Model studies at mechanical aortic heart valve prostheses--Part I: Steady-state flow fields and pressure loss coefficients

In a 3:1 scaled model of the human aorta models of the Omniscience, Bj?rk-Shiley Convexo-Concave, Bj?rk-Shiley Monostrut, Medtronic-Hall, Duromedics (Hemex) and the Saint Jude Medical heart valve prostheses are studied in steady flow representing the systolic peak flow phase. Detailed flow visualization experiments show flow separations at all inner ring surfaces as well as at most of the occluders. The resulting stagnation areas increase the risk of thrombus accumulation. Flow separations also stimulate vortex formation and turbulent mixing at the downstream jet boundaries and thus may intensify blood damage by turbulent shear stresses. The different influences of struts and occluder guides on the flow around the occluders are discussed. The effects of the individual valve components on the flow fields are analyzed and correlated with the resulting pressure losses.     

Ionescu-Shiley pericardial xenograft valve: Hemodynamic evaluation and early clinical follow-up of 326 patients

Dissatisfaction with the hemodynamic characteristics of available porcine valves prompted a clinical trial of the Ionescu-Shiley percardial xenograft (ISPX) valve. Three hundred fifty-six ISPX valves were implanted consecutively in 326 patients. Operative mortality was 2.6% (2/75) for aortic valve replacement alone and 7.7% (12/155) for aortic valve replacements that included reoperations and combined procedures such as mitral commissurotomy, annuloplasty, and coronary artery bypass. Operative mortality for all patients who underwent mitral valve replacement was 9.5% (14/147). The mean peak systolic gradient pressure in the aortic position was 5.4 mm Hg overall and 4.27 mm Hg with the size 19 mm valve. There were no embolic episodes in patients who received the ISPX valve in the aortic position. The available data indicate that the rate of peripheral embolism with the ISPX valve compares favorably with that of porcine valves. Considering its hemodynamic advantage, if the longterm durability of the full-orifice Ionescu-Shiley pericardial xenograft valve continues to be confirmed by follow-up studies, it is our opinion that it is the biologic valve of choice.     

Glucocorticoids regulate TCR-induced elevation of CD4: functional implications

CD4 serves as a coreceptor during Ag recognition by the TCR. This interaction results in a marked increase in the sensitivity of a T cell to Ag presented by MHC class II molecules. Here we report that activation of T cells either by plate-bound mAb (anti-TCR, anti-CD3) or soluble activators (staphylococcal enterotoxin A, Con A) is associated with an (up to 3-fold) increase in CD4 cell surface expression on CD25+ cells, which was maximal after 72-96 h. Incubation with the glucocorticoid hormone corticosterone (CORT) shifted the enhancement of CD4 expression to a point about 24 h earlier than that observed in control cultures. In parallel, the proliferative response of these CORT-treated cells was profoundly enhanced. An involvement of increased CD4 expression in this enhanced proliferative response was evidenced by the observation that T cell proliferation in CORT-treated cultures was much less sensitive to inhibition by an inhibitory, nondepleting anti-CD4 mAb than that in control cultures. TCR down-regulation was, however, not affected by CORT. Thus, based on this study and previous reports we propose that both TCR-mediated signals and glucocorticoids are important physiological regulators of CD4 expression. In addition, these findings may be of significance for the sensitivity of CD4+ cells to HIV infection upon T cell activation, as the efficacy of primary patient HIV entry depends on the level of surface CD4.     

Control of microplankton size structure in contrasting water columns of the Celtic Sea

Water column structure, microphytoplankton size spectra andnutrient concentration were analysed at six sampling stationsin the Celtic Sea. Three types of stations were distinguished:(i) where the upper mixed layer (UML) reaches the total depth(TD), (ii) where the UML is about half of TD and (iii) wherethe UML is considerably less than half the TD. The UML was nutrientrich at type A stations and was nutrient depleted at type Bstations. At type C stations, the UML was nitrate depleted andsilicate rich. Two groups of microplankton size-abundance spectra(SAS) were found: (i) a typical linear SAS and (ii) a more complex‘atypical’ SAS, with a linear part up to 160 µmand a dome at 300 µm caused by a Coscinodiscus wailesiibloom. The dome was observed at all depths at type A stationsand above the pycnocline and at the seafloor of type B stations.Combining intrinsic growth rate, sinking rate and mixing layerdepth, the C. wailesii dome persists only at type A stationsbut settles out of the UML at the remaining stations. This suggeststhat a large part of the perturbation at the right extreme ofphytoplankton SAS does not propagate along the planktonic SASbut sinks to the seafloor. This paper was presented in a session on "Size Structure ofPlankton Communities", at the ASLO Summer International Meeting,held in Santiago de Compostela, Spain, between 19 and 24 June,and coordinated by Xabier Irigoien, Roger Harris and Angel Lopez-Urrutia.     

Type I and type II corticosteroid receptor gene expression in the rat: effect of adrenalectomy and dexamethasone administration

We have used 32P-labeled cRNA probes directed against Type I (mineralocorticoid, high affinity glucocorticoid) and Type II (classical glucocorticoid) receptor mRNA to screen various tissues, and have investigated the effect of adrenalectomy (ADX) and dexamethasone (DM) administration on their levels in hippocampus. Both Northern blot and S1 nuclease analysis showed Type I mRNA to be high in hippocampus, colon, and heart; low in liver; and undetectable in thymus. Type II mRNA was high in liver, thymus, and brain; and low in testis and parotid. A transient increase in both hippocampal Type I and Type II mRNA was noted at 1-3 days post ADX. DM similarly elicited a rise in hippocampal Type I mRNA at 2-4 days after ADX, but prevented the ADX-induced increment in Type II mRNA. In contrast to the transient increase in Type I receptor mRNA levels, hippocampal levels of Type I receptors measured by [3H]aldosterone binding were constant 1-16 days post ADX. DM administration caused a doubling in Type I receptor levels over 4 days, with plateau levels at 4-16 days; previously, DM has been shown to lower Type II receptor levels in the hippocampus.(ABSTRACT TRUNCATED AT 250 WORDS)     

HEMIAZYGOS CONTINUATION TO CORONARY SINUS WITH NORMAL LEFT INNOMINATE VEIN

A case is described of absent hepatic segment of the inferior vena cava with hemiazygos continuation and drainage into the coronary sinus with associated atrial septal defect and patent ductus arteriosus. In all previously reported cases of inferior vena caval anomalies with persistent hemiazygos, the hemiazygos joined the homolateral superior vena cava. To our knowledge this is the first case to be reported of a patient who had hemiazygos continuation to the coronary sinus with a normal left innominate vein and a single right superior vena cava.     

Anatomical resolution of two types of corticosterone receptor sites in rat brain with in vitro autoradiography and computerized image analysis

The rat brain contains two receptor systems for corticosterone (CORT): the glucocorticoid (GR) and corticosterone or mineralocorticoid-like (CR) receptor sites. We have studied the localization of these receptors by in vitro autoradiography and by in vitro cytosol binding assays in microdissected brain areas. In vitro autoradiography revealed that CR receptor sites are almost entirely restricted to the septal-hippocampal complex, whereas the presence of GR extends throughout the brain. Highest levels of GR are present in the lateral septum, hippocampal, cortical and thalamic regions and the paraventricular nucleus. In vitro determination of binding of 3H-labelled steroids to CR and GR in cytosol of "punched out" brain tissue revealed a similar neuroanatomical distribution as observed with the autoradiographic analysis. In addition, it was found that CORT binds to CR (KD approximately 0.5 nM) with 5-10-fold higher affinity than to GR (KD approximately 2.5-5 nM).