Methods Immunohistochemistry was used to examine the expression

Methods. Immunohistochemistry was used to examine the expression of p27 in 130 primary NPC tissues. The relationship between the levels of p27 expression and clinicopathologic characteristics was analyzed. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. The significance of various survival variables was analyzed using multivariate Cox

proportional hazards model. Results. p27 was expressed in both nuclear and cytoplasmic compartments. Nuclear expression of p27 was inversely correlated with T classification and clinical stage. Patients with nuclear p27 expression had better overall survival rates than those without nuclear RSL-3 expression of p27. Further, we observed that nuclear expression of p27 was positively

associated with survival time of NPC patients not only in N0-1 and M0 classifications but also in radiotherapy and chemotherapy treatment groups. Finally, we found that nuclear expression of p27 was not an independent prognostic factor for Src inhibitor patients with NPC. Conclusions. Our findings hint that nuclear expression of p27 is a potentially favorable factor in the progression and prognosis of NPC.”
“Aims: There are several epidemiological studies suggesting that moderate daily consumption of red wine may reduce cardiovascular risk. Additionally, results from a great number of in vitro studies indicate that constituents found in red wine are responsible for quite a few beneficial effects on endothelial cells. However, comparison of postprandial studies and clinical trials concerning red wine consumption leads to controversial results about its effect on endothelial function and especially flow-mediated

dilatation (FMD).

Endothelial function is an early indicator of atherosclerosis and vessel damage and at the same time, it is an independent prognostic factor for cardiovascular risk. Therefore, it is very important BIIB057 price to investigate the known acute postprandial effects of red wine consumption, which is highly advised by dieticians and doctors, especially in high-risk populations, Such as patients with coronary artery disease (CAD).

Data synthesis: This is a review of studies investigating acute and short-term effects of red wine on endothelial function, as well. as relevant in vitro studies.

Conclusion: Analysis of all data about the acute effects of red wine constituents on endothelial function, is inconclusive and it is obvious that new studies are necessary in order to elucidate this matter. Undoubtedly, one should be very careful in suggesting red wine consumption in high-risk populations, as its acute postprandial effect is not yet clear. (C) 2009 Elsevier B.V. All rights reserved.”
“Comparative effectiveness research (CER) can provide valuable information for patients, providers and payers These stakeholders differ in their incentives to invest in CER.

Thus, the clay platelets in the matrix phase acted as barrier tha

Thus, the clay platelets in the matrix phase acted as barrier that restricted the coalescence of dispersed domains during melt-mixing. Addition selleck chemicals llc of PE-g-MA in both the compositions of nylon6/HDPE blend effectively reduced the D of dispersed phases. Storage modulus and thermal stability of the blend were improved in presence of small amount of clay, whereas addition of PE-g-MA lowered the mechanical and thermal properties of the blends. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 121: 359-368, 2011″
“Background: The development and spread of drug resistant Plasmodium falciparum strains is a major concern and novel anti-malarial drugs are, therefore, needed.

Ferroquine is a ferrocenic derivative of chloroquine with proven anti-malarial activity against learn more chloroquine-resistant and -sensitive P. falciparum laboratory strains.

Methods: Adult young male aged 18 to 45 years, asymptomatic carriers of P. falciparum, were included in two-dose escalation, double-blind, randomized, placebo-controlled Phase I trials, a single dose study and a multiple dose study aiming to evaluate oral doses of ferroquine from 400 to 1,600 mg.

Results: Overall, 54/66 patients (40 and 26 treated

in the single and multiple dose studies, respectively) experienced at least one adverse event, 15 were under placebo. Adverse events were mainly gastrointestinal symptoms such as abdominal pain (16), diarrhoea (5), nausea (13), and vomiting (9), but also selleck chemical headache (11), and dizziness (5). A few patients had slightly elevated liver parameters (10/66) including two patients under placebo. Moderate changes in QTc and morphological changes in T waves were observed in the course of the study. However, no adverse cardiac effects with clinical relevance were observed.

Conclusions: These phase I trials showed that clinically, ferroquine was generally well-tolerated up to 1,600 mg as single dose and up to 800 mg as repeated dose in asymptomatic young male with P. falciparum infection. Further clinical development

of ferroquine, either alone or in combination with another anti-malarial, is highly warranted and currently underway.”
“An oncocytic mucoepidermoid carcinoma arising from the minor salivary gland origin is extremely rare. We report on a 44-year-old man with a high-grade oncocytic mucoepidermoid carcinoma originating in the minor salivary gland of the posterior mandible. All tumor cells showed the expected pattern of immunoreactivity, with positive results for the antimitochondrial antibody and p63, and negative results for the androgenic receptor antibody. Microscopically, the tumor was considered to be a high-grade carcinoma in the grading systems of the Armed Forces Institute of Pathology and Brandwein.

(c) 2011 American Institute

(c) 2011 American Institute HM781-36B in vivo of Physics. [doi:10.1063/1.3530631]“
“Purpose:

To retrospectively evaluate the clinical outcome of patients

with hepatocellular carcinoma (HCC) who exceeded the Milan criteria, who underwent transarterial chemoembolization (TACE) before orthotopic liver transplantation (OLT), to determine the value of computed tomography (CT)-based tumor response to TACE as a preoperative selection criterion for OLT.

Materials and Methods:

The study included 33 patients with HCC who exceeded the Milan criteria and underwent OLT after TACE. Informed written consent was obtained before TACE and OLT. Institutional review board approval was not required. Tumor response to TACE was evaluated at 1 month with CT according to amended Response Evaluation Criteria in Solid Tumours (RECIST) guidelines. Cilengitide Cytoskeletal Signaling inhibitor In the explanted liver, degree of tumor necrosis (>= 90%, 50%-89%, or, 50%), residual tumor stage and grade, and presence of microvascular invasion were assessed. Follow-up after OLT ranged from 1 to 143 months.

Results:

After

TACE, CT showed complete tumor response (CR) in 18 (55%) patients. On the explanted liver, tumor necrosis was rated 90% or greater in 20 (61%) patients, with a good correlation with CT. Microvascular invasion was observed in nine (27%) of 33 patients; none of them were reported to have a CR at CT. The 5-year cumulative survival rate after OLT was 72.5%; it was significantly (P=.003) higher in patients with a CR (94.4%) compared with patients with a partial response (PR) (45.4%) and stable disease (50%). The 5-year cumulative recurrence-free rate after OLT was 74.4%; it was not affected by the tumor nodule size and number, whereas it

was significantly (P=.008) higher in patients with a CR (94.4%) compared with patients with a PR (46.7%) and stable disease (50%).

Conclusion:

In patients with HCC who exceeded the Milan criteria, a CR after TACE, selleck chemicals llc on the basis of amended RECIST guidelines, is associated with excellent posttransplantation outcomes. Therefore, 1-month response to TACE assessed at CT may represent a valid selection criterion for OLT. (C) RSNA, 2010″
“A series of shape-memory polyurethanes based on poly(E-caprolactone) diol were prepared with novel hydroxyl-terminated hyperbranched polyurethanes as crosslinkers and were characterized by Fourier transform infrared spectroscopy, H-1-NMR, gel permeation chromatography, differential scanning calorimetry, scanning electron microscopy, wide-angle X-ray diffraction, dynamic mechanical analysis, tensile testing, and shape-memory testing. The molecular weight of the soluble polymers ranged from 5.1 x 10(4) to 29.0 x 10(4) g/mol.


“We address the problem of segmenting high angular resolut


“We address the problem of segmenting high angular resolution diffusion imaging (HARDI) data into multiple regions (or fiber tracts) with distinct diffusion properties. We use the orientation distribution function (ODF) to model diffusion and cast the ODF segmentation problem as a clustering problem in the space of ODFs. selleck chemicals Our approach integrates tools from sparse representation theory and Riemannian geometry into a graph theoretic segmentation framework. By exploiting the Riemannian properties of the space of ODFs, we learn a sparse representation for each ODF and infer the segmentation by applying spectral clustering to a similarity matrix built from these representations. In

cases where regions with similar (resp. distinct) diffusion properties belong to different (resp. same) fiber tracts, we obtain the segmentation by incorporating spatial and user-specified pairwise relationships into the formulation. Experiments on synthetic data evaluate the sensitivity of our method to image noise and to the concentration parameters, and show its superior performance compared to alternative methods when analyzing complex fiber configurations.

Experiments on phantom and real data demonstrate PND-1186 clinical trial the accuracy of the proposed method in segmenting simulated fibers and white matter fiber tracts of clinical importance.”
“Background: Immersion in seawater after open chest trauma may induce acute lung injury. Higher osmotic pressure is one of the main characteristics of seawater. The effects of vascular endothelial growth factor (VEGF)

on endothelial cell permeability and proliferation have been demonstrated in studies. The early responses and effects of the VEGF on acute lung injury induced by seawater immersion after open chest trauma (SWI-ALI) are unknown. Objective: To investigate the levels of VEGF and its receptors in SWI-ALI and further explore whether the levels of VEGFs are connected with the pathogenesis of SWI-ALI. Methods: We put dogs into group ‘seawater’ and group ‘control’. The control group only suffered from open chest trauma, whereas the seawater group was exposed to seawater after trauma. The levels of total protein in plasma and bronchoalveolar lavage fluid were measured to calculate the pulmonary permeability index. 0, 2, 4, 6 and 8 h after open chest trauma, the plasma samples were collected to test the levels of VEGFs with ELISA Selleck ARN-509 kit. Western blotting and real-time RT-PCR were used to measure the VEGF levels in lung. Results: Compared with control animals, plasma osmotic pressure, VEGF and sVEGFR-1 significantly increased in plasma, while VEGF and VEGFR-2 significantly increased in seawater-immersion lung tissue. The levels of VEGF in plasma were significantly correlated with plasma osmotic pressure and pulmonary permeability index. Conclusion: Early release of VEGFs increases pulmonary vascular permeability and partially leads to the development of SWI-ALI. VEGFs may have a crucial role in the early onset of SWI-ALI.


“The aim of this study is to explore causality of birth tr


“The aim of this study is to explore causality of birth trauma after vaginal delivery and anatomical findings.

A total of 28 virgin mice were studied. Treatment groups received vaginal distention. Specimens were collected and subjected to the following fluorescence stains: progenitor cell (c-kit), smooth muscle (SMA), fibroblast (vimentin), and skeleton muscle

(Masson’s trichrome). Confocal microscopy was used to screen all of the urogenital tissue to localize the stained cells.

Fibroblasts were spread all over perivaginal and urethral surroundings. Progenitor cells appeared at urethral-vagina intersection and urethral circle. They were noticeable only within smooth muscle this website layer. Two extraordinary skeleton muscle bands appeared on the urethra bilaterally.

Our study demonstrates existence of muscle bands at the bilateral urethra. They can limit the mobility of urethra during vaginal delivery and thereby cause urethra injury. Progenitor cells are located only in the smooth muscle of the urethral circle.”
“To observe the maternal and MK-2206 nmr perinatal outcome in pituitary tumor (macro- and micro-adenoma) during pregnancy.

A retrospective analysis of a total of 19 cases of pituitary tumor group 1 (10 macroadenoma), and group 2 (9 microadenoma), during pregnancy over last 3 years in our unit were evaluated for pregnancy outcome, comparing maternal

and perinatal outcome in the two groups using statistical analysis (Chi square test and Fischer exact t test).

The mean age was 27.1 years in group

1 (macroadenoma), 29.2 years in group, parity was 0.2 and 0.55, respectively, in the two groups. Mean pituitary size 14.85 cm(3) in group 1 and 0.22 cm(3) in group 2. While there https://www.selleckchem.com/products/nocodazole.html was no significant difference in infertility, menstrual disorder in the two groups, galactorrhea, headache, seizures and blurring of vision were more common in macroadenoma group. More patients required medications (cabergoline/bromocriptine) in group 1 with significantly more women had worsening of their symptoms (raised intracranial tension, seizures) in group 1 than in group 2. Mean gestation and birthweight were better in group 2 (37.6 vs. 36.1 weeks and 2,849 vs. 2,401 g). While vaginal delivery could be achieved in 88.8% women in microadenoma group (group 2), 80% women required cesarean delivery in macroadenoma group (group 1), a highly significant difference (P value 0.005), there were no perinatal death in any group.

Pituitary tumor during pregnancy if properly treated is associated with excellent maternal and perinatal outcome but macroadenoma is associated with lower gestation, birth weight and increased cesarean delivery rate.”
“P>Photoactivatable and photoconvertible fluorescent proteins capable of pronounced light-induced spectral changes are a powerful addition to the fluorescent protein toolbox of the cell biologist.

Twelve hours after surgery, the mean IOP decreased by -0 57 +/- 3

Twelve hours after surgery, the mean IOP decreased by -0.57 +/- 3.82 mm Hg (P=.49) in the treatment group and increased by 2.20 +/- 4.56 mm Hg (P=.009) in the control group. Twenty-four hours after surgery, the mean IOP decreased by -1.57 +/- 2.30 mm Hg (P=.012) in the treatment group and increased by 0.86 +/- 4.21 mm Hg (P=.175) in the control group. The mean IOP change between the 2 study groups 6, 12, and 24 hours postoperatively was statistically significantly different (P=.015, P=.006, and P=.003; respectively).

CONCLUSION: The fixed brimonidine-timolol combination effectively reduced

IOP 6, 12, and 24 hours after phacoemulsification cataract surgery.”
“Near-infrared (NIR) spectroscopy combined with chemometrics has been utilized in predictions of natural medicine content

without destroying samples. Suppositories (oren powdered extract content 0, 0.5, 1.0, 2.5, 10, 12.5, and selleck chemical 15%) were produced by mixing oren powdered extract with macrogol mixture consisting of 1 part macrogol 1500 and 2.5 parts macrogol 4000 at find more 54A degrees C, and pouring the melt mixture into a plastic container. NIR spectra of the 10 prepared samples were recorded 10 times, and a total of 100 spectra were randomly divided into two data sets, one for calibration and the other for validation. The calibration model for the oren content of the suppository was calculated based on NIR spectra using a partial least-squares regression analysis after pre-treatment (smoothing and the multiplicative scatter correction). The relationship between the actual and predicted values for calibration and validation models had a straight line with correlation JNK-IN-8 molecular weight coefficients of 0.9936 and 0.9898, respectively. The regression vector result of the calibration

model indicates that the peaks at 6945, 5747, and 5160 cm(-1) in the regression vector were consistent with those in oren powder extracts. NIR spectroscopy combined with chemometrics offers promise as a method of predicting the oren powder content in suppositories without destroying the samples.”
“Our systematic study employing high-resolution nuclear magnetic resonance measurements shows that the hydrogen bonds and proton transport in the KH2PO4 (KDP) system may be tuned sensitively by proton irradiation. In particular, the hydrogen-bond length in KDP increased by a properly chosen dose of proton irradiation is shown to give rise to a minimum in the activation energy of proton hopping in the hydrogen-bond direction. (C) 2011 American Institute of Physics. [doi:10.1063/1.3622334]“
“Purpose: The purpose Of this Study was to evaluate the effect of metallic rigid fixation of mandibular corpus fracture on mandibular growth in growing rabbits.

Materials and Methods: Thirteen 90-day-old white New Zealand rabbits weighing 2 to 2.6 kg were included in this Study. Unilateral mandibular fractures were created in all of the animals and fixed with microplates and screws.

Longer donor ischemic time was

Longer donor ischemic time was find more associated with the development (p = 0.043) and size (p = 0.05) of NC-CAFs. NC-CAFs were not associated with rejection, death, re-transplantation, or coronary revascularization, and none required intervention.

CONCLUSIONS: Fistulae from donor coronary arteries to recipient pulmonary vasculature develop frequently and early after pediatric HTx. These correlate with graft ischemic time, but are not associated with

early graft loss or death. J Heart Lung Transplant 2012;31:744-9 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.”
“Objective The objective of this study is to ascertain the presence of extrauterine spread in radiologically early stage and grade endometrial cancer. This could be the basis for offering vaginal hysterectomy without salpingo-oophorectomy as an alternative option to primary

radical radiotherapy in women with significant medical co-morbidities in whom laparotomy will be contraindicated.

Materials and methods. A retrospective cohort study assessing patients with clinically early stage endometrioid adenocarcinoma of the endometrium, treated at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital and James Paget University Hospital between January 2003 and July 2008. The cancer registry was reviewed, and 542 endometrial cancer Liproxstatin-1 cell line cases were identified during the study period, of these 439 were endometrioid type. MR is the standard staging investigation unless there are contraindications. Demographic, clinic-pathologic and surveillance data were collected from hospital records, operative notes and histopathology reports. The histology included tumour type, stage and grade. Post-operative histopathological

findings served as a reference standard. Sensitivity and specificity of pre-operative MRI scan were assessed.

Results Of the 439 cases treated during the study periods, 415 patients HKI-272 in vivo had an MRI pre-operatively imaging and 14% of these cases showed signs of extrauterine spread. MRI staging was then compared with the histopathology staging; the latter was taken as the gold standard. In 8% of the cases where no spread was seen on MRI, the disease was actually spread outside uterine corpus mainly to the cervix and pelvic lymph nodes. The sensitivity, specificity, positive predictive value and negative predictive value for MRI were 56, 93, 60, and 92, respectively, while predicting early stage disease. There were three cases of adnexal metastases, where the tumour had already spread to uterine serosa. Two cases had poorly differentiated and one had moderately differentiated tumour.

Conclusions The risk of adnexal metastasis is less than 1% in clinically early stage disease and highly unlikely if MRI suggests that the disease is confined to the inner half of the myometrium and low-grade disease.

Using different parameter values in conjunction with the relative

Using different parameter values in conjunction with the relative growth rate of the pathogen and antimicrobial agent concentration ranges, various conventional pharmacodynamic surrogate indices (e. g., AUC/MIC, Cmax/MIC, %T>MIC) could be satisfactorily linked

to outcomes. In addition, the dosing intensity represented by the average kill rate of a dosing regimen can be derived, which could be used for quantitative comparison. Ro-3306 in vitro The relevance of our approach is further supported by experimental data from our previous investigations using a variety of gram-negative bacteria and antimicrobial agents (moxifloxacin, levofloxacin, gentamicin, amikacin and meropenem). The pharmacodynamic profiles of a wide range of antimicrobial agents can be assessed by a more flexible computational tool to support dosing selection.”
“It is shown that a variety of single crystal substrates (Al(2)O(3), LaAlO(3), SrTiO(3), TiO(2), and ZnO), purchased from commercial suppliers, contain a ferromagnetic component to the magnetization in addition to the expected linear magnetic response. This ferromagnetic contribution is only CP-868596 mw observed on the unpolished surfaces and can be eliminated by either polishing or annealing at 600 degrees C in air, but not by annealing at 600 degrees C in a vacuum of 5 x 10(-6) Torr.

Particle induced x-ray emission spectra demonstrate that there is excess Fe on the unpolished surfaces of these single crystal substrates. While defect related ferromagnetic signals have been reported in some of these substrates, and while our results do not exclude this origin of ferromagnetism, we clearly show that the ferromagnetic signals observed in our samples are largely due to excess iron on the unpolished surfaces, possibly in the form of a mixture of Fe, Fe(3)O(4), and or gamma-Fe(2)O(3). (C) 2011 American Institute of Physics. [doi: 10.1063/1.3611034]“
“Background: Infective endocarditis

is Selleck Androgen Receptor Antagonist the most serious manifestation of cardiac device infection and metastatic seeding of distant sites has been reported. However, the association between device-related endocarditis and spinal abscess has not been fully described.

Methods: We reviewed hospital records at three high-volume cardiovascular referral centers from January 2005 to October 2010. Device-related endocarditis was confirmed in all cases with positive blood cultures and transesophageal echocardiogram revealing lead and/ or valvular vegetations. Six patients with spinal abscesses in association with device-related endocarditis were identified.

Results: A total of 384 patients met the clinical criteria for device-related endocarditis. Among these, infection was complicated by spinal abscess formation in six (1.5%) cases. The mean age of patients was 69.3 +/- 11.8 years (47-82 years). The predominant clinical manifestations in these six patients included a recent history of fever (six), malaise (four), and neurological or meningeal signs (five).

Results: The patient cohort was 65 8% male with a mean age of 52

Results: The patient cohort was 65.8% male with a mean age of 52.7 years. Mean FT was 183

s, and mean surgical time was 68.4 +/- 29 minutes. Mean stone size was 10 +/- 5mm in the greatest dimension. A large proportion of patients (50%) had renal stones, multiple stones were present in 31.6% of cases, and 22.3% of stones were radiolucent. Cases were equally distributed between surgeons A and B, and 46% of patients had preoperative stents. On multivariate analysis, increased FT was independently associated with surgeon A (104 additional seconds per case, P < 0.001), longer duration of surgery (14 s per 10 minutes, P < 0.001), and male patients (54 s per procedure, P = 0.02). Age, stone characteristics, presence of ureteral stent, and stone-free status did not correlate with FT.

Conclusions: Surgeon behavior, longer selleck chemicals llc duration of surgery, and male gender were significant predictors of FT and, hence, radiation exposure during ureteroscopy. In the present study, stone characteristics were not found to be predictors of FT.”
“Semimembranosus tendon avulsion fractures are an uncommon occurrence and are often associated with anterior cruciate ligament (ACL) and medial meniscus tears. We present the imaging features of

an unusual case Selleck PND-1186 of semimembranosus avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament (PCL) tear, medial meniscus tear, and capsular rupture in a 26-year-old man with a football injury.”
“Background: The aim of this study was to evaluate whether plate fixation with screws in an oblique fashion would change

the strength of the fixation to bending forces and PF-04929113 whether any relationship existed between deformity and increased strength of fixation.

Methods: Rear leg tibias from 2-year to 3-year-old sheep were affixed with the help of a custom-made guide to a six-hole dynamic compression plate and divided into three groups. In group 1, fixation was performed using screws perpendicular to the plate axis in two planes. In group 2, screws were placed at a 20-degree angle to the axis of the shaft and perpendicular to the transverse plane. In group 3, the screws were placed at a 20-degree angle to the shaft axis and 7 degrees on the transverse plane. Gap-close bending and side-bending tests were performed in a three-point bending fashion. The maximum moment of force and deformation at the time of the failure was analyzed.

Results: In gap-close bending tests, mean maximum moment of forces for groups 1, 2, and 3 was 51.90 Nm, 67.47 Nm, 82.05 Nm, respectively (p < 0.05 for group 1 vs. groups 2 and 3; p = 0.053 for group 2 vs. group 3). In side-bending tests, the mean maximum moment of force was 34.63 Nm, 49.91 Nm, and 49.29 Nm, respectively (p < 0.05 for group 1 vs. groups 2 and 3; no significant difference was observed between groups 2 and 3).

Since phosphatidic acid (PA)

accumulation and leaf cell d

Since phosphatidic acid (PA)

accumulation and leaf cell death are a consequence of wounding, PA- and hormone-induced senescence was studied in leaf discs from Philodendron cordatum (Vell.) Kunth plants in the presence or absence of egg-derived 18:0-LPE and senescence progression quantified by monitoring both lipid peroxidation (as the change in malondialdehyde concentration), and by measuring retention of total chlorophyll (Chl(a+b)) and carotenoids (C(c+x)). Only abscisic acid (ABA) stimulated lipid peroxidation whereas ABA, 1-aminocyclopropane-1-carboxylic acid (ACC), the immediate precursor to ethylene (ETH), and 16:0-18:2-PA stimulated loss of chloroplast pigments. Results using BTSA1 cell line primary alcohols as attenuators of the endogenous PA signal confirmed a role for PA as an intermediate in both ABA- and ETH-mediated senescence progression. Exogenous 18:0-LPE did not appear to influence senescence progression and was unable to reverse hormone-induced senescence

progression. However, when supplied together with 16:0-18:2-PA at 1:1 (mol:mol), activity of phosphatidylglycerol (PG) hydrolase, chlorophyllase (E.C. 3.1.1.14), and progression of leaf senescence were negated. This apparent anti-senescence activity of exogenous 18:0-LPE was associated with induction of the pathogenesis-related protein, extracellular acid invertase (Ac INV, Fer-1 supplier E.C. 3.2.1.26) suggesting that 18:0-LPE like 16:0-18:2-PA functions as an elicitor. (C) 2008 Elsevier Masson SAS. All rights reserved.”
“Symmetrical peripheral

gangrene (multilimb ischemia without large artery occlusion) is a rare condition usually associated with disseminated intravascular coagulation, hemodynamic compromise, and/or sepsis. However, it has not been described in patients on extracorporal membrane oxygenation (ECMO). Over a 5 year period, four pediatric patients developed symmetrical peripheral gangrene on ECMO after cardiac surgery. They subsequently died and came to autopsy. History, physical examination, and laboratory studies were examined. Gross and microscopic autopsy material was reviewed. Patients were 11 days to 13 years old. Extracorporal membrane oxygenation duration was 11-22 days, and limb ischemia began 2-4 days before death. Three patients had rapid Selleckchem Pevonedistat onset, with ischemia developing in <48 hours. In the fourth, ischemic changes began as focal lesions and gradually spread. Two patients were septic. Three had evidence of other end-organ damage. Pressors were used in 3 patients before the limb ischemia. Autopsies disclosed ischemic changes involving all limbs, with confluent ecchymoses. In a detailed examination in 1 case, large arteries of the extremities were patent. Involved skin and soft tissue showed bland fibrin thrombi in the microcirculation, with tissue necrosis and hemorrhage.