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[Figure: see text]. [ABSTRACT FROM AUTHOR]

Hemodynamic management based on cerebral autoregulation range is a possible strategy for preserving major organ perfusion during cardiovascular surgery. The purpose of this study was to evaluate the relation of vascular properties with lower limit of cerebral autoregulation (LLA). LLA was monitored in 66 patients undergoing cardiovascular surgery using near‐infrared spectroscopy. To determine the clinical importance of LLA monitoring, association of blood pressure excursions below LLA and acute kidney injury (AKI) was evaluated. Flow‐mediated dilation (FMD) and pulse wave velocity (PWV) were measured for the evaluation of endothelial function and aortic stiffness. Variables associated with LLA were evaluated. Excluding patients on hemodialysis, there were 15 patients (25.9%) who developed AKI. Blood pressure excursions below LLA were higher in patients who developed AKI (4.55 mm Hg × hr vs. 1.23 mm Hg × hr, P =.017). In the univariate analysis, prevalence of ischemic heart disease (No IHD: 53 ± 13.0 mm Hg vs. IHD: 60.0 ± 13.6 mm Hg, P =.056) and FMD (r = −0.42, 95% CI −0.61 to −0.19, P <.001) were associated with LLA before cardiopulmonary bypass (CPB). During CPB, calcium channel blocker (No Ca blocker: 42 ± 10.6 mm Hg vs. Ca blocker: 49 ± 14.3 mm Hg, P =.033), diabetes (no DM: 44 ± 13.2 mm Hg vs. DM: 55 ± 10.0 mm Hg, P =.024), FMD (r = −0.32, 95% CI −0.55 to −0.05, P =.021), and PWV (r = 0.28, 95% CI 0.012 to 0.513, P =.041) were associated with LLA. Multivariate analysis showed that FMD was correlated with LLA before CPB (r = −2.19, 95% CI −3.621 to −0.755, P =.003), while PWV was correlated with LLA during CPB (r = 0.01, 95% CI 0.001‐0.019, P =.023). Endothelial function and aortic stiffness may be important factors in determining LLA at different phases in cardiovascular surgery. [ABSTRACT FROM AUTHOR]

Drought often causes emersion, which can seriously damage aquatic organisms in inland aquatic ecosystems. To identify mussel characteristics associated with emersion tolerance, I investigated relationships between survival duration and mussel characteristics under an experimental emersion treatment. The survival durations of six lotic unionid mussel species (Nodularia douglasiae biwae, Pronodularia japanensis, Obovalis omiensis, Lanceolaria grayii, Inversidens brandtii, and Sinanodonta japonica) during emersion in an incubator at 25°C were determined. Shell length, body mass, moisture loss per day, shell thickness, and overall shell shape (shell length/shell height) were measured, and the relationships between these characteristics and survival duration were estimated using Cox’s regression analyses both by species (single-species analysis) and overall, excluding I. brandtii (multispecies analysis). The mussels survived 0.5–8.5 days, and survival duration differed among species. Single-species analyses indicated that in P. japanensis and L. grayii, longer shells and greater mass increased survival. O. omiensis survived longer as moisture loss from their soft bodies occurred more slowly. Multispecies analyses indicated shorter survival by mussels that had relatively heavy body mass, rapid moisture loss, and thin shells. Species with such characteristics are expected to be the most sensitive to emersion and may require conservation. [ABSTRACT FROM AUTHOR]

A 53-year-old woman visited her district hospital complaining of right lower limb numbness 8 days after being diagnosed with COVID-19. She had been suffering diarrhea for 25 days before the hospital visit. Computed tomography showed multiple arterial and venous thromboses, and anticoagulation with a therapeutic dose of heparin was initiated. Acute aortic occlusion occurred on hospital day 5, and balloon thromboembolectomy was performed for revascularization of the lower limbs 9 hours after onset. Ulcerative colitis was diagnosed on postoperative day 7. With the anticoagulation and immunosuppression therapy, no thromboembolic event occurred postoperatively., (@ 2024 The Editorial Committee of Annals of Vascular Diseases.)

An anomalous right coronary artery originating from the left Valsalva is rare, but sometimes causes sudden cardiac death in a healthy young to middle-aged patient. We present a case of 30-year-old male who was suggested from cardiopulmonary arrest, during playing basketball. He was resuscitated using automated external defibrillator, and was brought to the emergency department. Electrocardiogram showed no ST segment elevation. Coronary angiography and computed tomography revealed anomalous right coronary artery, which originated from the left sinus of Valsalva, and ran between the aorta and the pulmonary artery trunk. Coronary artery bypass grafting was performed using the right internal thoracic arterial graft, with proximal native coronary artery ligation. He was discharged on the nineth postoperative day and had no chest symptoms for seven months.

Objectives: Monitoring cerebral autoregulation may help identify the lower limit of autoregulation in individual patients. Mean arterial blood pressure below lower limit of autoregulation appears to be a risk factor for postoperative acute kidney injury. Cerebral autoregulation can be monitored in real time using correlation approaches. However, the precise thresholds for different cerebral autoregulation indexes that identify the lower limit of autoregulation are unknown. We identified thresholds for intact autoregulation in patients during cardiopulmonary bypass surgery and examined the relevance of these thresholds to postoperative acute kidney injury., Design: A single-center retrospective analysis., Setting: Tertiary academic medical center., Patients: Data from 59 patients was used to determine precise cerebral autoregulation thresholds for identification of the lower limit of autoregulation. These thresholds were validated in a larger cohort of 226 patients., Methods and Main Results: Invasive mean arterial blood pressure, cerebral blood flow velocities, regional cortical oxygen saturation, and total hemoglobin were recorded simultaneously. Three cerebral autoregulation indices were calculated, including mean flow index, cerebral oximetry index, and hemoglobin volume index. Cerebral autoregulation curves for the three indices were plotted, and thresholds for each index were used to generate threshold- and index-specific lower limit of autoregulations. A reference lower limit of autoregulation could be identified in 59 patients by plotting cerebral blood flow velocity against mean arterial blood pressure to generate gold-standard Lassen curves. The lower limit of autoregulations defined at each threshold were compared with the gold-standard lower limit of autoregulation determined from Lassen curves. The results identified the following thresholds: mean flow index (0.45), cerebral oximetry index (0.35), and hemoglobin volume index (0.3). We then calculated the product of magnitude and duration of mean arterial blood pressure less than lower limit of autoregulation in a larger cohort of 226 patients. When using the lower limit of autoregulations identified by the optimal thresholds above, mean arterial blood pressure less than lower limit of autoregulation was greater in patients with acute kidney injury than in those without acute kidney injury., Conclusions: This study identified thresholds of intact and impaired cerebral autoregulation for three indices and showed that mean arterial blood pressure below lower limit of autoregulation is a risk factor for acute kidney injury after cardiac surgery., Competing Interests: Drs. Lee, Hogue, and Brown received support for article research from the National Institutes of Health (NIH). Dr. Lee has received support from and been a paid consultant for Medtronic, and she received research support from Edwards Life Sciences. Dr. Lee’s arrangements have been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Some methods used to measure and monitor autoregulation as described in this article were patented by The Johns Hopkins University, listing Dr. Brady as a coinventor. These patents are exclusively licensed to Medtronic. Dr. Brown reported receiving grants from the NIH during the conduct of the study, and consulting for and participating in a data share with Medtronic. Dr. Brady is listed as inventor on patents awarded and assigned to the Johns Hopkins University. These patents are related to the monitoring technology described in this article and are exclusively licensed to Medtronic, and Dr. Brady received a portion of the licensing fee. Dr. Venkataraman received funding from Vixiar Medical (consulting) and from universities for speaker honorariums, and she was supported by the National Science Foundation CAREER award 1845430. Dr. Hogue reported receiving grants and personal fees for being a consultant and providing lectures for Medtronic/Covidien, being a consultant to Merck, and receiving grants from the NIH outside of the submitted work, and he disclosed off-label product use of autoregulation monitoring is investigational. Drs. Czosnyka and Smielewski received funding from licensing ICM+ through Cambridge Enterprise Ltd, United Kingdom. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background/aims: We recently described a novel regulatory role for histone deacetylase 2 (HDAC2) in protecting endothelial cells from oxidized low-density lipoprotein (OxLDL)-induced injury. In this study, we examined the effects of endothelial-specific HDAC2 overexpression on endothelial-dependent vasorelaxation and atherogenesis in vivo., Methods: Endothelial-specific HDAC2-overexpressing transgenic mice (HDAC2-Tg) were generated under control of the Tie2 promoter. An atherosclerosis model was produced by injecting HDAC2-Tg and wild-type (WT) mice with adeno-associated virus encoding a PCSK9 gain-of-function mutant under control of a liver-specific promoter and feeding them a high-fat diet for 12 weeks. Aortic stiffness in vivo was determined by measuring pulse wave velocity. Wire myography was used to measure endothelium dependent (acetylcholine) and independent (sodium nitroprusside) relaxation in isolated mice aortas. Atherosclerotic plaque burden in aortas was determined by Oil Red O staining and protein expression was determined by western blotting., Results: At baseline, HDAC2-Tg mice had normal mean arterial blood pressure (MAP) and body weight, but pulse wave velocity (PWV), an inverse measure of vascular health and stiffness, was decreased, suggesting that their vessels were more compliant. Moreover, basal nitric oxide production was enhanced in the vessels of HDAC2-Tg mice as compared to that in WT controls, although no significant differences in acetylcholine (endothelial component)- or sodium nitroprusside (non-endothelial component)-mediated relaxation were observed. However, after exposure to OxLDL, aortas from HDAC2-Tg mice exhibited greater acetylcholine-induced relaxation than did those from WT mice. Thus, endothelial-specific vasodilator production was enhanced despite oxidative injury. Atherosclerosis induction in WT mice led to a significant increase in PWV, but in HDAC2-Tg mice, PWV and MAP remained unchanged. Further, aortic rings from HDAC2-Tg exhibited better endothelial-dependent vascular relaxation than did those from WT mice, but not when treated with nitric oxide synthase inhibitor L-NAME. Finally, plaque burden, determined by Oil red O staining, was significantly increased in WT, but not HDAC2-Tg mice, subjected to the atherogenic model. Deletion of endothelial HDAC2 led to impaired endothelial cell-dependent vascular relaxation and increased PWV, compared with those in littermate controls., Conclusion: HDAC2 protects against endothelial dysfunction and atherogenesis induced by oxidized lipids. Hence, overexpression or activation of HDAC2 represents a novel therapy for endothelial dysfunction and atherosclerosis. HDAC2-Tg mice provide an opportunity to determine the role of endothelial HDAC2 in vascular endothelial homeostasis., Competing Interests: The authors have no conflicts of interest to disclose., (© Copyright by the Author(s). Published by Cell Physiol Biochem Press.)