Close Anatomical Relationship Research Articles

Effects of osteopathic manipulative treatment vs. osteopathic cranial manipulative medicine on Parkinsonian gait.

Sixty thousand people are diagnosed with Parkinson's disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances, including muscular rigidity and decreased range of motion (ROM), that increase the fall risk of those afflicted. Osteopathic manipulative treatment (OMT) emphasizes the central role of the musculoskeletal system, which could be ideal for addressing the somatic dysfunction associated with neurodegeneration in PD. The close anatomical relationship of structures implicated in PD within the skull and the increased frequency of strain patterns raise the question of whether osteopathic cranial manipulative medicine (OCMM) can improve gait performance by improving circulation to the affected nervous tissue. However, there have been few studies in recent years that explore the effects of a standardized OMT protocol on Parkinsonian gait characteristics, and there have been few studies that include OCMM techniques. This study aims to determine whether a single session of OMT or OMT+OCMM can improve the gait of individuals with PD by addressing joint restrictions in the sagittal plane and by increasing ROM in the lower limb. The following study is a two-group, randomized controlled trial in which individuals with PD (n=45) and age-matched healthy control participants (n=45) were recruited from the community. PD participants were included if they were otherwise healthy, able to stand and walk independently, had not received OMT or physical therapy (PT) within 30days of data collection, and had idiopathic PD in Hoehn and Yahr stages 1.0-3.0. PD participants were randomly assigned to one of three experimental treatment protocols: a 'whole-body' OMT protocol (OMT-WB), which included OMT and OCMM techniques; a 'neck-down' OMT protocol (OMT-ND), including only OMTtechniques; and a sham treatment protocol. Control participants were age-matched to a PD participant and were provided the same OMT experimental protocol. An 18-camera motion analysis system was utilized to capture 3-dimensional (3D) position data in a treadmill walking trial before and after the assigned treatment protocol. Pretreatment and posttreatment hip, knee, and ankle ROM were compared with paired t-tests, and joint angle waveforms during the gait cycle were analyzed with statistical parametric mapping (SPM), which is a type of waveform analysis. Individuals with PD had significantly reduced hip and knee extension in the stance phase compared to controls (32.9-71.2% and 32.4-56.0% of the gait cycle, respectively). Individuals with PD experienced a significant increase in total sagittal hip ROM (p=0.038) following a single session of the standardized OMT-WB treatment protocol. However, waveform analysis found no significant differences in sagittal hip, knee, or ankle angles at individual points of the gait cycle following OMT-WB, OMT-ND, or sham treatment protocols. The increase in hip ROM observed following a single session of OMT-WB suggests that OCMM in conjunction with OMT may be useful for improving gait kinematics in individuals with PD. Longitudinal studies over multiple visits are needed to determine the long-term effect of regular OMT and OMT+OCMM treatments on Parkinsonian gait characteristics.

Relationship between Intestinal Microflora and Hepatocellular Cancer Based on Gut-Liver Axis Theory.

The intestinal microflora is a bacterial group that lives in the human digestive tract and has a long-term interdependence with the host. Due to the close anatomical and functional relationship between the liver and the intestine, the intestinal flora affects liver metabolism via the intestinal-hepatic circulation, thereby playing an extremely important role in the pathological process of liver inflammation, chronic fibrosis, and liver cancer. In recent years, the rapid development of technologies in high-throughput sequencing and genomics has opened up possibilities for a broader and deeper understanding of the crosstalk between the intestinal flora and the occurrence and development of liver cancer. This review aims to summarize the mechanisms by which the gut microbiota changes the body's metabolism, through the gut-liver axis, thereby affecting the occurrence and development of primary liver cancer. In addition, the potential regulation of intestinal microflora in the treatment of liver cancer is discussed.

Are of Osteomeatal Complex Variations Related to Nasolacrimal Canal Morphometry.

Introduction:Due to the close anatomic relationship between paranasal structures and NLC, the morphometric measure of the nasolacrimal canal (NLC) could be affected by the osteomeatal complex (OMC) anatomical variations. The present study aimed to assess the effect of OMC variations on the NLC morphometric features using cone-beam computed tomography (CBCT).Materials and Methods: This cross-sectional study consisted of CBCT images of 150 subjects in the case group with at least one OMC variation and 40 cases in the control group without any OMC variation within the age range of 18-50 years. The presence of the OMC variations, including agger nasi, nasal septum deviation, concha bullosa, Haller cells, paradoxical middle turbinate, and pneumatization of the uncinate process, was evaluated in each patient. The NLC morphometric measurements were performed and compared between the case and control groups.Results:The middle anteroposterior diameter and middle sectional area of NCL were significantly higher in patients with OMC variations, as compared to that in the control group. The NLC volume was significantly higher in patients with agger nasi, nasal septum deviation, concha bullosa, and pneumatization of the uncinate process, as compared to that in the control group. Nonetheless, no significant difference in NLC angulation with the nasal floor or Frankfurt horizontal plane was observed in the presence of each OMC variation.Conclusions:As evidenced by the obtained results, a higher volume of the canal was revealed in the presence of some of the OMC variations. Therefore, it can be suggested that OMC variations cannot be a predisposing factor in cases with primary acquired nasolacrimal duct obstruction.

Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study

PurposeAlthough lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta.Methods557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc’s and vertebra’s height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location.Results54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)—those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5.ConclusionBifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention.

Distance between the middle turn of cochlea and labyrinthine portion of the facial nerve: A surgical-radiologic comparison and clinical importance.

AbstractObjectiveTo highlight the close anatomical relationship between the middle turn of the cochlea and the labyrinthine segment of the facial nerve, which will be helpful to predict the probability of occurrence of facial nerve stimulation following cochlear implant surgery.MethodsHigh-resolution computed tomography of 40 cadaveric temporal bones was performed, followed by microscopic dissection. Cochleo-facial distance was measured with the help of a Digital Imaging and Communications in Medicine (‘DICOM’) viewer on high-resolution computed tomography and by a millimetre scale in the dissected specimen.ResultsThe cochleo-facial distance on high-resolution computed tomography was 0.62 ± 0.09 mm, ranging from 0.41 to 0.81 mm, and on dissection it was 0.57 ± 0.10 mm, ranging from 0.35 to 0.74 mm.ConclusionThe labyrinthine segment is the most likely area of stimulation in patients suffering from facial nerve stimulation following cochlear implantation. Pre-operative high-resolution computed tomography of the temporal bone can be used to examine the bone separating the labyrinthine segment of the facial nerve from the middle turn of the cochlea. This has clinical significance regarding implant side selection and pre-operative patient counselling.

Surgeon-modified Stentgrafts für komplexe Aortenrekonstruktionen – was ist möglich?

The close anatomical relationship to the visceral vessels renders the treatment of complex throacoabdominal aortic pathologies challenging. In emergent cases, off-the-shelf stent grafts and parallel techniques are feasible treatment options. Alternatively, the treating surgeon can alter a conventional stent graft, creating a so-called surgeon-modified stent graft (SMSG) to adapt it to the complex aortic pathology. The aim of this publication is to present the possibilities and results of this method. The location of SMSG's fenestrations can be determined after manual measurements of the centerline of flow reconstructions of the aortic computed tomography-angiography. The planning of the SMSG can be simplified and standardized by creating personalized 3D aortic models, and by using algorithms for the automated determination of the ideal fenestration positions. Most approved stent grafts can be used as platforms for SMSG. Different manufacturing techniques have been described. In addition to simple fenestrations, mini-cuffs, directional branches, and inner branches are used. Furthermore, diameter reducing ties and preloaded catheters could facilitate the implantation. The treatment of complex aortic pathologies using SMSG has achieved good results, with high technical success rate of 90-100%, and low 30-day mortality, especially when compared to open surgical treatment of similar patients. The rate of endoleak of 0-14% was also acceptable. Long-term durability results after treatment with SMSG are not yet available. Surgeon-modified stent grafts are safe and feasible for the endovascular treatment of patients with urgent complex thoracoabdominal aortic pathologies. They represent compassionate use and show promising results in the published literature.

An investigation of neck pain in older adults, and its relation with shoulder position sense and upper extremity function

Purpose Neck pain is a musculoskeletal problem increasing with age. The disorders that occurs in the neck region may also affect the upper extremity due to its close anatomical relationships. The aim of this study was to determine whether neck pain affects shoulder position sense and upper extremity function in the older adults. Methods This cross-sectional study was carried out in nursing homes. The older adults over 65 years of age with chronic neck pain for the last 6 months were included. Pain intensity was evaluated with a Visual Analog Scale. Acumar dual digital inclinometer was used for the evaluation of shoulder position sense. 9-Hole Peg Test was used for the measure of upper extremity function. Results It was found dominant side shoulder position sense and the function of both upper extremities were different between the three groups (p < 0.05). Pain was correlated with dominant and non-dominant 60ᵒ flexion shoulder position sense and 60ᵒ abduction shoulder position sense (p < 0.05). Additionally, a relationship was found only between pain and non-dominant side upper extremity function (p < 0.05). Conclusion In conclusion, we found that in older adults with neck pain, position sense and function decreased in upper extremities. The findings from this study support that detailed evaluation of anatomically related regions as well as the cervical region where pain is felt is important in creating a more effective rehabilitation program.

Imaging of acute pelvic pain.

Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.

The role of the brachialis muscle in elbow stability with collateral ligament injury: A biomechanical investigation

BackgroundThe brachialis muscle lies in close anatomic relation to the anterior capsule of the elbow joint. The contribution of the brachialis muscle to elbow stability has not yet been fully investigated. Therefore, the aim of this biomechanical in-vitro study was to analyze its influence on joint stability. MethodsNine fresh frozen cadaveric elbows were evaluated for stability against valgus and varus/posterolateral rotatory forces. Brachialis loading was measured indirectly using strain gauges. Three distinct scenarios were analyzed: A) with intact lateral ulnar and ulnar collateral ligaments B) with a ruptured lateral ulnar collateral ligament C) with ruptured lateral ulnar and ulnar collateral ligaments. FindingsIn all scenarios, an increased strain was observed under posterolateral rotatory/varus forces. The maximum measured strain occurred with elbow flexion of 30° and pronation of the forearm. The strain was significantly higher with dual-ligament rupture (mean - 210.5 μm/m; min. 97.8 μm/m; max. -310 μm/m; SD 107.8 μm/m; p = .034) compared to intact ligaments (mean − 106.9 μm/m; min. -32.51 μm/m, max. -287 μm/m; SD 100.2 μm/m) and single-ligament rupture (mean – 109.5 μm/m; min. - 96.7 μm/m; max - 130.4 μm/m; SD 18.2). InterpretationA strain of the brachialis muscle was observed under varus/posterolateral rotatory forces with a pronated forearm and the strain increased significantly in the event of a dual-ligament rupture. This suggests that the brachialis muscle may influence varus/posterolateral rotatory stability of the elbow. Hence, a concomitant tear of the brachialis muscle might result in pronounced instability following simple elbow dislocation. Level of evidenceBasic Science Study, Biomechanics.

Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study.

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.

MR Imaging of Cochlear Modiolus and Endolymphatic Hydrops in Patients With Menière's Disease.

Background: Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD.Purpose: Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD?Methods: We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops.Results: No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area.Conclusion: No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.

The role of the gut microbiome and intestinal barrier in liver diseases

The human gastrointestinal tract is inhabited by almost 100 trillion bacteria, more than 90 % of which belong to the phylotypes Bacteroidetes and Firmicutes. This is about the same as the entire human body contains. The complex network of microbes that inhabit the body regulates its health and is supported by a balance of genetic and dietary factors. For the proper existence and survival of microbial populations in the intestine, a strictly regulated intestinal barrier is required, the violation of which can lead to the systemic spread of microbes and their penetration into the portal bloodstream. The intestinal barrier includes physical, immunological and microbial components. When any aspect of the gut barrier is not working, even bacteria that normally promote health can wreak havoc and contribute to disease and damage. It is known that changes in the intestinal barrier, intestinal permeability, and gut microbiome (GM) are associated with many diseases, including liver pathology. To understand how GM changes can lead to liver disease, a comprehensive understanding of the physiology of the intestinal barrier is required. Because of the close anatomical and physiological relationship between the gut and the liver, there has been a lot of research into how changes in one organ affect another. This review considers the main components of the intestinal barrier and the mechanisms of its pathological changes, including increased intestinal permeability, as well as GM disorders and their role in the pathogenesis of liver diseases, such as alcoholic liver disease, non‑alcoholic fatty liver disease, drug‑induced liver damage, liver cirrhosis. and its complications. Existing and promising therapeutic strategies for modifying GM and the intestinal barrier, which can be used in the treatment of hepatic pathology, are also considered.&#x0D;

Sex Differences in Neural – Immune – Epithelial Anatomical Plasticity in the Mouse Small Intestine

Background Pathways of neural signaling leading to alterations in gut wall immune – epithelial function are not well understood, particularly in the context of sex. Specific neural factors regulating epithelial or immune cell localization and secretion are emerging. Vasoactive intestinal peptide (VIP), often a neuropeptide, can play a role in goblet cell production (1) and signals bi-directionally with enteric mast cells (2). Immune components like mast cells are key in gut wall defense against pathogens. Epithelial components of host defense include goblet cells secreting mucus to form a physical barrier, and Paneth cells secreting anti-microbial compounds. Neural fibers course intimately with goblet and Paneth cells and may signal with gut mucosal mast cells (2). The present study establishes the anatomic arrangement of immunoreactive VIP (VIP-IR) fibers in relation to mast and Paneth cells in the mouse ileum, and tests the hypothesis that sex is a key variable in neural – immune – epithelial signaling in the gut wall in healthy and perturbed tissue. Methods We used an organotypic gut slice model that maintains the cellular diversity of the gut wall ex vivo. Slices were treated with selected pharmacological reagents that block neuronal function (e.g., tetrodotoxin) or VIP receptors prior to challenge with lipopolysaccharide (LPS) to assess their influence on anatomic plasticity of VIP-IR fibers with Paneth cells and mast cells at 48h ex vivo. Results There were more mast cells in females than males whether drop fixed in vivo (214%) or after 48h of ex vivo culture (53%). The mast cells in tissue from females drop fixed in vivo were ~18% larger than in males, and similarly ~26% larger in slices of ileum maintained ex vivo for 48h (Fig 1A-D). Approximately 70% of mast cells had VIP-IR fibers within 1µm, regardless of sex. However, those mast cells within 1 µm of a fiber were 15% larger than those without a nearby fiber, regardless of sex (Fig 1E-H). A small percentage of mast cells were induced to show substantial VIP-IR ex vivo only in slices treated with a VIP receptor antagonist or tetrodotoxin. Surprisingly, this effect occurred more in female slices (~200% more) than in male (Fig 1I-L). Paneth cells were labelled with the lectin Ulex europaeusagglutinin-1 and >75% were within 1 µm of a VIP-IR neuronal fiber, independent of sex or treatment with LPS. By contrast, Paneth cells in slices from females showed 51% greater fluorescent intensity than males, a difference not found after LPS treatment (Fig 2). Conclusions The present study demonstrates a close anatomical relationship of mast and Paneth cells with VIP-IR neuronal fibers. We extend previous work demonstrating a functional influence of VIP over goblet cell production in mouse ileum. The current results suggest sex differences in neural-immune and neural-epithelial plasticity that could potentially impact function. Additional data is needed to test the hypothesis that VIP has a functional role in regulating mast and Paneth cell secretion of histamine and anti-microbials in healthy and pathogen challenged states. References (1) Schwerdtfeger LA and Tobet SA. Physiol Rep 8:e14363, 2020. (2) Buhner S et al., Front Physiol 8:971, 2017.

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model.

Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.

Subcutaneous, Paracardiac, and Epicardial Fat CT Density Before/After Contrast Injection: Any Correlation with CAD?

Adipose tissue, in particular epicardial adipose tissue, has been identified as a potential biomarker of cardiovascular pathologies such as coronary artery disease (CAD) in the light of its metabolic activity and close anatomic and pathophysiologic relationship to the heart. Our purpose was to evaluate epicardial adipose tissue density at both unenhanced and contrast-enhanced computed tomography (CT), along with CT densities of paracardiac and subcutaneous adipose tissue, as well as the relations of such densities with CAD. We retrospectively reviewed patients who underwent cardiac CT at our institution for CAD assessment. We segmented regions of interest on epicardial, paracardiac, and subcutaneous adipose tissue on unenhanced and contrast-enhanced scans. A total of 480 patients were included, 164 of them presenting with CAD. Median epicardial adipose tissue density measured on contrast-enhanced scans (−81.5 HU; interquartile range −84.9 to −78.0) was higher than that measured on unenhanced scans (−73.4 HU; −76.9 to −69.4) (p < 0.001), whereas paracardiac and subcutaneous adipose tissue densities were not (p ≥ 0.055). Patients with or without CAD, did not show significant differences in density of epicardial, paracardiac, and subcutaneous adipose tissue either on unenhanced or contrast-enhanced scans (p ≥ 0.092). CAD patients may experience different phenomena (inflammation, fibrosis, increase in adipose depots) leading to rises or drops in epicardial adipose tissue density, resulting in variations that are difficult to detect.

Transoral impalement injury in a child: An unusual case

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge due to many factors such as nature of foreign body material, the size of the object, difficult access and a close anatomical relationship of the foreign body to vital structures. We present an unusual case of a penetrating injury by a large metallic bar (15.0 cm) in a 5 year old child, embedded on the right side of the oral cavity. Penetrating injuries by blunt objects are a rare finding in maxillofacial region. In this case, we discuss the clinical presentation, diagnosis, surgical treatment and draw attention to this very rare situation.

STING, the Endoplasmic Reticulum, and Mitochondria: Is Three a Crowd or a Conversation?

The anti-viral pattern recognition receptor STING and its partnering cytosolic DNA sensor cGAS have been increasingly recognized to respond to self DNA in multiple pathologic settings including cancer and autoimmune disease. Endogenous DNA sources that trigger STING include damaged nuclear DNA in micronuclei and mitochondrial DNA (mtDNA). STING resides in the endoplasmic reticulum (ER), and particularly in the ER-mitochondria associated membranes. This unique location renders STING well poised to respond to intracellular organelle stress. Whereas the pathways linking mtDNA and STING have been addressed recently, the mechanisms governing ER stress and STING interaction remain more opaque. The ER and mitochondria share a close anatomic and functional relationship, with mutual production of, and inter-organelle communication via calcium and reactive oxygen species (ROS). This interdependent relationship has potential to both generate the essential ligands for STING activation and to regulate its activity. Herein, we review the interactions between STING and mitochondria, STING and ER, ER and mitochondria (vis-à-vis calcium and ROS), and the evidence for 3-way communication.

Individual patient data meta-analysis of the effects of the CARILLON® mitral contour system.

AimsFunctional mitral regurgitation (MR) (FMR) is common in heart failure with reduced ejection fraction and worsens morbidity and mortality, even when mild. The CARILLON® mitral contour system (Cardiac Dimensions, Kirkland, WA, USA), a mitral annuloplasty device delivered percutaneously to the coronary sinus, is designed to reduce the mitral annular dimension by virtue of the close anatomic relationship between the coronary sinus and the posterior mitral annulus. We performed a comprehensive individual patient data meta‐analysis of all studies that used CARILLON® device vs. control that have measured mitral regurgitation severity, left ventricular (LV) remodelling, functional status, and heart failure‐related outcomes in heart failure with reduced ejection fraction patients.Methods and resultsThe Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched in July 2020. Primary outcomes of interest were measures of MR severity, LV remodelling, New York Heart Association functional class and heart failure‐related outcomes [mortality and heart failure hospitalization (HFH) during follow up]. All data were received as individual patient and individual time point data‐points. Mean differences and 95% confidence intervals (CIs) were calculated for continuous data using a fixed‐effects model. Three studies (REDUCE FMR, TITAN and TITAN II) enrolling 209 participants were identified and included. Pooled analysis showed that, compared with control, CARILLON® device significantly improved both MR volume (mean difference MD ‐9.20, 95% C.I. −16.11 to −2.29 mL, P = 0.009) and MR grade (MD ‐1.12, 95% CI −1.36 to −0.88, P < 0.00001) and this was associated with a significant reduction in LA volume, MD −7.54 mL, 95% CI −14.90 to − 0.18, P = 0.04. Significant LV reverse remodelling was also seen in terms of EDV (MD −16.53, 95% CI −28.61 to −44.4 mL, P = 0.007), and a trend in ESV (MD −8.68, 95% CI −18.69 to −1.34 mL, P = 0.09) but no significant effect on LVEF (MD 0.88, 95% CI −1.52% to 2.38%, P = 0.47), due presumably to the greater residual MR in the control patients falsely elevating the LVEF. In addition, the CARILLON® device significantly improved New York Heart Association functional Class (MD −0.22, 95% CI −0.24 to −0.16, P < 0.00001), associated with a lower rate of HFH compared with controls (45.3% vs. 64%, respectively, P = 0.04). As a sensitivity analysis we also restricted the analyses to those patients with Class 3+/4+ MR at baseline. In this cohort, the echocardiographic results were similar, and the reduction in HFH rates was even more marked (43.9% vs. 82.9%, respectively, P = 0.04).ConclusionsThis comprehensive meta‐analysis of individual patient data has shown that CARILLON® device provides statistically significant and clinically meaningful benefits on MR severity, LA and LV volumes, and remodelling and rates of subsequent heart failure hospitalization

Vestibular Infant Screening (VIS)\u2013Flanders: results after 1.5\xa0years of vestibular screening in hearing-impaired children

Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening–Flanders (VIS–Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS–Flanders project aims to set an example for other regions worldwide.

Assessment of recurrent laryngeal nerve injury due to thyroid surgery in gorgan medical centers

Introduction: Thyroid surgery is one of the most common surgeries performed on the neck. There is a possibility of nerve injury and vocal cord paralysis due to the close anatomical relationship between recurrent laryngeal nerve and thyroid. Considering the importance of this study, it was performed to determine nerve damage during thyroid surgery. Methods: This cross-sectional descriptive study was conducted on patients undergoing thyroidectomy at Gorgan University of Medical Sciences, Golestan Province, Iran, from 2016-2017. After providing a list of patients, their files were obtained. The demographic data relating to the type of surgery, type of pathology, and condition of the larynx after surgery were recorded. The patients were asked for a re-examination (if necessary), and the current condition of their larynx was determined. The collected data were recorded and analyzed in SPSS software (version 16). Results: The statistical population of this study consisted of 195 patients, among which 12.3% were male (24 cases), and 87.7% were female (171 patients). The type of surgery in 65.6% (n=128), 28.7% (n=56), and 5.6% (n=11) cases was thyroidectomy, hemithyroidectomy, and subtotal thyroidectomy, respectively. It was revealed that the most common pathology was papillary carcinoma. In terms of complications, there were two cases of laryngeal nerve injury, which persisted in only one case of unilateral paralysis. The type of surgery in both cases was total thyroidectomy. Conclusions: Although recurrent laryngeal nerve injury is not common, in cases of total thyroidectomy, greater care should be taken to preserve the nerve.