Large Tract Research Articles

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 Apr 2021Editorial CommentThis article comments on the following:Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma Mehrad Adibi, and Surena F. Matin Mehrad AdibiMehrad Adibi Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author , and Surena F. MatinSurena F. Matin Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001505.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(4), p. 1046 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyNov 20, 2020, 12:00:00 AMEndoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma Volume 205Issue 4April 2021Page: 1046-1046 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mehrad Adibi Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author Surena F. Matin Department of Urology, MD Anderson Cancer Center, Houston, Texas More articles by this author Expand All Advertisement Loading ...

RESPIRATORY SYSTEM AND PULMONARY INTERSTITIAL DISEASE DUE TO CIGARETTE SMOKE IN RADIOLOGICAL ASPECTS

Smoking is a risk factor for disease that contributes the most to lung and respiratory diseases. Lung disease related with cigarette smoke can be classified as COPD (Chronic Obstructive Pulmonary Disease) and several types of interstitial lung disease such as pulmonary langerhans cell histiocytosis, bronchiolitis, desquamative interstitial pneumonitis and interstitial fibrosing lung disease. This literature review aims to shed a light that cigarette smoke not only causes inflammation and damages the epithelium of the large respiratory tract but also the small airways and lung parenchyma. COPD (including chronic bronchitis and emphysema) is one of the most common lung diseases and causes death due to smoking. Lung disease related with smoking in addition to providing a mass image can also provide an interstitial picture such as Langerhans cell histiocytosis, bronchiolitis, desquamative interstitial pneumonitis and interstitial fibrosing lung disease. Radiological overview in lung disease caused by cigarette smoke can also occur in combination. Although the radiological overview / image of computerized tomography can provide adequate information, a comprehensive diagnostic by combining clinical symptoms and histopathological features will be quite meaningful, especially for overlapping cases.

Large aneurysms and pseudoaneurysms of surgically reconstructed right ventricular outflow tracts.

Aneurysm and pseudoaneurysm development is a known, albeit uncommon, complication after right ventricular outflow tract surgical reconstruction. Large right ventricular outflow tract aneurysms and pseudoaneurysms have not been extensively described in recent literature and we report our experience with this unusual complication in five patients at our institution over the last 8 years. Although uncommon, this complication has potentially important clinical implications. Thus, clinicians should be aware of its potential, particularly in certain anatomic conditions.

Percutaneous transhepatic cholangioscopy using a single-operator cholangioscope (pSOC), a retrospective, observational, multicenter study.

Percutaneous cholangioscopy (PC) is more complex and invasive than a transpapillary approach, with the need for a large percutaneous tract of 16 French (Fr) on average in order to advance standard percutaneous cholangioscopes. The aim of this study was to investigate whether percutaneous single-operator cholangioscopy (pSOC) using the SpyGlass™ DS system is feasible, safe, and effective in PC for diagnostic and therapeutic indications. The data of 28 patients who underwent pSOC in 4 tertiary referral centers were retrospectively analyzed. Technical and clinical success for therapeutic procedures was assessed as well as diagnostic accuracy of pSOC-guided biopsies and visualization. Adverse events and the required number and size of dilatations were reviewed. 25/28 (89%) patients had a post-surgical altered anatomy. The average number of percutaneous dilatations prior to pSOC was 1.25 with a mean dilatation size of 11 French. Histopathology showed a 100% accuracy. Visual impression showed an overall accuracy of 96.4%. Technical and clinical success was achieved in 27/28 (96%) of cases. Adverse events occurred in 3/28 (10.7%) cases. pSOC is a feasible, safe, and effective technique for diagnostic and therapeutic indications. It may be considered an alternative approach in clinical cases where gastrointestinal anatomy is altered. It has the potential to reduce peri-procedural adverse events and costs. Prospective randomized-controlled trials are necessary to confirm the previously collected data.

Endoscopic Treatment for Large Multifocal Upper Tract Urothelial Carcinoma.

We reviewed the oncologic and surgical outcomes of endoscopic treatments for low grade upper tract urothelial carcinoma, and assessed the prognostic significance of tumor size, location and multifocality. We retrospectively reviewed all patients who underwent endoscopic treatment for low grade upper tract urothelial carcinoma at our institution between 2014 and 2019. Tumors were treated with a dual laser generator, which alternately produces holmium and neodymium lasers. A stringent ureteroscopic followup protocol was conducted. We looked for an association between outcome and tumor size, location or multifocality, and for predictive factors for time to local recurrence and progression. The cohort included 59 patients (62 renal units), 27% of tumors were multifocal and 40% were >2 cm. The median followup time was 22 months (IQR 11-41), and the median number of ureteroscopies was 5.5 (4-9). Local recurrence was observed in 46 renal units (74.1%) at a median of 6.5 months after initial surgery. Four patients (6.4%) developed disease progression and were referred for radical surgery: 2 had pathological progression and 2 had a rapid and high volume local recurrence, and 1 later developed metastatic disease. The progression-free rate was 93.2%. Tumor location in kidney (p=0.03, HR 1.95) and multifocality (p=0.005, HR 3.25) significantly predicted time to local recurrence. No factor predicted time to progression. Ureteroscopic treatment of large, multifocal, low grade upper tract urothelial carcinoma is feasible, does not involve significant complications and has good short-term oncologic outcomes, with a 93.2% progression-free survival rate. Tumors located in the kidney and multifocality yielded shorter time to local recurrence but not progression.

Irregular silviculture positively influences multiple bat species in a lowland temperate broadleaf woodland

Changing economics in the 20th century led to losses and fragmentation of semi-natural woodland in Britain and to a reduction in active woodland management with many becoming increasingly neglected, even-aged and with closed canopy. Lack of woodland management is known to contribute to declines in some taxonomic groups, for example birds. However, the response of bats to changes in woodland structure are poorly understood. We compared two measures of bat activity, derived from static acoustic recorders across 120 sample plots in coppice, irregular high forest (uneven-aged, continuous cover) and limited intervention (under-managed, even-aged) management stands, within a large tract of ancient woodland in southern England. Bat species richness was highest in irregular high forest stands, and there were significant differences in occupancy rates for most bat species across stand management types. Coppice recorded low activity of several bat species and irregular high forest showed high occupancy rates, including for Barbastelle Barbastella barbastellus, which is IUCN listed as near threatened. The occupancy rates in stand management types differed for some bat species between mid- and late summer counts, suggesting seasonal variation in habitat use. Within stands, most bat species were associated with opened canopy, lower growing stocks and reduced densities of understorey, and to a lesser extent, with large-girthed trees and presence of deadwood snags. In some cases, species responded to a given habitat variable similarly across the three stand management types, whereas in others, the response differed among stand management types. For example, increased numbers of large-girthed trees benefitted a number of bat species within coppice where these were least common, but not in irregular stands. Irregular silviculture high forest appears to provide many of the structural attributes that positively influence occupancy of several woodland bat species, including Barbastella barbastellus.

The Tokyo Olympic Games and the Risk of COVID-19.

Purpose of ReviewWe reviewed the occurrence of outbreaks at past Olympics and discuss the threat of the COVID-19 pandemic at the Tokyo Games.Recent FindingsEvidence for large respiratory tract infection outbreaks at past Olympics is scant. Nevertheless, in order to control the spread of the COVID-19 outbreak, the Tokyo 2020 Olympics were postponed for 2021. Given the high contagiousness of the disease and the epidemiology of COVID-19 in Japan, this decision was appropriate and important in order to safeguard athletes and the public. However, it is a major problem for Japan, involving massive financial losses and a lost opportunity for athletes, coaches, and instructors.SummaryUp-to-date epidemiological data is needed on which to base an appropriate decision regarding the Tokyo 2021 Olympics. The actual effect of cancellations of such events in reducing the spread of COVID-19 needs to be determined.

The Mesoarchaean Akia terrane, West Greenland, revisited: New insights based on spatial integration of geophysics, field observation, geochemistry and geochronology

The northern part of the North Atlantic Craton (NAC) in southern West Greenland comprises a large tract of exposed Meso-Neoarchaean continental crust, divided into the ca 3300–2900 Ma Akia and ca 2900–2500 Ma Tuno terranes. We combine aeromagnetic, stream sediment geochemical, new litho-chemical and zircon geochronological data with previously published data to re-evaluate the crustal architecture and evolution of the Akia terrane and its boundary towards the Tuno terrane.The previously recognised, but overlooked, Alanngua complex, situated between the Akia and Tuno terranes is bounded by aeromagnetic lineaments interpreted as Neoarchaean shear zones and has a distinct spectrum of Neoarchaean magmatic and metamorphic zircon ages that are rare in the Akia terrane. The Alanngua complex comprises components derived from both the Akia and Tuno terranes and is interpreted as a tectonic melange created during the Neoarchaean assembly of the NAC.Within the Akia terrane, the chemistry of orthogneiss samples indicate that a large percentage is too mafic to classify as TTG s.s., implying that not only partial melting of mafic crust, but also some yet unaddressed mantle involvement is necessary in their formation. Previous models for the generation of the ca. 3015–2990 Ma quartz-dioritic Finnefjeld and Taserssuaq complexes conflict with their geochemical variation. We argue that the complexes may be genetically linked to buried gabbro-dioritic rocks indicated by their strong aeromagnetic response. Formed at same time are carbonatite, high-Mg gabbro and tonalite-trondhjemite, and we propose that this wide spectrum of rocks was formed by lithospheric and crustal melting in response to asthenospheric upwelling possibly in an extensional setting.Periods of extensive magmatism in the Akia terrane were previously recognised at ca. 3220–3180 Ma and 3070–2970 Ma. We now subdivide the latter period into three episodes: juvenile basaltic-andesitic volcanism at 3070–3050 Ma; tonalitic and dioritic plutonism at 3050–3020 Ma, and gabbroic-dioritic plus tonalitic-trondhjemitic plutonism at 3020–2985 Ma. This last episode was immediately followed by crustal reworking during collision at 2980–2950 Ma.

S0953 Novel Axially Parallel Endoscopic Submucosal Dissection Knife vs Insulated Tip Endoscopic Submucosal Dissection Knife: Outcomes of a Randomized ex-vivo Pilot Study

INTRODUCTION: Endoscopic Submucosal Dissection (ESD) is utilized for the treatment of large gastrointestinal tract lesions or lesions not amenable to standard endoscopic mucosal resection. Insulated tip (IT-ESD) knife is a commonly used knife for ESD. A recent axially paralleled ESD (AP-ESD) knife has shown promising results in tissue resection. The primary aim of this study was to compare the efficacy, safety, physical and mental workload of AP-ESD knife to IT-ESD knife in ex-vivo models. METHODS: This was a randomized-controlled, pilot study comparing IT-ESD to AP-ESD knife in ex-vivo porcine models. AP-ESD knife is a single use, electrocautery enhanced knife that allows for safe dissection and low risk of perforation given the parallel orientation of the knife to the mucosa [s]. A total of 18 participants divided into two groups (novices, n = 9 and experts n = 9) without prior experience with AP-ESD knife were randomized 1:1 into two groups (group 1: AP-ESD followed by IT-ESD; group 2: IT-ESD followed by AP-ESD). A standard template was used to create 2 × 2 cm gastric lesions. The primary outcome was complete en-bloc resection. Secondary outcomes included differences in procedure time, perforation rate, and National Aeronautical and Space Administration Task Load Index (NASA-TLX) to assess physical and mental workload. RESULTS: 18 participants each performed 2 tissue resections (1 AP-ESD and 1 IT-ESD), for a total of 36 procedures. Complete en-bloc resection was achieved in 33 models (resection rate 91.6%). No differences were observed in complete resection or perforation rate between IT-ESD and AP-ESD (88.2% vs 94.4%, P = 0.51 and 11.8 vs 11.1%, P = 0.95, respectively). Participants had a longer time with AP-ESD (1045 +/- 779 vs 783+/-532 seconds, P = 0.04) however there was no difference in demand using total NASA TLX (33 +/- 11 vs 39 +/- 9, P = 0.07). While experts (N = 9) had longer time with AP-ESD (895 +/- 649 seconds vs 595 +/- 383, P = 0.05), there was no difference in resection rate, perforation rate or NASA TLX demand. On the other hand, Novices (N = 9) showed no difference in resection rate, perforation rate or procedure time, however did have higher demand with AP-ESD (45 +/- 9 vs 37 +/- 11, P = 0.05). CONCLUSION: AP-ESD knife yielded similar rates of resection and perforation compared to a standard IT-ESD knife. Experts endoscopists required more time for dissection, likely due to an undefined learning curve with this new device and extensive familiarity with conventional knives.Figure 1.: Novel Axially Paralleled Endoscopic Submucosal Dissection (AP-ESD) Knife.

Mammal use of wildlife crossing structures along a new motorway in an area recently recolonized by wolves

Wildlife crossing structures (WCSs) enhance connectivity between habitats of wild animals fragmented by fenced motorways, but factors affecting their use by targeted species remain understudied, particularly in areas recently recolonized by large carnivores. We investigated the use of WCS—6 overpasses (width 30-45m), 5 large underpasses (width 33–114 m) and 4 small underpasses (width 15–19 m)—located along the A4 motorway in the Lower Silesian Forest (western Poland), a large forest tract recently recolonised by wolves (Canis lupus). Identifying and counting tracks of mammals left on sand-beds as well as individuals recorded by camera traps were used to determine species diversity, number and activity patterns of mammals on WCS, and to reveal seasonal and temporal changes of WCS use over 3 years of study (2010–2013). WCSs were mostly used by wild species (51.5%), followed by humans (34.8%), livestock and pets (13.7%). Among wild species, ungulates were the most common (77.4% of crossings), while lagomorphs and carnivores were recorded less often (15% and 7.6% of crossings, respectively). The number of species and crossings of wild mammals, especially wild ungulates and wolves, was substantially higher on overpasses (mean effective number of species (Hill numbers): 0D = 7.8, 1D = 4.1 and 2D = 3.3) than on underpasses (0D = 6.3, 1D = 2.9 and 2D = 2.3) and was not affected by distance between WCS and human settlements or WCS width. There was a higher diversity of wild species and more crossings under large extended bridges than on smaller underpasses. The number of species and number of crossings of wild mammals, domestic animals and people increased from 2010 to 2013. There was a significant difference in activity patterns, with almost all wild species being nocturnal, in contrast to people and dogs. There was no relationship between crossing time and rates of wild carnivores and potential prey. We conclude that overpasses, even with steep entrance slopes (25–26.5%) or integrated with moderately used gravel roads, maintain movement of wild terrestrial mammals much better than underpasses, and the presence of wolves does not hamper the movement of other wild species. As there are significant temporal changes in use of WCS by mammals, we recommend monitoring WCS in all seasons for at least 3 years as a minimum standard for the post-investment assessment of WCS utilization by animals.

Geologic Map of Aphrodite Map Area (AMA; I-2476), Venus.

We present a 1:10‐M‐scale geologic map of the Aphrodite Map Area (AMA) of Venus (0°N–57°S/60–80°E). Geologic mapping employed NASA Magellan synthetic aperture radar and altimetry data. The AMA geologic map, with detailed structural elements and geologic units covering over one eighth of Venus' surface, affords an important and unique perspective to test models of global‐scale geologic processes through time. Geologic relations record a history inconsistent with global catastrophic resurfacing. The AMA displays a regional coherence of preserved geologic patterns that record three sequential geologic eras: the ancient era, the Artemis superstructure era, and the youngest fracture zone era. The ancient era and Artemis superstructure, with a footprint covering more than 25% of the surface, are recorded in the Niobe Map Area to the north. The latter two eras likely overlap in time. The fracture zone domain, part of a globally extensive province, marks the most spatially focused tectonomagmatic domain within the AMA. Impact craters are both cut by and overprint fracture zone structures. Twelve percent of AMA impact craters that occur within the fracture zone domain predate or formed during fracture zone development. This observation indicates the relative youth of the fracture zone era and is consistent with the possibility that this domain remains geologically active. The AMA records a rich geologic history of large tract of the surface of Venus and provides an important framework to formulate new working hypotheses of Venus evolution and contribute to planning future studies of the surface of planets.

Re: Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan.

No AccessJournal of UrologyUrological Survey1 Nov 2020Re: Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan Dean G. AssimosMD Dean G. AssimosDean G. Assimos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001258.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan." The Journal of Urology, 204(5), pp. 1090–1091 Suggested Reading : Impact of potassium citrate vs citric acid on urinary stone risk in calcium phosphate stone formers. J Urol 2018; 200: 1278. Link, Google Scholar : Profile of the brushite stone former. J Urol 2010; 184: 1367. Link, Google Scholar : Short-term tolvaptan increases water intake and effectively decreases urinary calcium oxalate, calcium phosphate and uric acid supersaturations. J Urol 2016; 195: 1476. Link, Google Scholar : Nephrolithiasis associated with autosomal dominant polycystic kidney disease: contemporary urological management. J Urol 2000; 163: 726. Link, Google Scholar : Percutaneous nephrolithotomy for large or multiple upper tract calculi and autosomal dominant polycystic kidney disease. J Urol 2010; 183: 183. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 5November 2020Page: 1090-1091 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean G. Assimos More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Active Components in Whole Grain Wheat for Colon Cancer Prevention: Synergistic Effects Between Phytochemical Alkylresorcinols and Fiber Microbial Metabolite Butyrate

Abstract Objectives Wheat bran (WB) is a rich source of dietary fiber and phytochemicals with health-promoting properties. However, the active components especially the interaction between different components in whole grain (WG) wheat have not been fully explored. This study aimed to investigate whether WB phytochemicals, alkylresorcinols (ARs), and the active intestinal microbial metabolite of fiber, butyrate, could synergistically suppress human colon cancer cells. Methods Cell viability was determined by MTT assay in HCT-116 and HT-29 cells after the treatments of the combination of ARs, C21 and C19, and NaB, respectively. Apoptosis was determined by Cell Death ELISA Kit. The further mechanism was investigated by western blot associated with apoptosis, autophagy, and ER stress pathways. The C21 levels in gastrointestinal tract were measured by HPLC in mice treated with human-relevant doses of C21. Isobologram analysis was employed for the determination of synergistic or additive anticancer effects of the co-treatments of AR and NaB. Results The combination of C21 or C19 and butyrate synergistically inhibited the growth of colon cancer cells and induced apoptosis. Further mechanistic studies demonstrated that the co-treatment of C21 and butyrate induced significant upregulations in cleaved Poly(ADP-ribose) polymerase (PARP), cleaved caspase 3, p53 upregulated modulator of apoptosis (PUMA), cytochrome C, lipid-conjugated membrane-bound form of microtubule-associated protein 1A/1B-light chain 3 (LC3-II), and C/EBP homologous protein (CHOP) expressions. Notably, the C21 concentrations in the large intestinal tract of mice treated with human-relevant doses of C21, were from 0.86 to 1.78 μmol/g, suggesting the C21 doses used in vitro may be achievable after daily WG wheat intake. Conclusions We demonstrated for the first time that phytochemical component ARs and the microbial metabolites of WB fiber exhibit synergistic anticancer effects in human colon cancer cells, which may be associated with the induction of apoptosis, autophagy, and ER stress pathways. The present study provides novel insights into the understanding of the chemo-preventive effects of WG wheat against CRC. However, the mechanism of the synergistic anticancer effect of phytochemicals and fiber is complicated and still needs to be further investigated in vivo. Funding Sources USDA NIFA R01.

Processes of Acquiring Large Scale Land by Investors in the Pru District of Ghana: A Critical Inquest

The study examines the process of acquiring large-scale land for investment in the Pru district. Ghana has become one of the destinations for large-scale land deals in Africa, attracting high foreign investments in the agricultural sector. Over the past ten years, the Government of Ghana have leased out large tracts of land for investors, mainly foreign investors. The Pru district in the Bono East Region have large-scale land acquisition by investors. This study aims to examine the process through which large scale land are acquired in the district. The study employed a mixed method approach, where smallholder farmers were interviewed. Focus group discussions were conducted to achieve the objective of the study as well as computing statistical analysis for the socio-demography for the respondents. Both primary and secondary data were employed in the study and the qualitative data was analysed thematically whiles inferential and descriptive statistics with the help of Statistical Package for Social Sciences (SPSS Version 20). The study found out that process of acquiring large tract of land for investment purposes include identification of vacant lands, deciding to lease the vacant lands, advertising the vacant lands, assessment of the land by prospective investors, negotiating terms of leasehold and documentation and transfer of ownership. The findings revealed that occupants of farmlands do not participate in decisions leading to the acquisition of those lands by investors, which has a significant influence on the effects of large-scale land acquisition on the livelihood of smallholder farming households. The study recommended that households should be given the opportunity to negotiate for better terms of compensation from investors and the government especially for farming households losing their farmlands.

Multicenter Comparison of Percutaneous and Surgical Pulmonary Valve Replacement in Large RVOT

A percutaneous approach for pulmonary valve replacement (PVR) is a feasible alternative to surgical PVR in selected patients with severe pulmonary regurgitation after repair of tetralogy of Fallot. However, large right ventricular outflow tract (diameter ≥ 25 mm) remains challenging. This retrospective multicenter study enrolled consecutive patients with large right ventricular outflow tract who underwent percutaneous PVR (Venus P-valve, Venus MedTech Inc, Hangzhou, China) (n= 35) or surgical PVR (homograft valve; n= 30) between May 2014 and April 2017. Patients were followed up at 1, 3, 6, and 12 months, and yearly thereafter. Main study outcomes were pulmonary valve function and right ventricular function at discharge and midterm follow-up. PVR was successful in all patients. Percutaneous compared with surgical PVR group had: similarly distributed baseline characteristics; shorter hospitalization, intensive care unit stay, and endotracheal intubation duration; lower cost; lower pulmonary valve gradient before discharge; lower pulmonary valve regurgitant grade (mean difference, -0.63; 95% CI -1.11 to -0.20, P= .022), pulmonary valve gradient (mean difference, -5.7 mm Hg; 95% CI -9.4 to -2.2 mm Hg, P= .005), and right ventricular end-diastolic volume index (mean difference, -9.5 mL/m2; 95% CI -16.9 to -3.1 mL/m2, P= .022); and greater right ventricular ejection fraction (mean difference, 5.4%; 95% CI 2.4%-8.3%, P= .002) at median 36 months follow-up, without deaths in either group. Percutaneous PVR using Venus P-valve appeared to be a safe, efficacious and minimally invasive alternative to surgical PVR in selected patients with large right ventricular outflow tract yielding better right ventricular and pulmonary valve function at midterm follow-up.

Circulating S100A8/A9 is potentially a biomarker that could reflect the severity of experimental colitis in rats

AimsThe clinical significance of circulating S100A8/A9 (calprotectin) in patients with ulcerative colitis (UC) is poorly understood. We examined whether serum S100A8/A9 is a good biomarker for UC, and whether the serum level is a useful index for the severity of the disease. Main methodsExperimental animal (rats) were used to verify clinical significance of serum S100A8/A9 as a biomarker. Rats treated with 5% dextran sulfate sodium (DSS) alone (UCR) or with 5%DSS plus tacrolimus (TMR) were subjected to the experiment. The serum concentrations of rat S100A8/A9 (r-S100A8/A9) and other inflammatory biomarkers, such as C-reactive protein (CRP) and inflammatory cytokines, in the both groups were measured using enzyme-linked immunosorbent assays (ELISAs). The tissue damage in the large intestinal tract was visualized by hematoxylin-eosin staining. The relationship between the serum concetrations of these inflammatory biomarkers and the histological scores of the rectal tissue was statistically analyzed. Principle findingsAs determined by the ELISAs, the serum concentration of r-S100A8/A9 in the UCR hardly correlated with those of not only CRP but also some inflammatory cytokines. The deterioration of the rectal tissue, mainly epithelium structure of a large intestine, in the UCR was clearly observed, but was not so severe as that in the TMR. The histological scores of the rectal tissue in the UCR significantly correlated with the serum level of r-S100A8/A9, but not with other inflammatory biomarkers. Furthermore, macrophages actively produced r-S100A8/A9 in response to stimulation with lipopolysaccharide and quickly secreted it in circulation. Therefore, the serum level of r-S100A8/A9 suggestively changes in accordance with the severity of experimental UC. ConclusionCirculating r-S100A8/A9 is a useful biomarker for experimental UC, and its serum level correlates with the disease severity as judged by histological score.

Pulmonary artery 3D printing to plan percutaneous pulmonary valve implantation in Tetralogy of Fallot patients with large native outflow tract

Percutaneous pulmonary valve implantation (PPVI) is a challenging intervention, especially in Tetralogy of Fallot (TOF) patients with large native outflow tract. We assess the ability of 3D printing to predict PPVI success. We retrospectively printed 15 cardiac models with flexible photopolymer resine from tomodensitometry. Patients (Median age 40 yo [26–56]) had TOF with large regurgitant native outflow tract. Especially patients with complex PPVI procedures were selected. Printing method was adjusted to mimic pulmonary artery elasticity. Balloon sizing was performed under fluoroscopy on the models and in patients. Models analysis were performed blinded to outcome. Median minimal landing zone diameter was 25 mm [22–27]. Two patients were referred for elective surgical valve replacement (outflow tract measured at 32 mm after sizing in one and at 34 mm after prestenting in the second). Sapien 3 valves were implanted in 13 patients after prestenting. Shape of the outflow tract was described as tubular ( n = 8), sandglass ( n = 1), chicane ( n = 2), funnel-shaped ( n = 2) and ballooning ( n = 1) on models. Correlation between invasive and models balloon calibration was not significant. Using Bland-Altman analysis, mean difference between the 2 techniques was 0.4 ± 3.9 mm ( Fig. 1 ). Two patients were considered unsuitable for PPVI based on models. These 2 patients matched with the 2 referred for surgery. Assessing size and shape of the models, 2 interventionalists rated the expected complexity of PPVI from straightforward ( n = 11), to moderate ( n = 2) and complex ( n = 2). Analysis of outcome confirmed challenging procedures in 2 and uneventful in 12. Kappa agreement coefficient was 0.44, P = 0.007. 3D printed cardiac models are useful to predict challenging PPVI but lacks accuracy to size the outflow tract. Prospective studies are needed to corroborate these preliminary results and better define the interest of this new tool before PPVI.

Decline in beetle abundance and diversity in an intact temperate forest linked to climate warming

Insect abundances are declining in many areas around the world, but the causes of those declines are seldom clear. Here we report a dramatic decline in the abundance and diversity of Coleoptera (beetle) taxa in a large tract of intact northern hardwood forest during the last 45years, and provide evidence supporting winter warming as the primary cause. Beetles were sampled using the same method (window traps) and in the same locations within the Hubbard Brook Experimental Forest, New Hampshire, in 1973–1977 and again in 2015–2017. The mean (±SE) number of beetles captured per 48-h fell from 23.2 (±3.89) to 3.9 (±1.19), a decline of 83% over this 45-year period. The number of beetle taxa captured decreased by 39%, with 19 beetle families disappearing entirely. Beetle capture rate was least when and where climate was warmest. Capture rate was significantly lower in the 2010s when mean daily temperature was about 1.8°C warmer, and sampling during 2016–2017 at low, mid and high elevations (320, 540, and 810m asl, respectively) revealed lowest beetle captures at low elevation where climate was warmest. Most importantly, beetle capture rate was significantly lower after winters with less snow cover during the previous winter, indicating that snow cover in northern hardwood forest is essential for sustaining the beetle community. These results imply that additional climate warming might further reduce the abundance and diversity of beetles and other arthropods inhabiting the forest-floor, potentially affecting critical ecosystem processes such as decomposition and carbon storage.

Wheat Bran for Colon Cancer Prevention: The Synergy between Phytochemical Alkylresorcinol C21 and Intestinal Microbial Metabolite Butyrate.

There is convincing evidence that consuming whole grains (WGs) may decrease the risk of colorectal cancer (CRC). Wheat bran (WB) is a rich source of dietary fiber and phytochemicals with health-promoting properties. However, the active components especially the interaction between different components in WG wheat have not been fully explored. Here, we investigated whether one of the major WB phytochemicals, alkylresorcinol (AR) C21, and the major active intestinal microbial metabolite of fiber, butyrate, could synergistically suppress human colon cancer cells. Our results demonstrated for the first time that the combination of C21 and butyrate synergistically inhibited the growth of human colon cancer cells and induced apoptosis. Further mechanistic studies demonstrated that the cotreatment of C21 and butyrate induced significant up-regulations in cleaved Poly(ADP-ribose) polymerase (PARP), cleaved caspase 3, p53 upregulated modulator of apoptosis (PUMA), cytochrome C, lipid-conjugated membrane-bound form of microtubule-associated protein 1A/1B-light chain 3 (LC3-II), and C/EBP homologous protein (CHOP) expressions, indicating the synergistic anticancer effects of C21 and butyrate were associated with induction of apoptosis, autophagy, and ER stress pathways. Notably, the C21 concentrations in the large intestinal tract of mice treated with human relevant doses of C21, were from 0.86 to 1.78 μmol/g, suggesting the C21 doses used in vitro may be achievable after daily WG wheat intake. These results provide novel insights into the dietary prevention of CRC regarding the potential interaction of bioactive WG wheat phytochemicals and the microbial metabolites of fiber.

2527 Posterior Perforation Arising From a Duodenal Diverticulum

INTRODUCTION: Duodenal diverticulums (DD) are present in 6-22% of the general population on autopsy, however, it is uncommon to be symptomatic. We present a rare case of a patient who developed a posterior perforation of a duodenal diverticulum. CASE DESCRIPTION/METHODS: An 82-year old male presented with a chief complaint of weakness. On admission, the patient was found in septic shock, thought to be from pneumonia and started on antibiotics. Due to a lack of bowel movements over several days, a KUB was ordered and showed ileus of the proximal small bowel. The following day he developed large melanotic stools and laboratory workup revealed a hemoglobin of 5.6. The patient was resuscitated and underwent an endoscopy. A large ulcer covering 50% of the duodenal circumference with a large tract was discovered (Figure 1). A follow-up CT abdomen (Figure 2) demonstrated fluid and edema surrounding the pancreas, pneumoperitoneum, and fluid collection in the third portion of the duodenum. Additionally, a UGI with gastrografin (Figure 3) showed a diverticulum in the third portion of the duodenum with extravasation of contrast into the retroperitoneum indicating perforation. Surgery revealed a diverticulum of the second portion of the duodenum. The perforation was found to lead into the retroperitoneal space and directly into the body of the pancreas. Unfortunately, the patient would develop multi-organ failure secondary to fulminant septic shock and passed away. DISCUSSION: It is uncommon for duodenal diverticulums to be symptomatic with only about 10% doing so. They can present with upper abdominal pain, obstruction, ulcer, diverticulitis, perforation, and pancreatitis. Bleeding can occur but is rare. DD can be classified as primary acquired diverticula or secondary diverticula, which is caused by peptic ulceration. They are thought to be caused by herniation of the mucous membrane through the muscular coat at sites weakened by the passage of blood vessels or aberrant growth of pancreatic tissue. Perforations associated with duodenal diverticulums are typically located in the anterior portion of the duodenum or stomach however, spontaneous non-traumatic posterior perforation is a distinct clinical rarity, not commonly encountered. Posterior perforations tend to present late due to insidious onset. These ulcers perforate into the retroperitoneal space or lesser sac. Local inflammatory reaction and fibrosis of the adherent retroperitoneal space tend to seal off these perforations which may explain their vague symptoms.