Myocardial bridge over coronary arteries and myocardial coat over coronary sinus: a cadaveric study

Funding Acknowledgements

Type of funding sources: None.

Background

Myocardial Bridge (MB) over the coronary artery and myocardial coat (MC) over the cardiac veins are sometimes detected in angiography and cadaveric dissection. Left anterior descending (LAD) branch of left coronary artery is most frequent site of MB. Rarely MB is also seen over right coronary artery (RCA) branch. MB has proven association with ischemic heart disease and other critical cardiac consequences like myocardial infarction (MI)(1)(2). MC on the other hand has not gained enough attention in erstwhile studies. Large MB can be readily identified in angiograms, but minute MB can be picked up by newer imaging studies like multi-detector computed tomography (MDCT) and optical coherence tomography (OCT) scan(3). Cadaveric dissection however holds its unique place in direct visualization and studying the macro and micro-anatomical characteristics.

Purpose

To study the prevalence and anatomical attributes of MB and MC in cadaveric hearts.

Methods

Ten adult cadaveric hearts (6 male and 4 female) were dissected as part of routine undergraduate teaching during academic year 2021-22. MB over the coronary artery and MC over cardiac vein was identified. Data pertaining to the MB and MC dimensions were measured with digital vernier calliper. Histology of the MC was carried out to confirm its presence and observe the cyto-architecture pattern. Relevant gross macroscopic and microscopic images were photographed and photomicrographed.

Results

20% of the dissected cadavers revealed MB involving LAD in first heart while LAD and RCA both in second heart with length 7.5 mm, 11.5 mm and 1.8 mm respectively. MC was noted over coronary sinus and proximal few millimeters of great and middle cardiac veins. Histological examination revealed cardiac striated muscle in MC with typical cyto-architecture. The mean myocardial muscle index (MMI) of MBs was 1.39.

Conclusions

Present study highlights 20% prevalence of MBs in cadavers involving both right and left coronary artery. 10% of the subjects had histologically confirmed MC over cardiac veins. MC over coronary sinus and other cardiac veins needs more elaborate explorative studies to quantify the anatomic properties and to examine the possible association with cardiovascular disease. Nevertheless, anatomic attributes should be kept in mind to better appreciate MI in evolution and MI at evaluation in a case with MB.

Evidence of a New Excited Charmed Baryon Decaying to Σ_{c}(2455)^{0,++}π^{±}

We present the study of B[over ¯]^{0}→Σ_{c}(2455)^{0,++}π^{±}p[over ¯] decays based on 772×10^{6}  BB[over ¯] events collected with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The Σ_{c}(2455)^{0,++} candidates are reconstructed via their decay to Λ_{c}^{+}π^{∓} and Λ_{c}^{+} decays to pK^{-}π^{+}, pK_{S}^{0}, and Λπ^{+} final states. The corresponding branching fractions are measured to be B(B[over ¯]^{0}→Σ_{c}(2455)^{0}π^{+}p[over ¯])=(1.09±0.06±0.07)×10^{-4} and B(B[over ¯]^{0}→Σ_{c}(2455)^{++}π^{-}p[over ¯])=(1.84±0.11±0.12)×10^{-4}, which are consistent with the world average values with improved precision. A new structure is found in the M_{Σ_{c}(2455)^{0,++}π^{±}} spectrum with a significance of 4.2σ including systematic uncertainty. The structure is possibly an excited Λ_{c}^{+} and is tentatively named Λ_{c}(2910)^{+}. Its mass and width are measured to be (2913.8±5.6±3.8)  MeV/c^{2} and (51.8±20.0±18.8)  MeV, respectively. The products of branching fractions for the Λ_{c}(2910)^{+} are measured to be B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{0}π^{+})=(9.5±3.6±1.6)×10^{-6} and B(B[over ¯]^{0}→Λ_{c}(2910)^{+}p[over ¯])×B(Λ_{c}(2910)^{+}→Σ_{c}(2455)^{++}π^{-})=(1.24±0.35±0.10)×10^{-5}. Here, the first and second uncertainties are statistical and systematic, respectively.

Effect of Protonation and Deprotonation on Electron Transfer Mediated Decay and Interatomic Coulombic Decay

Electronically excited atoms or molecules in an environment are often subject to interatomic/intermolecular Coulombic decay (ICD) and/or electron transfer mediated decay (ETMD) mechanisms. A few of the numerous variables that can impact these non-radiative decay mechanisms include bond distance, the number of nearby atoms or molecules, and the polarisation effect. In this paper, we have studied the effect of protonation and deprotonation on the ionization potential (IP), double ionization potential (DIP), and lifetime (or decay width) of the temporary bound state in these non-radiative decay processes. We have chosen LiH-NH3 and LiH-H2 O as test systems. The equation of motion coupled cluster singles and doubles method augmented by complex absorbing potential (CAP-EOM-CCSD) has been used in calculating the energetic position of the decaying state and the system's decay rate. Deprotonation of LiH-NH3 /LiH-H2 O either from the metal center (LiH) or from ammonia/water lowers the IP and DIP compared to the neutral systems. In contrast, protonation increases these quantities compared to neutral systems. The protonation closes the inner valence state relaxation channels for ICD/ETMD. For example, the decay of the O-2s/N-2s state stops in protonated systems (LiH2 + -H2 O, LiH2 + -NH3 , and LiH-NH4 + ). Our study also shows that the efficiency, i. e., the rate of ICD/ETMD, can be altered by protonation and deprotonation. It is expected to have implications for chemical and biological systems.

Gamma (γ)-radiation stress response of the cyanobacterium Anabaena sp. PCC7120: Regulatory role of LexA and photophysiological changes

High radioresistance of the cyanobacterium, Anabaena sp. PCC7120 has been attributed to efficient DNA repair, protein recycling, and oxidative stress management. However, the regulatory network involved in these batteries of responses remains unexplored. In the present study, the role of a global regulator, LexA in modulating gamma (γ)-radiation stress response of Anabaena was investigated. Comparison of the cytosolic proteome profiles upon γ-radiation in recombinant Anabaena strains, AnpAM (vector-control) and AnlexA⁺ (LexA-overexpressing), revealed 41 differentially accumulated proteins, corresponding to 29 distinct proteins. LexA was found to be involved in the regulation of 27 of the corresponding genes based on the presence of AnLexA-Box, EMSA, and/or qRT-PCR studies. The majority of the regulated genes were found to be involved in C-assimilation either through photosynthesis or C-catabolism and oxidative stress alleviation. Photosynthesis, measured in terms of PSII photophysiological parameters and thylakoid membrane proteome was found to be affected by γ-radiation in both AnpAM and AnlexA⁺ cells, with LexA affecting them even under control growth conditions. Thus, LexA functioned as one of the transcriptional regulators involved in modulating γ-radiation stress response in Anabaena. This study could pave the way for a deeper understanding of the regulation of γ-radiation-responsive genes in cyanobacteria at large.

68Ga-DOTANOC PET/CT in Adrenal Schwannoma

ABSTRACT

Adrenal schwannoma is a rare adrenal incidentaloma. It is a benign tumor arising from the Schwann cells. Differentiating benign from malignant adrenal lesions requires a combination of clinical, biochemical, imaging, and histopathological findings. 68Ga-DOTANOC PET/CT is one of the sensitive imaging modalities to detect adrenal lesions such as pheochromocytoma. Multiple benign and malignant lesions show somatostatin receptor expression causing a high probability of false-positive findings on somatostatin receptor imaging. We present a case of adrenal incidentaloma positive on 68Ga-DOTANOC PET, which revealed a benign adrenal spindle cell tumor on histopathology.

Yoga: A Natural Solution to Decrease Disease Burden in Children of MTHFR Deficient Parents

Introduction

MTHFR being a key regulatory enzyme of 1-carbon metabolism pathway serves critical function of generation of SAM, replenishment of glutathione and nucleotide synthesis and finally methylation of the bio molecules. MTHFR gene mutation is a rare au-tosomal recessive inborn error of metabolism and presents with severe hyperhomocysteinemia. MTHFR polymorphisms on the other hand are commonly encountered of which two 677 C>T and 1298 A>C have been most widely studied and reported to increase the vulnerability to neural tube defects, congenital heart disease, various neuropsychiatric disorders like autism spectrum diseases and attention deficit hyperactiv-ity disease, cleft lip/ palate, acute leukaemia, cardiovascular diseases, occlusive vascular disease in children.

Methods

We conducted this prospective clinical trial to examine whether yoga practice can up regulate MTHFR gene expression. Considering the prevalence of MTHFR polymorphism, varied spectrum of its implications in disease causation including male infertility, we conducted the trial involving 30 infertile men who underwent 3 weeks of supervised YBLI. Pre and post intervention assessment of the blood and semen sample was done to see the effects.

Results

We have found more than fivefold up-regulation in the expression of MTHFR gene with significant reduction of seminal free radical levels after 3 weeks of yoga practice. Interestingly we noticed significantly higher MTHFR polymorphic variants in infertile male patients compared to healthy fertile controls.

Conclusion

MTHFR polymorphisms are also independently associated with many paediatric diseases. Diagnosing MTHFR deficiency in children is a challenging job and requires high index of suspicion and continuous vigilance. Yoga based lifestyle may be adopted both by parents planning conception and also by adolescent children who are sufferers of this condition to halt the consequences of mild to moderate MTHFR deficiency.

Comparison of 18 F-PSMA-1007 PET/CT With 68 Ga-PSMA-11 PET/CT for Initial Staging in Intermediate- and High-Risk Prostate Cancer

PURPOSE

This study aimed to compare 18 F-PSMA-1007 PET/CT with 68 Ga-PSMA-11 PET/CT for initial staging in intermediate- and high-risk prostate cancer (PCa) patients.

METHODS

Forty treatment-naive, biopsy-proven, intermediate- or high-risk PCa patients were prospectively recruited. Each patient underwent PET/CT with 68 Ga-PSMA-11 and 18 F-PSMA-1007 (within 2 weeks). Assessment of both set of images included delineating number and characteristics of lesions, measurement of tracer uptake (SUV max ), miPSMA scoring, and PET-based stage categorization.

RESULTS

Intraprostatic lesions were detected in all patients by both tracers with concordant PET-based T stage. Median SUV max of the dominant PSMA-positive prostatic lesions was not significantly different with 18 F-PSMA-1007 and 68 Ga-PSMA-11 (19.9 vs 19.4, P = 0.127, n = 40). Prostatic miPSMA scores were similar in 31/40 (77.5%) patients with both tracers (weighted κ = 0.71). In 23/40 (57.5%) patients, regional lymph nodes (n = 171) were detected by both tracers. Few additional PET-positive regional lymph nodes (n = 3) were exclusively detected by 18 F-PSMA in 2 patients without altering PET-based N stage. Extraregional lymph nodes (n = 123 in 17/40 patients) and visceral metastatic lesions (n = 18 in 3/40 patients) were detected concordantly by both tracers. PET-positive marrow based and skeletal metastases (n = 71) were detected in 14/40 (35%) patients by both tracers. Few additional marrow and skeletal lesions (n = 7) were exclusively detected on 18 F-PSMA-1007 in 5/14 patients, potentially upstaging PET-based M stage in 2/5 patients. Both radiotracers showed excellent interreader agreement for region-wise detection of lesions.

CONCLUSIONS

Our results suggest that 18 F-PSMA-1007 PET/CT is comparable to 68 Ga-PSMA-11 PET/CT in detecting primary and metastatic lesions of PCa.

Potential Role of 68Ga-NOTA-Duramycin PET/CT Imaging for Early Response Evaluation in a Lymphoma Patient: A Case Report

ABSTRACT

Duramycin, a 19 amino acids peptide, is known for its potential to target phosphatidylethanolamine. During cell death (apoptosis), rearrangement of membrane phospholipids results in the externalization of phosphatidylethanolamine to the outer leaflet of the cell membrane, which can be imaged using 68Ga-NOTA-duramycin. We report 68Ga-NOTA-duramycin imaging in a 50-year-old man with biopsy-proven diffuse large B-cell lymphoma planned for anthracycline-based chemotherapy. 68Ga-NOTA-duramycin PET/CT imaging along with 18F-FDG PET/CT was performed before and after 2 cycles of chemotherapy. The tracer avidity in interim 68Ga-NOTA-duramycin PET/CT showed its diagnostic potential to assess early response to chemotherapy.

IgG4-related hypophysitis: A monocentric experience from North India

Background

Immunoglobulin (Ig)G4-related disease is a systemic fibroinflammatory disease characterized by dense infiltration of IgG4-positive plasma cells in the affected tissue(s) with or without elevated plasma levels of IgG4. Hypophysitis itself is a very rare disease with reported prevalence in the operative specimens are around 0.2-0.88%. IgG4-related hypophysitis (IgG4-RH) may account for a substantial percentage of cases previously regarded as idiopathic hypophysitis.

Methods

This study is a registry-based, retrospective, and cohort study from a tertiary care hospital in North India. The medical records and clinical data of biopsy-proven and suspected IgG4-RH patients registered were retrospectively analyzed. Treatment outcome of cases was also explored during this analysis.

Results

Two thousand and six sellar area space-occupying lesions have been operated-on since 2006, among them only four patients had IgG4-RH on histopathological specimen. One case was diagnosed on clinical suspicion. Mean age of the patients was 31.8 ± 6.32 years. Most frequent presenting complaint was headaches. Extracranial manifestations were present in four patients. The most common pituitary dysfunction was cortisol deficiency. 18 F-fluorodeoxyglucose positron emission tomography (18F FDG PET) was helpful in three cases for diagnosis of hypophysitis and other organ involvement. Classical histological findings with storiform fibrosis, obliterative phlebitis seen in two cases, and IgG4-positive plasma cell infiltration were positive in four cases. Surgery was the primary modality of treatment in all four cases. Only one patient received steroids as a primary therapeutic modality.

Conclusion

IgG4-RH is rare. High index of suspicion is required to diagnosis the case precisely. FDG PET is helpful in diagnosing hypophysitis and extrapituitary lesions.

Unilateral sacral erector spinae plane block for lower limb surgery in children

The erector spinae plane block is a versatile regional anaesthesia technique used for a variety of truncal surgeries. A novel variation is the sacral erector spinae plane block which is gaining popularity for perineal and anorectal procedures. Local anaesthetic injected at this level blocks the sacral dermatomes and has the potential for more proximal spread to involve lumbar nerve fibres via spread to the lumbar plexus or the epidural space. The advantage of a sacral erector spinae plane block over a neuraxial block is that it is less invasive and may have a better safety profile: there is a reduced risk of epidural haematoma, epidural abscess, haemodynamic instability and motor weakness of the lower extremities. Until now, this approach has been used for midline surgical procedures when the local anaesthetic was injected bilaterally. Its application for lower limb procedures with a single unilateral injection has not been described. We report the use of a unilateral sacral erector spinae plane block at the level of the S2 median crest in two children undergoing lower limb procedures of the hip and thigh. The block was found to provide effective peri-operative analgesia with minimal need for any opioid analgesics and without any significant adverse effects.

Natural naphthoquinones and their derivatives as potential drug molecules against trypanosome parasites

Over the past decades, a number of 1,4-naphthoquinones have been isolated from natural resources and several of naphthoquinone derivatives with diverse structural motif have been synthesized; they possess a multitude of biochemical properties and modulate numerous pharmacological roles that offer new targets for addressing the challenges pertaining to novel drug developments. Among natural naphthoquinones, lapachol, α-lapachone, β-lapachone, lawsone, juglone, and plumbagin have been evaluated for its potential as antitrypanosomal activities. The chemotherapeutic drugs available for combating human trypanosomiasis, that is, American trypanosomiasis and African trypanosomiasis caused by Trypanosoma cruzi and Trypanosoma brucei, respectively, and animal tripanosomosis caused by Trypanosoma evansi have a problem of drug resistance and several toxic effect. Therefore, search of alternative effective drug molecules, without toxic effects, have enthused the researchers for searching new drug entity with potential clinical efficacy. In the search for new antitrypanosomal compound, this review focuses on different natural quinones and their synthetic derivatives associated with antitrypanosomal studies. In this context, this review will be useful for the development of new antitrypanosomal drugs mainly based on different structural modification of natural and synthetic naphthoquinones.

Biochemical Characterization and Molecular Insights into Substrate Recognition of Pectin Methylesterase from Phytophthora Infestans

Pectin methylesterases (PMEs) are a class of carbohydrate-active enzymes that act on the O6-methyl ester groups of the homogalacturonan component of pectins, resulting in de-esterification of the substrate polymers and formation of pectate and methanol. PMEs occur in higher plants and microorganisms, including fungi, oomycetes, bacteria, and archaea. Microbial PMEs play a crucial role in pathogens’ invasion of plant tissues. Here, we have determined the structural and functional properties of Pi-PME, a PME from the oomycete plant pathogen Phytophthora infestans. This enzyme exhibits maximum activity at alkaline pH (8.5) and is active over a wide temperature range (25–50 °C). In silico determination of the structure of Pi-PME reveals that the protein consists essentially of three parallel β-sheets interconnected by loops that adopt an overall β-helix organization. The loop regions in the vicinity of the active site are extended compared to plant and fungal PMEs, but they are shorter than the corresponding bacterial and insect regions. Molecular dynamic simulations revealed that Pi-PME interacts most strongly with partially de-methylated homogalacturonans, suggesting that it preferentially uses this type of substrates. The results are compared and discussed with other known PMEs from different organisms, highlighting the specific features of Pi-PME.

Initial results from near-infrared spectroscopy on ADITYA-U tokamak

Spectroscopy in vacuum ultraviolet (VUV) and visible ranges plays an important role in the investigation and diagnosis of tokamak plasmas. However, under harsh environmental conditions of fusion grade devices, such as ITER, VUV-visible systems encounter many issues due to the degradation of optical components used in such systems. Here, near-infrared (NIR) spectroscopy has become an effective tool in understanding the edge plasma dynamics. Considering its importance, a NIR spectroscopic diagnostic has been developed and installed on the ADITYA-U tokamak. The system consists of a 0.5 m spectrometer having three gratings with different groove densities, and it is coupled with a linear InGaAs photodiode array. Radiation from the ADITYA-U edge plasma has been collected using a collimating lens and optical fiber combination and transported to the spectrometer. The spectrum in the NIR range from the ADITYA-U plasma has been recorded using this system, in which Pa_β and Pa_γ along with many spectral lines from neutral and singly ionized impurities have been observed. The influxes of H and C have been estimated from measurements. The H influx value is found to be 2.8 × 10¹⁶ and 1.9 × 10¹⁶ particles cm^-2 s^-1 from neutral hydrogen lines H_α and Pa_β, respectively, and the C influx value is found to be 3.5 × 10¹⁵ and 2.9 × 10¹⁵ particles cm^-2 s^-1 from the neutral carbon and singly ionized carbon, respectively. A good agreement is seen between these results and the results obtained by using a routine photomultiplier tube based diagnostic.