Perioperative Right Ventricular Pressure Monitoring in Cardiac Surgery.

Right ventricular (RV) dysfunction is a cause of increased morbidity and mortality in both cardiac surgery and noncardiac surgery and in the intensive care unit. Early diagnosis of this condition still poses a challenge. The diagnosis of RV dysfunction traditionally is based on a combination of echocardiography, hemodynamic measurements, and clinical symptoms.

VEGF Requires the Receptor NRP-1 To Inhibit Lipopolysaccharide-Dependent Dendritic Cell Maturation.

To stimulate a productive T cell response, dendritic cells (DC) must undergo maturation characterized by heightened cell surface expression of MHC and costimulatory molecules as well as cytokine production. Conversely, the inhibition of DC maturation is a central mechanism of immune tolerance. The control of the DC maturation process relies on the integration of several cellular stimulatory or inhibitory signals.

Insufficient Body Weight of Adults Born With Esophageal Atresia.

Objectives: Impaired growth has been reported in children born with esophageal atresia (EA). Their nutritional fate at adulthood remains uncertain though. Our objectives were to determine the body mass index (BMI) of adult patients with EA followed up from 2009 to 2011 in the EA clinic of a university-affiliated hospital in Quebec (Canada), and investigate characteristics associated with underweight.

Defining novel parameters for the optimal priming and expansion of minor histocompatibility antigen-specific T cells in culture.

Background: Adoptive transfer of minor histocompatibility antigen (MiHA)-specific T cells is a promising therapy for patients with hematological cancers. However, the efficacy of the transferred cells is hampered by the acquisition of terminal effector differentiation and exhaustion features during expansion in vitro thus preventing their function and persistence in vivo. Yet, the factors that induce T-cell differentiation and functional impairment in culture remain poorly defined and are likely to vary depending on the method used for expansion.

Early exposure to interleukin-21 limits rapidly generated anti-Epstein-Barr virus T-cell line differentiation.

Background Aims: The adoptive transfer of ex vivo-expanded Epstein-Barr virus (EBV)-specific T-cell lines is an attractive strategy to treat EBV-related neoplasms. Current evidence suggests that for adoptive immunotherapy in general, clinical responses are superior if the transferred cells have not reached a late or terminal effector differentiation phenotype before infusion. The cytokine interleukin (IL)-21 has shown great promise at limiting late T-cell differentiation in vitro, but this remains to be demonstrated in anti-viral T-cell lines.

Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit.

Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important.

Identification of tyrosine 189 and asparagine 358 of the cholecystokinin 2 receptor in direct interaction with the crucial C-terminal amide of cholecystokinin by molecular modeling, site-directed mutagenesis, and structure/affinity studies.

The cholecystokinin (CCK) receptors CCK1R and CCK2R exert important central and peripheral functions by binding the neuropeptide cholecystokinin. Because these receptors are potential therapeutic targets, great interest has been devoted to the identification of efficient ligands that selectively activate or inhibit these receptors. A complete mapping of the CCK binding site in these receptors would help to design new CCK ligands and to optimize their properties.

Magnesium potentiates neuromuscular blockade with cisatracurium during cardiac surgery.

Purpose: Magnesium potentiates the effect of nondepolarizing neuromuscular blocking agents. It is used in cardiac anesthesia to prevent hypertension and arrhythmias. This study was performed to measure the interaction between magnesium and cisatracurium in cardiac surgery.

Optimizing pH-responsive polymeric micelles for drug delivery in a cancer photodynamic therapy model.

Different pH-sensitive, randomly- and terminally-alkylated N-isopropylacrylamide (NIPAM) copolymers were synthesized and used to prepare pH-responsive polymeric micelles (PM). These copolymers were modified from previously-studied copolymers by incorporating an additional hydrophilic monomer, N-vinyl-2-pyrrolidone (VP) to decrease uptake by the mononuclear phagocyte system (MPS) and improve localization in tumors. VP lowered the phase transition pH of the copolymers but did not affect the onset of micellization.

A comprehensive strategy to avoid transesophageal echocardiography probe damage.

Purpose: To describe the factors predisposing to transesophageal echocardiography (TEE) probe damage and to propose a strategy aimed at preventing damage to the TEE probe. Description of equipment and procedures: Damage to the TEE probe can occur anywhere and anytime during use in the operating room (OR) or when the probe is not in use in the OR, such as in the cleaning room, during storage or during transport of the probe. The components of the strategy used in our institution to avoid probe damage are: 1) storage of the probe in a dedicated holder in the OR when it is not in use, 2) use of a lexan box in the OR to protect the probe connector, 3) use of a custom-made holder when the probe is inserted in the patient, 4) use of a dedicated holder for soiled TEE probe storage in the cleaning room and for subsequent probe storage.

Mitral Doppler indices are superior to two-dimensional echocardiographic and hemodynamic variables in predicting responsiveness of cardiac output to a rapid intravenous infusion of colloid.

Unlabelled: We hypothesized that mitral flow (MF) Doppler measurements could be used to predict cardiac output (CO) responsiveness to fluid challenge. Fourteen patients with normal systolic and diastolic function, scheduled for coronary artery bypass graft surgery, were evaluated as part of a pilot study in which preload was varied immediately before the beginning of cardiopulmonary bypass. A Validation group of 36 patients with different levels of systolic and diastolic function received a rapid infusion of 500 mL of 10% pentastarch.

Pulmonary metabolism of endothelin 1 during on-pump and beating heart coronary artery bypass operations.

Background: Coronary artery bypass operations are associated with increased circulating levels of the powerful vasoconstrictor endothelin 1. The pulmonary circulation is an important site for both production and clearance of endothelin 1. Lung endothelial injury resulting from cardiopulmonary bypass could modify pulmonary endothelin 1 metabolism through an increase in production, a reduction in removal, or a combination of both.

In-vitro and in-vivo evaluation of pH-responsive polymeric micelles in a photodynamic cancer therapy model.

pH-sensitive polymeric micelles of randomly and terminally alkylated N-isopropylacrylamide copolymers were prepared and characterized. Aluminium chloride phthalocyanine (AlClPc), a second generation sensitizer for the photodynamic therapy of cancer, was incorporated in the micelles by dialysis. Their photodynamic activities were evaluated in-vitro against EMT-6 mouse mammary tumour cells and in-vivo against EMT-6 tumours implanted intradermally on each hind thigh of Balb/c mice.

Preparation and characterization of pH-responsive polymeric micelles for the delivery of photosensitizing anticancer drugs.

pH-responsive polymeric micelles (PM) consisting of random copolymers of N-isopropylacrylamide (NIPA), methacrylic acid (MAA), and octadecyl acrylate (ODA) were prepared and characterized. The critical aggregation concentration, as determined by a fluorescence probe technique, was approximately 10 mg/L in water and phosphate-buffered saline. Phase transition pH was estimated at 5.

Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery.

Purpose: To compare the hemodynamic effects of sevoflurane when used for induction and maintenance of anesthesia with a total intravenous technique in patients with known coronary artery disease (CAD).

Methods: Thirty patients undergoing elective coronary artery bypass graft (CABG) were randomly allocated to receive either sevoflurane (S group, n = 15) at a minimal concentration of 4% in oxygen for induction and at 0.5-2 MAC end-tidal concentration for maintenance, or a total intravenous technique (T group, n = 15) consisting of midazolam for induction and propofol for maintenance.

Propofol or midazolam for sedation and early extubation following cardiac surgery.

Purpose: The purpose of this randomized, double-blind study was to evaluate the efficacy of midazolam and propofol for postoperative sedation and early extubation following cardiac surgery.

Methods: ASA physical status II-III patients scheduled to undergo elective first-time cardiac surgery with an ejection fraction > 45% were eligible. All patients received a standardized sufentanil/isoflurane anaesthesia.

Hemodynamic and pharmacodynamic comparison of doxacurium and high-dose vecuronium during coronary artery bypass surgery: a cost-benefit study.

Doxacurium (DOX), a new nondepolarizing neuromuscular blocking drug (NMBD), was compared in a randomized, double-blind fashion to high-dose vecuronium (VEC) in 60 coronary artery bypass grafting (CABG) patients. A third group of 15 patients older than 70 years of age (DOX-70) was added to compare the effects of DOX to VEC in the older population. Endpoints of the study were hemodynamic stability, ease of ventilation and intubation, anesthesiologist's satisfaction, drug interventions to correct hemodynamic instability, and total cost of the drug.

Successful non-surgical extraction of a knotted pulmonary artery catheter trapped in the right ventricle.

A patient is presented in whom a pulmonary artery catheter (PAC) formed a knot which was fixed in the region of the tricuspid valve chordea. The PAC was successfully and nonsurgically freed from its attachment and removed. A guide wire was introduced by the distal port of the PAC and under fluoroscopy the PAC was manipulated free and then extracted easily.

[Anesthetic induction with Althesin or diazepam in patients undergoing an aortocoronary bypass].

The haemodynamic effects of induction of anaesthesia with diazepam (group D) and Althesin (group A) were studied in 25 coronary patients under betablockers with good myocardial function. Haemodynamic variables monitored were vascular pressures, cardiac output and systolic time intervals. The effects of both drugs were observed when used alone (time I) and in combination with fentanyl, pancuronium and nitrous oxide (time II).

Pathophysiology of rupture of the pulmonary artery by pulmonary artery balloon-tipped catheters.

High pressures have been reported in pulmonary artery catheter balloons. This study was undertaken to determine the in vitro rupturing pressures of human peripheral pulmonary arteries and to evaluate whether such pressures could be generated under clinical conditions. The in vitro model then was confirmed in vivo in the dog and the evolution of a rupture of a peripheral pulmonary artery studied.