Appendage Research Articles

Usefulness of spectral cardiac computed tomography for the evaluation of thrombotic complications in patients with ischemic stroke

Objective: The aim of this study was to evaluate the usefulness of spectral cardiac computed tomography (CT) angiographyin patients with ischemic stroke. Methods: In the setting of COVID-19 pandemic, we incorporated the use of spectral cardiac CT in patients with ischemicstroke to rule out the presence of cardioembolic sources, thrombotic complications or myocardial damage in a single session.Since July 2020, a delayed-phase image acquisition was incorporated to cardiac CT scans in the context of ischemic stroke.We describe four representative cases of the usefulness of the method and the cardiovascular findings. Results: We present four cases recorded recorded within a 40-day period. Two patients with patients with cardioembolic source(aorta and left atrial appendage) and two with ischemic stroke of undetermined source with evidence of cardiomyopathy(ischemic and non-ischemic). Conclusions: In the setting of ischemic stroke, spectral cardiac CT with delayed acquisition could be useful to rule out thepresence of cardioembolic sources and identify the underlying etiology.

Treatment of Madhumehajanya Vrana (Diabetic Wound) of 57 Years Old Male Patient Based on Local Application of Ingudi (Balanites Aegyptiaca Linn. Delile) Seed Oil: A Case Study

There is a sharp increase in the prevalence of diabetes and their complications across the globe. Madhumeha-janya vrana (Diabetic wound) has been a burden to society from ancient times. Diabetic Foot ulcers can deteriorate the complete health if left untreated. People who have madhumeha (diabetes) and develop an ulcer over the foot will end up having a lower limb amputation. These facts instigate researchers to develop new, cost-effective wound treatment for diabetic patients without side effects. This work aims to anticipate the clinical efficacy of Ingudi seed oil in madhumeha-janya Vrana (Diabetic wound) of Fifty-seven years old patient has developed a diabetic wound over the plantar aspect of the left foot. This oil treatment demonstrated compelling, and the injury mended totally inside 45 days. In any case, further assessment is needed to be finished by taking an enormous sample size to demonstrate its essentialness in treating Diabetic foot ulcer and evading lower appendage removal. The Ingudi seed oil has quick healing properties against diabetic wounds. The Ingudi seed oil is natural, safe and inexpensive for human chronic wound repair.

Real-World Experience with Left Atrial Appendage Occlusion

Left atrial appendage occlusion (LAAO) offers hope to reduce the risk for embolism in patients with atrial fibrillation, without the use of

Relationship between hypospadias and HOXA13, EGF and EGFR genes in children

Objective To analyze the relationship between the expression of homeobox A13 (HOXA13), epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) gene in prepuce tissue of children with congenital hypospadias, discuss the relationship and significance of HOXA13, EGF and EGFR genes in congenital hypospadias and to understand their role in the pathogenesis of hypospadias. Methods 65 cases of hypospadias were selected as the experimental group and 42 cases of phimosis as the control group. Hematoxylin-eosin (HE) staining was used to observe the pathological characteristics of prepuce tissues in the two groups. Immunohistochemistry, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of HOXA13, EGF and EGFR in the two groups. Results ⑴ HE staining showed that the epidermis of hypospadias was composed of keratinized stratified flat epithelium and epidermis of penile skin. The prepuce of phimosis children showed only infiltration of inflammatory cells in the superficial layer of the inner prepuce, blood vessel congestion, no obvious appendage structure, mostly fibroblasts. ⑵ Immunohistochemistry: The positive expressions of HOXA13, EGF and EGFR in the control group were significantly higher than those in the experimental group (P<0.01). ⑶ qRT-PCR: The expression levels of HOXA13, EGF and EGFR in the control group were 53.447±33.471, 80.012±20.430, 75.012±14.339, and the expression levels of HOXA13, EGF and EGFR in the experimental group were 9.128±5.996, 45.521±18.242, 32.043±10.215, respectively. The expression of HOXA13, EGF and EGFR in the control group was significantly higher than that in the experimental group (P<0.01). ⑷ Western blot: The expression levels of HOXA13, EGF and EGFR in the experimental group were lower than those in the control group. Conclusions The expression of HO-XA13, EGF and EGFR in prepuce tissue of children with hypospadias is low, which may be related to hypospadias. Key words: Hypospadias; Child; Homeodomain proteins; Epidermal growth factor; Receptor, epidermal growth factor

Complete cor triatriatum sinister misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound

Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS. Key words: Cor triatriatum; Ultrasonography, prenatal; Pulmonary veins; Vascular malformations; Diagnostic errors

A historical cohort study of anesthetic methods for percutaneous left atrial appendage closure

Objective To explore the appropriate anesthetic method of percutaneous left atrial appendage closure by comparing the safety and feasibility of the different anesthetic methods. Methods Ninety nine patients with percutaneous left atrial appendage closure were divided into three groups according to anesthetic scheme by using a method of Historical Cohort Research: laryngeal mask general anesthesia without muscle relaxant (L group, n=19), endotracheal intubation general anesthesia with muscle relaxation antagonist (S group, n=40), and endotracheal intubation general anesthesia without muscle relaxation antagonist (G group, n=40). Target controlled infusion(TCI) of propofol and remifentanil for anesthesia induction and maintenance were used in L group and S group. The laryngeal mask was used in L group without muscle relaxants. Rocuronium was used for endotracheal intubation in S group, but the muscle relaxation was antagonized by sugammadex at the end of operation. Endotracheal intubation was performed after TCI propofol, intravenous sufentanil and cisatracurium in G group, but the muscle relaxation was not antagonized at the end of the operation. The outcome indexes were as follows: the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the time of staying at the postanesthesia care unit (PACU), the successful rate of esophageal ultrasonic probe placement, the incidence of displacement and air leakage of laryngeal mask, the incidence of replacement of a laryngeal mask with tracheal intubation during operation, and the adverse events after awakening. Results The recovery time of autonomic respiration in S group and L group were significantly shorter than that in G group[(2.5±0.5), (1.9±0.6) min vs (22.2±7.1) min, P<0.05]. The recovery time of consciousness was (3.4±0.6), (2.7±0.6) min in L group and S group respectively, both which were significantly shorter than that in G group[(28.8±12.9) min, P<0.05]. The time of extubation in L and S group was (4.5±1.0), (3.6±1.0) min respectively, both which were significantly shorter than that in G group [(34.6±16.0) min, P<0.05]. The time of staying at PACU in L group and S group was (28±4), (26±5) min respectively, which were significantly shorter than that in G group[(65±20) min, P<0.05]. The successful rate of one-time placement of TEE was 42.1% in L group, but that in S group and G group was more than 95% respectively(P<0.05). The intraoperative displacement rate in L group was 36.8%. The incidence of replacement of a laryngeal mask with tracheal intubation during operation was 21.1% in L group(P<0.05). The incidence of transient hypoxemia, agitation, nausea and vomiting and urinary retention were lower in S group and L group than in G group after awakening(P<0.05). Conclusions Endotracheal intubation general anesthesia was performed by combined intravenous injection of rocuronium with TCI propofol and remifentanil and reversal of rocuronium by sugammadex, which have the advantages of safe airway controllability, recovery rapidly after operation, extubation earlier, the lower incidence of hypoxemia and the lower incidence of agitation. Therefore, this anesthetic pattern is an ideal anesthetic method for percutaneous left atrial appendage closure. Key words: Left atrial appendage closure; General anesthesia; Sugammadex

19-Month-Old Male Presenting with Near Strangulation by Human Hair

Introduction: Hair tourniquet syndrome is a well-documented phenomenon in which hair can become tightly wrapped around an appendage resulting in ischemic injury and necrosis. When a hair tourniquet involves the neck as the appendage, fatality can result due to asphyxia, specifically strangulation. Strangulation can be fatal, and death can result within minutes. In the pediatric population, suffocation is a concern when assessing the sleep of newborns and infants. There are inherent dangers of co-sleeping that are routinely discussed during pediatric office visits, particularly about newborns. Parents are alerted to the …

Development of agricultural bionic four-legged robot: Effect of head movement adjustment on the stability of goats

The four-legged bionic robot for agriculture has been one of the hotspots in the field of robotics. The farmland environment is complex, and the balance requirement of quadruped bionic robot is higher. However, head adjustment is a key factor affecting the balance of quadruped animals. Based on this, this study takes the four-legged animal goat as an example to investigate the effect of goat head movement adjustment on the balance of goat. In this study, the head and neck of goats were simplified to a two-link model. The kinematics model was established by D-H method. MATLAB software was used to solve it. Origin software was used to draw the movement track of the center of mass of the head. The center of mass movement of the head is a quarter ellipse. Then, the goat walking experiments were carried out on the different slopes (0°, 5°, 10°, 15°, 20°, 25°, 30°, 35° and 40°). MATLAB software was used to fit the movement data of goat head. The movement of the center of mass of the goat's head corresponds to Fourier 6. The result is: the determination coefficient is 0.8629, and the mean variance is 0.019. When the slope gradient gradually increases, the volatility gradually increases and is cyclical. The results of this study verify the rationality of the four-legged bionic mechanism under various parameters and reveal the mechanism of goat walking with an appendage at the head. Keywords: bionic four-legged robot, slope, head, center of mass, trajectory, balance DOI: 10.25165/j.ijabe.20191204.4287 Citation: Zhang F, Wang Y F, Teng S, Zheng L M, Wang J J, Chen Z J. Development of agricultural bionic four-legged robot: Effect of head movement adjustment on the stability of goats. Int J Agric & Biol Eng, 2019; 12(4): 10–15.

How to Safely Implant a Dual-Chamber Pacemaker for Right Ventricular Outflow Tract Pacing in a Patient with Persistent Left Superior Vena Cava: A Step by Step Guide.

The implementation of advanced endovascular electrophysiological methods in patients with congenital venous anomalies (CVA) remains understudied.1 Patients with CVA have an average life expectancy. At times requiring interventional management of dysrhythmias, CVA can pose a challenge for the placement of implantable pacing devices. Persistent left superior vena cava (PLSVC) is the most common venous congenital anomaly. Herein the author discusses a safe technique of transvenous pacing lead implantation into right ventricular outflow tract (RVOT) and right atrial appendage in a 70-year-old patient with PLSVC.

Device-related thrombosis on atrial septal defect occluder after simultaneous closure of left atrial appendage and atrial septal defect: a case report.

Device-related thrombosis on atrial septal defect occluder after simultaneous closure of left atrial appendage and atrial septal defect: a case report.

Heart-brain interactions

Heart-brain interactions are represented by the association of cerebral ischemia with coronary artery disease, cardioembolic cerebral ischemia, and cardiovascular complications due to brain damage. As atherosclerosis is a systemic inflammatory disease, in patients with transient ischemic attack, stroke or asymptomatic carotid artery disease, a previous myocardial infarction, angina or an asymptomatic coronary artery disease are often associated and a correlation between the carotid atherosclerosis and coronary artery disease severity has been reported. Furthermore, the long-term prognosis of patients with stroke is strongly affected by coronary events. At the same time, the prevalence of concomitant cerebrovascular disease is common in patients with coronary artery disease. Other cardiovascular diseases, including left atrial and left atrial appendage thrombosis in atrial fibrillation, thrombi in the left ventricle in acute and chronic coronary artery disease and dilated cardiomyopathies, infective endocarditis with vegetations, cardiac valve prosthesis thrombosis, cardiac tumors, mitral and aortic valve calcifications, aortic plaques and patent foramen ovale, are associated with cardioembolic events. Finally, acute ischemic or hemorrhagic cerebral events, epileptic seizures, cerebral traumas, and brain tumors can be associated with electrocardiographic abnormalities, catecholaminergic myocardial damage, or arrhythmias.

Right Atrial Appendage Clot in Atrial Fibrillation Complicated by Pulmonary Thromboembolism: A Case Report

Nonvalvular atrial fibrillation (AF) can affect both right and left atria. Left atrial thrombus is more common in patients with nonvalvular AF. The presence of a large right atrial thrombus is a rare condition, which is seldom demonstrated as an etiology ofpulmonary embolism, especially without any deep vein thrombosis at the presence of only atrial fibrillation, as was observed in this case. Right atrial thrombus is an underdiagnosed entitywith a high mortality and morbidity rate. Therefore, right atrial appendage (RAA) and left atrial appendage assessmentsshould be consideredin patients with chronic nonvalvular AF.The best management modality has not yet been documented, and it sometimes resolved by anticoagulant therapy alone or neededsurgical removal. Here, we report a case of pulmonary thromboembolism with the complaints of coughing and blood-stained sputumwithout clinical or sonographic signs of deep vein thrombosis. Permanent AF rhythm and a large clot in RAA were detected as the sources for pulmonary embolism. We started anticoagulant therapy and the clot got smaller using a transesophageal echocardiogram as a diagnostic tool.

The value of left atrial structural and functional parameters combined with cardiac biomarkers in predicting left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Objective To investigate the relationships between the structure, function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF), and evaluate its predictive value for left atrial SEC. Methods Thirty-four control subjects and 80 patients with NVAF were included, patients with NVAF were divided into positive group (30 cases) and negative group (50 cases) according to whether SEC was presented on transesophageal echocardiography (TEE). Clinical and laboratory data were collected, including medical history, cardiac troponin I (cTnI), and pro-brain natriuretic peptide (pro-BNP), etc. Then CHA2DS2-VASc scores were calculated.The left atrial appendage width (WLAA), left atrial appendage depth (DLAA), left atrial appendage blood flow velocity (VLAA), left atrial volume index (LAVI) and other parameters were measured by TEE and transthoracic echocardiography (TTE), and left atrial ejection fraction (LAEF) was calculated. The clinical and TEE parameters were compared between the positive and negative group, TTE parameters and cardiac biomarkers levels were compared among the three groups, and ROC curve was used to evaluate the diagnostic efficiency. Results ①Compared with those in control group, the value of LAVI and pro-BNP were significantly increased and LAEF was significantly decreased in negative group (all P 0.05), but presented a significant increase in positive group compared with those in control group and negative group (all P<0.01). The AUC, sensitivity and specificity of CHA2DS2-VASc scores for SEC were 0.71 (95% CI: 0.60~0.82), 73.3% and 62.0%, respectively. When left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP), the AUC, sensitivity and specificity for SEC were 0.90 (95%CI: 0.84~0.97), 74.0% and 100%, respectively, both enhanced when compared with CHA2DS2-VASc scores alone(P<0.01). Conclusions Left atrial enlargement, decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF.CHA2DS2-VASc scores can be used for perdicting left atrial SEC, left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP) provide significant increments in prediction of left atrial SEC. Key words: Echocardiography, transesophageal; Atrial fibrillation; Atrial function, left; Spontaneous echo contrast; Cardiac biomarker

Nursing care of 5 patients with atrial fibrillation treated with left atrial appendage occlusion combined with his bundle up pacing

Objective To summarize the nursing experience of left atrial appendage occlusion combined with his bundle lifting pacing in the treatment of atrial fibrillation. Methods The heart center of our hospital was first created with left atrial appendage combined with hirson bundle pacing, and 5 cases were completed from January 1, 2017 to January 1, 2018, and the nursing points were summed up in combination with the perioperative and postoperative follow-up nursing. Results All 5 patients were successfully performed with combined operation, and no serious complications occurred during the perioperative period and follow-up period. Conclusions Because the process of innovation is more complicated, it is necessary for the nursing team to carry out strict auxiliary nursing and monitoring of the disease in different stages so as to ensure the operation safety and improve the quality of life of the patients. Key words: Atrial fibrillation; Nursing care; His bundle pacing; Left atrial appendage closure

The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion.

The article "The efficacy of trans-esophageal echocardiography in treatment of nonvalvular atrial fibrillation with left atrial appendage occlusion" by Y. Song, S.-C. Qin, X. Fu, Z.-M. Jiang, K. Chen, X.-L. Wang, R.-F. Zhang, Y. Liuang, R.-F. Zhang, Y. Liu, published in Eur Rev Med Pharmacol Sci 2018; 22 (16): 5335-5338 has been withdrawn.

17Incidence of left atrial appendage thrombus in patients undergoing AF ablation in the NOAC era: is toe needed in low risk patients?

17Incidence of left atrial appendage thrombus in patients undergoing AF ablation in the NOAC era: is toe needed in low risk patients?

92Left atrial appendage occlusion for stroke prevention in atrial fibrillation: experience from a single tertiary centre in the UK

92Left atrial appendage occlusion for stroke prevention in atrial fibrillation: experience from a single tertiary centre in the UK

Oxypetalum marchesii (Apocynaceae, Asclepiadoideae), an Endemic New Species from Uruguay

Fil: Gonzalez, Andres. Museo Nacional de Historia Natural. Departamento de Botanica; Uruguay

Construction of left atrial appendage three-dimensional model based on transesophageal echocardiography and its value in preoperative simulated left atrial appendage closure

Objective To evaluate the accuracy of simulated operation before the left atrial appendage (LAA) occlusion by filed LAA model with soft materials, which is based on transesophageal three-dimensional echocardiography (3D-TEE). Methods Silica and hydrogel were mixed to imitate cardiac tissue. Silica and hydrogel mixed materials, silica and Tangoplus were subjected to mechanical detection and ultrasonic shear wave elastography (SWE). The preoperative and postoperative 3D-TEE image processing was performed on 21 patients undergoing LAA occlusion. The silica and hydrogel LAA 3D model, silicone model and Tangoplus model were acquired to evaluate the accuracy of 3D model. LAA closure was simulated using the 3D models and the compression ratio of the device in models was compared with the value measured in operation. Results The silica and hydrogel mixed materials were successfully prepared. The elastic modulus and stress-strain curve were closer to the myocardial tissue. Twenty-one 3D printing models of three materials were obtained in 21 patients based on 3D-TEE images.There was no significant difference in the anchor zone between the 3D model and 3D-TEE (P>0.05). The 3D model measurements were consistent with the 3D-TEE measurements. The compression ratios of the decive in the 3D models of all three materials were greater than those measured in operation, and the compression ratio of the device in the 3D model of silica and hydrogel materials had a better correlation with that measured in operation (r=0.900, P<0.01). Conclusions The 3D model of LAA made of silica and hydrogel material based on 3D-TEE can improve the accuracy of the LAA occlusion simulation, also can optimize the preparation of LAA occlusion. Key words: Echocardiography, transesophageal, three-dimensional; Three-dimensional printing; Left atrial appendage; Soft printing material

The research of artificial dermis in promotion of skin and its appendage regeneration

Objective To explore the function of artificial dermis in repair of full-thickness skin defects, and investigate its potential of inducing skin appendage regeneration. Methods A 3 cm×3 cm full-thickness skin defect was made on the dorsal skin of SD rats. In the experimental group, artificial dermis was used to cover the wound, and the control group was covered with silicon film only. The wound healing and hair regeneration were observed at 2 and 4 weeks after the operation. At these time points, HE and Masson staining were performed to detect the regeneration of skin appendages under the microscope. Simultaneously, BrdU (5-bromodeoxyuridine) incorporation test was used to verify whether the tissue of wound healing was derived from cell proliferation. Results The wounds in the experimental group was significantly smaller at 2 and 4 weeks after the operation than those in the control group. In the experimental group, hair growth was seen in the wound healing area at 4 weeks postoperatively. HE and Masson staining showed the regeneration of hair follicles and sebaceous glands in the newborn skin area. BrdU test indicated that there were a large number of BrdU positive cells in the epithelial tissue, hair follicles and sebaceous glands of the newborn skin area in the experimental group, which also showed that the cells in the above tissue were derived from division and proliferation. Conclusion Artificial dermis can play a good role in the repair of full-thickness skin defects. It not only can induce the regeneration of epithelial tissue, but also can guide the skin appendages stem/progenitor cell migration, proliferation and differentiation to promote the regeneration of skin appendages. The discovery will provide new ideas for the clinical and basic research of tissue repair and skin regeneration. Key words: Regeneration; Animals,laboratory; Artificial dermis; Full-thickness skin defects; Skin appendage