Acute arterial occlusions occur in high shear rate hemodynamic conditions. Arterial thrombi are platelet-rich when examined histologically compared with red blood cells in venous thrombi. Prior studies of platelet biology were not capable of accounting for the rapid kinetics and bond strengths necessary to produce occlusive thrombus under these conditions where the stasis condition of the Virchow triad is so noticeably absent. Recent experiments elucidate the unique pathway and kinetics of platelet aggregation that produce arterial occlusion. Large thrombi form from local release and conformational changes in von Willebrand factor under very high shear rates. The effect of high shear hemodynamics on thrombus growth has profound implications for the understanding of all acute thrombotic cardiovascular events as well as for vascular reconstructive techniques and vascular device design, testing, and clinical performance.

A series of thiazoloquin(az)olinones were synthesized and found to have potent inhibitory activity against CD38. Several of these compounds were also shown to have good pharmacokinetic properties and demonstrated the ability to elevate NAD levels in plasma, liver, and muscle tissue. In particular, compound 78c was given to diet induced obese (DIO) C57Bl6 mice, elevating NAD > 5-fold in liver and >1.2-fold in muscle versus control animals at a 2 h time point. The compounds described herein possess the most potent CD38 inhibitory activity of any small molecules described in the literature to date. The inhibitors should allow for a more detailed assessment of how NAD elevation via CD38 inhibition affects physiology in NAD deficient states.

Over the past 15 years, repair techniques, improved prostheses, retrograde cardioplegia, and enhanced exposure collectitvely have led to impressive advances in mitral valve surgery. Just as minimally invasive coronary surgery appears efficacious, cardiac valve operations using similar techniques are promising. Recently, Kaneko and associates 1 reported videoscopic examination of the mitral valve during a commissurotomy done via a sternotomyo Early this year, port-access mitral replacements were done in Malaysia by the Stanford team using new aortic balloon occlusive technology. On February 26, 1996, Carpentier successfully performed the first video-assisted mitral valve repair through a minithoracotomy during ventriculai fibrillation. 2 On May 26, 1996, our group performed a direct vision "micro-mitral" valve repair with antegrade cardioplegic arrest through a 2.4-inch incision. Two days later we replaced a rheumatic mitral valve using a video-assisted minimally invasive approach, and this case is the subject of this report.The patient was a 43-year-old man with diabetes and long-standing mitral insufficiency that had progressed to class III heart failure and recent-onset atrial fibrillation. Cardiac catheterization showed normal coronary arteries and a 0.45 ventricular ejection fraction. Transthoracic echocardiography showed an immobile posterior leaflet with type III severe mitral insufficiency. Intraoperative transesophageal echocardiography confirmed the transthoracic study. The patient was intubated with a double-lumen endotracheal tube for single lung ventilation and positioned with the right side of the chest elevated 45 degrees and the pelvis nearly flat. A 2-inch incision was made in the midaxillary line over the fifth rib and a small section was removed. A custom retractor was used to provide operative exposure (Snowden-Pencer Inc.). The pericardium was opened just anterior to the phrenic nerve with thoracoscopy scissors. Specialized instruments were used throughout the operation: however, video access was established by means of standard thoracoscopic techniques. A 10 mm thoracoscopic port was placed posterior and cephalad to the main incision, and a three-chip lighted camera (Linvatec Inc.) was inserted to visualize the limited surgical field.Peripheral cardiopulmonary support (28 ° C

Most proximal aortic necks remain stable, but approximately 20% of necks increase in diameter by 2 years. Smaller necks dilate more often than larger ones. This effect is independent from the frequent oversizing of grafts in smaller necks. The integrity of the repair remains good at 3 years of follow-up.