Anatomical study of the sacrotuberous ligament and the hamstring muscles: A histomorphological analysis

The sacrotuberous ligament (STL) and the hamstrings are important structures that are mutually connected and influenced by the pelvis. However, the anatomical connectivity and histological characteristics of these structures remain unclear. The present study aimed to comprehensively investigate the relationship between the STL and the proximal hamstrings through histological analysis. Sixteen specimens were obtained from eight fresh cadavers (mean age at death, 73.4 years). Verhoeff Van Gieson, Masson's trichrome, and immunohistochemical staining were used to analyze the connectivity between the STL and the hamstrings and to verify the ratios of collagen and elastic fibers. Dense connective tissue that overlapped tightly between the STL and hamstrings was observed. The relative ratios of collagen and elastic fibers between the STL and hamstrings characteristically identified regional differences. The ratio of elastic fibers to collagen in the biceps femoris (BF) was ~38.6 ± 4.7%, and the lowest ratio was 5.9 ± 2.6% observed in the semimembranosus (SM). In the case of the BF, contractibility is well-regulated due to a high content of elastic fibers; however, the muscular structure of the BF is relatively fragile due to the low content of collagen. In the SM, collagen content is higher than that in the STL. This ratio of elastic fibers in the collagen analysis could provide crucial information for understanding the differences in hamstring contractility and maintaining the morphology of these structures.

Characterization of reproductive hormones and related gene expression in the hypothalamus and pituitary gland in the egg-laying interval in White King pigeon

The egg-laying interval (LI) directly reflects the laying performance of breeding pigeons, influenced by reproductive hormones. This study aimed to assess reproductive hormone levels in serum and the expression of related genes and their receptors in the hypothalamus and pituitary gland in 4 stages: first (LI1), third (LI3), fifth (LI5), and seventh (LI7) days. The results showed that serum gonadotropin-releasing hormone (GnRH) level decreased from LI1 to LI7 (P < 0.01) and peaked in LI1. The serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels stayed at high levels from LI1 to LI5. The FSH level decreased slightly from LI5 to LI7 (P > 0.05), but the LH level decreased rapidly (P < 0.01). The prolactin (PRL) levels significantly increased in LI5 (P < 0.01) compared with LI1 and then stayed at a high level. The GnRH1 expression in the hypothalamus had no significant change in LI (P > 0.05). However, the GnRHR first decreased from LI1 to LI3 (P < 0.05) and then increased. The FSH mRNA level in the pituitary gland decreased from LI1 to LI3 and slightly increased in LI5 (P > 0.05). The change pattern of FSHR was similar to that of FSH and peaked in LI5 (P < 0.05). The LH expression level was the highest in LI5 and significantly higher than that in LI3 and LI7 (P < 0.05). However, the LHR mRNA level decreased in LI (P < 0.05). The expression patterns of PRL and PRLR were similar; they were upregulated in LI and peaked in LI7 (P < 0.01). The expression pattern of GnRHR was similar to that of FSH, LH, and FSHR, suggesting the critical role of GnRHR in LI. Furthermore, the expression levels of these genes peaked in LI5, closely correlating with the maturation of the first largest follicle in pigeons. PRL-PRLR signaling inhibited GnRH activity to promote ovulation. This study provided a basis for further investigating the molecular mechanisms underlying the regulation of reproduction in pigeons.

Infraspinatus-teres minor (ITM) interfascial block: a novel approach for combined suprascapular and axillary nerve block

BACKGROUND

Combined suprascapular and axillary nerve block could be an analgesic option for shoulder pain control. The current description of this technique requires performing the block procedures at two different sites without consideration for catheter placement. We hypothesized that a single site injection to the interfascial plane between the infraspinatus and teres minor would result in an injectate spread to the suprascapular and axillary nerves.

METHODS

We performed 10 injections with this approach using 25 mL dye solution in 10 shoulders of five unembalmed cadavers. Also, we described three case reports, two single-injection cases and one catheter-placement case, using this approach in patients with acute postsurgical pain and chronic pain in their shoulder region.

RESULTS

In cadaveric evaluations, dye spreading to the suprascapular nerves on the infraspinatus fossa and the spinoglenoid notch cephalad and axillary nerves in the quadrilateral space caudally were observed in all injections. In addition, the most posterolateral part of the joint capsule was stained in 8 out of 10 injections. There was no dye spreading on the nerves to the subscapularis or lateral pectoral nerves. Clinically successful analgesia with no adverse events was achieved in all three cases.

CONCLUSION

Our anatomical and clinical observations demonstrated that an injection to the interfascial plane between the infraspinatus and teres minor consistently achieved injectate spreading to both suprascapular and axillary nerves, which innervate the glenohumeral joint.

Intramuscular innervation of the tensor fasciae latae: Application to total hip arthroplasty

The aims of this study were to clarify the extra- and intramuscular branching patterns of the tensor fasciae latae (TFL) with reference to surface landmarks on the thigh and to thus suggest a safe approach for total hip arthroplasty. Sixteen fixed and four fresh cadavers were dissected and subjected to the modified Sihler's staining method to reveal the extra- and intramuscular innervation patterns, and the findings were matched with surface landmarks. The landmarks were measured from the anterior superior iliac spine (ASIS) to the patella and divided into 20 parts along the total length. The average vertical length of the TFL was 15.92 ± 1.61 cm, which was 38.79 ± 2.73% when converted to a percentage. The entry point of the superior gluteal nerve (SGN) was an average of 6.87 ± 1.26 cm (16.71 ± 2.55%) from the ASIS. In all cases, the SGN entered parts 3-5 (10.1%-25%). As the intramuscular nerve branches traveled distally, they had a tendency to innervate more deeply and inferiorly. In all cases, the main SGN branches were intramuscularly distributed in parts 4 and 5 (15.1%-25%). Most tiny SGN branches were found inferiorly in parts 6 and 7 (25.1%-35%). In three of 10 cases, very tiny SGN branches were observed in part 8 (35.1%-38.79%). We did not observe SGN branches in parts 1-3 (0%-15%). When information on the extra- and intramuscular nerve distributions was combined, we found that the nerves were concentrated in parts 3-5 (10.1%-25%). We propose that damage to the SGN can be prevented if parts 3-5 (10.1%-25%) are avoided during surgical treatment, particularly during the approach and incision.

[Study on the associations of meeting intensive systolic blood pressure control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China]

Objective: To evaluate the associations of meeting intensive systolic blood pressure (SBP) control goals with risk for incident cardiovascular and cerebrovascular diseases among the adult hypertensive patients in China. Methods: We used data from adult hypertensive patients from the China Kadoorie Biobank. logistic regression models evaluated the influencing factors of meeting intensive and standard SBP control goals. Cox proportional hazard models evaluated the associations between meeting intensive vs. standard SBP control goals and risk for incident cardiovascular and cerebrovascular diseases. Results: A total of 3 628 hypertensive patients who reported continuous medication use were included in this study, of which 5.0% of the participants met the goals of intensive SBP control (≤130 mmHg). Participants with higher educational attainment (OR=2.36,95%CI: 1.32-4.04), healthier diet (OR=2.09,95%CI: 1.45-2.96), daily intake of fresh fruit (OR=1.67,95%CI: 1.17-2.36) and combination treatment (OR=1.82,95%CI: 1.03-3.09) were more likely to meet intensive SBP control goal after adjustment of age, sex and urban/rural areas. During an average follow-up of (10.0±3.7) years, 1 278 cases of composite cardiovascular outcome were recorded. This study did not find a statistical correlation between achieving the goal of enhanced SBP control and the occurrence of composite cardiovascular and cerebrovascular outcomes (HR=0.89, 95%CI: 0.63-1.25). For major adverse cardiovascular events (MACE), cerebrovascular diseases, stroke, and ischemic stroke, we observed a trend of decrease in risk of outcomes with more intensive SBP control (trend test P<0.05). Conclusions: We observed decreased risk for MACE and cerebrovascular diseases with more intensive SBP control. However, there was no significant risk reduction for cardiovascular and cerebrovascular diseases when meeting the intensive SBP control goal, compared to the standard SBP control goal.

Optical spectrum analyzers and typical applications in astronomy and remote sensing

Scientists are increasingly relying on astronomical and remote sensing technologies to gain deeper insights into the Earth and the universe. In these fields, the optical spectrum analyzer (OSA) or spectrometer plays a pivotal role. This Review offers a comprehensive overview of the fundamental principles, key parameters, and applications of various branches of traditional OSAs, including prisms, gratings, interferometers, tunable filters, and reconstructive spectrometers. We specifically focus on their latest major applications in astronomy and remote sensing. Additionally, we present a mathematical model of the generalized reconstructive spectrometer and provide a summary of its principles pertaining to spectral mapping, reconstruction, and imaging. Despite its limited aperture and étendue, the reconstructive spectrometer holds great potential for future use in astronomy and remote sensing due to its compact size and exceptional ultrahigh spectral resolution.

Neuromuscular compartmentation of the subscapularis muscle and its clinical implication for botulinum neurotoxin injection

In this study, using immunohistochemistry with fresh cadavers, deliberate histological profiling was performed to determine which fibers are predominant within each compartment. To verify the fascial compartmentation of the SSC and elucidate its histological components of type I and II fibers using macroscopic, histological observation and cadaveric simulation for providing an anatomical reference of efficient injection of the BoNT into the SSC. Seven fixed and three fresh cadavers (six males and four females; mean age, 82.5 years) were used in this study. The dissected specimens revealed a distinct fascia demarcating the SSC into the superior and inferior compartments. The Sihler's staining revealed that the upper and lower subscapular nerves (USN and LSN) innervated the SSC, with two territories distributed by each nerve, mostly corresponding to the superior and inferior compartments of the muscle, although there were some tiny communicating twigs between the USN and LSN. The immunohistochemical stain revealed the density of each type of fiber. Compared with the whole muscle area, the densities of the slow-twitch type I fibers were 22.26 ± 3.11% (mean ± SD) in the superior and 81.15 ± 0.76% in the inferior compartments, and the densities of the fast-twitch type II fiber were 77.74% ± 3.11% in the superior and 18.85 ± 0.76% in the inferior compartments. The compartments had different proportions of slow-fast muscle fibers, corresponding to the functional differences between the superior compartment as an early-onset internal rotator and the inferior compartment as a durable stabilizer of the glenohumeral joint.

Anatomical study of the adductor canal: three-dimensional micro-computed tomography, histological, and immunofluorescence findings relevant to neural blockade

BACKGROUND

A precise anatomical understanding of the adductor canal (AC) and its neural components is essential for discerning the action mechanism of the AC block. We therefore aimed to clarify the detailed anatomy of the AC using micro-computed tomography (micro-CT), histological evaluation, and immunofluorescence (IF) assays.

METHODS

Gross dissections of 39 thighs provided morphometric data relevant to injection landmarks. Serial sectional images of the AC were defined using micro-CT and ultrasonography. The fascial and neural structures of the AC proper were histologically evaluated using Masson's trichrome and Verhoeff-Van Gieson staining, and double IF staining using choline acetyltransferase (ChAT) and neurofilament 200 antibodies.

RESULTS

The posteromedial branch insertion of the nerve to vastus medialis (NVM) into the lateral border of the AC proper was lower (14.5 ± 2.4 cm [mean ± SD] above the base of the patella) than the origin of the proximal AC. The AC consists of a thin subsartorial fascia in the proximal region and a thick aponeurosis-like vastoadductor membrane in the distal region. In the proximal AC, the posteromedial branch of the NVM (pmNVM) consistently contained both sensory and motor fibers, and more ChAT-positive fibers were observed than in the saphenous nerve (27.5 ± 11.2 / 104 vs. 4.2 ± 2.6 / 104 [counts/µm2], P < 0.001).

CONCLUSIONS

Anatomical differences in fascial structures between the proximal and distal AC and a mixed neural component of the neighboring pmNVM have been visualized using micro-CT images, histological evaluation, and IF assays.

[Predictive factors for sequelae of bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia]

Objective: To investigate the predictive factors for bronchitis obliterans in refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods: A restrospective case summary was conducted 230 patients with RMPP admitted to the Department of No.2 Respiratory Medicine of Beijing Children's Hospital, Capital Medical University from January 2013 to June 2017 were recruited. Clinical data, laboratory results, imaging results and follow-up data were collected. Based on bronchoscopy and imaging findings 1 year after discharge, all patients were divided into two groups: one group had sequelae of bronchitis obliterans (sequelae group) and the other group had not bronchitis obliterans (control group), independent sample t-test and nonparametric test were used to compare the differences in clinical features between the two groups. Receiver operating characteristic (ROC) curve to explore the predictive value of Bronchitis Obliterans in RMPP. Results: Among 230 RMPP children, there were 115 males and 115 females, 95 cases had sequelae group, the age of disease onset was (7.1±2.8) years;135 cases had control group, the age of disease onset was (6.8±2.7) years. The duration of fever, C-reative protein (CRP) and lactate dehydrogenase (LDH) levels, the proportion of ≥2/3 lobe consolidation, pleural effusion and the proportion of airway mucus plug and mucosal necrosis were longer or higher in the sequelae group than those in the control group ((17±9) vs. (12±3) d, (193±59) vs. (98±42) mg/L,730 (660, 814) vs. 486 (452, 522) U/L, 89 cases (93.7%) vs. 73 cases (54.1%), 73 cases (76.8%) vs.59 cases (43.7%), 81 cases (85.3%) vs. 20 cases (14.8%), 67 cases (70.5%) vs. 9 cases (6.7%), t=5.76, 13.35, Z=-6.41, χ²=14.64, 25.04, 22.85, 102.78, all P<0.001). Multivariate Logistic regression analysis showed that the duration of fever ≥10 days (OR=1.200, 95%CI 1.014-1.419), CRP levels increased (OR=1.033, 95%CI 1.022-1.044) and LDH levels increased (OR=1.001, 95%CI 1.000-1.003) were the risk factors for sequelae of bronchitis obliterans in RMPP. ROC curve analysis showed that CRP 137 mg/L had a sensitivity of 82.1% and a specificity of 80.1%; LDH 471 U/L had a sensitivity of 62.7% and a specificity of 60.3% for predicting the development of bronchitis obliterans. Conclusions: The long duration of fever (≥10 d), CRP increase (≥137 mg/L) may be used to predict the occurrence of sequelae of bronchitis obliterans in RMPP. It is helpful for early recognition of risk children.

Delineation and histological examination of the intramuscular innervation of the platysma: Application to botulinum neurotoxin injection

This study aimed to identify the whole innervation pattern of the platysma using the Sihler's staining, and the axonal composition profile of the sensory-motor anastomosis identified by immunofluorescence assays. The findings provide a comprehensive understanding of the neural anatomy of the platysma and facilitate efficient and safe manipulation for neurotoxin injection. Ten fixed and two fresh hemifaces were included in this study. Sihler's staining was used to the study 10 fixed hemifaces and two fresh hemifaces were used for immunofluorescence assays. In all cases, the cervical branch of facial nerve (Cbr) broadly innervated the platysma, and the marginal mandibular branch of facial nerve (MMbr) provided supplementary innervation to the uppermost part of the platysma. The transverse cervical nerve (TCN), great auricular nerve (GAN), and supraclavicular nerve (SCN) were observed in the lower half of the platysma. In 30% of all cases, there was a communicating loop between the Cbr and TCN. In 20% of all the cases, a communicating branch joined between the Cbr and GAN. For successful esthetic rejuvenation procedures, a clinician should consider the Cbr distribution to the overall platysma and additionally innervation by individual nerves (MMbr, GAN, TCN, and SCN) to the middle and lower portions of the platysma muscle.

Prasugrel-based de-escalation vs. conventional therapy after percutaneous coronary intervention in ACS patients according to the renal function

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): A consortium of six companies in Korea (Daiichi Sankyo, Boston Scientific, Terumo, Biotronik, Qualitech Korea, and Dio).

Background

Patients with coronary artery disease and impaired renal function are at higher risk for both bleeding and ischemic adverse events after percutaneous coronary intervention (PCI).

Purpose

We assessed the efficacy and safety of a prasugrel based de-escalation strategy in patients with impaired renal function.

Methods

We conducted a post-hoc analysis of the HOST-REDUCE-POLYTECH-ACS study. Patients with available estimated glomerular filtration rate (eGFR) (n=2,311) were categorized into three groups. (high eGFR: ≥90 mL/min; intermediate eGFR: ≥60 and &lt;90 mL/min; low eGFR: &lt;60 mL/min). The endpoints were bleeding outcomes (Bleeding Academic Research Consortium type 2, or higher), ischemic outcomes (cardiovascular death, myocardial infarction, stent thrombosis, repeat revascularization, and ischemic stroke), and net adverse clinical events (all cause death, BARC 2 or greater bleeding, MI, stent thrombosis, repeat revascularization, and ischemic stroke) at 1 year follow-up. The hazard ratio (HR) and 95% Confidence interval (CI) were calculated from the multivariate Cox proportional hazard regression analysis. Covariates that were considered clinically meaningful were included. The probability risk ratio was obtained by dividing ischemic hazard function from the bleeding hazard function.

Results

With respect to net adverse clinical events, prasugrel de-escalation was beneficial regardless of baseline renal function (p for interaction = 0.508). The relative reduction in bleeding risk from prasugrel de-escalation was higher in the low eGFR group compared with that from both the intermediate and high eGFR groups (relative reduction: 64% [HR 0.36, 95% CI 0.15–0.83] vs. 50% [HR 0.50, 95% CI 0.28-0.90] and 52% [HR 0.48, 95% CI 0.21-1.13] for low, intermediate, and high eGFR groups, p for interaction=0.646). Ischemic risk from prasgurel de-escalation was not significant in all eGFR groups ([HR 1.18, 95% CI 0.47-2.98], [HR 0.95, 95% CI 0.53-1.69], and [HR 0.61, 95% CI 0.26-1.39)], respectively, p for interaction=0.119). The probability risk ratio was highest in low eGFR group (1.06 vs. 1.26 vs. 1.36, for high, intermediate, and low eGFR groups, respectively, p for trend&lt;0.001), suggesting higher relative bleeding risk above ischemic risk. Within those randomized to the de-escalation strategy, the mean probability risk ratio was not significantly different according to renal function (0.89, vs. 0.84 vs. 0.80 respectively, p for trend = 0.053), which was in contrast to those randomized to the conventional strategy where the mean probability risk ratio increased significantly as renal function decreased (1.24 vs. 1.67 vs. 1.94 respectively, p for trend&lt;0.001).

Conclusion

The beneficial effect of prasugrel-based de-escalation strategy was consistent regardless of the baseline renal function, which was mostly driven by a reduction in bleeding risk which was greatest in those with low eGFR.

The Surgical Anatomy of the Jowl and the Mandibular Ligament Reassessed

INTRODUCTION

A visible jowl is a reason patients consider lower facial rejuvenation surgery. The anatomical changes that lead to formation of the jowl remain unclear. The aim of this study was to elucidate the anatomy of the jowl, the mandibular ligament and the labiomandibular crease, and their relationship with the marginal mandibular branch of the facial nerve.

MATERIALS AND METHODS

Forty-nine cadaver heads were studied (16 embalmed, 33 fresh, mean age 75 years). Following preliminary dissections and macro-sectioning, a series of standardized layered dissections were performed, complemented by histology, sheet plastination and micro-CT.

RESULTS

The jowl forms in the subcutaneous layer where it overlies the posterior part of the mandibular ligament. The mandibular ligament proper exists only in the deep, sub-platysma plane, formed by the combined muscular attachment to the mandible of the specific lower lip depressor muscles and the platysma. The mandibular ligament does not have a definitive subcutaneous component. The labiomandibular crease inferior to the oral commissure marks the posterior extent of the fixed dermal attachment of depressor anguli oris.

CONCLUSION

Jowls develop as a consequence of aging changes on the functional adaptions of the mouth in humans. To accommodate wide jaw opening with a narrowed commissure requires hypermobility of the tissues overlying the mandible immediately lateral to the level of the oral commissure. This hypermobility over the mandibular attachment of the lower lip depressor muscles occurs entirely in the subcutaneous layer to allow the mandible to move largely independent from the skin. The short, elastic subcutaneous connective tissue, which allows this exceptional mobility without laxity in youth, lengthens with aging, resulting in laxity. The development of subcutaneous and dermal redundancy constitutes the jowl in this location.

LEVEL OF EVIDENCE IV

"This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

Retrodural space of Okada in the posterior ligamentous complex region: clinical and anatomical findings relevant to lumbar interlaminar epidural injection

Background

The retrodural space of Okada is a potential space posterior to the ligamentum flavum that allows communication with the bilateral facet joints. However, the actual anatomy of this space has not been clearly visualized to date. We sought to investigate the characteristics of patients showing contrast spreading to the facet joint space during epidural injection and to clarify the anatomical structures of the retrodural space and adjacent ligamentous tissues in cadaveric specimens.

Methods

Fluoroscopic images of patients who underwent fluoroscopy-guided lumbar interlaminar epidural injection were assessed for contrast flow to the facet joints. Patient demographics, preprocedural imaging study findings, and epidural approaches were analyzed. The anatomical study included the sectional dissection, micro-CT imaging, and histological evaluation of lumbar spine specimens from 16 embalmed cadavers.

Results

Fluoroscopic images of 605 epidural injections were analyzed. Among them, 36 with inadvertent spread into the facet joints (5.9%) were identified. Multivariate analysis revealed that facet joint pathologies were significantly associated with inadvertent spread into the facet joints (OR 4.382; 95% CI 1.160 to 16.558; p=0.029). Micro-CT and histological findings consistently showed a retrodural space between the ligamentum flavum and interspinous ligament. Various anatomical communication routes in the posterior ligamentous complex leading to this space were observed in specimens with degenerative and pathological changes.

Conclusion

Degenerative and pathological facet joint changes were associated with a higher incidence of spread into the retrodural space during epidural injection. Our findings confirm anatomical evidence for a false loss of resistance before the needle enters the epidural space.

Effects of betaine supplementation on reproductive performance of breeding geese

1. An experiment feeding three concentrations of betaine was conducted using breeding geese to analyse the reproductive performance, serum biochemical indexes, egg quality and intestinal immunity.2. A total of 450 female and 90 male Jiangnan White breeding geese were divided into three treatments, with five pen replicates each containing 30 female geese and 6 male geese.3. The results showed that there was no significant effect on the reproductive performance, serum biochemical indexes or jejunal villi goblet cells of geese with different levels of betaine in the diet (P>0.05). Compared with the control group, the addition of 2.5 g/kg betaine to the diet showed a tendency to increase egg mass (P>0.05) the betaine content in the yolk (P<0.05). Feeding betaine significantly increased the height of jejunal villi and egg yolk total cholesterol content in female geese (P<0.05).4. In conclusion, adding betaine to the goose diet was effective in its ability to improve intestinal structures and increase egg production. Adding 2.5 g/kg betaine to feed significantly increased the content of TCHOL and betaine in goose eggs.

[Review of genome-wide association research of aging phenotypes]

"Active health" has been emphasized in "Healthy China 2030" in dealing with the challenges of population aging, so the anti-aging strategies are requires to be more precise and effective at both individual and population levels. Aging is influenced by both genetic and environmental factors. In the recent 20 years, the research of genetics of human ageing has been greatly facilitated owning to the development of high-throughput sequencing techniques, statistical methodology for multi-omics data, as well as the growing qualified evidence of large-scale population-based genomic research. This paper provides a review of genome-wide association research of aging.

Effects of betaine on growth performance, intestinal health, and immune response of goslings challenged with lipopolysaccharide

The objective of this experiment was to investigate the effects of betaine on growth performance, serum parameters, intestinal health, and immune performance of goslings in response to lipopolysaccharide (LPS) challenge. A total of 168 healthy male 15-day-old Jiangnan White Goslings were randomly divided into 4 groups, with 6 replicates per treatment and seven goslings per replicate. A 2 × 2 factorial arrangement included 2 factors, that is, LPS challenge (injection of LPS or physiological saline) and betaine (added 0 or 0.06% betaine in diet). The results indicated that LPS challenge significantly reduced the average daily feed intake (ADFI), average daily gain (ADG), and body weight (BW) at 21 D of the goslings, while dietary betaine supplementation tended to increase the ADFI during the LPS stress period (P = 0.08) and BW at 21 D of the goslings (P = 0.09). The LPS-challenged goslings showed higher pro-inflammatory cytokines (interleukin-1 [IL-1β], interleukin-6 [IL-6], tumor necrosis factor-α (TNF-α), and Interferon-gamma [IFN-γ]) and lower anti-inflammatory cytokine (Interleukin-10 [IL-10]) (P < 0.05) at 21 D of age. Dietary betaine supplementation alleviated LPS-induced increase in pro-inflammatory cytokines. The LPS challenge significantly decreased duodenal and jejunal villus height (VH) and villus height and crypt depth ratio (VCR), while the addition of betaine significantly increased duodenal VH and VCR (P < 0.05). On the other hand, addition of betaine significantly alleviated decline of enzyme activity on lipase, amylase, trypsin, and chymotrypsin in the intestinal of goslings. The LPS challenge significantly increased the content of serum D-lactic acid (D-LA) and the activity of diamine oxidase (DAO) at 21 D of the goslings. The LPS challenge and betaine addition significantly increased the mRNA expression of Occcludin (OCLN) in jejunal mucosa at 28 D of the goslings (P < 0.05). In conclusion, our research demonstrated that betaine can alleviate the decline of growth performance and immune performance in goslings caused by LPS. The results also indicate betaine possesses anti-inflammation properties and improves intestinal barrier functions. We recommend that 0.06% betaine be added into the diet to improve the intestinal health and immune performance of goslings.

Dietary amylose and amylopectin ratio changes starch digestion and intestinal microbiota diversity in goslings

1. Research has confirmed that amylopectin (AP) is more easily digested than amylose (AM) because AP polymers have more intramolecular hydrogen bonds and less surface area. Studying the relationship between the amylose:amylopectin (AM:AP) ratio and intestine digestion in goslings can provide useful information for effective utilisation of starch.2. A total of 288 healthy male Jiangnan White Goslings, aged three days old, were randomly allotted to four groups, which included six pen replicates per treatment with 12 goslings per replicate. Four diets were formulated with maize, long-grained rice and glutinous rice as starch sources, with AM:AP ratios of 0.12, 0.23, 0.34, and 0.45. In vitro starch digestion of the four diets was measured, as well as the effect of AM:AP ratio on growth performance, serum amino-acid concentration and intestinal microbiota diversity of goslings.3. In terms of in vitro starch digestion, the increase in dietary AM:AP ratio resulted in a decrease followed by an increase in both rapidly and slowly digestible starch. The glucose release rate at an AM:AP ratio of 0.34 showed a steady upward trend.4. The in vivo study showed that increasing the AM:AP ratio resulted in a quadratic increase in body weight (BW) and average daily feed intake (ADFI; P<0.05). Goslings fed diets with an AM:AP ratio of 0.34 had lower (P<0.05) histidine and valine serum concentrations compared with the other three starch sources. Higher AM was beneficial to jejunal microbial and diversity. The species colonisation level of the jejunum microbiota samples at an AM:AP ratio of 0.34 was higher than that in the other groups.5. The results indicated that diets with an AM:AP ratio of 0.34 improved the growth performance and intestinal microbiota diversity of goslings. This may have been due to the higher level of resistant starch in amylose, which resulted in a slow release of intestinal glucose that acted as a substrate for the microbial species, thus providing conditions that were more conducive to growth.

[Clinical features of children with post-primary tuberculosis]

Objective: The aim of this study was to summarize the clinical and imaging characteristics of post-primary tuberculosis in children, so as to improve the early identification and diagnosis of post-primary tuberculosis. Methods: This was a retrospective study which enrolled children who were admitted to the Department No.2 of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University between January 2015 to December 2020 and with a diagnosis of post-primary tuberculosis. Results: A total of 30 patients were enrolled, including 10 males and 20 females. The age on admission were 13.0 (12.0, 13.3) years. Their common symptoms were cough and fever, there were 26 cases (87%) with cough and 23 cases (77%) with fever, but only 4 cases (13%) had other toxic symptoms (night sweat, weakness or weight loss) of tuberculosis other than fever. Blood examination showed that the white blood cell count was (10±3)×10⁹/L, accompanied by elevated proportion of neutrophils (0.69±0.11) and increased level of C-reactive protein (31 (15,81) mg/L). The common radiographic findings of CT were nodular or mass shadow with cavitation (19 cases (63%)), consolidation (13 cases (43%)), bronchogenic spread (12 cases (40%)), hilar or mediastinal lymphadenopathy (5 cases (17%)) in this cohort. The affected locations included the right upper lobe (21 cases (70%)), the left lower lobe (17 cases (57%)) and the right lower lobe (15 cases (50%)). Acid-fast bacillus smears and mycobacterial cultures were attempted for all cases, resulting in 33% (10/30) with smear positivity and 50% (15/30) with culture positivity. Conclusions: Post-primary tuberculosis in children has no specific clinical manifestations. Imaging of chest CT is mainly manifested as nodular shadow with cavitation, consolidation or bronchogenic spread. Accurate identification of post-primary tuberculosis is crucial for preventing the spread and early treatment of tuberculosis.

Aspirin vs. Clopidogrel as a Chronic maintenance monotherapy after PCI in patients with high ischemic risk and high bleeding risk: Subgroup analysis of the HOST-EXAM trial

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the HOST-EXAM investigators

Background

The HOST-EXAM randomized clinical trial recently performed a comparison of clopidogrel monotherapy vs. aspirin monotherapy in patients requiring indefinite antiplatelet monotherapy after percutaneous coronary intervention (PCI). This study randomized 5,438 patients who maintained dual antiplatelet therapy without clinical events for 6–18 months after PCI with drug-eluting stents (DES) to receive a monotherapy agent of clopidogrel 75 mg once daily or aspirin 100 mg once daily for 24 months. During the 24-month follow-up, the primary outcome (a composite of all-cause death, non-fatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium (BARC) bleeding type 3 or greater) rate was significantly lower in the clopidogrel group (hazard ratio [HR] 0.73 [95% CI 0.59–0.90]; p = 0.0035). However, it is uncertain whether the beneficial effect of clopidogrel will be consistent in patients with high ischemic risk or those with high bleeding risk.

Methods

This is a post-hoc analysis of the HOST-EXAM trial. A high ischemic risk was defined as those who had at least 1 of the following procedural features: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation PCI, total stent length &gt;60 mm, or left main PCI. Patients with high bleeding risk were defined according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The co-primary outcome were thrombotic endpoints (a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, readmission due to acute coronary syndrome, and definite or probable stent thrombosis) and bleeding endpoints (BARC type ≥2 bleeding events) at 24-month follow-up.

Results

 Among the total population, 22.1% had high ischemic risk and 21.4% had high bleeding risk. Complex PCI was not associated with a higher risk of thrombotic endpoints, nor bleeding endpoints. For patients with a high bleeding risk, these patients had a higher risk of both thrombotic endpoints (HR 1.545, 95% CI 0.141-2.092, p = 0.005) and bleeding endpoints (HR 3.418, 95% CI 2.413-4.840, p &lt; 0.001). The primary results focusing on the interaction between high ischemic risk, high bleeding and the antiplatelet regimen will be presented.

Conclusion

The current post-hoc analysis of the HOST-EXAM trial will evaluate the efficacy of clopidogrel monotherapy vs. aspirin monotherapy during the chronic maintenance period after PCI, in patients with high ischemic risk or those with high bleeding risk.

The pathway of injectate spread during thoracic intertransverse process (ITP) block: Micro-computed tomography findings and anatomical evaluations

STUDY OBJECTIVE

To investigate the mechanism of action of the thoracic intertransverse process (ITP) block.

DESIGN

Three-dimensional micro-computed tomography (3D micro-CT) study and cadaveric evaluation.

SETTING

A translational research unit for anatomy and analgesia in a university hospital.

PATIENTS

Twelve embalmed and three non-embalmed human cadavers were used in this study.

MEASUREMENTS

Micro-CT images of the mid-thoracic paravertebral space and its adjacent ligamentous tissues were acquired and 3D images were reconstructed. Manual dissection and histologic examination of these structures complemented the images. To confirm our findings, the dye-spreading pattern after ultrasound-guided ITP injection of 20 mL dye solution at T4-T5 was evaluated.

MAIN RESULTS

Micro-CT and histologic findings showed that the costotransverse foramen (the medial slit of the superior costotransverse ligament) and the costotransverse space (between the rib and the transverse process) were potential pathways to the thoracic paravertebral space during ITP block. Single-level ITP injection with a dye solution resulted in a multilevel segmental paravertebral spread in cadaveric evaluation.

CONCLUSIONS

The space posterior to the superior costotransverse ligament, the target area for ITP blocks, has potential anatomical pathways to the thoracic paravertebral space. The costotransverse foramen and the costotransverse space provided the anatomical conduit for the anterior and intersegmental paravertebral spread of the ITP block.

A novel index reflecting both anatomical and physiologic parameters in coronary artery disease, the FFR adjusted SYNTAX score (FaSs)

Background

Various physiology-based indices have been proposed to predict adverse clinical events in patients with coronary artery disease (CAD), such as the sum of three vessel-fractional flow reserve (3v-FFR), and the functional SYNTAX score (fSS). However, these values could not fully reflect the anatomical factors, which remains as a barrier for clinical application of these indices.

Purpose

To propose a novel index which can reflect both anatomical and physiologic features in CAD patients, and evaluate the additional predictive value for cardiovascular adverse events compared to previous indices.

Methods

For an index which can reflect both anatomical and physiologic features, we proposed the FFR adjusted SYNTAX score (FaSs). The FaSs is calculated by adding the product of the SYNTAX score and `1-FFR', for all three major coronary arteries. Among the 1136 patients who enrolled at 3V FFR-FRIENDS study, we investigated 866 patients, after excluding those who had missing variables. The 3v-FFR, fSS and FaSs were calculated, derived from the baseline FFR and SYNTAX score. Patients were divided into two groups according to the median value of each index. The primary endpoint was major adverse cardiac events (MACE, a composite of cardiac death, myocardial infarction and ischemia-driven revascularization) at 2 years follow-up.

Results

Among the total population, MACE occurred in 35 (4.04%) patients. Using the median value in a multivariable COX regression model, only FaSs was associated with an increased risk of MACE, (Hazard Ratio [HR] 5.256, 95% confidence interval [CI] 2.014–13.720), while 3v-FFR (HR 1.383, 95% CI 0.685–2.790) and fSS (HR 1.640, 95% CI 0.830–3.243) were not significantly associated with a higher risk of MACE. This was also observed in the Kaplan Meier survival curve analysis (log-rank p value: p&lt;0.001 for FaSs, 0.153 for 3v-FFR, and 0.061 for fSS; Figure 1) The sensitivity and specificity of the FaSs was 85.7% and 51.6%, which was higher compared to the 3v-FFR (62.9% and 49.3%, respectively) and fSS (57.1% and 58.5%, respectively). When these indices were combined with clinical risk factors (age, sex, hypertension, diabetes, hyperlipidemia, chronic renal failure, LVEF&lt;40%), FaSs was superior compared with 3v-FFR and fSS assessed in regards of the predictive accuracy for MACE (Figure 2).

Conclusion

The FaSs, which is a novel index calculated by a formula using the SYNTAX score and FFR, showed a superior predictive value for MACE compared to previous indices. Our results confirm the importance of considering both anatomical and physiologic parameters in evaluating the patient's risk for cardiovascular adverse outcomes.

Funding Acknowledgement

Type of funding sources: None.

Dietary supplementation of betaine promotes lipolysis by regulating fatty acid metabolism in geese

Supplementation of betaine in the diet appears to regulate fatty acid metabolism and decrease fat deposition. This study aims to identify the effects of dietary supplementation of betaine on zootechnical performance, fatty acid synthesis, abdominal fat deposition, and morphology. Three hundred healthy, male, one-day-old Jiangnan White geese of similar body weight were randomly divided into 5 groups, with 6 replicates per treatment and 10 geese per replicate, and given the following amounts of supplementary betaine: 0 (group A), 600 mg/kg (group B), 1,200 mg/kg (group C), 1,800 mg/kg (group D), or 2,400 mg/kg (group E). Feed intake (FI), body weight (BW), abdominal fat and sebum thickness, clinical blood parameters, hepatic enzyme activity, and abdominal fat morphology were monitored during the experiment. All geese had free access to feed and water throughout the study. Our results indicate that supplementation of betaine increased zootechnical performance at 21 and 42 d of age. The percentage of abdominal fat and sebum thickness of geese at 63 d of age decreased linearly with the addition of betaine (P < 0.05). The triglyceride (TG) and total cholesterol (TCHOL) content of serum decreased with the increased level of betaine when measured at 63 d of age (P<0.05). Hormone sensitive lipase (HSL) increased with the level of betaine (P<0.05). However, dietary betaine appeared to decrease the activity of fatty acid synthase (FAS) in the geese at 42 d and 63 d of age (P<0.05). The percentage of total area of lipid droplet decreased with the increased level of betaine supplementation. In conclusion, dietary supplementation of betaine increased lipolysis and decreased fat deposition in the finishing period of geese via reducing feed intake. However, the precise mode-of-action is yet unclear and warrants further research.

Protective effects of lycopene on mitochondrial oxidative injury and dysfunction in the liver of aflatoxin B1-exposed broilers

This study was conducted to investigate the effects of lycopene (LYC) on mitochondrial oxidative injury and dysfunction in the liver of aflatoxin B₁ (AFB₁)-exposed broilers. A total of 192 healthy 1-day-old male broilers were randomly divided into 3 groups with 8 replicates of 8 birds each. Birds in the 3 groups were fed basal diet (control), basal diet with 100 µg/kg AFB₁, and basal diet with 100 µg/kg AFB₁ and 200 mg/kg LYC, respectively. The experiment lasted 42 d. The results showed that AFB₁ decreased average daily body weight gain (ADG), average daily feed intake, and gain to feed ratio (G :F) compared to the control group, the LYC supplementation increased ADG and G/F compared to AFB₁ group (P < 0.05). Broilers in the AFB₁ group had lower mitochondrial glutathione (mGSH) concentration and glutathione peroxidase (GSH-Px), manganese superoxide dismutase (MnSOD), and thioredoxin reductase activities, and higher hydrogen peroxide (H₂O₂) and reactive oxygen species (ROS) concentrations than the control group (P < 0.05). The LYC increased mGSH concentration and GSH-Px and MnSOD activities, and decreased H₂O₂ and ROS concentrations compared to AFB₁ group (P < 0.05). Broilers fed the AFB₁ diet showed increased mitochondrial swelling and decreased adenosine triphosphate concentration than the control group, and LYC had opposite effects (P < 0.05). The AFB₁ decreased the activities of mitochondrial electron transfer chain (ETC) complexes I, II, III, and V, downregulated the mRNA expression levels of hepatic MnSOD, thioredoxin 2, thioredoxin reductase, peroxiredoxin-3, peroxisome proliferator-activated receptor γ coactivator 1α, nuclear respiratory factor 1, and mitochondrial transcription factor A compared with the control group (P < 0.05), and LYC increased activities of mitochondrial ETC complexes III and V, and upregulated mRNA expression levels of these genes in comparison to AFB₁ group (P < 0.05). In conclusion, the LYC protected broilers from AFB₁-induced liver mitochondrial oxidative injury and dysfunction by stimulating mitochondrial antioxidant capacity and maintaining mitochondrial biogenesis.

[Clinical features and early diagnostic clues of chronic granulomatous disease]

Objective: To explore the early clinical clues for diagnosis of chronic granulomatous disease (CGD). Methods: One hundred and thirty-nine children with CGD seen in Beijing Children's Hospital from January 2007 to October 2020 were included in this study. The clinical features including age of onset, first presentations, reason for being hospitalized, etiology, imaging features, clues for early diagnosis of all patients were evaluated retrospectively. According to the time of diagnosis, the patients were divided into two groups, cases diagnosed before 2015 and after 2015 and 2015. The time of diagnosis, the length of stay and the hospital charges were compared between the two groups. T test and χ² test were used for statistical analyses. Results: One hundred and nineteen of the cases were males and 20 were females. The age of onset was 4 months (8 d to 14 years), and 103 cases (74.1%) had onset before 1 year of age. The age at diagnosis was 1.8 years (21 d to 14.7 years), and the time of diagnosis delay was 1 year (7 d to 13.7 years). One hundred and thirty-five cases (97.1%) had pulmonary infection as the main reason for hospitalization, of whom 76 cases (56.3%) had positive pulmonary etiology. One hundred and thirty-six patients (97.8%) were referred cases, of whom 5 were suspected of CGD before referral, and the misdiagnosis rate was as high as 96.3% (131/136). Eight early clues for diagnosis were found, the frequency from high to low, large bacillus Callmette-Guer scar in 99 cases (70.5%), left axillary lymphadenopathy or calcification in 73 cases (52.5%), skin or other lymph node infections in 58 cases (41.7%), skin scars in 50 cases (36.0%), multiple lung nodules in 42 cases (30.2%), perianal abscess in 35 cases (25.2%), pulmonary Aspergillus infection in 26 cases (18.7%) and pulmonary Burkholderia infection in 15 cases (10.8%). A total of 120 cases of CGD were diagnosed by respiratory burst test during hospitalization, including 55 cases diagnosed before 2015 and 65 cases diagnosed after 2015. After using these 8 early diagnosis clues, the cases diagnosed after 2015 had shorter time of diagnosis and the length of stay and lower hospitalization charge than cases diagnosed before 2014, and the difference was statistically significant ((25±7) vs. (10±5) d, (29±7) vs. (18±6) d, (3.7×10⁴±1.2×10⁴) vs. (3.2×10⁴±1.2×10⁴) Yuan, t=13.763, 9.262, 2.381, all P<0.05). Conclusions: Patients with CGD are younger at onset and the diagnosis is delayed. Pulmonary infections are the most common. Large BCG scar, left axillary lymphadenopathy or calcification, skin or other lymph node infections, skin scars, multiple lung nodules, perianal abscesses, pulmonary Aspergillus infection and Burkholderia infection can help early diagnosis of CGD.

[Application of endobronchial ultrasound in children: an analysis of 4 cases]

Objective: To investigate the feasibility, clinical efficacy and safety of endobronchial ultasound (EBUS) in children. Methods: The radiological features, EBUS images, pathological results and intraoperative and postoperative complications of 3 cases who underwent EBUS examination and 1 case who underwent EBUS guided transbronchial needle aspiration (EBUS-TBNA) were retrospectively analyzed. Results: Among the 4 cases, 2 were males and 2 were females, with the onset age of 7.4-9.2 years. The child who underwent successful EBUS-TBNA was presented with fever and diagnosed with mediastinal lymphadenopathy before the operation, and the postoperative pathology indicated histiocytic necrotic lymphadenitis (HNL). The other 3 children diagnosed with primary airway tumors, whose pre-operative CT imaging found no infiltration in extra-bronchial structures, had the masses resected through EBUS. According to postoperative pathological findings, two were diagnosed with mucoepidermoid carcinoma and one with bronchial leiomyoma. The lesions were located at the opening of the right main bronchus in 1 case and at the main airway in 2 cases. EBUS showed abnormal echogenicity of the tracheal wall in the 3 cases, including hyperechoic area in the water capsule and mucous layer, relatively hypoechoic area in the submucosal smooth muscle layer, hyperechoic area in the inner cartilage layer, hypoechoic in the cartilage layer and hyperechoic in the outer cartilage layer. In one case, structural disorder of the submucosal smooth muscle layer and partial disruption of the cartilage layer of the tracheal wall were found at the lesion site, while the other 2 cases had intact tracheal wall structure. There were no postoperative complications such as pneumothorax or hemoptysis in the 4 children. Conclusion: EBUS is a safe and feasible technique for evaluating mediastinal lymph node enlargement and the degree of airway wall infiltration in primary airway tumor.

Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade

BACKGROUND

A precise anatomical understanding of the thoracic paravertebral space (TPVS) is essential to understanding how an injection outside this space can result in paravertebral spread. Therefore, we aimed to clarify the three-dimensional (3D) structures of the TPVS and adjacent tissues using micro-CT, and investigate the potential routes for nerve blockade in this area.

METHODS

Eleven embalmed cadavers were used in this study. Micro-CT images of the TPVS were acquired after phosphotungstic acid preparation at the mid-thoracic region. The TPVS was examined meticulously based on its 3D topography.

RESULTS

Micro-CT images clearly showed the serial topography of the TPVS and its adjacent spaces. First, the TPVS was a very narrow space with the posterior intercostal vessels very close to the pleura. Second, the superior costotransverse ligament (SCTL) incompletely formed the posterior wall of the TPVS between the internal intercostal membrane and vertebral body. Third, the retro-SCTL space broadly communicated with the TPVS via slits, costotransverse space, intervertebral foramen, and erector spinae compartment. Fourth, the costotransverse space was intersegmentally connected to the adjacent retro-SCTL space.

CONCLUSIONS

A non-destructive, multi-sectional approach using 3D micro-CT more comprehensively demonstrated the real topography of the intricate TPVS than previous cadaver studies. The posterior boundary and connectivity of the TPVS provides an anatomical rationale for the notion that paravertebral spread can be achieved with an injection outside this space.

Assessment of vitamin A requirement of gosling in 0-28 d based on growth performance and bone indexes

A dose-response experiment assessing 6 total dietary vitamin A (VA) levels (0, 3,000, 6,000, 9,000, 12,000, and 15,000 IU/kg) was conducted to study the effects of different levels of VA on growth performance and bone indexes of 0 to 28 d goslings. A total of 360 healthy 1-day-old goslings with similar body weights were randomly divided into 6 groups with 6 replicates in each group and 10 goslings in each replicate. The experiment duration was 28 d. The experimental results showed that the VA content in the serum and liver of gosling increased with increasing VA amount (P < 0.05). When the diet was supplemented with 9,000 IU/kg VA, the content of vitamin D in serum and the liver was higher than those in other groups (P < 0.05). The 28-day body weight and average daily gain in gosling in the 9,000 IU/kg VA group were higher than those in the 0, 3,000 and 15,000 IU/kg VA groups (P < 0.05). Growth hormone, thyroxine, and parathyroid hormone levels in the 9,000 IU/kg VA group were higher than those in the 0, 3,000, 6,000 and 15,000 IU/kg VA groups (P < 0.05). The insulin level in the 9,000 IU/kg VA group was higher than those in the other groups (P < 0.05). The osteocalcin (BGP) levels in the VA supplementation groups were higher than that in the no VA groups (P < 0.05). The tibia length and phosphorus content in the 9,000 IU/kg VA group were higher than those in the 12,000 IU/kg VA group and 15,000 IU/kg VA group (P < 0.05). The tibia shear hardness values in the 6,000, 9,000 and 12,000 IU/kg VA groups were higher than those in the 0, 3,000 and 15,000 IU/kg VA groups (P < 0.05). The tibia calcium content in the 9,000 IU/kg VA group was higher than those in the 0 and 15,000 IU/kg VA groups (P < 0.05). The tibia crude ash content in the 9,000 IU/kg VA group was higher than that in the 15,000 IU/kg VA group (P < 0.05). In conclusion, the optimum dietary VA supplementation for 0- to 8 day gosling was 9,000 IU/kg.

[Clinical features and interventional bronchoscopic treatment of primary airway tumor in 8 children]

Objective: To summarize the clinical manifestations and to evaluate the feasibility of therapeutic bronchoscopy in pediatric primary airway tumors. Methods: The clinical data of 8 children presented with airway tumors in Beijing Children's Hospital from November 2016 to March 2018 were retrospectively analyzed. Descriptive analysis was used to summarize the outcome and prognosis of these children after interventional bronchoscopy. Results: Among the 8 children, 5 were male and 3 were female, aged from 4 years and 8 months to 9 years and 2 months. The main clinical manifestations were cough and wheezing in 6 cases, hemoptysis in 3 cases and recurrent pulmonary infection in 2 cases, and none of them had lymph node metastasis and extra-pulmonary metastasis. All 8 children underwent bronchoscopic resection of the tumors, and the 4 children with blood-rich tumors had bronchial artery embolization at the blood supply site before the resection. No major bleeding or pneumothorax occurred during or after the operation. Four cases had low grade malignant bronchial mucoepidermoid carcinoma, 2 had inflammatory myofibroblastoma, and the rest two had pleomorphic adenoma and bronchial smooth muscle spindle cell tumor. Postoperative follow-up lasted 2 to 4 years, and 3 had tumor recured. Among the 3 cases, 2 had inflammatory myofibroblastoma who underwent surgical resection of the lesion and combined chemotherapy, respectively; and one had mucoepidermoid carcinoma who was under follow-up after interventional cryotherapy. Conclusions: The clinical manifestations of primary airway tumors in children are atypical. The main clinical manifestations are dry cough, wheezing, recurrent pulmonary infection and hemoptysis. Interventional bronchoscopy is a feasible choice for the treatment of pediatric airway tumors.

[The evaluation value of transient elastography for liver characteristics in obese children]

Objective: To evaluate the feasibility of transient elastography (FibroTouch) in obese children and to investigate the liver characteristics of obese children based on FibroTouch. Methods: Children (5-18 years of age) from the Guangzhou Women and Children's Medical Center were examined by FibroTouch. The fat attenuation parameter (FAP) was used to assess liver fat deposition, and liver stiffness measurement (LSM) was used to assess liver fibrosis. The children were divided into obesity group (n=67) and non-obesity group (n=139). The FAP, LSM, and their influencing factors were analysed in the obese group. Results: The total effective rate of FibroTouch in non-sedated children aged 5-18 years (n=229) was 97.8%. The FAP value 259.4 (235.9-275.5) dB/m in obese children was significantly higher than that in the control group 178.1 (168.7-195.6) dB/m, (Z=-10.586, P<0.001). The LSM value in obese children 5.9 (4.5-7.5) kPa was significantly higher than that in non-obese children 3.2 (2.3-4.1) kPa, (Z=-8.832, P<0.001). The proportion of liver fibrosis in obese group was 30%, and that of nonalcoholic fatty liver was 65.7%. Logistic regression analysis showed that BMI percentile (≥ 95%) was an independent factor for significant liver fibrosis (OR=1.267, 95%CI: 1.056-1.519, P=0.011) and nonalcoholic fatty liver disease (OR=1.248, 95%CI: 1.007-1.546, P=0.043). Conclusions: FibroTouch can be successfully applied to obese children. Fibrotouch can accurately evaluate the liver fibrosis and fat attenuation parameters in obese children. Obese children have higher FAP and LSM, which increase the risk of non-alcoholic fatty liver and liver fibrosis.

The body fat distribution and fatty acid composition of muscles and adipose tissues in geese

In this study, we evaluated the body fat distribution and fatty acid composition of muscles and adipose tissues of Yangzhou geese, including thirty 60-day-old goslings (15 males and 15 females) and 20 320-day-old geese (10 males and 10 females). Adipose tissues of Yangzhou geese were distributed widely and could be divided into 5 types: subcutaneous fat, abdominal fat, sartorial fat, neck fat, and mesenteric fat. Higher contents of abdominal fat, sartorial fat, neck fat, and mesenteric fat but a lower content of subcutaneous fat were found in adult geese than in goslings (P ≤ 0.05). Adult female geese deposited more fat than adult male geese (P ≤ 0.05). No difference was found in the fat distribution and fat content between male and female goslings (P > 0.05). The breast muscle of adult geese was characterized by a higher content of total monounsaturated fatty acids (ΣMUFAs) and a lower content of n-6 polyunsaturated fatty acids (ΣPUFAs n-6) than that of goslings (P ≤ 0.05). Lower concentrations of total saturated fatty acids and ΣPUFA were found in adult female geese than in female goslings (P ≤ 0.05). In comparison with adult female geese, the breast muscle of adult male geese had higher total saturated fatty acids and stearic acid (P ≤ 0.05). For the thigh muscle, adult female geese had a higher ΣMUFAs content than adult male geese (P ≤ 0.05). In adipose tissues, adult geese had a higher Σn-6/Σn-3 ratio but had lower contents of erucic acid, linolenic acid, arachidonic acid, docosatetraenoic acid, and ΣPUFA n-3 than goslings, and adult female geese had a higher ΣMUFAs content than adult male geese (P ≤ 0.05). In conclusion, adult geese, especially adult female geese, accumulated more fat than goslings. Both age and sex affected the fatty acid composition of muscles and adipose tissues in geese. This research provides essential information not only for the nutritional evaluation of geese but also for the consumption and processing of goose products.

LINC00662 promotes glycolysis and cell survival by regulating miR- 375/HIF-1α axis in ovarian cancer

Ovarian cancer (OC) is one of the most common gynecological malignancies, with the highest mortality rate in women worldwide. LINC00662, a long non-coding RNA (lncRNA), was shown to play a vital role in many malignancies, while little is known about its role in OC. Firstly, our study determined the expression of LINC00662 in OC tissues and cells. Upregulation or downregulation of LINC00662 were performed in OC cells to explore its effects on cell proliferation and glycolysis of OC. The interaction between LINC00662 and miR-375 was verified using luciferase assays and RNA immunoprecipitation. Results showed that LINC00662 was highly expressed in OC tissues and cells, and patients with increased expression of LINC00662 were associated with shorter overall survival. Furthermore, functional assays proved that LINC00662 was essential for OC cell proliferation and glycolysis. Subsequently, our study further revealed that LINC00662 acted as a competitive RNA and it could modulate the expression of HIF-1α through directly binding with miR- 375. Collectively, upregulation of LINC00662 in ovarian cancer tissues is closely correlated to poor survival. LINC00662 might regulate HIF-1α expression via miR-375. These findings suggested that LINC00662 has the potential to be explored as a diagnostic biomarker for OC.

Analysis of the positional relationship of the long thoracic nerve considering clinical treatment

INTRODUCTION

The long thoracic nerve (LTN) has a risk of being damaged during chest surgery and should be considered when performing anesthesia such as a serratus anterior plane block (SAPB). We analyzed the relationship between landmarks-the fourth to ninth intercostal space (ICS) at the midaxillary line (MAL), through which the distal part of the LTN passes-and the LTN.

MATERIALS AND METHODS

We used 25 specimens from 17 embalmed Korean cadavers. The MAL, level of rib and ICS, and regions 5 cm anteroposterior to the MAL (aMAL/pMAL) were established to measure the position of the LTN crossing the MAL, pathway of the LTN, and entering points of the LTN to the SA.

RESULTS

The LTN crossed the MAL in 76% of the specimens. The LTN crossed the MAL within the fifth to sixth rib level in 70.8%. Seventy-six percent of the branches entered the SA within the fourth to sixth ICS. The fifth rib and ICS were the most frequent regions aMAL; however, several branches were found pMAL. The LTN entered the SA in 92.6% of the specimens within 3 cm anterior and 1 cm posterior to the MAL.

CONCLUSIONS

We set the danger zone as 4 cm near the MAL at the fourth to sixth ICS for thoracotomy. In addition, we proposed the fifth ICS in aMAL at the superficial plane as the alternative injection point for SAPB when blocking the LTN, and the fifth ICS in pMAL at the deep plane to prevent blocking the LTN.

Longitudinal muscular column in the prostatic urethral wall: Its form, shape, and possible function based on mathematical simulation in ejaculation

BACKGROUND

The shape and function of the longitudinal muscular column (LMC) of the prostate have not been established in detail. The present study was undertaken to elucidate the roles of the LMC of the posterior wall of the prostatic urethra (PSU) in the emission phase of ejaculation by investigating the form and muscular arrangement of the LMC.

METHODS

Prostates and urinary bladders were obtained from 14 Korean adult cadavers. Nine specimens were histologically analyzed using hematoxylin and eosin, Masson's trichrome, and Verhoeff-van Gieson staining. Two specimens were scanned using microcomputed tomography (micro-CT), and all scanned images were reconstructed into a three-dimensional model.

RESULTS

At the proximal level of the prostate, the ejaculatory ducts (EDs) and prostatic utricle (PU) together were surrounded by circular smooth-muscle fibers. However, at the seminal colliculus (SC) where the EDs and PU opened, they were mainly surrounded by an abundance of longitudinal fibers. The longitudinal fibers posterior to the EDs and PU formed a distinctive LMC in the posterior urethral wall. In histologic sections and micro-CT images, the LMC extended distally from the level of the SC to the level of the membranous urethra (MBU). We simulated a potential mechanism of LMC using a mathematical model of its movements.

CONCLUSIONS

Comprehensive analyses based on in-depth assessment of histologic characteristics and micro-CT images demonstrated extension of the LMC from the level of the SC to the level of the MBU, enabling a better understanding of ejaculation physiology involving the LMC. These results suggest that the LMC in the posterior wall of the PSU is a critical component of ejaculation by facilitating the ejection of seminal vesicle fluid into the PSU via well-coordinated contractions.

The effect of dietary vitamin A supplementation in maternal and its offspring on the early growth performance, liver vitamin A content, and antioxidant index of goslings

This study investigated the effect of dietary VA supplementation on maternal and its offspring in terms of the early growth performance, antioxidant index, and tissue VA content of the goslings. Yangzhou geese aged 180 D were selected and randomly distributed into 5 experimental groups with 15 female geese and 3 male geese in each group. The geese were fed a basal diet supplemented with 0, 4,000, 8,000, 12,000, or 16,000 IU/kg VA. Eggs were collected from each group starting at 300 D. After hatching, 96 goslings were selected from each maternal group and randomly distributed into 2 experimental groups with factorial arrangement (6 replicates × 8 geese), including 2 levels of VA supplementations, 0 and 9,000 IU/kg. The results are as follows: (1) Different levels of maternal VA supplementation significantly affected the BW and weight gain of 7-day-old offspring (P < 0.05). The weight gain of offspring administered 9,000 IU/kg VA was significantly higher than that of offspring administered the basal diet (P < 0.05). (2) Maternal VA levels significantly affected the T3, T4, and insulin levels of the offspring (P < 0.05). (3) The GSH-PX, SOD, T-AOC, CAT, and tissue VA content of the offspring were significantly higher and MDA was significantly lower in the 9,000 IU/kg VA group than in the no VA group (P < 0.05). (4) Maternal VA levels had a significant effect on offspring GSH, GSH-PX, SOD, MDA, T-AOC, and CAT (P < 0.05). Maternal and offspring VA supplementation interact with the weight gain, tissue VA content, GSH, GSH-PX, SOD, MDA, and CAT of goslings (P < 0.05). Maternal supplementation with 12,000 IU/kg VA and offspring supplementation with 9,000 IU/kg VA was conducive to gosling growth.

Biological background of the genomic variations of cf-DNA in healthy individuals

BACKGROUND

Cell-free DNA (cf-DNA)-based liquid biopsy is emerging as a revolutionary new method in individualized cancer treatment and prognosis monitoring, although detecting early-stage cancers using cf-DNA remains challenging, partially because of the undefined biological background of cf-DNA.

MATERIALS AND METHODS

We investigated somatic mutations in the cf-DNA of 259 cancer-free individuals with a median age of 47 years using an endogenous barcoding duplex method with an ultralow base error rate (2 × 10-7) and compared the variant allele frequencies (VAFs) of these mutations between the cf-DNA and the corresponding blood cell DNA.

RESULTS

Sixty percent (155/259) of the samples showed at least one nonsynonymous mutation on either of two similar target panels covering 508 and 559 cancer-related genes. For individuals older than 50 years of age, the positive rate increased to 76%. Most cf-DNA mutations were also present at similar VAFs in the paired blood cell DNA. The most frequently mutated genes were driver genes of hematologic malignancies, including DNMT3A, TET2, AXSL1, and JAK2. However, the other 58.4% (192/329) of the mutations were likely 'passenger mutations' of clonal hematopoiesis, including mutations in NOTCH2, FAT3, EXT2, ERBB4, and ARID2, which are driver genes of solid tumors.

CONCLUSION

Hematopoietic clone-derived mutations, including 'driver mutations' and 'passenger mutations', are prevalent in the cf-DNA of both healthy individuals and cancer patients and may be a potential source of false positives in the liquid biopsy. Our results also suggest the ineffectiveness for distinguishing clonal hematopoietic mutations of low VAF (≤0.1%) from tumor-derived mutations using conventional next-generation sequencing of blood cell DNA. However, an error correction model with an ultralow error rate and high coverage depth is required for blood cell DNA sequencing, which is difficult and costly to achieve with current technologies.

Impact of simulation-based anesthesiology training using an anesthetized porcine model for ultrasound-guided transversus abdominis plane block

Objective

This study was performed to assess the impact of simulation-based training for ultrasound-guided transversus abdominis plane (TAP) block using anesthetized pigs.

Methods

In this prospective study, 23 participating residents (10 in their second year, 13 in their third year) underwent simulation-based training for ultrasound-guided TAP block. The residents completed standard questionnaires comprising 10 multiple-choice questions regarding essential general knowledge of abdominal ultrasound and TAP block before and after the training session. On a 5-point Likert scale, they reported their levels of comfort with the use of ultrasound and block equipment, subject/operator positioning, proper block technique, image documentation, needle handling, anxiety, and their overall confidence with the procedure.

Results

Compared with those before training, the comfort levels of the residents significantly improved for all measures except needle handling. The participants also indicated significantly reduced anxiety regarding performance of the TAP block technique.

Conclusion

The use of anesthetized pigs in simulation-based training for ultrasound-guided TAP block improves procedural knowledge and confidence while reducing the associated anxiety in anesthesiology trainees.

Estimation of the net energy and protein requirements for maintenance of male arctic foxes (Alopex lagopus) during the growth period1,2

The maintenance requirements of net energy and net protein were assumed to represent the most accurate and important values totally for the animal's utilization. The objective of this experiment was to determine the net energy and net protein requirements for maintenance of growing arctic foxes. The experiments was evaluated using regression models estimated from data collected by means of indirect calorimetry, nitrogen balance trials, and digestion and metabolism experiments. Thirty-six growing arctic foxes (3 487 ± 261.7 g) at the age of 85 days were randomly assigned to four groups with 9 animals in each group. Arctic foxes were fed a complete formula diet at four intake levels (100%, or 80%, 60%, and 40% of feed requirements) from 24 July 2017 to 23 September 2017. Arctic foxes in each treatment were kept individually in respiration chambers after 1-d adaptation at day 2 for a 3-d balance trial and then at day 5 followed by a 3-d fasting period. The metabolizable energy intake (MEI), heat production in the fed state (HP), and retained energy (RE) of arctic foxes significantly decreased (P < 0.01) as the feed intake level decreased. Fasting heat production (FHP) of arctic foxes was not influenced by feed intake level (P > 0.05). The metabolizable energy maintenance requirement (MEm) and net energy maintenance requirement (NEm) estimated from the linear relationship between RE and MEI were 230 and 217 kJ/kg of body weight BW0.75/d, respectively. The MEm and NEm estimated by logarithmic regression of HP on MEI were 225 and 209 kJ/kg BW0.75/d, respectively. The net N maintenance requirement (NNm) and net protein maintenance requirement (NPm) estimated from the linear relationship between retained nitrogen (RN) and daily nitrogen intake (NI) were 179.6 mg/kg BW0.75/d and 1.123 g/kg BW0.75/d, respectively. It is concluded that NEm and NPm values obtained fill the net energy and protein requirements shortage, and provide the basic data for establishing the standard of nutrition demand of breeding arctic foxes in China.

Intramuscular innervation patterns of the splenius capitis and splenius cervicis and their clinical implications for botulinum toxin injections

INTRODUCTION

The purpose of this study was to clearly characterize the intramuscular nerve distributions of the splenius capitis and splenius cervicis muscles that are both responsible for the onset of a chronic tension type headache and to use this information to identify the effective botulinum toxin (BoNT) injection sites.

MATERIALS AND METHODS

Ten splenius capitis and splenius cervicis specimens were subjected to Sihler's staining to reveal intramuscular nerve arborization patterns and determined the optimal location for BoNT injection.

RESULTS

Nerve distribution patterns in the splenius capitis were identified as nerve pathways that travel down toward the origin point and others that travel up toward the insertion point. This neuromuscular innervation from the central (50%) point was distributed evenly in these two directions. The neural pathways of splenius cervicis traveled vertically from the insertion point to the origin point. If the length from the muscle origin point to the insertion point is normalized to 100%, motor neurons innervate the muscle from around the 30% to the 70% point.

CONCLUSIONS

The safest and most-effective BoNT injection sites for the splenius capitis and splenius cervicis were found at around the 50% point and the 30% to the 70% point, respectively.

Effects of cottonseed meal on slaughter performance, meat quality, and meat chemical composition in Jiangnan White goslings

Cottonseed meal (CSM), which is an unconventional protein material with abundant sources, high protein content, and a relatively cheap price, can be used in poultry diets. The aim of this study was to investigate the effects of CSM on slaughter performance, meat quality and meat chemical composition in Jiangnan White goslings. A total of 300 healthy 28-day-old male goslings were randomly divided into 5 treatments, with 6 pens containing 10 geese each. Five isonitrogenous and isocaloric experimental diets were formulated such that 0% (a corn-soybean meal basal diet, control), 25% (CSM25), 50% (CSM50), 75% (CSM75), and 100% (CSM100) protein from soybean meal was replaced with CSM (corresponding to 0, 6.73, 13.46, 20.18, and 26.91% CSM in the feed, respectively). On day 70, 1 goose from each pen (6 geese per treatment) was randomly selected and killed to measure the slaughter performance, meat quality, and the meat amino acid (AA) and fatty acid (FA) compositions. The results showed that dietary CSM did not affect the slaughter performance or meat quality of geese (P > 0.05). The fat content of breast muscle in the CSM100 group was higher than that in the control group (P < 0.05). A concentration of 13.46% or more dietary CSM increased the threonine content but decreased the cysteine content, and 20.18% dietary CSM also decreased the valine content (P < 0.05). Dietary CSM concentration had no effect on the content of total saturated FAs (SFAs, P > 0.05), but 20.18 and 26.91% dietary CSM increased the content of total monounsaturated FAs and decreased the content of total polyunsaturated FAs (PUFAs) and PUFA/SFA in the breast muscle of geese (P < 0.05). In conclusion, dietary CSM did not affect the slaughter performance or meat quality of geese, but the replacement of soybean meal with CSM in whole or high proportion altered the composition of AAs and FAs in breast muscle.

Effect of age on the relationship between metabolizable energy and digestible energy for broiler chickens

A total of 960 male Ross 308 chicks (day-old) were used to investigate the effect of age on the relationship between metabolizable energy (ME) and digestible energy (DE) for broiler chickens. Bird growth variables, nitrogen retention (NR), nitrogen digestibility (ND), as well as the relative weight of liver, pancreas, and the gastrointestinal tract were determined. Practical diets that compared 2 cereals (corn and wheat) and exogenous xylanase (0 or 16,000 BXU/kg) were evaluated at 5 ages (7, 14, 21, 28, and 35 D) in a 2 × 2 × 5 factorial arrangement of treatments with 8 replicates per treatment and started with 30 birds per replicate. A randomized block ANOVA analysis of repeated measures was performed, and a 2 × 2 × 5 factorial structure was used to investigate the 2 dietary treatment factors (cereal type and the presence of xylanase) within the 5 bird ages (7, 14, 21, 28, and 35 D), and their interactions. Apparent metabolizable energy (AME) increased linearly from 7 until 28 D of age, but (P < 0.05) decreased at 35 D of age. Digestible energy was high at 7 D of age, then dropped and remained similar (P > 0.05) from 14 to 35 D of age. The AME: DE ratio was lowest (P < 0.05) at 7 D of age but there were no (P > 0.05) differences thereafter. Cereal type and xylanase supplementation did not (P > 0.05) change the ME: DE ratio. The results indicate that determining ME before 14 D of age may give absolute values that are lower than would be obtained with older birds. ME values that are determined on older broiler chickens may overestimate the energy availability of practical feeds used in broiler starter feeds.

Dietary selenomethionine increases antioxidant capacity of geese by improving glutathione and thioredoxin systems

A total of 200 healthy 28-day-old male Jiangnan White geese were used to investigate the free radical scavenging ability, reduced glutathione (GSH) and thioredoxin systems, and the concentrations of reactive oxygen metabolites (ROM), malondialdehyde (MDA), and protein carbonyl (PC) in geese fed diets with organic selenium (Se) (Selenomethionine, SeMet) and inorganic Se (sodium selenite, SS). All geese were randomly allotted into 4 groups with 5 replicates of 10 geese each, and received basal diet supplemented with 0.3 mg Se/kg SS, 0.2, 0.3 and 0.4 mg Se/kg SeMet until 70 D of age, respectively. Geese in the SS and SeMet groups exhibited similar growth performance. Diet with SeMet increased the scavenging abilities of 2,2-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt free radical (ABTS•+, P < 0.001) and superoxide radical (O2-•, P = 0.002) in the serum of geese, as well as the scavenging abilities of ABTS•+ (P = 0.023), hydroxyl radical (P = 0.009) and O2-• (P = 0.019) in the liver of geese. Compared to the SS group, SeMet increased hepatic GSH concentration (P = 0.002), the activities of glutathione peroxidase (P = 0.031), γ-glutamate cysteine ligase (P < 0.001), and thioredoxin reductase (P < 0.001), and decreased the concentrations of ROM, MDA, and PC in the serum and liver of geese (P < 0.05). In conclusion, dietary SeMet inclusion would be more effective than SS in increasing the antioxidant capacity of geese, possibly by improving GSH and thioredoxin systems, and 0.2 mg Se/kg SeMet in goose diet is recommended.

Influence of injectate volume on paravertebral spread in erector spinae plane block: An endoscopic and anatomical evaluation

The paravertebral spread that occurs after erector spinae plane block may be volume-dependent. This cadaveric study was undertaken to compare the extent of paravertebral spread with erector spinae plane block using different dye volumes. After randomization, twelve erector spinae plane blocks were performed bilaterally with either 10 ml or 30 ml of dye at the level of T5 in seven unembalmed cadavers except for two cases of unexpected pleural puncture using the 10 ml injection. Direct visualization of the paravertebral space by endoscopy was performed immediately after the injections. The back regions were also dissected, and dye spread and nerve involvement were investigated. A total of five 10 ml injections and seven 30 ml injections were completed for both endoscopic and anatomical evaluations. No paravertebral spread was observed by endoscopy after any of the 10-ml injections. Dye spread to spinal nerves at the intervertebral foramen was identified by endoscopy at adjacent levels of T5 (median: three levels) in all 30 ml injections. In contrast, the cases with two, four, and three out of five were stained at only the T4, T5, and T6 levels, respectively, with the 10 ml injection. Upon anatomical dissection, all blocks were consistently associated with posterior and lateral spread to back muscles and fascial layers, especially with the 30 ml injections, which showed greater dye expansion. In one 30 ml injection, sympathetic nerve involvement and epidural spread were observed at the level of the injection site. Although paravertebral spread following erector spinae plane block increased in a volume-dependent manner, this increase was variable and not pronounced. As the injectate volume increased for the erector spinae blocks, the injectate spread to the back muscles and fascial layers seemed to be predominantly increased compared with, the extent of paravertebral spread.

Guideline for Botulinum Toxin Injections in the Effective Treatment of Fibular Spasticity

This study used a modified Sihler's staining method to analyze the nerve distributions of the fibularis muscle to identify the most effective sites for botulinum toxin injection for fibular spasticity treatment. Ten specimens of the fibularis longus and brevis were obtained bilaterally from five fixed cadavers. The applied method of modified Sihler's staining was designed to reveal the intramuscular nerve distribution of the fibularis muscles. We divided the fibularis muscles into four quarters, which were defined as Sections 1-4 starting from the proximal part of the leg. There were one, two, and three nerve entry points in one (10%), six (60%), and three (30%) of the fibularis longus specimens, respectively, and in four (40%), five (50%), and one (10%) of the fibularis brevis specimens, respectively. We counted the number of nerve endings in each section: 321 and 195 points were identified in the fibularis longus and brevis, respectively. The densities of nerve endings were highest in Section 2 of the fibularis longus (147 of 321, 46%) and in Section 3 of the fibularis brevis (78 of 195, 40%). The landmarks used in this study (the fibular head and lateral malleolus) are easily palpable on the skin's surface, allowing clinicians to target the effective injection site (Section 2) without requiring ultrasound guidance, especially for the fibularis longus. Clin. Anat. 33:365-369, 2020. © 2019 Wiley Periodicals, Inc.

P5989Effect of neprilysin inhibitor for ischemic mitral regurgitation after myocardial injury

Background

After myocardial infarction (MI), mitral valve (MV) tethering and fibrosis stimulate functional mitral regurgitation (MR), resulting in high morbidity of heart failure and cardiac mortality. However, pharmacological treatment has not been proven effective in reducing ischemic MR. MV change post-MI is associated with an excessive endothelial-to-mesenchymal transition (EMT) by transforming growth factor (TGF)-β overexpression and also with left ventricular (LV) remodeling. In a recent clinical study using echocardiography, angiotensin receptor neprilysin inhibitor (ARNI) reduced functional MR to a greater extent than did valsartan, but the mechanism was not revealed.

Purpose

This study tested the hypothesis that treatment of neprilysin inhibitor attenuates functional MR after MI by facilitating LV reverse remodeling and suppressing EMT which mitigates inadequate leaflet adaptation.

Methods

In male Sprague-Dawley rats (n=31), functional MR was induced by occluding the left circumflex coronary artery. Two weeks after MI, MR and LV dilatation were confirmed by echocardiography and magnetic resonance imaging (MRI). Rats were randomly assigned to LCZ696 treatment (ARNI, 60 mg/kg/d, n=10), valsartan treatment (30mg/kg/d, n=10), or corn oil only (MR control group; n=11). After 6 weeks, LV volumes, functions and MR extent were quantified by using echocardiography, cardiac MRI and pressure-volume loop analysis. Also, excised mitral leaflets and LV were analyzed by histopathology and primary cultured valvular endothelial cells (VECs) were evaluated focusing on molecular changes.

Results

LCZ696 significantly attenuated post-MI LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume (EDV), 461.3±41.3 uL versus 525.1±78.2 uL; p<0.05), while valsartan did not (LV EDV, 471.2±26.8 uL; p>0.05 to control). There were no significant differences in the change of arterial pressure and ejection fraction between the treatment groups, however, dP/dt was greater in the LCZ696 group than in the MR control group (8203±286 mmHg/s for LCZ696 versus 6936±555 mmHg/s for MR control; p=0.01). MR extent and LA volume were significantly decreased in the LCZ696 group compared with the valsartan group. Pathological analysis showed that fibrosis was more prominent in the MR control than in the LCZ696 group. LCZ696 strongly reduced leaflet thickness, TGF-β, and downstream phosphorylated extracellular-signal-regulated kinase and EMT (25.4±11.8% vs. 53.4±12.6% α-smooth muscle actin-positive VECs; p<0.05). Leaflet area increased comparably (5%) in the LCZ696 group compared with the valsartan group.

Conclusions

Neprilysin inhibitor has positive effects on LV reverse remodeling and also directly modulates profibrotic changes of MV leaflets post-MI without eliminating adaptive growth. Understanding the mechanisms could provide new opportunities to ARNI reducing ischemic MR.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A6A3A04056205). It was also

P313ADGRL2 is an essential surface molecule for cardiac lineage specification and heart development

Background

Specific surface markers that enable monitoring of cell subsets would be valuable for establishing the conditions under which pluripotent stem cells (PSCs) differentiate into cardiac progenitor cells (CPCs) and cardiomyocytes (CMCs).

Methods and results

To verify whether a specific marker is expressed during heart development, we assessed its expression using the CLARITY technique. After immersion in a solution with a refractive index matching that of the CLARITY hybrid, the mouse embryo became transparent. After immunostaining the cleared embryo sample, Adgrl2 was exclusively observed in cardiac cells expressing α-SA at embryonic day E9.5 and E10.5. Our clarified 3D images and movies show that four chambers of the heart are fully developed at E10.5 but not at E9.5. At E9.5, Adgrl2 is observed at the ventricle and atrium, while Adgrl2 is present in all chambers of the heart at E10.5. Next, we performed LacZ (β-Gal) staining in heterozygous Adgrl2 KO embryos to evaluate Adgrl2 expression. As a result, LacZ staining showed that Adgrl2 was predominantly expressed in the heart during the embryonic developmental stage. Adgrl2 knockout in mice was embryonically lethal because of severe heart, but not vascular, defects. To examine the use of Adgrl2 as a bona fide CPC marker during heart development, we tracked Adgrl2 expression during early embryonic development. The heart of Adgrl2−/− embryos at E10.5 exhibited occlusion of the RV, and the expression levels of Gata4 and Nkx2.5 were not as high as those in wild-type and Adgrl2+/− embryos. Interestingly, the heart of Adgrl2−/− embryos, unlike those of wild-type and Adgrl2+/− embryos between E13.5 and E15.5 had a single ventricle revealing a ventricular septal defect. The specific expression pattern of Adgrl2 in PSC-derived cardiac lineage cells as well as in embryonic heart, adult mice, and human heart tissues.

Conclusion

We demonstrate that Adgrl2 plays a pivotal and functional role across all strata of the cardiomyogenic lineage, as early as the precursor stage of heart development. These findings shed light on heart development and regeneration.

Acknowledgement/Funding

Grants from “Strategic Center of Cell and Bio Therapy” (grant number: HI17C2085) and “Korea Research-Driven Hospital” (HI14C1277)

6112Usefulness of the trans-stent fractional flow reserve gradient for predicting clinical outcomes

Aims

The clinical meaning of a trans-stent pressure gradient after DES implantation has not been estimated adequately. We evaluated the usefulness of a fractional flow reserve (FFR) gradient across the stent (ΔFFRstent) for long-term clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES).

Methods and results

FFR pull-back and intravascular ultrasound (IVUS) were performed after successful PCI in 135 left anterior descending artery lesions. ΔFFRstent was defined as the FFR gradient across the stent. The ΔFFRstent/length was defined as the ΔFFRstent value divided by the total stent length multiplied by 10 [= (ΔFFRstent ÷ stent length) x 10]. Major adverse cardiac events (MACEs) were the composite of all-cause death, target vessel related myocardial infarction, and target lesion revascularisation. Despite successful PCI without significant complications on IVUS, ΔFFRstent >0 was observed in 98.5% of cases. ΔFFRstent ≥0.04 and ΔFFRstent/length ≥0.009 predicted suboptimal stenting defined as final minimal stent area <5.5 mm2. During 2183±898 days, the MACE-free survival rate was significantly lower in patients with ΔFFRstent ≥0.04 and ΔFFRstent/length ≥0.009 compared to those with lower values (69.6 vs. 93.4%, log-rank p=0.031; 72.1 vs. 97.7%, log-rank p=0.003, respectively). ΔFFRstent/length ≥0.009 (hazard ratio 10.1, p=0.032) was an independent predictor of MACE.

Trans-stent FFR and MACE

Conclusion

A trans-stent FFR gradient was frequently observed in DES-treated patients despite successful PCI results. ΔFFRstent and ΔFFRstent/length are useful indicators for optimising a DES and are related to long-term outcomes.

P3479Sequential stimulation and inhibition of lysophosphatidic acid receptor 4 are critical for cardiac differentiation and repair

Background

The clinical application of cell therapy to repair the damaged heart needs to understand the precise differentiation process of stem cells and the characteristics of cardiac progenitor cells.

Purpose

We examined the cardiac-specific markers that expressed on the cell surface and determined their functional significance during cardiac differentiation.

Methods and results

We screened cell-surface expressing proteins on cardiac progenitor cells at differentiation day 3 compared to undifferentiated pluripotent stem cells (PSCs). Among candidates, we identified lysophosphatidic acid receptor 4 (LPAR4) that is a G protein-coupled receptor. During in vitro differentiation of mouse PSCs toward cardiac cells, LPAR4 expression peaked for 3–5 days and then and declined immediately. Also in vivo, LPAR4 was specifically expressed in the early stage of heart development in embryos and disappeared completely in adults, suggesting that stimulatory signal of LPAR4 at an early stage should be shut off for further progression of differentiation. We next have identified the LPAR4 downstream signaling molecule, p38MAPK, by comparing PSCs and LPAR4 knockdown PSCs. In both mouse and human PSCs, ODP (LPAR4 specific agonist) followed by p38MAPK blocker (SB203580) treatment significantly increased cardiac differentiation efficiency. Furthermore, we investigated whether LPAR4 is the maker for adult cardiac progenitor cells. We found that LPAR4-positive cells were rarely present in normal adult mouse hearts, but LPAR4-positive cells were increased when the heart was damaged. LPAR4-positive cells from adult hearts differentiated into cardiomyocytes. After myocardial infarction (MI), the sequential stimulation and inhibition of LPAR4 with ODP and p38MAPK blocker resulted in the reduction of infarct size and improvement of left ventricular dysfunction.

Conclusion

We demonstrated that LPAR4 is a cardiac progenitor-specific marker and its functional significance during cardiac differentiation and regeneration. Our findings provide a new insight in cell-free cardiac repair by the modulation of progenitor-specific downstream signaling.

Acknowledgement/Funding

Grants from “Strategic Center of Cell and Bio Therapy” (grant number: HI17C2085) and “Korea Research-Driven Hospital” (HI14C1277)