratospherical balloon; the charge distribution obtained spans in the range 5≤Z≤31. Both experiments were based on the use of plastic Nuclear Track Detectors, which records the passage of ionizing particles; by using some chemical reagents such passage can be make visible at optical microscopes.

Analisi della dinamica e composizione chimica del particolato atmosferico mediante un modello alla mesoscala

The vertical profile of aerosol in the planetary boundary layer of the Milan urban area is studied in terms of its development and chemical composition in a high-resolution modelling framework. The period of study spans a week in summer of 2007 (12-18 July), when continuous LIDAR measurements and a limited set of balloon profiles were collected in the frame of the ASI/QUITSAT project. LIDAR observations show a diurnal development of an aerosol plume that lifts early morning surface emissions to the top of the boundary layer, reaching maximum concentration around midday. Mountain breeze from Alps clean the bottom of the aerosol layer, typically leaving a residual layer at around 1500-2000 m which may survive for several days. During the last two days under analysis, a dust layer transported from Sahara reaches the upper layers of Milan area and affects the aerosol vertical distribution in the boundary layer. Simulation from the MM5/CHIMERE modelling system, carried out at 1 km horizontal resolution, qualitatively reproduced the general features of the Milan aerosol layer observed with LIDAR, including the rise and fall of the aersol plume, the residual layer in altitude and the Saharan dust event. The simulation highlighted the importance of nitrates and secondary organics in its composition. Several sensitivity tests showed that main driving factors leading to the dominance of nitrates in the plume are temperature and gas absorption process. A modelling study turn to the analysis of the vertical aerosol profiles distribution and knowledge of the characterization of the PM at a site near the city of Milan is performed using a model system composed by a meteorological model MM5 (V3-6), the mesoscale model from PSU/NCAR and a Chemical Transport Model (CTM) CHIMERE to simulate the vertical aerosol profile. LiDAR continuous observations and balloon profiles collected during two intensive campaigns in summer 2007 and in winter 2008 in the frame of the ASI/QUITSAT project have been used to perform comparisons in order to evaluate the ability of the aerosol chemistry transport model CHIMERE to simulate the aerosols dynamics and compositions in this area. The comparisons of model aerosols with measurements are carried out over a full time period between 12 July 2007 and 18 July 2007. The comparisons demonstrate the ability of the model to reproduce correctly the aerosol vertical distributions and their temporal variability. As detected by the LiDAR, the model during the period considered, predicts a diurnal development of a plume during the morning and a clearing during the afternoon, typically the plume reaches the top of the boundary layer around mid day, in this time CHIMERE produces highest concentrations in the upper levels as detected by LiDAR. The model, moreover can reproduce LiDAR observes enhancement aerosols concentrations above the boundary layer, attributing the phenomena to dust out intrusion. Another important information from the model analysis regard the composition , it predicts that a large part of the plume is composed by nitrate, in particular during 13 and 16 July 2007 , pointing to the model tendency to overestimates the nitrous component in the particular matter vertical structure . Sensitivity study carried out in this work show that there are a combination of different factor which determine the major nitrous composition of the “plume” observed and in particular humidity temperature and the absorption phenomena are the mainly candidate to explain the principal difference in composition simulated in the period object of this study , in particular , the CHIMERE model seems to be mostly sensitive to the absorption process.

Stratospheric aerosol extinction retrieved from SCIAMACHY measurements in limb geometry

Stratosphärische Partikel sind typischerweise mit dem bloßen Auge nicht wahrnehmbar. Dennoch haben sie einen signifikanten Einfluss auf die Strahlungsbilanz der Erde und die heteorogene Chemie in der Stratosphäre. Kontinuierliche, vertikal aufgelöste, globale Datensätze sind daher essenziell für das Verständnis physikalischer und chemischer Prozesse in diesem Teil der Atmosphäre. Beginnend mit den Messungen des zweiten Stratospheric Aerosol Measurement (SAM II) Instruments im Jahre 1978 existiert eine kontinuierliche Zeitreihe für stratosphärische Aerosol-Extinktionsprofile, welche von Messinstrumenten wie dem zweiten Stratospheric Aerosol and Gas Experiment (SAGE II), dem SCIAMACHY, dem OSIRIS und dem OMPS bis heute fortgeführt wird. rnrnIn dieser Arbeit wird ein neu entwickelter Algorithmus vorgestellt, der das sogenannte ,,Zwiebel-Schäl Prinzip'' verwendet, um Extinktionsprofile zwischen 12 und 33 km zu berechnen. Dafür wird der Algorithmus auf Radianzprofile einzelner Wellenlängen angewandt, die von SCIAMACHY in der Limb-Geometrie gemessen wurden. SCIAMACHY's einzigartige Methode abwechselnder Limb- und Nadir-Messungen bietet den Vorteil, hochaufgelöste vertikale und horizontale Messungen mit zeitlicher und räumlicher Koinzidenz durchführen zu können. Die dadurch erlangten Zusatzinformationen können verwendet werden, um die Effekte von horizontalen Gradienten entlang der Sichtlinie des Messinstruments zu korrigieren, welche vor allem kurz nach Vulkanausbrüchen und für polare Stratosphärenwolken beobachtet werden. Wenn diese Gradienten für die Berechnung von Extinktionsprofilen nicht beachtet werden, so kann dies dazu führen, dass sowohl die optischen Dicke als auch die Höhe von Vulkanfahnen oder polarer Stratosphärenwolken unterschätzt werden. In dieser Arbeit wird ein Verfahren vorgestellt, welches mit Hilfe von dreidimensionalen Strahlungstransportsimulationen und horizontal aufgelösten Datensätzen die berechneten Extinktionsprofile korrigiert.rnrnVergleichsstudien mit den Ergebnissen von Satelliten- (SAGE II) und Ballonmessungen zeigen, dass Extinktionsprofile von stratosphärischen Partikeln mit Hilfe des neu entwickelten Algorithmus berechnet werden können und gut mit bestehenden Datensätzen übereinstimmen. Untersuchungen des Nabro Vulkanausbruchs 2011 und des Auftretens von polaren Stratosphärenwolken in der südlichen Hemisphäre zeigen, dass das Korrekturverfahren für horizontale Gradienten die berechneten Extinktionsprofile deutlich verbessert.

Coronary collateral growth by external counterpulsation: a randomised controlled trial

The efficacy of external counterpulsation (ECP) on coronary collateral growth has not been investigated in a randomised controlled study. Objective To test the hypothesis that ECP augments collateral function during a 1 min coronary balloon occlusion.

Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty

Vertebroplasty and kyphoplasty are well-established minimally invasive treatment options for compression fractures of osteoporotic vertebral bodies. Possible procedural disadvantages, however, include incomplete fracture reduction or a significant loss of reduction after balloon tamp deflation, prior to cement injection. A new procedure called "vertebral body stenting" (VBS) was tested in vitro and compared to kyphoplasty. VBS uses a specially designed catheter-mounted stent which can be implanted and expanded inside the vertebral body. As much as 24 fresh frozen human cadaveric vertebral bodies (T11-L5) were utilized. After creating typical compression fractures, the vertebral bodies were reduced by kyphoplasty (n = 12) or by VBS (n = 12) and then stabilized with PMMA bone cement. Each step of the procedure was performed under fluoroscopic control and analysed quantitatively. Finally, static and dynamic biomechanical tests were performed. A complete initial reduction of the fractured vertebral body height was achieved by both systems. There was a significant loss of reduction after balloon deflation in kyphoplasty compared to VBS, and a significant total height gain by VBS (mean +/- SD in %, p < 0.05, demonstrated by: anterior height loss after deflation in relation to preoperative height [kyphoplasty: 11.7 +/- 6.2; VBS: 3.7 +/- 3.8], and total anterior height gain [kyphoplasty: 8.0 +/- 9.4; VBS: 13.3 +/- 7.6]). Biomechanical tests showed no significant stiffness and failure load differences between systems. VBS is an innovative technique which allows for the possibly complete reduction of vertebral compression fractures and helps maintain the restored height by means of a stent. The height loss after balloon deflation is significantly decreased by using VBS compared to kyphoplasty, thus offering a new promising option for vertebral augmentation.

Impact of arterial injury on neointimal hyperplasia after implantation of drug-eluting stents in coronary arteries: an intravascular ultrasound study

Aims: We investigated the impact of arterial injury on neointimal hyperplasia following implantation of drug-eluting stents (DES). Methods and results: A total of 196 patients with 223 segments (sirolimus-eluting stents [SES]: 104, paclitaxel-eluting stents [PES]: 119) underwent intravascular ultrasound eight months after DES implantation. Arterial injury was defined as the balloon-to-artery ratio (BAR). Segments were categorised into two groups: high BAR defined as BAR>1.1 (120 segments), and low BAR defined as BAR ≤1.1 (103 segments). Baseline clinical characteristics were similar for both groups. Although reference vessel diameter was smaller, stent diameter, maximal balloon pressure and balloon diameter were higher in the high BAR compared with the low BAR group. Lumen (7.10±1.91 vs. 6.25±1.69, p=0.001), stent (7.31±1.95 vs. 6.41±1.80, p=0.001), and external elastic membrane (17.1±4.9 vs. 14.8±4.0, p<0.0001) areas (mm2) were higher, but neointimal hyperplasia (0.21±0.36 vs. 0.16±0.48, p=0.42) area (mm2) was similar in the high BAR compared with the low BAR group. Arterial injury as assessed by BAR was not associated with the amount of neointimal hyperplasia (R2=0.003, p=0.40). Conclusions: Arterial injury does not correlate with the amount of neointimal hyperplasia following DES implantation. Conventionally aggressive DES implantation techniques do not adversely affect long-term outcome with respect to restenosis. - See more at: http://www.pcronline.com/eurointervention/30th_issue/79/#sthash.1do4X31G.dpuf

Transapical implantation of a novel self-expanding sutureless aortic valve prosthesis

To date, transapical aortic valve implantation has required a balloon-expandable stented valve prosthesis. More recently, a novel self-expanding sutureless stented bovine pericardial prosthesis has been developed which allows rapid aortic valve replacement via an open transaortic approach in humans. The aim of this animal study was to develop a reliable protocol to facilitate the transapical implantation of this self-expanding valve in a porcine model.

Genome-wide association study of intracranial aneurysm identifies three new risk loci

Saccular intracranial aneurysms are balloon-like dilations of the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. We report a second genome-wide association study with discovery and replication cohorts from Europe and Japan comprising 5,891 cases and 14,181 controls with approximately 832,000 genotyped and imputed SNPs across discovery cohorts. We identified three new loci showing strong evidence for association with intracranial aneurysms in the combined dataset, including intervals near RBBP8 on 18q11.2 (odds ratio (OR) = 1.22, P = 1.1 x 10(-12)), STARD13-KL on 13q13.1 (OR = 1.20, P = 2.5 x 10(-9)) and a gene-rich region on 10q24.32 (OR = 1.29, P = 1.2 x 10(-9)). We also confirmed prior associations near SOX17 (8q11.23-q12.1; OR = 1.28, P = 1.3 x 10(-12)) and CDKN2A-CDKN2B (9p21.3; OR = 1.31, P = 1.5 x 10(-22)). It is noteworthy that several putative risk genes play a role in cell-cycle progression, potentially affecting the proliferation and senescence of progenitor-cell populations that are responsible for vascular formation and repair.