Apical Segments Research Articles

A review of Asian mayfly species of Habrophlebiodes (Ephemeroptera: Leptophlebiidae)

The mayfly genus Habrophlebiodes Ulmer, 1920 has four Asian species (three from China). To show the real characters of Asian species and to ensure the differences between the two clades of the genus, we studied all three endemic Chinese species (H. gilliesi Peters, 1963, H. tenella Kang & Yang, 1994, H. zijinensis You & Gui, 1995) with examining specimens from more than 30 sites. Adults of Chinese Habrophlebiodes can be separated by the male genitalia, female ovipositor and spots on adult wings, nymphs can be recognized by the abdominal color and prostheca shape of mandibles. Comparatively, the fourth species H. prominens Ulmer, 1939 is more different by its longer apical segment of maxillary palpi and colored wings. A key to the four Asian species is given. The status of the latter species, the exact difference between Asian and American clades, and their distribution pattern need more fresh materials to confirm.

Left Ventricular Noncompaction Masquerading as Hypertrophic Nonobstructive Cardiomyopathy

A 61-year-old male with no significant medical history presented with dyspnea on exertion for the past 3 months. Clinical examination findings and electrocardiogram showed sinus rhythm and left ventricular hypertrophy. The chest X-ray and basic laboratory tests were within the normal limits. A transthoracic echocardiogram was performed which showed left ventricular wall thickening involving the anterior wall, lateral wall, septum, and inferior wall in the basal, mid, and apical segments. The left ventricular apex showed disproportionately increased thickness. There was no left ventricular outflow tract (LVOT) turbulence or obstruction. Left ventricular angiogram showed prominent trabeculations with deep intertrabecular recesses. LVOT obstruction was ruled out. The patient then underwent cardiac magnetic resonance imaging, which showed features suggestive of left ventricular noncompaction.

Totally endoscopic trans-mitral removal of a left ventricular apical thrombus through right thoracotomy in a patient with subacute anterior myocardial infarction: a case report

BackgroundLeft ventricular thrombosis confers a life-threatening risk of systemic embolism; therefore, it requires prompt intervention. Although anticoagulation is the primary treatment, surgery is indicated in instances of large or/and mobile thrombus or when there is potential for recovery of ventricular contraction. However, standard left ventriculoplasty with thrombectomy carries risks of cardiac dysfunction due to left ventriculotomy.Case presentationA 70-year-old man developed chest pain and vomiting 3 weeks before presenting to our hospital. A chest radiograph showed substantial cardiomegaly and mild pulmonary congestion; N-terminal pro-brain natriuretic peptide (5698 ng/L) was substantially increased, and troponin T (56 ng/L) levels were slightly above reference values. Transthoracic echocardiography showed akinesis of the anteroseptal and apical segments with an ejection fraction reduced to approximately 20%. We diagnosed subacute myocardial infarction and initiated pharmacotherapy. On hospital day 7, coronary angiography revealed a left anterior descending artery lesion with 99% stenosis; percutaneous coronary intervention was successfully performed the next day. That same day, transthoracic echocardiography revealed a large mobile left ventricular apical thrombus without any left ventricular aneurysm, and heparin therapy was initiated. On hospital day 10, three-dimensional computed tomography confirmed the location of an apical thrombus, and we planned a fourth intercostal approach. A thrombectomy was performed on hospital day 11 using an endoscopic trans-mitral approach with a right thoracotomy to avoid a left ventriculotomy. The patient was discharged from intensive care on postoperative day 2 under heparin and warfarin therapy. The subsequent postoperative course was uneventful, and he was discharged on postoperative day 14 with a vitamin K antagonist. At the 6-month follow-up, there was no recurrence of thrombus in the left ventricle and Ejection Fraction had improved to 46%.ConclusionsTotally endoscopic thrombectomy via a trans-mitral approach through right thoracotomy was effective for a left ventricular thrombus. When concomitant coronary artery bypass grafting or left ventriculoplasty are not required, this procedure can be an effective option.

<i>Ranunculus dahlgreniae</i> (section <i>Batrachium</i>, Ranunculaceae), a new species from Crete, Greece, with remarks on taxonomy and phylogenetic relations within the section

A new species, <i>Ranunculus dahlgreniae</i>, is described from a seasonal lake at Omalos Plateau, Lefka Ori Mountains, western Crete, Greece. The heterophyllous species resembles <i>R. saniculifolius</i>, <i>R. peltatus</i>, and the Mediterranean forms of <i>R. baudotii</i>. It differs from the aforementioned species by a combination of characters not found in any of them, i.e., 5–6 mm long petals, up to 2.2 mm long, glabrous achenes with a partly persistent style, a densely pubescent, in fruit slightly elongating receptacle, and intermediate leaves with rigid filiform apical segments, being divided into two or three cuneate, shortly petiolate leaflets. A key to all similar East Mediterranean taxa is presented. DNA analyses based on the sequencing of nuclear, ribosomal Internal Transcribed Spacer (ITS), and two chloroplast noncoding regions (<i>rpl</i>32-<i>trn</i>L and <i>psb</i>E-<i>pet</i>L), complemented by the analysis of genome-wide polymorphism using double digest RAD Sequencing (ddRADseq) supported that <i>Ranunculus dahlgreniae</i> is a distinct lineage, clearly separated from <i>R. peltatus</i>, <i>R. baudotii</i>, and <i>R. saniculifolius</i>. The phylogeny based on ddRADseq resembles the topologies obtained from chloroplast and nrITS data but with increasing resolution and support of fine-scale relationships. Extensive sampling, including taxa from temperate Europe and the West Mediterranean area, as well as the application of reduced-representation sequencing, allowed to better understand the pattern of diversity in the section <i>Batrachium</i>.

A case of primary pulmonary follicular dendritic cell sarcoma

Here, we report a 66-year-old woman who presented with an irregular and lobulated pulmonary mass in the apical segment of the right superior lobe with an enlarged mediastinal lymph node. Abdominal computed tomography (CT), brain magnetic resonance imaging, and fluorine-18 fluorodeoxyglucose positron emission tomography/CT scans showed no extrapulmonary distant metastases. The patient underwent surgical sleeve resection of the right superior lobe with systematic hilar and mediastinal lymph node dissection. Post-operative histopathology, including hematoxylin and eosin staining, immunohistochemistry, and Epstein–Barr virus in situ hybridization, suggested primary pulmonary follicular dendritic cell sarcoma (FDCS). A follow-up plain chest CT indicated recurrence with multiple metastases of the liver, ribs, and mediastinal lymph nodes 1 year after surgery. The patient declined further therapy and was lost follow-up. In this case, FDCS located in the lung was unusual and rare. Corresponding imaging and histopathological features have enhanced our understanding of this disease. Meanwhile, it is necessary to include this tumor as a differential diagnosis of lung tumors and pay particular attention to the possibility of post-operative recurrence and metastasis. Moreover, considering the heterogeneity of FDCS, it is essential to identify the biological or imaging features that can reflect or predict the high risk of tumor recurrence and metastasis. A corresponding post-operative examination is also necessary to determine if any lesions remain.

Myocardial deformation analysis using cardiac magnetic resonance in apical hypertrophic cardiomyopathy: is it an useful tool to predict adverse outcomes?

Apical hypertrophic cardiomyopathy (AHCM) has a broad phenotypic spectrum and still poses many diagnostic and prognostic challenges. Our team performed a retrospective study to examine the prognostic value of myocardial deformation obtained with cardiac magnetic resonance tissue tracking (CMR-TT) analysis in predicting adverse events in AHCM patients. We included patients with AHCM referred to CMR in our department from August 2009 to October 2021. CMR-TT analysis was performed to characterize the myocardial deformation pattern. Clinical, other complementary diagnostic exams characteristics and follow-up data were analysed. Primary endpoint was the composite of all-cause hospitalizations and mortality. During the 12-year period, 51 AHCM patients were evaluated by CMR, with a median age of 64 years-old and male predominance. 56,9% had an echocardiogram suggestive of AHCM. The most frequent phenotype was "the relative form" (43,1%). CMR evaluation revealed a median maximum left ventricle thickness of 15mm and the presence of late gadolinium enhancement in 78,4%. Applying CMR-TT analysis, median global longitudinal strain was - 14,4%, with a median global radial strain of 30,4% and global circumferential strain of -18,0%. During a median follow-up of 5,3 years, the primary endpoint occurred in 21,3% of patients, with a hospitalization rate of 17,8% and all-cause mortality rate of 6,4%. After multivariable analysis, longitudinal strain rate in apical segments was an independent predictor of the primary endpoint (p = 0,023), showing that CMR-TT analysis could be useful in predicting adverse events in AHCM patients.

Role of miR-204 in segmental cardiac effects of phenylephrine and pressure overload

Cardiotoxicity caused by adrenergic receptor agonists overdosing or stress-induced catecholamine release promotes cardiomyopathy, resembling Takotsubo cardiomyopathy (TC). TC is characterized by transient regional systolic dysfunction of the left ventricle. The animal models of TC and modalities for assessing regional wall motion abnormalities in animal models are lacking. We previously reported the protective role of a small noncoding microRNA-204-5p (miR-204) in cardiomyopathies, but its role in TC remains unknown. Here we compared the impact of miR-204 absence on phenylephrine (PE)-induced and transaortic constriction (TAC)-induced changes in cardiac muscle motion in the posterior and anterior apical, mid, and basal segments of the left ventricle using 2-dimensional speckle-tracking echocardiography (2-STE). Wildtype and miR-204−/− mice were subjected to cardiac stress in the form of PE for four weeks or TAC-induced pressure overload for five weeks. PE treatment increased longitudinal and radial motion in the apex of the left ventricle and shortened the peak motion time of all left ventricle segments. The TAC led to decreased longitudinal and radial motion in the left ventricle segments, and there was no difference in the peak motion time. Compared to wildtype mice, PE-induced peak cardiac muscle motion time in the anterior base of the left ventricle was significantly earlier in the miR-204−/− mice. There was no difference in TAC-induced peak cardiac muscle motion time between wildtype and miR-204−/− mice. Our findings demonstrate that PE and TAC induce regional wall motion abnormalities that 2-STE can detect. It also highlights the role of miR-204 in regulating cardiac muscle motion during catecholamine-induced cardiotoxicity.

A new, widespread genus of Baetidae from South Asia (Insecta, Ephemeroptera).

Material collected on different islands across South Asia revealed a new genus of Baetidae with a widespread distribution, Arcobaetisgen. nov. The larvae present important similarities with Nigrobaetis, but have paraglossae dorsally with an arc of long, spine-like setae in distal area; long, slightly feathered setae between prostheca and mola of both mandibles; and very slender legs with row of short setae at dorsal margin of femur. The male imago has an extraordinarily small 3rd (apical) segment of gonostylus, which is much narrower than the apex of the 2nd segment. The new genus includes five species: A.sumbawensissp. nov. is described from Sumbawa (Indonesia) based on larvae, A.sumatrensissp. nov. from Sumatra (Indonesia) based on larvae, A.bornensissp. nov. from Borneo (Brunei) based on larvae, and A.sripadaisp. nov. (type species) is described from Sri Lanka based on a reared male imago with its larval and subimaginal exuviae; A.gracilentus (Chang & Yang, 1994), comb. nov. from Taiwan, formerly described in Margobaetis Kang & Yang, 1994, a subgenus of Baetis Leach, 1815, and subsequently transferred to the genus Nigrobaetis Kazlauskas (in Novikova & Kluge), 1987, is transferred to the new genus. A key to the larvae of all species is provided. Morphological similarities and the relationship of the new genus to other genera of Baetidae are discussed.

PANCOAST TUMOR PRESENTING WITH HORNER SYNDROME: A CASE REPORT

Case Report: A 50-year-old man was referred to Dr. Moewardi General Hospital with history of right chest pain that radiate to the right back and hand for 2 months. His complaint did not improve with medication and physical therapy. On physical examination we observed multiple nodules on the right axilla, scapula, and colli region. Neurological examination revealed right sided partial ptosis, anisocoria, ipsilateral weakness, and ipsilateral allodynia, and anhidrosis T1 dermatome. CT-scan showed a right lung mass in the superior lobe of the apical segment. The diagnosis of Horner syndrome is then established caused by multiple lymphadenopathies. His symptoms then relieved after lymphadenectomy. Conclusion: Horner syndrome, characterized by ipsilateral pupillary anisocoria, ptosis and anhidrosis, is one of the complications of Pancoast tumor invasion to the sympathetic nervous system in the C8, T1, and T2 nerve territory.

Acute Changes in Right Ventricular Function in Pediatric Patients with Pulmonary Valve Stenosis Undergoing Percutaneous Valvuloplasty: A Speckle-Tracking Study.

Pulmonary valve stenosis determines multiple effects on the right ventricular dimension and function. Percutaneous balloon valvuloplasty is the treatment of choice in severe pulmonary valve stenosis in patients of all ages. However, little is known regarding right ventricular function immediate changes after percutaneous balloon dilation. Pediatric patients with isolated pulmonary valve stenosis represent a pure clinical model of chronic RV pressure overload not affected by other confounders or comorbidities. This study seeks to explore right ventricle (RV) mechanics in pediatric patients early after percutaneous balloon pulmonary valvuloplasty (BPV) for valvar pulmonary stenosis (PS). Forty-three pediatric patients (19 males), mean age 3.2 ± 4.9 years old, with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent standard transthoracic echocardiography (TTE), and speckle-tracking echocardiography (STE) with an analysis of right ventricle free-wall longitudinal strain (RVFWLS) one day before and one day after the procedure. For each patient, we collected invasive parameters during the interventional procedure before and after BPV. After the procedure, there was an immediate significant reduction in both peak-to-peak transpulmonary gradient (peak-to-peak PG) and ratio between the right ventricle and aortic systolic pressure (RV/AoP) with a drop of ∆29.3 ± 14.67 mmHg and ∆0.43 ± 0.03, respectively. Post-procedural echocardiography showed peak and mean transvalvar pressure gradient drop (∆50 ± 32.23 and ∆31 ± 17.97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, affecting 29% of our patients post-BPV (p = 0.007). The analysis of right ventricular mechanics showed a significant improvement of fractional area change (FAC) immediately after BPV (40.11% vs. 44.42%, p = 0.01). On the other hand, right ventricular longitudinal systolic function parameters, TAPSE and global RVFWLS, did not improve significantly after intervention. The segmental analysis of the RVFWLS showed a significant regional increase in the myocardial deformation of the apical segments. Percutaneous BPV represents an efficient and safe procedure to relieve severe pulmonary valve stenosis. The analysis of the right ventricular function on echocardiography demonstrated an immediate global systolic function improvement, while longitudinal systolic function was persistently impaired 24 h after intervention, possibly due to the necessity of a longer recovery time.

Clinical outcomes of transbronchial cryobiopsy using a 1.1-mm diameter cryoprobe for peripheral lung lesions - A prospective pilot study

ObjectivesTransbronchial cryobiopsy (TBCB) is a novel technique for the diagnosis of peripheral lung lesions (PLLs). We aim to evaluate the clinical outcomes of TBCB using a new 1.1-mm diameter cryoprobe for the diagnosis of PLLs. Materials and methodsWe performed a prospective observational pilot study on the diagnosis of PLLs (diameter ≤30 mm) by TBCB, using a 1.1-mm diameter cryoprobe with radial endobronchial ultrasound (RP-EBUS), virtual bronchoscopic navigation and fluoroscopy from December 2021 to July 2022. Primary outcome was the pathological diagnostic yield of TBCB, and secondary outcome was adverse event. ResultsA total of 50 patients were enrolled (mean lesion size, 21 mm). TBCB was performed in 49 patients up to three times except for the one with “invisible” finding on RP-EBUS. The overall diagnostic yield of TBCB was 90% (45/50). There was no difference in the diagnostic yield between size (20 mm vs. 20–30 mm; 88% [22/25] vs. 92% [23/25]; P = 1.000), RP-EBUS findings (concentric vs. others; 97% [28/29] vs. 81% [17/21]; P = 0.148), and acute angle location (apical segment of both upper lobes vs. others; 92% [12/13] vs. 89% [33/37]; P = 1.000). The cumulative diagnostic yields of the first, second, and third TBCB were 82% (41/50), 88% (44/50), and 90% (45/50), respectively. Mild bleeding was developed in 56% (28/50), and moderate bleeding was found in 26% (13/50). ConclusionTBCB using a 1.1-mm diameter cryoprobe is an effective, reasonable method for the diagnosis of PLLs regardless of its size, RP-EBUS finding, and anatomical location without serious complication. Trial registrationClinical Trials.Gov (NCT05046093).

Characterization of hemicellulose in Cunninghamia lanceolata stem during xylogenesis

In this study, hemicellulose was isolated from the apical, middle and basal segments of C. lanceolata stem to investigate the dynamic change of its structure during xylogenesis. Results showed that the C. lanceolata hemicellulose is mainly consisted of O-acetylgalactoglucomannan (GGM) which backbone is alternately linked by β-d-mannopyranosyl (Manp) and β-d-glucopyranosyl (Glcp) via (1 → 4)-glycosidic bond, while the side chains are α-d-galactopyranosyl (Galp) and acetyl. In addition, 4-O-methylglucuronoarabinoxylan (GAX) is another dominant structure of C. lanceolata hemicellulose which contains a linear backbone of (1 → 4)-β-d-xylopyranosyl (Xylp) and side chains of 4-O-Me-α-d-glucuronic acid (MeGlcpA) and α-L-arabinofuranose (Araf). The thickness of the cell wall, the ratio of GGM/GAX and the molecular weight of hemicellulose were increased as the extension of growth time. The degree of glycosyl substitutions of xylan and mannan was decreased from 10.34 % (apical) to 8.38 % (basal) and from 15.63 % (apical) to 10.49 % (basal), respectively. However, the total degree of acetylation was enhanced from 0.28 (apical) to 0.37 (basal). Transcriptome analysis showed that genes (CSLA9, IRX9H1, IRX10L, IRX15L, GMGT1, TBL19, TBL25, GUX2, GUX3, GXM1, F8H1 and F8H2) related to hemicellulose biosynthesis are mainly expressed in mature part. This study is of great significance for genetic breeding and high-value utilization of C. lanceolata.

Cardiac phenotype of propionic acidemia in the Amysh community

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Propionic acidemia (PA) is an organic acid disorder with poorly described cardiac phenotype despite progressive important cardiac remodeling and causes of death including congestive heart failure and sudden cardiac death, often in a setting of vigorous exercise or stress. Cardiac modifications begin at cellular level, both metabolic and lipid depositions, resulting in overall changes in shape, size, geometry and function, with ventricular dysfunction and risk for arrhythmias at young age. Purpose Echocardiographic assessment of left ventricular (LV) shape and timing (especially the Isovolumic contraction time (IVCT)) can help us understand the pathophysiology during the remodeling process in this rare disease. Methods We included all the PA patients from the Amish plain Community seen in our center. Clinical data, including demographics, ECG and echo measurements were recorded. Results We included 22 patients, who were homozygous for the pathogenic variant for PA, (59% males, 20.3± 13.3 years old). ECG analysis showed mild tachycardia (92 ± 30bpm) with normal QRS (84± 18 msec) and QTc segments duration (424± 31 msec). Echocardiography demonstrated a globular LV with dilated base and apical segments, normal systolic function, and normal diastolic function. The Global Longitudinal Strain was mildly decreased (GLS −17±3.08) with a dispersion of the regional strain with apical sparing. (Figure 1). The mean LV IVCT (75 msec) was longer compared to mean RV IVCT (69 msec, Figure 1). Conclusion Patients with PA present with very specific remodeling, including an increase in sphericity of the heart and slightly decreased GLS with normal EF. The very long LV IVCT suggests a problem with pressure generation, potentially as a marker of decreased LV contractility, either at cellular level or with activation-contraction coupling. Together with the difference in timings between the LV and RV this might become a substrate for life-threatening arrhythmias. A contractility problem, together with the exercise induced arrhythmias suggest that PA patients might benefit from afterload reduction.

Echocardiographic myocardial stiffness for the diagnosis and tissue characterization of cardiac amyloidosis

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation Philips Healthcare. Introduction Intrinsic cardiac elastography in echocardiography estimates myocardial stiffness by measuring the propagation of the myocardial stretch generated by atrial contraction. The aims of the present study were (A) to assess its value in differentiating cardiac amyloidosis (CA) from hypertrophic cardiomyopathy (HCM) and healthy volunteers (controls), and B) to correlate it with an established marker of cardiac amyloid burden and fibrosis. Methods This prospective study evaluated myocardial stiffness in 52 participants with CA (n=27), HCM (n=9) and controls (n=16) by ultra-high-frame rate (above 250 frames/sec) ultrasound imaging using diverging beam mode. The slope of the isovelocity wave front was measured as the intrinsic velocity propagation of myocardial stretch (iVP, in m/s). Additionally, participants with CA and HCM underwent comprehensive transthoracic echocardiography including quantification of global longitudinal strain (GLS) by speckle-tracking imaging. The relative apical sparing (RELAPS) ratio was calculated as the average GLS of apical segments / average GLS of midventricular and basal segments. Extracellular volume (ECV) by native and post-contrast T1 mapping from cardiac magnetic resonance (CMR) was quantified in 12 participants with CA and 4 with HCM. Results iVP was significantly higher in CA (i.e., 2.6 m/s [1.7–3.8]) than in HCM (1.2 m/s [1.0–1.8], p = 0.001) and controls (1.4 m/s [1.3–1.5], p = 0.004) but did not differ between HCM and controls (p = 0.928; Panel A). The diagnostic accuracy of iVP to identify CA was 82% and similar to the RELAPS ratio (i.e., 84%). iVP > 2.0 m/s has a sensitivity, specificity, positive predictive value and negative predictive value of 59%, 100%, 100%, and 69% to diagnose CA among the 52 participants. There was a strong correlation of iVP with ECV (rho=0.747, p = 0.001; Panel B). In contrast, iVP correlated weakly to moderately with GLS (rho=0.514, p = 0.001), RELAPS ratio (rho=0.433, p = 0.008), E/e’ (rho=0.413, p = 0.014) and NT-proBNP (rho=0.476, p = 0.006). Conclusions Echocardiographic myocardial stiffness is highly specific to diagnose cardiac amyloidosis and provides unique insights into myocardial tissue composition.

Should we use a semi-quantitative assessment of apical rocking to predict outcome in CRT patients?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Apical rocking (AR) is a systolic septal-to-lateral motion of the apex observed on echocardiography in the apical 4-chamber view in some patients with a ventricular conduction delay. It is a strong predictor for outcome after cardiac resynchronization therapy (CRT) and has been suggested as selection criterion for CRT. Critics argue that simple visual assessment of AR may be too subjective for clinical use. Speckle-tracking based myocardial motion analysis may allow to objectify AR and may reduce a potential observer dependence. Purpose To compare the visual assessment of AR (VAR) to the semi-quantitative assessment of AR (QAR) in patients for the prediction of (i) volume response and (ii) all-cause death after CRT. To assess interobserver agreement for VAR and QAR. Methods We retrospectively analyzed data from 166 patients with a first CRT implantation. All patients had an echo before CRT implantation and approximately 1 year after implantation. VAR and QAR analysis were performed by three experienced observers on echocardiographic apical 4-chamber views before CRT implantation. QAR was obtained by performing speckle-tracking in the apical segments of the lateral and septal wall. A negative lateral displacement with a positive septal displacement during systole was considered as AR (Figure). Areas under the ROC-curves (AUC) for prediction of volume response were determined and compared using the DeLong method. Volume response was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV) within 1 year. Patients were followed for a mean duration of 5.2 years. Hazard ratios (HR) for all-time all-cause death after CRT were calculated using an univariate Cox proportional-hazards regression model. Interobserver agreement was analysed using the intraclass correlation coefficient (ICC) based on an average measurement, absolute agreement, two-way mixed effects model. Results 77% (n = 122) of patients were volume responders. Seven patients died before follow-up echocardiography. 31% (n = 52) of patients died during follow-up. AUC for volume response were similar for VAR and QAR (0.73 vs 0.72, p = 0.782). HR for all-time all-cause death were similar for VAR (0.39, 0.25–0.61; p<0.001) and QAR (0.37, 0.23–0.59; p<0.001). ICC was good for VAR (0.78; 0.55–0.90) and QAR (0.84; 0.67–0.93). Conclusion Semi-quantification of AR (QAR) using speckle-tracking technology achieves comparable results as the simple visual assessment of AR (VAR) when performed by an experienced reader for prediction of volume response and prediction of all-cause death in patients eligible for CRT. Interobserver agreement for VAR and QAR was similarly good. QAR could be used as confirmation of the visual assessment and may support clinicians less familiar with the visual assessment.

Different Dentin Conditioning Protocols on Bond Strength of a Bioceramic Root Canal Filling.

Bioceramic-based sealers, in combination with bioceramic-coated gutta-perchas, have become more commonly used in root canal obturation. The present study aimed to assess the influence of laser-assisted dentin conditioning compared with conventional conditioning protocols on the push-out bond strength (PBS) of a bioceramic-based root canal filling. Sixty extracted mandibular premolars with one root canal were instrumented with EndoSequence rotary files up to size 40/0.04. Four types of dentin conditioning protocols were used: 1) 5.25% NaOCl (control), 2) 17% EDTA+5.25% NaOCl, 3) Diode laser-agitated 17% EDTA+5.25% NaOCl, 4) Er,Cr:YSGG laser irradiation+5.25% NaOCl. Teeth were obturated using the single-cone technique with EndoSequence BC sealer+BC points (EBCF). After having obtained 1-mm-thick horizontal slices from the apical, middle and coronal root thirds, push-out test was carried out, and failure modes were determined. The data were analyzed by two-way analysis of variance and Tukey's test with a significance level of p<0.05. The apical segments showed the highest PBS in all groups (p<0.05). In the apical segments, EDTA+NaOCl and diode laser agitated EDTA increased the PBS compared to the control (p=0.0001) and Er, Cr: YSGG laser (p=0.011 and p=0.027, respectively) groups. Both laser-used groups revealed significantly higher PBS values in the middle and coronal segments than EDTA+NaOCl (p<0.05). The bond failure was predominantly cohesive without any significant difference among the groups (p>0.05). Laser-assisted dentin conditioning had distinct effects on the PBS of the EBCF at different root segments. Although Er, Cr: YSGG was ineffective in the apical segments, generally, laser-assisted dentin conditioning affected PBS more favorably than conventional irrigation groups, with a more pronounced effect in the diode laser-agitated EDTA group.

Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study

In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1—G1) and medium to large (Group 2—G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals’ weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.

Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate–based root canal sealer: a confocal laser microscopy study

BackgroundThis study aimed to evaluate the effect of various irrigation protocols on the penetration depth of a calcium silicate–based sealer into dentinal tubules using confocal laser scanning microscopy (CLSM).MethodsTwenty single-rooted mandibular premolars were endodontically prepared and divided into the following two groups according to the irrigation protocol used (n = 10): Group I: NaOCl + EDTA and Group II: continuous chelation (NaOCl/Dual Rinse). Obturation was performed with the warm vertical compaction technique using TotalFill HiFlow bioceramic sealer mixed with a fluorophore dye. Samples were observed using CLSM at 10× to measure the percentage of sealer penetration and its maximum depth into the dentinal tubules. Data were analysed using one-way ANOVA followed by Tukey’s post-hoc test. The significance level was set at p < 0.05 within all tests.ResultsComparing the overall results of all sections tested, no statistically significant differences existed between the groups regarding the percentage of sealer penetration (p = 0.612) and maximum depth of penetration (p > 0.05).ConclusionsWith both types of irrigation used, dentinal tubule penetration was higher in the coronal section than in the apical section. Continuous chelation using NaOCl/Dual Rinse HEDP performed better in the coronal segments, while irrigation using NaOCl + EDTA promoted a higher percentage of sealer penetration in the apical segment.

Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation

ObjectivesThe study aimed to compare pre- and postoperative resting as well as postprocedural resting and exertional right ventricular speckle-tracking echocardiographic parameters at a mid-term follow-up after left ventricular assist device (LVAD) implantation. MethodsPatients with implanted third-generation LVADs with hydrodynamic bearings were prospectively enrolled (NCT05063006). Myocardial deformation was evaluated before pump implantation and at least three months after the procedure, both at rest and during exercise. ResultsWe included 22 patients, 7.3 months (IQR, 4.7-10.2) after the surgery. The mean age was 58.4 ± 7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. The RV strain analysis was feasible in all subjects both at rest and during exercise. The RV free wall strain (RVFWS) worsened from −13% (IQR, −17.3 to −10.9) to −11.3% (IQR, −12.9 to −6; p = 0.033) after LVAD implantation with a particular decline in the apical RV segment [-11.3% (IQR, −16.4 to −6.2) vs −7.8% (IQR, −11.7 to −3.9; p = 0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [-8.5% (IQR, −10.8 to −6.9) vs −7.3% (IQR, −9.8 to −4.7; p = 0.184)]. Neither RVFWS (−11.3% (IQR, −12.9 to −6) vs −9.9% (IQR, −13.5 to −7.5; p = 0.077) nor RV4CSL [−7.3% (IQR, −9.8 to −4.7) vs −7.9% (IQR, −9.8 to −6.3; p = 0.548)] changed during the exercise test. ConclusionsIn patients who are pump-supported, the right ventricular free wall strain tends to worsen after LVAD implantation and remains unchanged during a cycle ergometer stress test.

Influence of hypertension on systolic and diastolic left ventricular function including segmental strain and strain rate.

Left ventricular (LV) systolic and diastolic functions are important cardiovascular risk predictors in patients with hypertension. However, data on segmental, layer-specific strain, and diastolic strain rates in these patients are limited. The aim of this study was to investigate segmental two-dimensional strain rate imaging (SRI)-derived parameters to characterize LV systolic and diastolic function in hypertensive individuals compared with that in normotensive individuals. The study sample comprised 1194 participants from the population-based Know Your Heart study in Arkhangelsk and Novosibirsk, Russia, and 1013 individuals from the Seventh Tromsø Study in Norway. The study population was divided into four subgroups: (A) healthy individuals with normal blood pressure (BP), (B) individuals on antihypertensive medication with normal BP, (C) individuals with systolic BP 140-159mmHg and/or diastolic BP>90mm HG, and (D) individuals with systolic BP ≥160mmHg. In addition to conventional echocardiographic parameters, global and segmental layer-specific strains and strain rates in early diastole and atrial contraction (SR E, SR A) were extracted. The strain and SR (S/SR) analysis included only segments without strain curve artifacts. With increasing BP, the systolic and diastolic global and segmental S/SR gradually decreased. SR E, a marker of impaired relaxation, showed the most distinctive differences between the groups. In normotensive controls and the three hypertension groups, all segmental parameters displayed apico-basal gradients, with the lowest S/SR in the basal septal and highest in apical segments. Only SR A did not differ between the segmental groups but increased gradually with increasing BP. End-systolic strain showed incremental epi-towards endocardial gradients, irrespective of the study group. Arterial hypertension reduces global and segmental systolic and diastolic left ventricular S/SR parameters. Impaired relaxation determined by SR E is the dominant factor of diastolic dysfunction, whereas end-diastolic compliance (by SR A) does not seem to be influenced by different degrees of hypertension. Segmental strain, SR E and SR A provide new insights into the LV cardio mechanics in hypertensive hearts.