Phospholipid imprinted polymers as selective endotoxin scavengers

Herein we explore phospholipid imprinting as a means to design receptors for complex glycolipids comprising the toxic lipopolysaccharide endotoxin. A series of polymerizable bis-imidazolium and urea hosts were evaluated as cationic and neutral hosts for phosphates and phosphonates, the latter used as mimics of the phospholipid head groups. The bis-imidazolium hosts interacted with the guests in a cooperative manner leading to the presence of tight and well defined 1:2 ternary complexes. Optimized monomer combinations were subsequently used for imprinting of phosphatidic acid as an endotoxin dummy template. Presence of the aforementioned ternary complexes during polymerization resulted in imprinting of lipid dimers - the latter believed to crudely mimic the endotoxin Lipid A motif. The polymers were characterized with respect to template rebinding, binding affinity, capacity and common structural properties, leading to the identification of polymers which were thereafter subjected to an industrially validated endotoxin removal test. Two of the polymers were capable of removing endotoxin down to levels well below the accepted threshold (0.005 EU/mg API) in pharmaceutical production.

Lipidomic "deep profiling": an enhanced workflow to reveal new molecular species of signaling lipids

Current mass spectrometry-based lipidomics aims to comprehensively cover wide ranges of lipid classes. We introduce a strategy to capture phospho-monoester lipids and improve the detection of long-chain base phosphates (LCB-Ps, e.g., sphingosine-1-phosphate). Ten novel LCB-Ps (d18:2, t20:1, odd carbon forms) were discovered and characterized in tissues from human and mouse, as well in D. melanogaster and S. cerevisiae. These findings have immediate relevance for our understanding of sphingosine-1-phosphate biosynthesis, signaling, and degradation.

[Late failure of the endovascular infrarenal aortic aneurysm solutions - diagnosis and treatment]

INTRODUCTION

Nowadays, there are two possible solutions to aneurysms of the abdominal aorta. One is an open resection, which is undoubtedly one of the major surgeries and endovascular solutions, and which represents a smaller operating load for the patient. Long-term monitoring of patients after the endovascular solutions showed late failure in 7-17% of cases. The late incidence of endoleaks and the migration of stents are explained by changing the anatomy of the aneurysm and the resulting change in the mechanical pressure on the stent graft. If these conditions cannot be solved by an endovascular procedure the situation may present a technical challenge for the vascular surgeon.

MATERIAL AND METHODS

Our report on the five case studies points to possible late complications of EVAR and solutions to their individual states.

CONCLUSIONS

In the future, it should be recognized that if the endoleak is not proven it does not mean that it cannot occur over the years and massively fill the excluded aneurysm with the risk of rupture. Undoubtedly, re-operating the open patch is a challenging exercise. Nevertheless, it is possible even with the patients who were, primarily in terms of polymorbidity, indicated EVAR.

[Internal carotid artery surgery under locoregional anaesthesia at the Department of Surgery in Pilsen during the past 10 years (2002-2011)]

During the ten-year period (2002-2011), carotid artery surgery was performed in 1164 patients, with a mean age of 68 years (44 to 86 years), at the Department of Surgery, University Hospital in Pilsen. In total, 1304 procedures on internal carotid arteries were performed, and the ratio of procedures in men and women was 912/392. The ratio of procedures in asymptomatic vs. symptomatic findings was 938/366. The ratio of patients with unilateral vs. bilateral damage to the internal carotid artery was 930/234. All surgical procedures on internal carotid arteries were performed under locoregional anaesthesia. From the total number of internal carotid artery operations (1304), the 30-day mortality and morbidity rate was 1.46%.

[Leriche's syndrome]

INTRODUCTION

Leriche's syndrome is defined as atherosclerotic occlusion of the infrarenal aorta and/or the iliac axis. It is associated with claudications or critical limb ischaemia and erectile dysfunction in men.

MATERIAL AND METHODS

Twenty patients with Leriche's syndrome were operated on at the Department of Surgery, University Hospital in Pilsen between 2008 and 2012. There were 6 women and 14 men of average age 60.3 years (41-76 years). Three patients were in group C and 17 in group D according to the Trans-Atlantic Inter-Society Classification IIb (TASC IIb). Fifteen patients suffered from chronic claudication or rest pain, five patients had acute limb ischaemic symptomatology. Aortobifemoral bypass with subsequent anti-aggregation therapy was the only treatment option.

RESULTS

Primary 30-day patency was 100%. 30-day postoperative mortality was 5% (one patient died of acute myocardial infarction). Two patients died in two and four years after the reconstruction (10%) due to cerebral ischaemia and bronchopneumonia. Only one extremity amputation was performed within the five-year interval after vascular reconstruction. All aortobifemoral reconstructions were patent in two months to five years after the operation. We had to manage only one false aneurysm in the groin three years after the aortobifemoral reconstruction.

CONCLUSION

Aortobifemoral bypass is a method of choice for the treatment of Leriche's syndrome. Endovascular treatment is suitable for patients with severe comorbidities.

[Vascular reconstructions infections in the aortofemoral region]

INTRODUCTION

The incidence of prosthetic vascular graft infections in the aortofemoral region is reported at 0.6-3%. These complications are burdened with a high mortality of up to 50% and an amputation rate of up to 20%. The aim of our study was to give a complex view on the diagnostic and treatment possibilities of these serious complications of reconstructive vascular surgery.

MATERIAL AND METHODS

Prosthetic bypass grafts were performed in 1088 patients in the aortofemoral region between 2001-2011 at the Department of Surgery, Teaching Hospital and the Faculty of Medicine, Charles University, in Pilsen. 24 (2.2%) patients suffered from graft infection at various time intervals after primary vascular reconstruction. Clinical examination, computed tomography and positron emission tomography were the main diagnostic methods of vascular graft infection. "In situ" reconstructions dominated over extra-anatomic reconstructions. When the infection involved only the peripheral part of the prosthetic graft, a more conservative approach - local debridement and drainage - was used.

RESULTS

The mortality of the patients was 20.8%, high amputation rate 12.5%, and morbidity rate 58.3%, respectively. The average time of hospitalization in surviving patients was 46.5 days. Primary 30-day patency rate in "in situ" and extra-anatomic reconstructions was 100 and 60%, respectively.

CONCLUSION

Prosthetic vascular graft infections in the aortofemoral region require tailored multidisciplinary treatment approach in vascular centres. "In situ" reconstructions are the method of first choice. A more conservative approach in infections involving only the peripheral part of the vascular reconstruction has a positive treatment effect.

[Incisional hernia following laparoscopy, complicated by perforated gangrenic appendicitis -- a case review]

Acute appendicitis is the commonest cause of acute abdomen. Early indication for surgery -- appendectomy, plays the key role in its therapy. The rate of incisional hernias (of all operated hernias) is high and they are, to a certain extent, caused by technical, mechanical factors and the patient himself. The authors present a case review of a female patient, presenting with atypical urgent abdomen, who was hospitalized with a diagnosis of advanced absces of the abdominal wall, resp. strangulated incisional hernia. Surgical revision confirmed that the condition was caused by perforated gangrenous appendicitis incisional hernia following laparoscopy. Acute appendicits is a very rare complication of the incisional hernia, and it is practically impossible to make its diagnosis based on clinical examination. Its diagnosis may be facilitated using visualization examination methods, however, its final diagnosis can only be made during surgical revision indicated for progressing acute abdomen.

Learning and discrimination of cuticular hydrocarbons in a social insect

Social insect cuticular hydrocarbon (CHC) mixtures are among the most complex chemical cues known and are important in nest-mate, caste and species recognition. Despite our growing knowledge of the nature of these cues, we have very little insight into how social insects actually perceive and discriminate among these chemicals. In this study, we use the newly developed technique of differential olfactory conditioning to pure, custom-designed synthetic colony odours to analyse signal discrimination in Argentine ants, Linepithema humile. Our results show that tri-methyl alkanes are more easily learned than single-methyl or straight-chain alkanes. In addition, we reveal that Argentine ants can discriminate between hydrocarbons with different branching patterns and the same chain length, but not always between hydrocarbons with the same branching patterns but different chain length. Our data thus show that biochemical characteristics influence those compounds that ants can discriminate between, and which thus potentially play a role in chemical signalling and nest-mate recognition.

Deciphering the chemical basis of nestmate recognition

Social insects maintain colony cohesion by recognizing and, if necessary, discriminating against conspecifics that are not part of the colony. This recognition ability is encoded by a complex mixture of cuticular hydrocarbons (CHCs), although it is largely unclear how social insects interpret such a multifaceted signal. CHC profiles often contain several series of homologous hydrocarbons, possessing the same methyl branch position but differing in chain length (e.g., 15-methyl-pentatriacontane, 15-methyl-heptatriacontane, 15-methyl-nonatriacontane). Recent studies have revealed that within species these homologs can occur in correlated concentrations. In such cases, single compounds may convey the same information as the homologs. In this study, we used behavioral bioassays to explore how social insects perceive and interpret different hydrocarbons. We tested the aggressive response of Argentine ants, Linepithema humile, toward nest-mate CHC profiles that were augmented with one of eight synthetic hydrocarbons that differed in branch position, chain length, or both. We found that Argentine ants showed similar levels of aggression toward nest-mate CHC profiles augmented with compounds that had the same branch position but differed in chain length. Conversely, Argentine ants displayed different levels of aggression toward nest-mate CHC profiles augmented with compounds that had different branch positions but the same chain length. While this was true in almost all cases, one CHC we tested elicited a greater aggressive response than its homologs. Interestingly, this was the only compound that did not occur naturally in correlated concentrations with its homologs in CHC profiles. Combined, these data suggest that CHCs of a homologous series elicit the same aggressive response because they convey the same information, rather than Argentine ants being unable to discriminate between different homologs. This study contributes to our understanding of the chemical basis of nestmate recognition by showing that, similar to spoken language, the chemical language of social insects contains “synonyms,” chemicals that differ in structure, but not meaning.

[Abdominal aortic aneurysms--long-term treatment results]

OBJECTIVE

To evaluate the single center experience in the treatment of patients with AAA.

METHODS

586 patients undergoing open resection (OR) and EVAR (2000-2009). The average age was 72.2 +/- 7.7 years. AAA diameter was 8.3 cm (range 5.0-13.1 cm). 451 (76.9%) patients had asymptomatic AAA, 135 (23.1%) RAAA. 448 patients (76.5%) suffered from various co-morbidities. 430 (73.4 %) OR, 156 (26.6%) EVAR and 52 (8.9%) one staged procedure (for concomitant diseases) was performed.

RESULTS

30 days mortality rate of elective OR and EVAR was 6.2, resp. 2.9% (n.s.) versus 36.6% of RAAA (p < 0.0001). 30 days mortality rate of one staged and single procedure was 19.5, resp. 3.6% (p < 0.0001). 30 days morbidity rate was in the whole group 52.1% (80.7% in RAAA x 43.4% in asymptomatic AAA - p < 0.0001), in one-stage procedures 60.8% x 51.1% in single procedures - n.s., 45.1% in OR x 39.0% in EVAR - n.s. Redo procedures were significantly higher in EVAR x OR in the long-term period after primary procedure. 1-, 3-, 5-, and 8 years survival of patients with asymptomatic AAA and RAAA was 91.6, 85.9, 81.1 and 73.6%, resp. 54.9, 48.9, 45.9 and 43.5 years (p < 0.0001). 1-, 3-, and 5 years patients survival with single versus one staged procedures was 85.5, 80.5 and 71.0% versus 71.1, 68.0 and 74.6% (n.s.). 1-, 3-, and 5- years patients survival after OR or EVAR was 91.2, 87.1 and 80.6%, resp. 90.7, 79.9 and 74.6 % (n.s.). The significant influence on patients long-term survival had RAAA, age of patients, postoperative complications and one stage procedures.

CONCLUSION

High percentage of polymorbidity was the cause of the significant 30 days postoperative mortality of patients after OR. EVAR and OR have similar long-term results. One staged procedures should be used very carefully in selected patients due to the higher mortality rate and worse long-term patients survival.

[Procedures on internal carotid performed under locoregional anesthesia in the Plzen Surgical Clinic, over a seven-year period. A discussion on AHA and ESVS guidelines]

During a seven-year period (2002-2008), 830 patients underwent internal carotid surgery in the Plzen Surgical Clinic. The mean age of the patients was 68 y.o.a. (range 48-86 years). A total of 916 internal carotid procedures were performed, the male/female ratio was 667/249. 639 procedures were performed for asymptomatic and 277 for symptomatic conditions. 677 patients suffered from unilateral carotid disorders and 153 subjects from bilateral carotid disorders. All the procedures were performed under locoregional anesthesia. The 30-day mortality rate was 1% (9 subjects) of all the procedures.

[Accidental finding of a malignancy during surgery for unusual intestinal obstruction in a female patient following kidney transplantation]

This case report of 62 year old woman observed and treated in Vascular surgery Dpt. of University Hospital in Pilsen because of small bowel obstruction may be an example of a malignant disease, which can occur after using immunosuppressive drugs. The reason of the obstruction was strangulation of the small bowel in a peritoneal defect, which was made arteficialy as a treatment of posttransplant lymf-collection. We found signs of malignant disease in peritoneal cavity during the operation, that was verified by biopsy. The patient did not suffer from malignant disease before the transplantation. The origin of malignancy was probably ovarian tumor.

Hybrid procedures in the treatment of pseudoaneurysms of the aortic arch--case report

Classical surgical therapy of dilatation disorders of the aortic arch require extracorporeal circulation, selective brain perfusion and/or deep hypothermia and it is still associated with very high mortality and morbidity. Endovascular therapy has until recently indicated only been in cases when the disease did not affect the area of the origins of the main branches within the aortic arch. We are presenting a case report of a 68 year female patient with a vascular anomaly (arteria lusoria) and 2 pseudoaneurysms of the aortic arch between the origins of arteria carotis communis on the right and arteria carotis communis on the left, respectively between a. carotis communis on the left and arteria subclavia on the left, when we took advantage of a hybrid procedure in the therapy. The patient was treated by creating a new branching of the aortal arch using a prosthesis from the ascendant aorta and subsequently by an introduction of 2 stent-grafts to the aortic arch using femoral arteries.

Internal carotid artery surgery in regional anesthesia at the Clinic of Surgery in Pilsen during the past 5 years

A low percentage of perioperative complications and excellent long-term outcome following carotid artery surgery in Vascular Centers demonstrate the priority of surgical solutions in patients with significant findings on carotid arteries, in the prevention and treatment of ischemic cerebrovascular accidents. The group of patients from the Clinic of Surgery in Pilsen demonstrates the benefits of regional anesthesia during internal carotid artery surgery, both in terms of the patients' health and the financial costs incurred by the hospital.

[Unusual mechanism of the onset of a brachial artery aneurysm--a case review]

The authors present the case report of a 78-years-old man who was admitted to our clinic with the diagnosis of acute recurrent upper limb ischemia. The cause was rather rare diagnosis of a brachial artery aneurysm. The etiology of the aneurysm was interesting--70 years using of a arm-pit crutch.

[Infections of vascular reconstructions in the aortofemoral region]

Infections of vascular reconstructions in the aortofemoral region are among the most feared of conditions in the vascular surgery, having a very poor prognosis. The perioperative mortality reaches over 50% and the extremity loss up to 75%. The authors point out inaccuracies in diagnostics and definitions of the vascular reconstructions infections. On four cases of the vascular reconstructions infections in the aortofemoral region which have been managed in the Surgical Clinic in Plzen in last two years, they demonstrate severity of the above conditions.

[Mesenteric fibromatosis. Case report]

The authors describe a case of a young patient, who underwent a by-pass surgery for ileus of the small intestinal loops due to a wide-spread tumor of the mesentery, conducted in a different hospital. The patient was then re-operated in the Faculty hospital in Plzen, the tumor was successfully removed en-block and the pathologist came to a conclusion and diagnosed mesenterial fibromatosis. The case is being discussed from the point of view of the rarely occurring intraabdominal fibromatosis.

[Extraanatomic bypass surgery for peripheral arterial vascular disease--is it still justified?]

OBJECTIVE

Our results of extraanatomic bypass surgery in the last 5 years should be analysed in a retrospective study.

PATIENTS AND METHODS

66 extraanatomic reconstructions were performed in 65 patients (52 male, 13 female). Femoro-femoral bypasses (78.8 %) were mainly included in this study, followed by axillo-femoral (bifemoral) and obturator bypasses. The procedures could be divided in 45 (68.2 %) primary and 21 (31.8 %) recurrent operations. 57.6 % of the patients revealed a critical lower limb ischemia.

RESULTS

The bypass patency rates were 97 % after one year and 81.1 % after 3 years. 24.2 % of the patients showed immediate postoperative complications, 12.1 % of them major complications (surgical and nonsurgical). No patient died postoperatively or in the first year after operation. The 3-year mortality rate ranged to 10.8 %. Major amputations had to be carried out in 4 patients (6.1 %) during the first year and in one patient later on, so that the total amputation rate amounted to 7.6 %.

CONCLUSIONS

Our results prove extraanatomic reconstructions to be a valuable surgical tool in lower limb ischemia with good long-term success. Extraanatomic bypasses are technically simple procedures in the majority of cases and take good care of the patient with low morbidity and mortality.

[A kidney harvesting technic from a non-heart beating donor]

The authors describe the technique of collection of kidneys from NHBD. They present their own protocol elaborated in Plzen for collection of kidneys from NHBD. For collection they use a special double-balloon catheter inserted into the aorta to ensure that the perfusion fluid will penetrate into visceral branches of the aorta. For the flow of the perfusion fluid a urinary catheter is used inserted via the femoral vein into the vena cava inferior. Immediately after the beginning of perfusion laparotomy is performed with immediate cooling of the kidney with ice. The authors give an account of their own experience and discuss further technical possibilities as regards collection of kidneys from NHBD.