AIM OF THE STUDY: A gastric tube is commonly used in thoracic esophageal reconstruction. When a gastric tube is not available, pedicled jejunum transfer and colonic interposition are alternative methods. Oral end of the reconstructed esophagus occasionally has poor blood flow and may result in partial necrosis of the oral segment. We performed additional microvascular blood flow augmentation, the "supercharge" technique, to improve a blood flow circulation in the oral segment of the reconstructed esophagus. METHODS: A series of 86 esophageal reconstructions with microvascular blood flow augmentation using the "supercharge" technique were performed. Reconstructive methods included a gastric tube in five patients, a gastric tube combined with a free jejunual graft in one, an elongated gastric tube in eight, a pedicled colonic interposition in 22, and a pedicled jejunum in 50. Recipient vessels were used in neck or chest region. RESULTS: The color and blood flow of the transferred intestine appeared greatly improved after microvascular blood flow augmentation. Thrombosis was noticed in three patients during the surgery, and all thrombosies were salvaged by re-anastomosis. There were only three patients with partial graft necrosis of oral segment, two patients with anastomotic leakage, one anastomotic stricture. CONCLUSIONS: Augmentation of microvascular blood flow by this "supercharge" technique can be expected to reduce the risk of leakage and partial necrosis of the transferred intestine. This technique contributes to the successful reconstruction of esophageal defect.

• MeSH
• Surgical Flaps MeSH
• Adult MeSH
• Esophagoplasty methods   MeSH
• Esophagus blood supply   MeSH
• Pharynx surgery   MeSH
• Jejunum transplantation   MeSH
• Middle Aged MeSH
• Humans MeSH
• Microsurgery MeSH
• Microcirculation MeSH
• Aged MeSH
• Vascular Surgical Procedures methods   MeSH
• Stomach transplantation   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cough is an important mechanism of airway clearance. In patients who present weak and ineffective cough, augmentation techniques aim to assist or simulate the maneuver. These techniques target different phases of the cough cycle, mainly the inspiratory and expiratory phases, through assisted inspiration, assisted expiration and their combination. They include the manual hyperinflation, ventilator hyperinflation, glossopharyngeal breathing, manually assisted cough and mechanical insufflator-exsufflator, each applied individually or in different combinations. The aim of this review is to investigate the effectiveness and safety of cough augmentation techniques. Findings support that all commonly used techniques can theoretically improve airway clearance, as they generate higher cough peak flows compared to unassisted cough. Still, the studies assessing cough augmentation present considerable limitations and the direct comparison of different techniques is challenging. Current evidence indicate that cough peak flow shows higher increase with the combination of assisted inspiration and expiration, and improvement is greater in patients with lower unassisted values. Associated adverse events are infrequent.

• MeSH
• Pulmonary Disease, Chronic Obstructive physiopathology   therapy   MeSH
• Insufflation methods   MeSH
• Cough etiology   physiopathology   MeSH
• Humans MeSH
• Inhalation physiology   MeSH
• Scoliosis physiopathology   therapy   MeSH
• Respiration, Artificial methods   MeSH
• Peak Expiratory Flow Rate physiology   MeSH
• Exhalation physiology   MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

BACKGROUND AND IMPORTANCE: Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION: A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION: This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.

• MeSH
• Carotid Artery, Internal surgery   MeSH
• Middle Cerebral Artery diagnostic imaging   surgery   MeSH
• Vertebral Artery diagnostic imaging   surgery   MeSH
• Cerebrovascular Disorders * surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cerebral Revascularization * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

BACKGROUND: Peripheral wave reflection augments central blood pressure and contributes to cardiac load. This pressure augmentation is not quantifiable from brachial cuff pressure but can be determined from carotid pulsations using the augmentation index (AI). However, carotid tonometry is technically challenging and difficult to standardize in practice. We tested whether automated radial pressure analysis provides a viable alternative. METHODS AND RESULTS: Carotid and radial AI (cAI, rAI) were measured in 46 volunteers with a broad range of arterial properties. Data were assessed at rest, during a cold-pressor test, and following 0.4 mg of sublingual nitroglycerin. cAI correlated with rAI independent of age, mean blood pressure (BP), gender or body mass (cAI = 0.79 x rAI - 0.467, r = 0.81, P < 0.00001), with zero mean bias. There was individual variability in the prediction (difference of -4 +/- 23%), though 65% of the estimates fell within 15% of each other. Change in rAI and cAI with provocative maneuvers also correlated (r = 0.77, P < 0.001). Both cAI and rAI were nonlinearly related to late-systolic pressure-time integral (PTI), an index of cardiac load. At cAI < 0.1 or rAI < 0.69, PTI was unaltered, while greater values correlated with increased PTI. rAI accurately predicted this cut-off in 88% of cases, with a 5.5% false negative rate. CONCLUSIONS: Automated rAI analysis is an easily applied method to assess basal and dynamic central pressure augmentation. While individual predictive accuracy of cAI was variable, overall population results were consistent, supporting use of rAI in clinical trials. Its prediction of when AI is associated with greater LV loading (i.e. cardiac risk) is good and may help stratify individual risk along with brachial cuff pressure.

• MeSH
• Radial Artery physiology   MeSH
• Carotid Arteries physiology   MeSH
• Adult MeSH
• Hypertension diagnosis   physiopathology   MeSH
• Myocardial Contraction physiology   MeSH
• Blood Pressure physiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Manometry instrumentation   methods   MeSH
• Blood Pressure Determination instrumentation   methods   MeSH
• Adolescent MeSH
• Elasticity MeSH
• Pulsatile Flow physiology   MeSH
• Blood Flow Velocity physiology   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

Natural killer (NK) cells constitute the predominant innate lymphocyte subset that mediates the anti-viral and anti-tumor immune responses. NK cells use an array of innate receptors to sense their environment and to respond to infections, cellular stress and transformation. The resulting NK cell activation, including cytotoxicity and cytokine production, is a fundamental component of the early immune response. The most recent discoveries in NK cell biology have stimulated the translational research that has led to remarkable results for the treatment of human malignancies. Therefore, the rapid isolation of NK cells from the peripheral blood or tumor microenvironment and the subsequent assessment of cytolytic function are crucial to the study of their potency and NK cell-mediated immunosurveillance. Here, we provide protocols for NK cell isolation and the assessment of NK cell cytotoxicity using flow cytometry.

• Keywords
• Cytotoxicity assay, Degranulation assay, Flow cytometry, NK-cell mediated cytotoxicity,
• MeSH
• Lymphocyte Activation MeSH
• Killer Cells, Natural immunology   MeSH
• Cytotoxicity, Immunologic * MeSH
• Cytotoxicity Tests, Immunologic methods   MeSH
• Humans MeSH
• Flow Cytometry methods   MeSH
• Cell Separation methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

The authors compare the classical method of typing of HLA antigens by the microlymphocytotoxic test (CTX) and the results obtained by flow cytometry (FCTX). They investigated agreement of results as regards estimation of 14 HLA antigens, loci A and B. in 42 sera. They compared possibilities of flow cytometry using microquantities of material and investigated changes of results obtained by cytotoxic reactions after 24 hours. The results evaluated by linear regression analysis proved the comparability of flow cytometry and the classical microlymphocytotoxic test.

• MeSH
• Cytotoxicity Tests, Immunologic MeSH
• HLA Antigens analysis   MeSH
• Humans MeSH
• Flow Cytometry * MeSH
• Cell Separation MeSH
• Histocompatibility Testing * MeSH
• Check Tag
• Humans MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH
• Comparative Study MeSH
• Names of Substances
• HLA Antigens MeSH

In experiments on 100 cats with multichannel recording, the effects of three vasodilators - papaverine, chloracyzine, and bencyclane (Halidor) - on the volume velocity of the blood flow (by microthermistor technique) and on oxygen tension (by polarography) in the carotid artery, the cerebral cortex, the thalamus, and in white matter were tested. Considerable differences were found in the effects of the drugs mentioned, although all of them augment the total and local blood flow in the brain, and in most instances elevate the oxygen tension in arterial blood and cerebral tissue. Characteristic of papaverine is a uniform augmentation of blood supply to the cerebral cortex, the thalamus, and white matter, whereas chloracyzine, and especially bencyclane, primarily augment the blood supply to the cerebral cortex. In an analogous way the drugs tested influence the cerebral blood flow and oxygen tension in experimental cerebral ischaemia induced by intracarotid infusion of a serotonin solution.

• MeSH
• Carotid Arteries MeSH
• Bencyclane pharmacology   MeSH
• Cycloheptanes pharmacology   MeSH
• Phenothiazines pharmacology   MeSH
• Cats MeSH
• Blood Pressure drug effects   MeSH
• Brain physiology   MeSH
• Cerebral Cortex blood supply   MeSH
• Cerebrovascular Circulation drug effects   MeSH
• Papaverine pharmacology   MeSH
• Polarography MeSH
• Oxygen Consumption drug effects   MeSH
• Thalamus blood supply   MeSH
• Vasodilator Agents pharmacology   MeSH
• Animals MeSH
• Check Tag
• Cats MeSH
• Male MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Bencyclane MeSH
• chloracizine MeSH Browser
• Cycloheptanes MeSH
• Phenothiazines MeSH
• Papaverine MeSH
• Vasodilator Agents MeSH

Myocardial blood flow in the region supplied by the right coronary artery was estimated in 36 patients after selective Xenon-133 injection into the artery. Its values were analyzed in relation to coronary driving pressure, diastolic coronary vascular resistance, and right ventricular triple product (tension-time index, TTI). Myocardial blood flow in the region supplied by the right coronary artery was increased in patients with moderately elevated pulmonary artery pressure (4.13 to 8.0 kPa; 31 to 60 mmHg). This increase was due to a significant lowering of diastolic coronary vascular resistance. In patients with severe pulmonary hypertension (above 8.00 kPa; >60 mmHg) the greatly increased value of TTI was not accompanied by a further augmentation of myocardial blood flow. This incommensurability between metabolic demand of the myocardium, reflected in TTI value, and the abililty to increase blood flow in the region supplied by the right coronary artery could be one of the causes of myocardial ischaemia and anginal pain in patients with extreme pulmonary hypertension.

• MeSH
• Pulmonary Artery physiopathology   MeSH
• Vascular Resistance MeSH
• Adult MeSH
• Coronary Circulation * MeSH
• Blood Pressure MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Hypertension, Pulmonary diagnosis   physiopathology   MeSH
• Pulmonary Circulation MeSH
• Systole MeSH
• Stroke Volume MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

In the past few years in vivo and ex vivo experiments using mechanical augmentation of portal inflow have shown a reduction in mesenteric portal venous pressure, intrahepatic portal vascular resistance and an improvement in liver function in cirrhotic animals. The latest technical development has allowed a construction of a miniature portal pump for human implantation. The aim of this study was to assess the short-term effect of mechanically increasing portal blood flow on hepatic haemodynamics and liver function in a cirrhotic porcine model. Liver cirrhosis was established by ligation of common bile duct in pigs. After four weeks, when the animals had become cirrhotic, the miniature pump was placed in the portal vein and blood flow was increased by 50% for one hour. Enhanced portal flow in the cirrhotic animals decreased mesenteric portal pressure, improved liver function and hepatic haemodynamics. However, long-term experiments will be needed to confirm the concept of enhancement of portal inflow as a feasible treatment for portal hypertension and liver failure in humans.

• MeSH
• Implants, Experimental * MeSH
• Liver Cirrhosis physiopathology   therapy   MeSH
• Liver blood supply   MeSH
• Hypertension, Portal complications   therapy   MeSH
• Swine MeSH
• Liver Failure etiology   therapy   MeSH
• Portal Vein * MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• English Abstract MeSH
• Journal Article MeSH

The present study was designed to investigate mechanisms of adenosine (ADO)-mediated prolongation of conductivity through the atrioventricular (AV) node during myocardial ischemia. Using the Langendorff preparation of the guinea pig heart, we tested the hypothesis that extracellular potassium concentration elevated due to ischemia could augment ADO effect. Exposure of the heart preparation to either stop-flow or hypoxic Krebs-Henseleit solution (KH) inhibited AV node conductivity observed as an increase in SH interval, and finally resulted in AV block. Superficial potassium concentration ([K+]s), recorded simultaneously increased in response to each stop-flow or hypoxia. Application of 0.1 mM BaCl2 markedly increased the SH interval, yet it did neither protect the heart from hypoxia-evoked AV block nor did it prevent hypoxia-induced [K+]s elevation. Neither did perfusion of the myocardium with modified KH containing 8 mM K+ affect the hypoxic AV block and [K+]s increase. The hypoxic effects were not affected by adenosine A1 agonist N6-cyclopentyl-adenosine (CPA, 30 nM). In the presence of CPA, application of high-K+ KH, where potassium was elevated to the value of hypoxic level, did not affect the SH interval. On the other hand, adenosine deaminase (ADA, 4 U/ml) significantly attenuated the hypoxic AV block. This indicated an involvement of endogenous ADO. Yet, in the presence of both ADA and CPA, the application of the high-K+ KH did not affect the SH interval. We concluded that increased extracellular [K+], elevated due to hypoxia, did not participate in the hypoxia-induced AV block mediated by ADO.

• MeSH
• Adenosine pharmacology   MeSH
• Potassium pharmacology   MeSH
• Potassium Channels physiology   MeSH
• Myocardial Ischemia physiopathology   MeSH
• Guinea Pigs MeSH
• Atrioventricular Node physiology   MeSH
• Heart Block physiopathology   prevention & control   MeSH
• Animals MeSH
• Check Tag
• Guinea Pigs MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Adenosine MeSH
• Potassium MeSH
• Potassium Channels MeSH