Abstract-Hibernating myocardium is accompanied by a downregulation in energy utilization that prevents the immediate development of ischemia during stress at the expense of an attenuated level of regional contractile function. We used a discovery based proteomic approach to identify novel regional molecular adaptations responsible for this phenomenon in subendocardial samples from swine instrumented with a chronic LAD stenosis. After 3 months (nϭ8), hibernating myocardium was present as reflected by reduced resting LAD flow (0.75Ϯ0.14 versus 1.19Ϯ0.14 mL ⅐ min Ϫ1 ⅐ g Ϫ1 in remote) and wall thickening (1.93Ϯ0.46 mm versus 5.46Ϯ0.41 mm in remote, PϽ0.05). Regionally altered proteins were quantified with 2D Differential-in-Gel Electrophoresis (2D-DIGE) using normal myocardium as a reference with identification of candidates using MALDI-TOF mass spectrometry. Hibernating myocardium developed a significant downregulation of many mitochondrial proteins and an upregulation of stress proteins. Of particular note, the major entry points to oxidative metabolism (eg, pyruvate dehydrogenase complex and Acyl-CoA dehydrogenase) and enzymes involved in electron transport (eg, complexes I, III, and V) were reduced (PϽ0.05). Multiple subunits within an enzyme complex frequently showed a concordant downregulation in abundance leading to an amplification of their cumulative effects on activity (eg, "total" LAD PDC activity was 21.9Ϯ3.1 versus 42.8Ϯ1.9 mU, PϽ0.05). After 5-months (nϭ10), changes in mitochondrial and stress proteins persisted whereas cytoskeletal proteins (eg, desmin and vimentin) normalized. These data indicate that the proteomic phenotype of hibernating myocardium is dynamic and has similarities to global changes in energy substrate metabolism and function in the advanced failing heart. These proteomic changes may limit oxidative injury and apoptosis and impact functional recovery after revascularization. Key Words: metabolism Ⅲ proteomics Ⅲ hibernating myocardium Ⅲ ischemic heart disease H ibernating myocardium is characterized by viable, chronically dysfunctional myocardium that develops in response to repetitive myocardial ischemia. 1,2 We have previously demonstrated that the relation between regional oxygen consumption, coronary flow, and function in response to stress is attenuated in hibernating myocardium and thus dissociated from the usual determinants of myocardial oxygen demand. 3 By reducing regional energy utilization, hibernation prevents the development of ischemia after submaximal stress. This is supported by a lack of biochemical markers of ischemia and preservation of total ATP and creatine phosphate content in swine with hibernating myocardium 3,4 as well as human biopsies from patients without significant fibrosis. 5 Although there has been interest in identifying the role of increased glucose uptake in these responses, maximal insulin stimulated glucose uptake is unchanged in chronic hibernating myocardium, and alterations in other metabolic pathways responsible for the attenuated increase...

Summary:The optimal approach to obtain an adequate graft for transplantation in patients with poor peripheral blood stem cell (PBSC) mobilization remains unclear. We retrospectively assessed the impact of different strategies of second-line stem cell harvest on the transplantation outcome of patients who failed PBSC mobilization in our institution. Such patients were distributed into three groups: those who proceeded to steady-state bone marrow (BM) collection (group A, n ¼ 34); those who underwent second PBSC mobilization (group B, n ¼ 41); those in whom no further harvesting was carried out (group C, n ¼ 30). PBSC harvest yielded significantly more CD34 þ cells than BM collection. Autologous transplantation was performed in 30, 23 and 11 patients from groups A, B and C, respectively. Engraftment data and transplantation outcome did not differ significantly between groups A and C. By contrast, group B patients had a faster neutrophil recovery, required less platelet transfusions and experienced less transplant-related morbidity, as reflected by lower antibiotics needs and shorter hospital stays. In conclusion, remobilization of PBSC constitutes an effective approach to ensure a rapid hematopoietic engraftment and a safe transplantation procedure for poor mobilizers, whereas unprimed BM harvest does not provide any clinical benefit in this setting.

The presence of a persistent median artery (PMA) has been implicated in the development of compression neuropathies and surgical complications. Due to the large variability in the prevalence of the PMA and its subtypes in the literature, more awareness of its anatomy is needed. The aim of our meta-analysis was to find the pooled prevalence of the antebrachial and palmar persistent median arteries. An extensive search through the major databases was performed to identify all articles and references matching our inclusion criteria. The extracted data included methods of investigation, prevalence of the PMA, anatomical subtype (antebrachial, palmar), side, sex, laterality, and ethnicity. A total of 64 studies (n = 10,394 hands) were included in this meta-analysis. An antebrachial pattern was revealed to be more prevalent than a palmar pattern (34.0% vs. 8.6%). A palmar PMA was reported in 2.6% of patients undergoing surgery for carpal tunnel syndrome when compared to cadaveric studies of adult patients in which the prevalence was 8.6%. Both patterns of PMA are prevalent in a considerable portion of the general population. As the estimated prevalence of the PMA was found to be significantly lower in patients undergoing surgery for carpal tunnel syndrome than those reported in cadaveric studies, its etiological contribution to carpal tunnel syndrome is questionable. Surgeons operating on the forearm and carpal tunnel should understand the anatomy and surgical implications of the PMA and its anatomical patterns.

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