[Safety and efficacy of transcatheter closure of Fontan fenestration with atrial septal occluder]

Objective: To assess the safety and efficacy of transcatheter fenestration closure following Fontan procedure with an atrial septal occluder. Methods: This is a retrospective study. The study sample consists of all consecutive patients who underwent closure of a fenestrated Fontan baffle at Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine between June 2002 and December 2019. The indications of Fontan fenestration closure included that normal ventricular function, targeted drugs for pulmonary hypertension and positive inotropic drugs were not required prior the procedure; and the Fontan circuit pressure was less than 16 mmHg (1 mmHg=0.133 kPa) and no more than a 2 mmHg increase during test occlusion of the fenestration. Electrocardiogram and echocardiography were reviewed at 24 hours, 1, 3, 6 months and annually thereafter post procedure. Follow-up information including clinical events and complications related to Fontan procedure was recorded. Results: A total of 11 patients, including 6 males and 5 females, aged (8.9±3.7) years old were included. The types of Fontan were extracardiac conduits (7 cases) and intra-atrial duct (4 cases). The interval between percutaneous fenestration closure and the Fontan procedure was (5.1±2.9) years. One patient reported recurrent headache after Fontan procedure. Successful fenestration occlusion with atrial septal occluder was achieved in all patients. Compared with prior closure, Fontan circuit pressure ((12.72±1.90) mmHg vs. (12.36±1.63) mmHg, P<0.05), and aortic oxygen saturation ((95.11±3.11)% vs. (86.35±7.26)%, P<0.01) were increased. There were no procedural complications. At a median follow-up of (3.8±1.2) years, there was no residual leak and evidence of stenosis within the Fontan circuit in all patient. No complication was observed during follow-up. One patient with preoperative headache did not have recurrent headache after closure. Conclusions: If the Fontan pressure is acceptable by test occlusion during the catheterization procedure, Fontan fenestration could be occluded with the atrial septum defect device. It is a safe and effective procedure, and could be used for occlusion of Fontan fenestration with varying sizes and morphologies.

Predictions of arrhythmic, heart failure and mortality outcomes in pericarditis using automatic electrocardiogram analysis: a retrospective cohort study

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Pericarditis is a relatively rare disease with a global burden. Despite its strong association with adverse cardiovascular outcomes, identification of patients at risk of future heart failure or arrhythmic events is difficult. In the following study, automated electrocardiogram (ECG) variables were used to predict new onset ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and heart failure with reduced ejection fraction (HF) in an Asian cohort of pericarditis patients.

Purpose

Assessing the use of automated ECG parameters to predict prognosis in pericarditis patients.

Methods

Consecutive patients admitted to a single tertiary center in China, for a diagnosis of pericarditis between 1st January 2005 and 31st December 2019, were included. Patients with existing AF or HF were excluded. The follow-up period was until the 31st December 2020, or death. Cox regression was applied to identify significant predictors of the incident VT/VF, AF or HFrEF.

Results

A total of 874 patients were included. The cohort was 57% male and had a median age of 59 (IQR: 50-70) years old. During follow-up, 57 patients (6.5%), 156 (17.8%) and 168 (19.2%) suffered from VT/VF, AF and HF, respectively. Cox regression identified baseline VT/VF, terminal angle of the QRS vector in the transverse plane, mean QRS duration and mean QTc intervals as significant predictors of incident VT/VF events, with only the foremost maintaining significance in multivariate analysis. In contrast, baseline age, prior diagnoses of hypertension, malignancy and atrial flutter, initial angle and magnitude of the QRS vector in the transverse plane, P-wave and QRS axis in the frontal plane, ST segment axis in the frontal and horizontal planes, mean PT interval, mean PR segment duration and QTc intervals were all univariate predictors of incident AF, albeit only baseline age and initial angle of the QRS vector in the transverse plane retained significance after multivariate adjustment. As it pertains to new-onset HFrEF, several clinical and electrocardiographic parameters demonstrated an association in univariate analysis, with history of hypertension, history of sudden cardiac death (SCD), initial QRS angle in transverse plane, initial 40ms QRS complex axis, ST-segment axis in the horizontal plane, T-wave frontal axis and atrial rate all showcasing significant relationships in multivariate analysis.

Conclusions

AF and HFrEF are relatively common complications, whilst VT/VF occurs less frequently in the context of pericarditis. Different clinical and ECG predictors of these outcomes were identified. Future studies are still needed to evaluate their use for risk stratification in the clinical setting.

[Medium and long-term follow-up of the Pul-Stent in treating postoperative branch pulmonary artery stenosis in children with congenital heart disease]

Objective: To evaluate the effectiveness and safety of Pul-Stent as the treatment of postoperative branch pulmonary artery stenosis in children with congenital heart disease. Methods: This was a retrospective study. Thirty-three patients who underwent Pul-Stent implantation in Shanghai Children's Medical Center due to postoperative residual pulmonary artery stenosis from August 2014 to June 2015 were included. The immediate curative effect, follow-up and complications of Pul-Stent implantation were assessed. Comparisons between groups were performed with unpaired Student t test. Results: Pul-Stent implantation of 33 patients (19 males and 14 females) were performed successfully. Thirty-one patients underwent percutaneous stenting, and 2 patients underwent hybrid stenting. A total of 35 Pul-Stents were implanted (19 of model small, 15 of model medium and one of model large), 23 stents were planted in the proximal left pulmonary artery and 12 stents were in the proximal right pulmonary artery. The initial diameter of dilation balloon ranged from 6 to 16 mm, and the long sheath of percutaneous implantation ranged from 8 to 10 F in 29 patients (29/31, 94%). After stenting, the diameter of the narrowest segment of pulmonary artery increased from (4.0±1.7) mm to (9.1±2.1) mm in all patients (t=-21.60, P<0.001). The pressure gradient at the stenosis in 26 patients after biventricular correction decreased from (30.5±12.3) mmHg (1 mmHg=0.133 kPa) to (9.9±9.6) mmHg (t=12.92, P<0.001), and the right ventricular to aortic pressure ratio decreased from 0.57±0.14 to 0.44±0.12 (t=7.44, P<0.001). The pressure of the superior vena cava after stenting in 5 patients after cavopulmonary anastomosis decreased from (17.0±1.9) mmHg to (14.0±0.7) mmHg (t=2.86, P=0.046). Two patients died during reoperation for repairing other cardiac malformations. The remaining 31 patients were clinically stable during the follow-up period of (5.3±1.6) years, and one stent fracture was found on chest X-ray. Cardiac catheterization reexaminations in 16 patients showed that restenosis was found in one stent, while stent position and patency were satisfactory in the remaining stents. Nine children underwent post-dilation without stent fracture, displacement or aneurysm formation. Cardiac tomography showed no stent stenosis, fracture observed, or significant change in diameter of the stent in 8 patients. The inner diameter and pulmonary blood perfusion could not be accurately evaluated due to artifacts by cardiac magnetic resonance imaging in 4 patients. Conclusions: Pul-Stent has good compliance and adequate radial strength, and can dilate further over time to accommodate for somatic growth. It performs safely and effectively in treating post-operative branch pulmonary artery stenosis in children.

The impact of COVID-19 telehealth on outpatient test completion

BACKGROUND

Pathology and imaging tests are frequently requested in the outpatient setting despite historically poor completion rates. The impact of COVID-19 telehealth on test completion rates is unknown.

AIMS

To examine the impact of the COVID-19 pandemic and telehealth transition on pathology and imaging test request and completion rates in Australian outpatient clinics.

METHODS

We performed a prospective cohort study with historical controls between March-May 2019 and March-May 2020. Pathology and imaging request and completion rates were collected in review consultation patients attending Gastroenterology and Rheumatology outpatient clinics at a tertiary healthcare system prior and during the early phases of the COVID-19 pandemic in Melbourne.

RESULTS

1376 patients were included in the study. Pathology tests were requested more frequently in the COVID-19 group (n = 582/684, 85.2%) than control group (n = 492/692, 71.1%, p < 0.001) but completion rates were lower in the COVID-19 group (n = 443/582, 76.1%) than control group (n = 426/492 (86.6%), p < 0.001). Imaging tests were requested more frequently in the COVID-19 group (n = 345/682, 50.6%) than control group (n = 295/692, 42.6%, p = 0.003) with lower rates of completion in the COVID-19 group (n = 229/345, 66.4%) then control group (n = 247/295, 83.7%, p < 0.001).

CONCLUSIONS

The COVID-19 pandemic and telehealth transition has resulted in more frequent pathology and imaging requests but fewer test completion in the outpatients setting. This study has identified new clinical risks associated with the abrupt transition to telehealth during COVID-19 that should be explored in future studies and appropriately mitigated. This article is protected by copyright. All rights reserved.

[Analysis of the clinical features and the risk factors of severe adenovirus pneumonia in children]

Objective: To analyze the clinical characteristics, risk factors for critical illness and death of severe adenovirus pneumonia in children, so as to provide clinical evidences for early diagnosis and reliable treatment. Methods: A total of 75 pediatric cases with severe adenovirus pneumonia admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January to October 2019 were studied. The clinical features, laboratory and imaging data, therapeutic approaches, efficacy of the treatments and prognosis were investigated retrospectively. Patients were divided into severe group and critical group. Chi square test and Mann-Whitney U rank sum test were used to analyze the data of the two groups. The risk factors for critical illness and death were analyzed by univariate and multivariate Logistic regression. Results: Among the 75 children, there were 52 males and 23 females, aged from 3 months to 8 years, including 30 of severe cases and 45 of critical case. The positive rate of adenovirus antigen in nasopharyngeal swab was 21% (15/72), and the positive rate of serum adenovirus IgM antibody was only 13% (10/75). However, the positive rate of adenovirus nucleic acid in nasopharyngeal swab was 75% (21/28). What is more, the positive rates of metagenomics next generation sequencing (mNGS) in plasma and bronchoalveolar lavage fluid were 92% (33/36) and 96% (54/56), respectively, of which 95% (63/66) were confirmed as adenovirus type 7. Relatively high dose of ribavirin and integrated therapeutic approaches (respiratory support, glucocorticoids, immunoglobulin and organ supportive therapies) were used. The recovery rate was 77% (58/75), the improvement rate was 8% (6/75) and the mortality rate was 15% (11/75). The proportion of children with the duration of fever longer than 3 days after ribavirin treatment in the critical group was significantly higher than that in the severe group(51% (18/35) vs. 8% (2/26), χ²=12.949, P<0.05). The risk factors for critical illness were younger than 4 years, longer duration of fever before and after admission to PICU, oxygenation index<300 mmHg (1 mm Hg=0.133 kPa), ferritin>1 000 μg/L, lactate dehydrogenase (LDH)>1 500 U/L, 5 lung lobes involvement, pleural effusion and (or) air leakage (all P<0.05). Among them, 5 lung lobes involvement was the independent risk factor for critical illness (adjusted OR=49.641, 95%CI 4.186-588.618, P=0.002). Risk factors for death included longer duration of fever after being admitted to PICU, oxygenation index<100 mmHg, ferritin>2 000 μg/L, interleukin (IL)-6>100 ng/L, LDH>1 500 U/L, pleural effusion and (or) air leakage (all P<0.05). Among them, IL-6>100 ng/L was the independent risk factor for the mortalities of critically ill children (adjusted OR=16.094, 95%CI 2.059-25.787, P=0.008). Conclusions: The mortality rate of severe pediatric adenovirus pneumonia caused by adenovirus type 7 is high. High positive rates of adenovirus nucleic acid in nasopharyngeal swabs and mNGS in plasma or bronchoalveolar lavage fluid contribute to early diagnosis, and mNGS can also be used for serotyping. Younger children under 4 years of age, persistent fever, extensive pulmonary lesions and significantly increased inflammatory cytokines such as IL-6 are warning indicators for critical illness and poor prognosis. Relatively high dose of ribavirin combined with integrated therapeutic approaches are beneficial for prognosis.

[Clinical characteristics of anomalous origin of the left coronary artery from the pulmonary artery in 91 children]

Objective: To explore the clinical manifestations, diagnosis, treatment and prognosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) . Methods: A retrospective study identified 91 patients diagnosed with ALCAPA at Shanghai Children's Medical Center from March 2010 to August 2017. According to the left ventricular ejection fraction (LVEF) at the time of consultation, patients were divided into the cardiac insufficiency group (n=54) and the normal cardiac function group (n=37). Clinical features (age of onset, clinical performance, etc) and auxiliary examinations (electrocardiogram, echocardiography, etc) between the two groups were compared using a t-test and a Chi-square test. Prognostic factors were analyzed by an ordered logistic regression and a Pearson correlation coefficient. Results: (1) The age of diagnosis of patients in the cardiac insufficiency group who were usually misdiagnosed as cardiomyopathy was (10.0±2.6) months (20/54) , whereas the age of diagnosis of patients in the normal cardiac function group who were usually misdiagnosed as valvular diseases was (40.0±7.8) months (4/37). According to the pathophysiological mechanism, forty of the 54 (74%) patients in the cardiac insufficiency group were infantile type, and 78% patients (29/37) in the normal cardiac function group were adult type. (2) Preoperative electrocardiogram showed the deep Q wave in lead I occurred more frequently in the cardiac insufficiency group than in the normal cardiac function group (28/54 vs. 11/37, χ(2)=4.388, P=0.036). (3) Twenty patients died in the cardiac insufficiency group including 12 patients who died from postoperative cardiac pump failure and 8 children who did not undergo surgery due to poor prognosis and died from other reasons. There was no death in the normal cardiac function group. (4) Preoperative LVEF was the unique risk factor affecting prognosis (F=16.872, P=0.005). The preoperative LVEF was significantly lower than the postoperative LVEF ((37±11)% vs. (45±14)%, t=3.614, P=0.001) in the cardiac insufficiency group. During the follow-up period, 6 patients in the cardiac insufficiency group still presented with postoperative cardiac dysfunction, and the patients in the normal cardiac function group still had normal cardiac function. Conclusions: Preoperative LVEF was the unique risk factor affecting prognosis of ALCAPA. Patients with infantile type ALCAPA and preoperative cardiac insufficiency should receive long-term follow-up treatment.

Correction to: Molecular characterization of Blastocystis sp. in captive wild animals in Qinling Mountains

There were errors in Fig. 1 of the originally published article. Correct fig. 1 is presented here.

Effect of ORF119 gene deletion on the replication and virulence of orf virus

Orf is a severe infectious disease of sheep and goats caused by orf virus (ORFV). To investigate the role of ORF119 gene of ORFV, we constructed ORFV with deleted ORF119 gene and LacZ as reporter gene (ORFV-Δ119-LacZ) via homologous recombination. The results showed that wild-type ORF-SHZ1 and ORFV-Δ119-LacZ deletion viruses replicated in Vero cells to similar titers. Relative transcriptional levels of virulence genes OVIFNR, GIF, VEGF and VIL-10 of ORFV-Δ119-LacZ deletion virus were slightly but not significantly lower after 24 hr compared with the wtORF-SHZ1 virus. In vivo experiments showed that 2-month-old lambs inoculated with ORFV-Δ119-LacZ deletion virus exhibited a similar total clinical score compared with those inoculated with wtORF-SHZ1 virus. Based on these results, we conclude that deletion of the ORF119 gene has no significant effect on ORFV replication and virulence.

How to map ses, a mutant of Arabidopsis thaliana affecting pollen development

In Arabidopsis, map-based cloning has been developed to an effective method in mutant genetic analysis because high-density markers are available, candidate genes or genomic sequences can be amplified by PCR and transgenic techniques are simplified. Mutant ses named from shortened early-stage siliques was used as an example to show how to map a mutant in this day. By the process of bulked segregants analysis, linkage testing, large-scale and fine scale mapping, mutant ses was narrowed into a 67 kb interval from CER448792 (2000541 bp) to CER464544 (2067844 bp) crossing over the right of BAC F12K11 to the left of the BAC F4H5 including at most 22 putative genes on the top of chromosome l. In sequence-based map of Arabidopsis genes with Mutant phenotype (SMAGMP) mutant ses was between ATlg06150 (EMB1444) and ATlg08060 (MOM). The SES mapping also showed that developed markers on polymorphism site of CAPC not only were simplified and but worked well. 24 markers from CAPC used in the mapping maybe help Arabidopsis researches with others and the methods related to SES mapping also gave an example of positional cloning.

Expression and localization of recombinant human B2 receptors in the methylotrophic yeast Pichia pastoris

The human bradykinin B2 receptor (B2R) fused with green fluorescent protein (GFP) at the C-terminal has been expressed in the methylotrophic yeast of Pichia pastoris. In the expression vector, B2R gene was drove under the highly inducible promoter of alcohol oxidase 1 gene of P. pastoris. By fluorescence activated cell sorting (FACS) analysis and western blot analysis, it was proved that B2R recombinant receptor proteins were expressed at high level in the yeast. Further more, the transformants of P. pastoris were monitored with confocal microscopy, a strong green fluorescence was checked out. The recombinant B2R receptor proteins were mainly located on the plasma membrane proved by immunofluorescence microscopy.

Preclinical study of adenoviral p53 gene therapy for esophageal cancer

An alteration of the p53 gene function is a major factor in the development of esophageal cancer. Recently, p53 gene therapy has been applied for clinical studies in lung cancer and head and neck cancer. However, no preclinical studies have yet demonstrated an anticancer effect of adenoviral-mediated wild-type p53 gene therapy on esophageal cancer. We herein evaluated the effect of p53 adenoviral gene therapy on human esophageal squamous cell carcinoma to test the ability of clinical application. A normal esophageal epithelial cell line (EN53F) and two human esophageal cancer cell lines (ECGI-10 and T.Tn) with a p53 alteration were used. The transduction efficiency, p53 protein expression, p21 protein expression, the induction of apoptosis, and growth suppression were assessed by using the recombinant adenoviral vector Ad5CMV-p53. The transduction efficiency was 60%-80% at 100 plaque-forming units (PFU)/cell and 80%-100% at 300PFU/cell. A significant growth suppression following an Ad5CMV-p53 infection was observed in both cancer cell lines. A Western blot analysis confirmed the presence of both exogenous p53 protein expression and p21 protein induction. Apoptotic cell death was observed with TUNEL staining. T.Tn xenografts in nude mice transduced with Ad5CMV-p53 demonstrated significant growth suppression. These data suggest that Ad5CMV-p53 may thus be a potentially effective therapeutic agent for locally advanced esophageal cancer.

[The development of an automatic dialyser reuse device by microcomputer]

This article introduces the principles, composition and main functions of an automatic dialyser reuse device by microcomputer. It Ras more practical uses, better reliability, easier operations and greater effect than previous ones, and it's an ideal dialyser ruse device.

Identification and genetic mapping of four novel genes that regulate leaf development in Arabidopsis

Molecular and genetic characterizations of mutants have led to a better understanding of many developmental processes in the model system Arabidopsis thaliana. However, the leaf development that is specific to plants has been little studied. With the aim of contributing to the genetic dissection of leaf development, we have performed a large-scare screening for mutants with abnormal leaves. Among a great number of leaf mutants we have generated by T-DNA and transposon tagging and ethyl-methae sulfonate (EMS) mutagenesis, four independent mutant lines have been identified and studied genetically. Phenotypes of these mutant lines represent the defects of four novel nuclear genes designated LL1 (LOTUS LEAF 1), LL2 (LOTUS LEAF 2), URO (UPRIGHT ROSETTE). and EIL (ENVIRONMENT CONDITION INDUCED LESION). The phenotypic analysis indicates that these genes play important roles during leaf development. For the further genetic analysis of these genes and the map-based cloning of LL1 and LL2, we have mapped these genes to chromosome regions with an efficient and rapid mapping method.

[Video-assisted thoracoscopic surgery for pulmonary wedge resection]

Video-assisted thoracoscopic surgery (VATS) wedge resection of lung has largely become a practical surgical procedure because the development of instruments and surgical techniques. The safety and feasibility are more remarkable comparing with standard surgical procedure. From November, 1992 to March, 1994, twelve patients suffering from pulmonary mass were underwent VATS. VATS wedge resection in 10, VATS pulmonary mass biopsy in 2. No operative death and severe complications occurred in this group. We discussed the clinical classification, indication and the surgical technique in this paper.

[Management of pleural adhesion in the video-assisted thoracoscopic surgery]

This article describes the pleural adhesion managements in the video-assisted thoracoscopic surgery (VATS). We have operated the VATS successfully and developed a new technique for management of diffuse cellulose symphysis. We used this technique in 3 patients for treatment of lung diseases. No death and no complications occurred. Comparing with control group, the chest tube drainage time and hospital stay are not significant difference.

[The clinical practice of video-assisted thoracic surgery (VATS)]

From November 1992 to March 1994, thirty five patients were performed using VATS in our hospital. The procedures included blebectomy with pleurodesis 14 cases; wedge resection 10 cases; malignant pleural effusion, pleural biopsy and pleurodesis 4 cases; pleural biopsy 3 cases; lung tumor biopsy 2 cases; lung biopsy 2 cases. Converted into thoracotomy 2 cases because of the tumors could not be resected thoracoscopically. No death and severe complication. The procedures were successful for diagnosis and treatment in our series. Compared with standard thoracotomy, the operative trauma, postoperative pain, drainage volume, tube time, postoperative hospitalization were remarkably less in this group (P < 0.05).

[Thoracoscopy for the treatment of spontaneous pneumothorax]

Video-assisted thoracoscopy has used for lots of thoracic disorders. Spontaneous pneumothorax may be ideally suited for thoracoscopic management. Stapling of apical blebs and pleurodesis can now be performed thoracoscopically. We compared our results with thoracoscopic management of spontaneous pneumothorax in 12 patients (group I) with a group of 8 patients (group II) previously subjected to lateral thoracotomy. Operative time and hospital stay were less in group I (P < 0.05), as the use of parenteral narcotics after 24 hours (P < 0.05). There have been no recurrences to date in group I. Video-assisted thoracoscopic management is safe and offers the benefits of shorter hospital stays and less pain.

Small cell carcinoma of the lung in a patient with rheumatoid arthritis: a case report

We describe an occurrence of small cell carcinoma of the lung in a 37-year-old woman with rheumatoid arthritis who did not receive any kind of cytotoxic agents for the rheumatic condition. There seemed to have no predisposing factor for the development of malignancy. The diagnosis of small cell carcinoma was based on repeated hemoptysis and cytologic finding of a rapidly growing mass over the forehead. The patient responded dramatically to chemotherapy with rapid resolution of forehead mass, relief of arthritis in the hands, and decrease of serum rheumatoid factor from 4800U/ml to 1200U/ml. This appeared to be the first report of small cell carcinoma of the lung developing in a patient with rheumatoid arthritis.

Comparative experimental study between retrograde cerebral perfusion and circulatory arrest

To evaluate the efficacy of retrograde cerebral perfusion in protecting the brain, we comparatively studied retrograde cerebral perfusion and total circulatory arrest in 18 hypothermic (20 degrees C) mongrel dogs (retrograde cerebral perfusion, n = 10; total circulatory arrest, n = 8). Retrograde cerebral perfusion was performed, maintaining an external jugular venous pressure of 25 mm Hg for 60 minutes. Retrograde cerebral perfusion provided half the cerebral blood flow and a third of the oxygen that was supplied during hypothermic cardiopulmonary bypass, which had a flow rate of 100 ml/min per kilogram. Oxygen consumption and carbon dioxide exudation did not increase on resuming cardiopulmonary bypass after retrograde cerebral perfusion, whereas they increased after total circulatory arrest (oxygen consumption 10.7 +/- 5.3 versus 19.1 +/- 8.6 ml/min, p < 0.05; carbon dioxide exudation, 0.92 +/- 0.54 versus 1.64 +/- 0.78 mmol/min, p < 0.05). Therefore, oxygen debt during retrograde cerebral perfusion was smaller than during total circulatory arrest. Retrograde cerebral perfusion also cooled the brain better than did total circulatory arrest (20.4 degrees +/- 1.5 degrees C versus 22.7 degrees +/- 0.7 degrees C, p < 0.01). Cerebral tissue oxygen tension decreased slightly (27.5 +/- 7.7 versus 12.3 +/- 3.0 mm Hg, p < 0.01), and cerebral tissue carbon dioxide tension increased slowly during retrograde cerebral perfusion (95 +/- 34 versus 147 +/- 44 mm Hg, p < 0.05). These changes were smaller than those seen in total circulatory arrest. Tissue concentrations of adenosine triphosphate in the brain remained relatively high during retrograde cerebral perfusion but decreased rapidly during total circulatory arrest (0.49 +/- 0.16 versus 0.21 +/- 0.05 mmol/gm, p < 0.01, just before resuming cardiopulmonary bypass). Retrograde cerebral perfusion cannot maintain aerobic metabolism but may reduce ischemic damage of the brain and may safely extend the cerebral circulation interruption time.

Determination of optimum retrograde cerebral perfusion conditions

Retrograde cerebral perfusion through a superior vena caval cannula is a new technique used to protect the brain during operations on the aortic arch. We measured cerebral tissue blood flow, oxygen consumption, and cerebrospinal fluid pressure under various perfusion conditions in hypothermic (20 degrees C) mongrel dogs (n = 18, 12.8 +/- 0.6 kg) to determine the optimum conditions for retrograde cerebral perfusion. Retrograde cerebral perfusion was performed by infusion via the superior vena caval cannula and drainage via the ascending aortic cannula while the inferior vena cava and azygos vein were clamped. Retrograde cerebral perfusion was performed as the external jugular venous pressure was changed from 15 to 35 mm Hg in increments of 5 mm Hg. Cerebral tissue blood flow was measured by the hydrogen clearance method. Hypothermic retrograde cerebral perfusion with an external jugular venous pressure of 25 mm Hg provided about half the cerebral tissue blood flow of hypothermic (20 degrees C) cardiopulmonary bypass with a flow rate of 1000 ml/min (13.7 +/- 7.9 versus 32.7 +/- 8.5 ml/min per 100 gm). It decreased significantly as the external jugular venous pressure was decreased from 25 to 15 mm Hg but did not increase significantly as the external jugular venous pressure was increased from 25 to 35 mm Hg. Whole-body oxygen consumption during hypothermic retrograde cerebral perfusion with an external jugular venous pressure of 25 mm Hg was one quarter of that during hypothermic cardiopulmonary bypass (3.4 +/- 0.7 versus 12.7 +/- 5.6 ml/min) and varied in proportion to external jugular venous pressure. The cerebrospinal fluid pressure was a little lower than the external jugular venous pressure (19.2 +/- 4.5 mm Hg versus 24.8 +/- 2.4 mm Hg) but also varied with the external jugular venous pressure. The cerebrospinal fluid pressure remained lower than 25 mm Hg so long as the external jugular venous pressure remained lower than 25 mm Hg. High external jugular venous pressure was associated with high intracranial pressure, which restricts cerebral tissue blood flow and may cause brain edema. We believe that a venous pressure of 25 mm Hg is the optimum condition for retrograde cerebral perfusion.

A quantitative study of the interphasic nucleolar organizer regions in two human cervical carcinoma cell lines

We have studied the relationship between interphase nucleolar organizer regions (NORs) distribution and nucleolar size in cancer cells under prolonged culture. Six morphometric parameters (NUCLEAR SIZE, NOR NUMB, AREA SUM, MEAN AREA, SIZE RATIO and SIZE RATIO MEAN) of AgNORs in cancer cells were analyzed by an image analyzing system. The results show that the parameters NORN NUMB, AREA SUM and NUCLEAR SIZE demonstrate the most consistent changes in the two cervical carcinoma cell lines studied. These three parameters of AgNORs appear to be correlated with the degree of "dedifferentiation" that occurred in tumor cells under prolonged culture.

Effects of short-term dietary restriction on survival of mammary ascites tumor-bearing rats

We studied the effects of short-term dietary restriction on the survival of 3-4-month-old tumor-free and tumor-bearing Fisher rats. The diet-restricted food regimen consisted of alternate day ad libitum feeding followed by alternate day fasting. Diet-unrestricted control rats were fed ad libitum daily. Six tumor-free rats on the diet-restricted regimen compensated for the dietary restriction by an increase in food consumption during the alternate feeding days, and lost an average of only 2-3% of their weight in 13 days. Six tumor-free rats on a daily ad libitum feeding regimen gained an average of 6.8% in 15 days. The above dietary-restricted regimen was initiated 1 week before 24 rats were inoculated intraperitoneally with 15 million Mat 13762 ascites tumor cells. Sixteen of 24 (66.7%) diet-restricted tumor-bearing hosts and 5/24 (20.8%) diet-unrestricted tumor-bearing hosts survived at 9 days after tumor inoculation (p less than 0.005). Twelve of 24 (50%) diet-restricted tumor-bearing hosts, and 3 of 24 (12.5%) diet-unrestricted tumor-bearing hosts, survived at 10 days after tumor inoculation (p less than 0.025). Thus, the survival of tumor-bearing rats was enhanced by short-term relatively mild dietary restrictions. We suggest that relatively mild dietary restrictions should be included in clinical trials designed to inhibit cancer growth and enhance the survival of human cancer patients.

Cytotoxic effects of free fatty acids on ascites tumor cells

The effect of physiologic common free fatty acids (FFAs) on Mat 1376b ascites tumor cells in vitro and in vivo in F344 rats was investigated. Unsaturated fatty acids, such as palmitoleic (16:1), oleic (18:1), linoleic (18:2), linolenic (18:3), and arachidonic (20:4) acids, were significantly more effective killers of tumor cells in vitro than the corresponding saturated fatty acids of the same carbon length, including palmitic (16:0), stearic (18:0), and arachidic (20:0) acids. The saturated 16-carbon fatty acid (palmitic acid) was more toxic to tumor cells in vitro than the saturated 18-carbon (stearic) and 20-carbon (arachidic) acids. Injections of linoleic (18:2)-linolenic (18:3) acid combinations into rats inoculated with the tumor significantly enhanced the survival of the tumor-bearing animals. These results suggest that natural FFAs may under certain conditions be utilized as effective anticancer agents.

Lymphocyte subsets in endometriosis

Recent investigations suggested a possible immunologic etiology for endometriosis. To determine whether cellular immunity may be affected in patients with endometriosis, peripheral lymphocyte populations were investigated in 31 confirmed endometriosis patients and 22 control patients. No statistical differences in OKT3, OKT4, OKT8, OKM1, and OKTa1 cells could be observed. Total lymphocyte numbers were within normal ranges for both groups. Helper/suppressor ratios were not statistically different and were in a normal range for both groups. It is concluded that numeric differences in lymphocyte subpopulations represent only a very unlikely contributing factor in a potential immunologic etiology of endometriosis.

Parenteral fat emulsions and immune adherence. The effects of triglycerides on red cell and neutrophil immune adherence in vitro and in vivo

Parenteral fat emulsions may not only exert nutritional effects but may also affect immune adherence phenomena and red cell morphology. Red cell immune adherence (RCIA) was augmented in vitro by 0.05% to 0.1% Intralipid. Similar augmentation of RCIA was observed by peanut oil, corn oil, half-and-half cream, paraffin oil, and human low-density lipoprotein fractions. Neutrophil immune adherence was augmented in vitro by 0.2% to 1.5% of Intralipid. The effects of fat emulsions in vivo were studied in ten patients who received intralipid for nutritional purposes. Red cell immune adherence was augmented in five of ten patients and inhibited in four of ten patients. Neutrophil immune adherence was augmented in two of ten patients. Cytotoxic red cell transformations were evident in five of ten patients. Depression of RCIA in four of five patients was associated with cytotoxic red cell transformations.

Cerebral metastatic choriocarcinoma in the People's Republic of China

Thirty-four patients with cerebral metastases from choriocarcinoma were treated between 1964 and 1978 by the Department of Gynecology of the Tumor Hospital Chung Shan Medical College, Kwongchow, People's Republic of China. Disease in 20.5% (7 of 34 patients) is currently in remission (12 to 120 months). Treatment was primarily by chemotherapy and Chinese herbs, with adjunctive craniotomy in selected patients. Myelosuppression was the main side effect.

Developmental changes of components of the red cell immune system in the rabbit

Red cell immune adherence (RCIA) occurs not only in primates but also in nonprimates such as the rabbit. We utilized the rabbit as an animal model to study developmental changes in the immune functions of rabbit red cells. Significant differences between adult and newborn rabbits were found. RCIA-receptor activity of the newborn rabbits was significantly larger than that of adult rabbits (p less than 0.0005). Serum RCIA inhibiting factor, which completely prevented any detectable RCIA, was evident in about 40% of adult but not in any of the newborn rabbits (p less than 0.01). RCIA-inhibiting factor was also detectable in three out of eight pregnant rabbits but did not cross the placenta into the rabbit fetus. High concentrations (33%-100%) of most adult sera but not of newborn sera inhibited RCIA (p less than 0.001). It is suggested that, like the thymus, red cell immune function may reach its peak activity during early developmental periods. The red cell immune function may be essential for the removal of antigen-antibody complement complexes from the fetal circulation and may participate in the activation of T suppressor cells which adhere to autologous red cells.

Immune complexes in pregnancy. III. Immune complexes in immune complex-associated conditions

Seventeen patients during the third trimester of pregnancy with associated immune complex disease and/or immune complex state and their infants' cord blood were investigated for the presence of immune complexes. In comparing maternal levels of immune complex in normal third-trimester pregnancies to the study group, no statistical significant difference was noted. However, levels in cord blood were significantly lower (p less than 0.0025) than levels in paired maternal samples, but were found to correlate significantly (p less than 0.002). On the basis of the immunochemical analysis of selected pairs, the conclusion is that IgG-containing immune complexes may be responsible for this observed correlation and may represent the normal physiologic situation of pregnancy, whereas IgM-containing immune complexes may represent pathologic, and, therefore, abnormal, states. The suggestion is that the presence of such IgM-containing immune complexes may become predictive of fetoplacental compromise.

The red-cell immune system

It is suggested that red cells have an immune function as well as a respiratory one. Adherence of red cells to antigen-antibody-complement complexes (red-cell immune adherence) has been observed in primates and in rabbits and may represent a basic immune phenomenon that is common to at least all mammals. It is estimated that 95% of C3b receptors in the human circulation are located on red cells and that an antigen-antibody-complement complex has a 500-1000 times greater chance of being removed from the circulation by a red cell than by a white cell. That red cells also adhere to autologous thymocytes and T cells suggests that they may act as intermediaries bringing antigens and T cells together.

Insulinoma. Experience in surgical treatment

Sixty cases of insulinoma were treated surgically. The possible causes for failure to find the tumor during exploratory surgery are discussed. Simple enucleation is preferred in most cases of single or a few insulinomas. A technique of enucleation with minimal chance of injury to adjacent pancreatic ducts and larger blood vessels can be used. When no tumor is found after thorough exploratory procedures, controlled staged resection of the pancreas under blood glucose monitoring is the procedure of choice. Postoperative complications are common but the late results are gratifying provided the operation is carried out early in the course of the disease.