Thesis (M.A.)--Boston University / The pericardial organs are neurosecretory structures situated within the pericardial cavity of stomatopod and decapod crustaceans. Their location in the pericardium is such that blood approaching the heart must flow directly over them. This arrangement facilitates the distribution of pericardial organ secretions to all parts of the organism. It is not known how many different neurohormones are secreted by the pericardial organs, but at least one of these has been shown to act as a strong cardioexcitor. Electron microscopy of pericardial organs has revealed the presence of membrane-bounded granules, approximately 1500 A in diameter, which are believed to contain the neurosecretory material. An attempt was made here to isolate the cardiaexcitor by means of differential centrifugation of crude 0.9 M sucrose homogenates of pericardial organs from two species of Cancer. Live Homarus heart served as bioassay material. Cardioexci tatory effects were found in material which sedimented below 17,000 x g. On two occasions another active sediment was found at 71,000 x g. The present data is in agreement with the hypothesis that the cardioexcitor is contained within neurosecretory granules. However, a definitive statement to this effect cannot be made, as sediments were not checked microscopically. Presumptive evidence is offered for the existence of a second type of neurosecretory granule.

In this MMed thesis I have reviewed retrospectively the pericardial aspirations performed between 1 July 1987 and 12th October 1989 at Groote Schuur Hospital, Cape Town. Documenting the reasons for aspiration, the complications of pericardiocentesis, and how cytologic, bacteriologic and biochemical examination of the aspirate influenced the clinicians' management of the 52 patients reviewed. The relatively low mortality of less than 2% is noted, in a procedure carried out for the relief of cardiac tamponade in 57% of the patients. A significant relationship between an ADA level higher than 51 international units per litre and a positive culture of mycobacterium tuberculosis from pericardial aspiration is demonstrated. The relatively low successful culture of mycobacterium tuberculosis (32% of the 29 patients clinically assessed as having tuberculous pericarditis) is noted, and recommendations to improve the yield from culture are made.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19572号 / 医博第4079号 / 新制||医||1013(附属図書館) / 32608 / 京都大学大学院医学研究科医学専攻 / (主査)教授 萩原 正敏, 教授 小西 靖彦, 教授 齊藤 博英 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Drosophila melanogaster has a tubular heart called the dorsal vessel, which is composed of contractile cardiomyocytes and hemolymph filtering pericardial cells. During larval development the dorsal vessel (heart) grows in size, and the luminal space inside the heart expands, however it has not been clear which cells are responsible for laying the extracellular matrix (ECM) during this expansion. Hemocytes (white blood cells), pericardial cells and cells of the fat body are candidate cell types that may secrete ECM for assembly during the growth of the heart lumen. With gene knock-down techniques we are exploring whether hemocytes participate in assembly of the heart ECM at this location. Additionally, studies of fluorescently tagged hemocytes in intact larvae reveal that hemocytes aggregate around pericardial cells of the dorsal vessel in 3rd instars. Confocal studies of dissected larval hearts indicate that hemocytes aggregate within infoldings of basement membrane associated with pericardial cells. Hemocyte-pericardial cell association could indicate that hemocytes take up proteins that are produced by pericardial cells and deliver them to other locations or that there might be a previously unidentified hematopoietic site at the Drosophila larval heart. / Thesis / Master of Science (MSc)

Diagnosis of infectious pericardial disease has been challenging in the developing world despite improvement of treatment modalities. The diagnostic utility of pH in diagnosing infectious pericardial fluid is unknown, yet this concept is well studied in pleural fluid. This cross-sectional diagnostic study evaluated the diagnostic utility of pH in infectious compared to non-infectious pericardial effusions in a high-burden setting. Methods: Patients of 18 years with moderate to large effusion between the 1st February 2016 and 31st May2018 were enrolled at Groote Schuur Hospital in Cape Town, South Africa. After safe pericardiocentesis, pH was measured with a blood gas analyzer. Mycobacterium tuberculosis culture and/or gene Xpert for TB and/or bacteria culture and/or microscopy served as the reference standard for definite infectious pericardial effusions. We calculated sensitivity, specificity, positive and negative predictive values, negative and positive likelihood ratios for an a priori pH cut off of 7.35. Receiver operating characteristic curve analysis was used for selection of ideal pH cut off. RESULTS Using a set sensitivity of 70% we estimated that we needed to recruit a sample size of 149 subjects for a 95% confidence interval and power of 80%. We screened 200 patients, and excluded 60 because they did not meet the appropriate exclusion criteria. The prevalence of infectious pericarditis was 27.1% (n/N=34/140) as confirmed by the reference standard. We found the median pH (IQR) was 7.30(7.20-7.30) for definite infection, 7.30(7.30-7.35) for probable infection and 7.50(7.40-7.55) for non-infectious effusions p value <0.01 (test for trend). At a cut off or <7.35, the sensitivity was 89.5(95%CI: 75%.5-97.1%) and the specificity was 72.5% (95% CI: 62.8%-80.9%). The ideal ROC- determined cut off for pH that would give maximum sensitivity and specificity was ≤7.30 and the maximum sensitivity and specificity at optimum cut off are 86.8% (95% CI:71.9 - 95.6) and 86.8% (95% CI:71.9 - 95.6), respectively. The area under the curve at this cut-off point is 0.86 (95% CI 0.79 to 0.9), p<0. 001. CONCLUSION: In conclusion, pericardial PH offers diagnostic utility for infectious causes of pericardial effusions using both a PH of 7.35 and an ideal cut-off of 7.30. We recommend that given the simplicity of the test it should be adopted in evaluation of patients with pericardial effusions.

The cardiovascular system of Drosophila melanogaster consists of a cardiac tube composed of myogenic cardiomyocytes and associating non-contractile pericardial cells, pumping hemolymph into the open circulatory system. The cardiac tube, known as the dorsal vessel, is embedded in a highly regulated extracellular matrix environment, required to maintain cellular integrity and cardiac function. After embryogenesis, the dorsal vessel undergoes extensive physiological changes, relying on the extracellular matrix to adapt and remodel accordingly. Three extracellular matrix proteins are investigated throughout this thesis: Type IV Collagen, Laminin and Pericardin. Due to their localization, morphology, and role in early development, the pericardial cells are candidate cells responsible for dorsal vessel extracellular matrix deposition and regulation throughout post-embryonic growth. Using immunofluorescence techniques in combination with confocal microscopy, I characterize the association between pericardial cells and extracellular matrix proteins, and quantify extracellular matrix protein deposition at the dorsal vessel throughout post-embryonic development. Gene knock-down experiments assess pericardial cell contribution to extracellular matrix synthesis and deposition at the dorsal vessel in third instar larva. Moreover, I quantify extracellular matrix protein deposition at the dorsal vessel in the absence of pericardial cells. These data suggests that pericardial cells regulate extracellular matrix protein deposition, localization and contribute to proper cardiac morphology in post-embryonic development. / Thesis / Master of Science (MSc)

Introduction: During cardiac surgery aided by cardiopulmonary bypass (CPB) the autotransfusion of pericardial suction blood (PSB) is regarded mandatory to limit allogeneic blood exposure. PSB is however proposed as a source of lipid microemboli and to contribute to brain damage. This thesis addresses the logistics of allogeneic blood transfusion during coronary artery bypass grafting (CABG), the embolic potential of reinfused PSB, and means to reduce PSB fat contamination, investigated both clinically and experimentally. Methods: Study I) Patients undergoing CABG surgery (n=2469) were included in a database study. The magnitude of surgical bleeding versus blood transfusion was analyzed to extract a subgroup of patients (n=982) in whom transfusions were independent from bleeding. Study II) PSB and venous-blood samples were collected from patients undergoing routine CABG (n=20). The in vitro capillary-flow properties of blood subcomponents and the effects of routine screen filtration were tested. PSB fat contamination was evaluated by imprint microscopy. Study III) Heat extracted liquid human fat or soya oil were mixed with mediastinal drain blood (n=20) and incubated in a temperature controlled column, to evaluate spontaneous density separation of fat. Study IV) The findings from study-III were applied to develop a fat-reducing system (FRS) using two stacked compartments. The FRS was experimentally tested (n=12), with similar methods as in study-III, and clinically evaluated (n=10). A single-chamber blood bag (n=10) served as reference. Results: Study I) A surgical bleeding of less than 400 mL showed no correlation to blood transfusion, although 64 of 982 patients still received allogeneic blood. The strongest predictors for this kind of transfusion were; female gender, weight ≤70 kg, CPB time ≥90 minutes, CPB temperature ≤32 ºC, and advanced age (P&lt;.001 - .038). Study II) The capillary-flow profile of PSB plasma was highly impaired compared to venous plasma (P&lt;.001). Conversely, blood-cell components showed no difference between PSB and venous blood. Routine screen filtration showed no ameliorating effect on capillary-flow resistance. Fat debris was detected on imprints in all PSB samples in contrast to venous plasma (P&lt;.05). Study III) After 10-min of incubation had 77% of added soya oil separated and found contained in the top 20% fraction of blood (P&lt;.001), aimed to be discarded. The density separation of human fat was less efficient compared to soya oil (P=.011). Fat also adsorbed to surface which was more pronounced at low temperature (P&lt;.001). The overall reduction of human fat was 70%. Study IV) PSB contained 1.5 mL fat suspended in 418 mL PSB. Of this fat was 24% surface-bound. Experimental analysis of the proposed FRS revealed an 83% fat-reduction which was clinically confirmed, suggesting 80% reduction (P=.001). The FRS also gave a small but significant erythrocyte-concentrating effect. Conclusions: Transfusion of allogeneic blood during CABG surgery appeared associated with an institutional, individual, and technical bias of an anticipated need and not only used to compensation for surgical bleeding. In part may this reflect a non-compliant CPB methodology and hemodilution. It was confirmed that PSB plasma contained fat, with a suggested embolic potential. Human fat was significantly reduced from mediastinal drain blood by spontaneous density separation and surface adsorption. The prototype FRS used for PSB incubation during CPB allowed an efficient fat reduction.

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Στην ιστοτεχνολογία (tissue engineering – TE), η ικανότητα των ικριωμάτων (scaffolds) να διατηρούν συμβατή μηχανική και βιολογική συμπεριφορά με τους περιβάλλοντες ιστούς και όργανα, αλλά και να διευκολύνουν την προσκόλληση κυττάρων του ξενιστή στην επιφάνεια και την τρισδιάστατη δομή τους κρίνεται ως υψίστης σημασίας για την επιθυμητή εκδήλωση αναγεννητικής αντίδρασης των κυττάρων in vivo. Ο σκοπός της παρούσας διδακτορικής διατριβής είναι η δημιουργία και ο χαρακτηρισμός ακυτταροποιημένης εξωκυττάριας μήτρας από μαλακούς ιστούς ζωικής προέλευσης, με στόχο τη δημιουργία ικριώματος με επιθυμητές μηχανικές και βιολογικές ιδιότητες για εφαρμογές στην ιστοτεχνολογία. Στην εργασία αυτή επιλέχθηκε ως υλικό της μελέτης ο βόειος περικαρδιακός ιστός, λόγω της ευρείας πολύχρονης χρήσης του ως βιοϋλικό σε μοσχεύματα. Εφαρμόστηκαν δύο διαφορετικά πρωτόκολλα για την ακυτταροποίηση του ιστού, χρησιμοποιώντας στο πρώτο Triton Χ-100, SDS και deoxycholic acid (12 ώρες, 4°C - Triton) και στο δεύτερο Trypsin/EDTA με RNAse/DNAse (48 ώρες, 37°C – Trypsin). Η ιστολογική εξέταση επιβεβαίωσε την ολική αφαίρεση των κυττάρων. Τα αποτελέσματα των εμβιομηχανικών δοκιμών δεν έδειξαν στατιστικά σημαντική διαφορά μεταξύ των μηχανικών ιδιοτήτων των μη κατεργασμένων ιστών και των ακυτταροποιημένων περικαρδιακών ιστών με Triton στην οριζόντια και κάθετη διεύθυνση προς τον οβελιαίο άξονα της καρδιάς σε αντίθεση με τη μείωση του χαμηλού μέτρου ελαστικότητας (φάση ελαστίνης) και του υψηλού μέτρου ελαστικότητας (φάση κολλαγόνου) μετά την κατεργασία των υλικών με Trypsin, και στις δύο κατευθύνσεις. Η βιοχημική ανάλυση επαλήθευσε την άμεση σχέση μεταξύ των μηχανικών βισκοελαστικών ιδιοτήτων των μαλακών ιστών με τα συστατικά (GAGs και κολλαγόνο) του ιστού και την εσωτερική διαμόρφωση τους. Τα αποτελέσματα των μη επεξεργασμένων και των επεξεργασμένων ιστών με τα παραπάνω διαλύματα, έδειξαν ότι το διάλυμα του Triton προκαλεί ήπια κατεργασία, με ελαχιστοποίηση των δομικών μεταβολών της εξωκυττάριας μήτρας, όπως η σταθερή σύσταση των γλυκοζαμινογλυκανών (GAGs) και η περιεκτικότητα των ιστών σε κολλαγόνο. Αυτό δεν επιτεύχθηκε με την χρήση διαλύματος Trypsin, όπου παρατηρήθηκε σημαντική μείωση των GAGs, τόσο στη συγκέντρωση της θειϊκής χονδροϊτίνης / δερματάνης όσο και στο υαλουρονικό. Για την αξιολόγηση της κυτταροσυμβατότητας αορτικά βόεια ενδοθηλιακά κύτταρα καλλιεργήθηκαν στα ακυτταροποιημένα υλικά. Η επιθηλιοποίησή τους επετεύχθη από 24 ώρες μέχρι και 4 μέρες. Προσδιορίστηκε επίσης η δύναμη προσκόλλησης των κυττάρων μετά από 4 μέρες καλλιέργειας στους ακυτταροποιημένους περικαρδιακούς ιστούς με την εφαρμογή διατμητικών τάσεων μέσω ροϊκού πεδίου, με χρήση κατάλληλης μηχανής περιστροφής των δειγμάτων σε ακινητοποιημένο υγρό. Τα αποτελέσματα έδειξαν εξάπλωση και πολλαπλασιασμό των κυττάρων στην επιφάνεια των βιοϋλικών, ενώ παρατηρήθηκε καλή συγκέντρωση κυττάρων (> 60%) στην κλίμακα των φυσιολογικών διατμητικών τάσεων. Συμπερασματικά, η ακυτταροποίηση του βόειου περικαρδιακού ιστού για μεγάλη χρονική διάρκεια στους 37°C (Trypsin) φάνηκε να μεταβάλλει την εμβιομηχανική συμπεριφορά και τη δομική ακεραιότητα του ιστού, η οποία, αντίθετα, διατηρείται σε φυσιολογική κατάσταση μετά από κατεργασία σε χαμηλή θερμοκρασία και σε σύντομο χρόνο (Triton). Επιπλέον, και τα δύο πρωτόκολλα είχαν ως αποτέλεσμα τη δημιουργία βιοϋλικού συμβατού με τα ενδοθηλιακά κύτταρα κατά την επαφή τους με την επιφάνειά τους. / In TE scaffolding, the ability of scaffolds to preserve proper mechanical and biological function and compatibility with the surrounding tissues and organs, as well to enhance host cells to adhere with scaffold material in their surface and 3D structure is of paramount importance for potential regenerative cell response in vivo. The aim of the present thesis is to produce and characterise a decellularized extracellular matrix derived from animal soft tissues, scoping to a scaffold capable of exhibiting the mechanical and biological properties desired for tissue engineering (TE) applications. For this work bovine pericardial tissue was selected, due to its broad use as a biomaterial in different implant technologies for decades. Two different protocols for the decellularization of bovine pericardial tissue were developed incorporating Triton® X–100, SDS and deoxycholic acid (12 h, 4°C) in solution 1 (Triton) and trypsin/EDTA with RNAse/DNase at 37°C for 48 h in solution 2 (Trypsin). Histological analysis confirmed total absence of cells after both treatments. The results of the biomechanical tests showed no mechanical differences demonstrated between the fresh and decellularized pericardial tissues by Triton solution in both, apex to base and transverse anatomical directions, contrary to a significant decrease of the low elastic modulus (elastin phase) and high elastic modulus (collagen phase) demonstrated after trypsin solution treatment in both directions. Biochemical analysis verified the direct relationship between mechanical viscoelastic properties of soft tissues with the constituent tissue components (GAGs and collagen content) and their internal arrangement. The comparison of the results from untreated and that from treated tissues suggested that the Triton decellularization method seemed to be a very mild treatment, as the glycozaminoglycans (GAGs) composition remained constant, as well as the collagen content. This was not achieved with the decellularization using Trypsin, where a significant reduction of GAGs, both chondroitin/dermatan sulphate and hyaluronan, was found. Aortic bovine endothelial cell seeding was used for estimation of its biomaterials’ cytocompatibility. Endothelialization achieved after 24hrs to 4 days periods. The adhesion strength of cells, cultured for 4 days on decellularized bovine pericardial tissues, was also determined. By applying a radially increasing shear stress field on rotating material samples within a stationary fluid mesh using a spinning disc device, we determined the shear stress necessary to detach the cells from the sfafolds’ surface. Fine cell spreading and proliferation on biomaterials’ surface and good surface cell density (>60%) at physiological shear stress scale were observed and measured. In conclusion, decellularization of bovine pericardial tissues under long time duration in 37°C (Trypsin) seems to alter its biomechanical behaviour and structural integrity, which, in contrast, was retained under low temperature short duration treatment (Triton). Additionally, both protocols resulted in a cytocompatible biomaterial, regarding its surface interactions with endothelial cells.

Fundamentos O acesso percutâneo ao espaço pericárdico pela via transatrial poderia ser uma alternativa ao acesso subxifóide para o mapeamento e ablação de fibras miocárdicas subepicárdicas. O objetivo deste estudo foi avaliar a viabilidade de alcançar o espaço pericárdico normal através do apêndice auricular direito (AAD) por acesso transvenoso. Métodos e Resultados - Um sistema Mullins (8F), originalmente desenvolvido para alcançar o átrio esquerdo (AE) por punção transeptal foi utilizado neste estudo para transfixar o AAD (16) ou AE (1) em 17 suínos, com uma média de 26,9 ± 2,6 kg, e alcançar o espaço pericárdico normal. Um cateter 7F quadripolar com eletrodo distal com 4 ou 8 mm foi introduzido no espaço pericárdico para aplicações de radiofrequência. Em 15 (88%) animais o procedimento foi realizado sem instabilidade hemodinâmica (PA média inicial = 80,4 ± 11.7 mmHg; PA média final = 86,8 ± 9.7 mmHg, p = 0,11). Foi identificado e aspirado derrame pericárdico discreto (28,9 ± 27.6 ml/animal) durante o procedimento. O espaço pericárdico foi acidentalmente acessado por punção do ventrículo direito (VD) em um animal e por punção do anel da valva tricúspide em outro. Ambos apresentaram sangramento xii pericárdico importante e tamponamento cardíaco. Um dispositivo para oclusão do orifício de perfuração foi testado com sucesso em três porcos, dois no AD e um no VD, sem ocorrência de derrame pericárdico significativo. Conclusões O acesso transatrial ao espaço pericárdico pode ser potencialmente útil para mapeamento e ablação de arritmias cardíacas, bem como para drenagem imediata de um tamponamento cardíaco agudo / Background A transvenous access to the pericardial space could provide a convenient route to map and ablate subepicardial myocardial fibers. The aim of this study was to evaluate the feasibility of reaching the normal pericardial space through the right atrial appendage (RAA) by transvenous access. Methods and Results An 8F Mullins system was used to transfix the right atrium (16) and left atrium (1) in 17 pigs with a mean of 26.9 ± 2.6 kg. A 7F quadripolar catheter with 4 or 8 mm distal tip electrode was introduced into the pericardial space to perform epicardial radiofrequency lesions. The pericardial space was successfully reached in 15 (88%) animals without hemodynamic instability (initial mean BP 80.4 ± 11.7 mmHg; final 86.8 ± 9.7 mmHg, p= 0,11). However, a mild pericardial serohemorrhagic effusion was identified and aspirated in all the animals (28.9 ± 27.6 ml/pig) during the procedure. The pericardial space was accidentally accessed through the right ventricle (RV) in one animal and through the tricuspid annulus in another, which presented important pericardial bleeding and cardiac tamponade. The hypothesis that an occlusion device could be useful to close the created atrial xiv orifice was tested successfully in thee pigs (two at RAA and one at RV) and without significant pericardial bleeding. Conclusions The right atrial appendage route might be potentially useful to access the normal pericardial space for mapping and ablating cardiac arrhythmias as well as to drain promptly an acute tamponade