Late Branch Research Articles

Planetary nebulae of the Large Magellanic Cloud II. The connection with the progenitors' properties

The study of planetary nebulae (PNe) offers the opportunity to evaluate the efficiency of the dust production mechanism during the very late asymptotic giant branch (AGB) phases, which allows us to assess the role played by AGB stars as dust manufacturers. We studied the relationship between the properties of PNe, particularly the gas and dust content, and the mass and metallicity of the progenitor stars to understand how dust production works in the late AGB phases and to shed new light on the physical processes the stars and the material in their surroundings are subject to in the period between the departure from the AGB and the start of the PN phase. We considered a sample of nine PNe in the Large Magellanic Cloud, seven of which are characterised by the presence of carbonaceous dust and the remaining two the presence of silicates. For these stars, we estimated the masses and the metallicity of their progenitor stars. We combined results from stellar evolution and dust formation modelling with results from analyses of the spectral energy distribution to determine the relation between the dust and gas mass of the PNe considered and the mass and metallicity of the progenitors. The physical properties of carbon-rich PNe are influenced by the mass of the progenitor star. Specifically, the dust-to-gas ratio in the nebula increases from $5 $ to $6 $ as the progenitor star's mass increases from approximately rm 0.9 M_ ⊙ to rm 2 M_ ⊙ . This change is partly influenced by the effective temperature of the PNe, and it occurs because higher-mass carbon stars are more efficient at producing dust. Consequently, as the progenitor's mass increases, the gas mass of the PN decreases since the larger amounts of dust lead to greater effects from radiation pressure, which pushes the gas outwards. No meaningful conclusions can be drawn from the study of the PNe with silicate-type dust, because the subsample comprises two PNe only, one of which is almost dust-free.

Simulation of range code tracking loop for multipath mitigation in NavIC receiver

Abstract The Operational Navigation with Indian Constellation (NavIC) comprises seven satellites in the orbit, including three in geostationary orbit (GEO) and four in geosynchronous orbit (GSO). NavIC provides both Standard Positioning Service and Restricted Service, using L5 (1176.45 MHz) and S1 (2492.028 MHz) frequencies, with coverage extending 1500 km around the mainland of India. In an urban canyon, multipath interference severely reduces the precision and reliability of NavIC positioning. Many current multipath mitigation techniques often exhibit high computational requirements or reliance on external assistance. In this paper, a ranging code tracking loop is proposed that can sustain either a late or early branch in contrast to the Narrow-Spacing (NS) correlation technique for mitigating multipath for NavIC receiver. The design of proposed code tracking loop is based on steepest descent algorithm. The findings demonstrate that, in terms of calculation time and code multipath mitigation, the suggested technique performs better than both Multipath Estimated Delay Locked Loop (MEDL) and NS correlation. The proposed method produces less than 0.016 chips for the tracking error Standard Deviation (STD). In addition, the recommended method takes 24 % less computation time.

Medium-term outcomes of EXTra-design engineering inner-branch ENdografts for the treatment of complex aortic aneurysms from a multicenter collaboration

This study aims to present the medium-term outcomes of Extra-Design engineering endografts with inner branches (EDE-iBEVARs, Artivion) in endovascular aortic repairs of complex aneurysms building upon promising early results. A retrospective, international, multi-center study was conducted including consecutive patients who underwent complex endovascular aortic repairs using EDE-iBEVARs between 2018 and 2022. Patient demographics, aneurysm anatomical features, procedural details, reinterventions, complications, and endograft failures during follow-up were assessed. The primary outcome was aneurysm-related mortality. Secondary outcome measures included the freedom from all-cause mortality and reintervention, technical and clinical success, and late related complications including branch instability, endoleaks, and serious adverse events. Our study encompassed a total of 260 patients across 13 European centers. The cohort included patients with thoracoabdominal aortic aneurysms (n= 116), suprarenal or juxta-renal aneurysms (n= 95), and those who had previous open repair or previous endovascular aortic repair with type 1A endoleak (n= 49). Of 982 possible inner branches (937 antegrade and 45 retrograde), 962 (98%) were successfully cannulated and bridged with covered stents during the index procedure. Overall, the endograft was successfully deployed in 98% of patients, and 93% were discharged from hospital following surgery. At 3years, freedom from aneurysm-related mortality was 97%, whereas the freedom of all-cause mortality was 89%. Freedom from reinterventions was 91% and 76% at 1 and 3years, respectively. The rate of late complications such as endoleaks or branch instability events was 12% (n= 30). The late branch occlusion rate during follow-up was 1.5% (n= 15), of which 12 were renal branches. EDE-iBEVARs demonstrate satisfactory medium-term outcomes with reintervention rates comparable toother endografts. Encouragingly, rates of branch patency were high, and major adverse events were low. This technology could expand the treatment options for patients with challenging complex aortic conditions.

A platypterygiid ichthyosaur from the Cenomanian of central New Zealand

ABSTRACT Understanding of Cretaceous ichthyosaur diversity has substantially increased in recent years; however, Eastern Gondwana’s ichthyosaur fauna is still poorly understood, particularly in New Zealand where only scarce fragmentary material is known. A Cenomanian-aged partial ichthyosaur skeleton has been recovered from the northeastern South Island of New Zealand and is described here. Whilst the specimen is too fragmentary to formally name, this taxon shows an extreme reduction of the basioccipital extracondylar area, a scapula with a prominent acromion process and a strap-like scapula shaft, as well as a complete left pelvic girdle with an elongated depression on the anteroproximal face of the ischiopubis. We suggest that it is a late branching member of the platypterygiid ichthyosaurs, closely related to the Eastern Gondwanan ichthyosaur Platypterygius australis and to many European Cretaceous taxa. However, it appears to be unrelated to the Cretaceous ichthyosaurs of Western Gondwana, suggesting potential regionalism amongst the Gondwanan Cretaceous ichthyosaur populations.

Concurrent Testing of Spatially Separated Tissue Samples and Circulating Tumor DNA Reveals Substantial Intra-Patient Genetic Heterogeneity in Relapsed/Refractory Follicular Lymphoma

Background: Scrutiny of genetic heterogeneity in follicular lymphoma (FL) patients has been mainly limited to the investigation of single-site biopsies in previous studies, while the potential of circulating cell-free DNA (cfDNA) to resolve intra-patient heterogeneity has not been fully exploited in FL. Therefore, we aimed to characterize spatiotemporal heterogeneity in relapsed/refractory (R/R) FL by performing comprehensive genomic profiling of spatially separated tissue samples with matching cfDNA samples collected throughout the disease course. Methods: We performed ultra-deep targeted sequencing of 63 tumor tissue DNA (tisDNA), 28 cfDNA and paired germline DNA samples collected from 22 R/R FL patients. Sequencing libraries were prepared using a SureSelectXT HS (Agilent, USA) panel encompassing 173 genes recurrently mutated in FL, as well as rearrangement regions for immunoglobulin V(D)J repertoire profiling. Sequencing was performed on a NovaSeq6000 or NextSeq2000 (Illumina, USA) platform reaching a median deduplicated depth of 5,419x and 1,695x for cfDNA and tisDNA samples, respectively. We called short somatic variants using GATK Mutect2 (v.4.1.7.0), copy number alterations using PureCN (v.1.20.0) and CNVKit (v.0.9.9), as well as immunoglobulin repertoire using the whole-mark module of ARResT/Interrogate. Results: Median 6 and 8 non-silent variants were detected in cfDNA and tisDNA samples, respectively, affecting KMT2D (52%), CREBBP (45%) and TNFRSF14 (33%) most frequently in both sample types. Non-silent variants were detected in 21 of 24 (87.5%) pretreatment cfDNA samples. Comparing tisDNA samples with matching pretreatment cfDNA samples median 63.6% of variants were shared, yet unique variants were identified in cfDNA in 13/20 sample pairs, involving a median 14.3% of the variants. Studying the phylogenetic evolution of tumor samples pointed to early branching in majority of the patients, with ubiquitously present mutations detected in all samples constituting a median 24.3% of variants, although late branching was also observed in a subset (2/22) of the patients with at least 50% of variants detected in all samples. Most conserved variants were detectable in KMT2D and CREBBP, with notable exceptions of a lower mutation prevalence, but a high conservation rate in ATP6V1B2 and STAT6 genes. Subclonal clustering of variants and hierarchy analysis of samples from patients (n=5) with 2 tisDNA collected at separate lymphoma sites and a matching pretreatment cfDNA indicated that spatially discordant variants formed the same subclone, that could be also recovered in cfDNA in 4/5 patients (80%). An additional patient presented with almost identical tisDNA samples, but further unique mutations in cfDNA (PAT-FL-20)(Figure 1.). Investigating the prognostic significance of ctDNA level in the relapsed setting revealed that higher ctDNA levels were significantly associated with poor response to therapy (p=0.023, Kruskal-Wallis test), yet when we stratified patients by the median pretreatment ctDNA level (1.44x10 5 haploid genome equivalent/mL plasma) progression free survival in the subsequent treatment line was not substantially different between the two arms (p=0.11, log-rank test). Conclusion: Based on our results, R/R FL is characterized by remarkable intra-patient genetic heterogeneity. Although the founder clone harboring pathogenic KMT2D and CREBBP mutations can be identified in majority of the samples, expansion of tumor subclones between lymphoma sites confers divergent evolution, leaving genetic alterations unidentified during single-site based genetic testing. We also provide preliminary evidence, that multitarget high-throughput sequencing of cfDNA can uncover spatially restricted subclones that play a role in disease progression in R/R FL and that pretreatment ctDNA level might have a predictive value in the relapsed setting of FL. Figure 1. Molecular alterations in FL patients with tisDNA samples from two separate lymphoma sites and a matching cfDNA. KMT2D and CREBBP variants show high conservation, yet further variants are often spatially restricted, which can be resolved by cfDNA profiling. Copy number alterations (CNA) show lower concordance, yet recurrent CNA-s can be recovered in a subset of the cases. Identical immunoglobulin heavy and light chain usage can be detected in all samples of 3 patients and in paired tisDNA in 2 patients.

Variability and evolution of gene order rearrangement in mitochondrial genomes of arthropods (except Hexapoda)

In the species-rich Phylum Arthropoda, the mitochondrial genome is relatively well conserved both in terms of number and order of genes. However, specific clades have a 'typical' gene order that differs from the putative arthropod ancestral arrangement. The aim of this work was to compare the rate of mitochondrial gene rearrangements at inter- and intra-taxonomic levels in the Arthropoda and to postulate the most parsimonious ancestral orders representing the four major arthropod lineages. For this purpose, we performed a comparative genomic analysis of arthropod mitochondrial genomes available in the NCBI database. Using a combination of bioinformatics methods that examined mitochondrial gene rearrangements in 464 species of arthropods from three subphyla (Chelicerata, Myriapoda, and Crustacea [except Hexapoda, previously analyzed]), we observed differences in the rate of rearrangement within major lineages. A higher rate of mitochondrial genome rearrangement was observed in Crustacea and Chelicerata compared to Myriapoda. Likewise, early branching clades exhibit less variability in mitochondrial genome order than late branching clades, within each subphylum. We identified 'hot regions' in the mitochondrial genome of each studied subphylum, and postulated the most likely ancestral gene order in each subphylum and taxonomic order. Our work provides new evidence on the evolutionary dynamics of mitochondrial genome gene order in arthropods and new mitochondrial genome architectures in different taxonomic divisions within each major lineage of arthropods.

Molecular Regulatory Mechanisms in Chicken Feather Follicle Morphogenesis.

In China, the sale of freshly slaughtered chickens is becoming increasingly popular in comparison with that of live chickens, and due to this emerging trend, the skin and feather follicle traits of yellow-feathered broilers have attracted a great deal of research attention. The feather follicle originates from the interaction between the epidermis and dermis in the early embryonic stage. Feather follicle morphogenesis is regulated by the Wnt, ectodysplasin (Eda), epidermal growth factor (EGF), fibroblast growth factor (FGF), bone morphogenetic protein (BMP), sonic hedgehog (Shh), Notch, and other signaling pathways that exist in epithelial and mesenchymal cells. The Wnt pathway is essential for feather follicle and feather morphogenesis. Eda interacts with Wnt to induce FGF expression, which attracts mesenchymal cell movement and aggregates to form feather follicle primordia. BMP acts as an inhibitor of the above signaling pathways to limit the size of the feather tract and distance between neighboring feather primordia in a dose-dependent manner. The Notch/Delta pathway can interact with the FGF pathway to promote feather bud formation. While not a part of the early morphogenesis of feather follicles, Shh and BMP signaling are involved in late feather branching. This review summarizes the roles of miRNAs/lncRNA in the regulation of feather follicle and feather growth and development and suggests topics that need to be solved in a future study. This review focuses on the regulatory mechanisms involved in feather follicle morphogenesis and analyzes the impact of SNP sites on feather follicle traits in poultry. This work may help us to understand the molecular regulatory networks influencing feather follicle growth and provide basic data for poultry carcass quality.

Shallow suture at ventricular septal defect may safely reduce right bundle branch block.

To avoid rhythm disturbance, sutures for ventricular septal defect closure have been traditionally placed 2∼5 mm or more away from the edge of the ventricular septal defect. However, the traditional suturing method appears to induce right bundle branch block and tricuspid valve regurgitation after ventricular septal defect closure more than our alternative technique, shallow suturing just at the edge of the ventricular septal defect (shallower bites at the postero-inferior margin). We aimed to verify our clinical experience of perimembranous ventricular septal defect repair. The alternative shallow suturing method has been applied since 2003 at our institution. We retrospectively reviewed the clinical data of 556 isolated perimembranous ventricular septal defect patients who underwent surgical closure from 2000 to 2019. We investigated the postoperative occurrence of right bundle branch block or progression of tricuspid regurgitation and analysed risk factors for right bundle branch block and tricuspid regurgitation. Traditional suturing method (Group T) was used in 374 cases (66.8%), and alternative suturing method (Group A) was used in 186 cases (33.2%). The right bundle branch block occurred more frequently in Group T (39.6%) than in Group A (14.9%). In multivariable logistic regression analysis, Group T and patch material were significant risk factors for late right bundle branch block. More patients with progression of tricuspid regurgitation were found in Group T. Shallow suturing just at the edge of the ventricular septal defect may reduce the rate of right bundle branch block occurrence and tricuspid regurgitation progression without other complications.

The Price of Human Evolution: Cancer-Testis Antigens, the Decline in Male Fertility and the Increase in Cancer.

The increasing frequency of general and particularly male cancer coupled with the reduction in male fertility seen worldwide motivated us to seek a potential evolutionary link between these two phenomena, concerning the reproductive transcriptional modules observed in cancer and the expression of cancer-testis antigens (CTA). The phylostratigraphy analysis of the human genome allowed us to link the early evolutionary origin of cancer via the reproductive life cycles of the unicellulars and early multicellulars, potentially driving soma-germ transition, female meiosis, and the parthenogenesis of polyploid giant cancer cells (PGCCs), with the expansion of the CTA multi-families, very late during their evolution. CTA adaptation was aided by retrovirus domestication in the unstable genomes of mammals, for protecting male fertility in stress conditions, particularly that of humans, as compensation for the energy consumption of a large complex brain which also exploited retrotransposition. We found that the early and late evolutionary branches of human cancer are united by the immunity-proto-placental network, which evolved in the Cambrian and shares stress regulators with the finely-tuned sex determination system. We further propose that social stress and endocrine disruption caused by environmental pollution with organic materials, which alter sex determination in male foetuses and further spermatogenesis in adults, bias the development of PGCC-parthenogenetic cancer by default.

Ectodysplasin Signaling through XEDAR Is Required for Mammary Gland Morphogenesis

XEDAR is a member of the TNF receptor subfamily and a mediator of the ectodysplasin (EDA) pathway. EDA signaling plays evolutionarily conserved roles in the development of the ectodermal appendage organ class, which includes hair, eccrine sweat glands, and mammary glands. Loss-of-function sequence variants of EDA, which encodes the two major ligand isoforms, EDA-A1 and EDA-A2, result in X-linked hypohidrotic ectodermal dysplasia characterized by defects in two or more types of ectodermal appendages. EDA-A1 and EDA-A2 signal through the receptors EDAR and XEDAR, respectively. Although the contributions of the EDA-A1/EDAR signaling pathway to EDA-dependent ectodermal appendage phenotypes have been extensively characterized, the significance of the EDA-A2/XEDAR branch of the pathway has remained obscure. In this study, we report the phenotypic consequences of disrupting the EDA-A2/XEDAR pathway on mammary gland differentiation and growth. Using a mouse Xedar knockout model, we show that Xedar has a specific and temporally restricted role in promoting late pubertal growth and branching of the mammary epithelium that can be influenced by genetic background. Our findings implicate Xedar in ectodermal appendage development and suggest that the EDA-A2/XEDAR signaling axis contributes to the etiology of EDA-dependent mammary phenotypes.

Clonal relationship and alcohol consumption-associated mutational signature in synchronous hypopharyngeal tumours and oesophageal squamous cell carcinoma

BackgroundThe patients with dual oesophageal squamous cell carcinoma (ESCC) and hypopharyngeal cancer (HPC) have poor prognosis; their underlying genetic pathogenesis is unclear. We hypothesise that development of synchronous ESCC/HPC depends on multicentricity or independent origin, rather than multifocality due to local or lateral spreading.MethodMultiple region whole-exome sequencing (M-WES) and clonality analysis were used to assess clonal relationship and spatial inter- or intra-tumour heterogeneity (ITH) in 62 tumour regions from eight dual ESCC/HPC and ten ESCC patients.ResultsAll synchronous ESCC/HPC patients had COSMIC 16 mutation signatures, compared to only 40% ESCC in the current study (p = 0.013) and public data set (n = 165, p = 0.003). This alcohol consumption-related mutation signature 16, commonly involved in multiple alcohol-related cancers, was significantly associated with drinking and alcohol metabolism-related ADH1B rs1229984. The mutational landscape and copy number profiles were completely distinct between the two primary tumours; clonality analysis further suggested the two primary tumours shared no or only one clone accompanying independent subclone evolution. M-WES strategy demonstrated higher sensitivity and accuracy for detection of mutational prevalence and the late branch mutations among different regions in the ESCC tumours, compared to traditional sequencing analysis based on single biopsy strategy. Patients with high ITH assessed by cancer cell fraction analysis after M-WES were significantly associated with both relapse and survival.ConclusionsOur hypothesis-generating M-WES ITH assessment data have implications for prognostication. Collectively, our findings support multicentric independent clonal evolution, the field cancerisation theory, and suggest novel insights implicating an aetiologic role of alcohol metabolism in dual ESCC/HPC carcinogenesis.

Short, Divergent, and Enantioselective Total Synthesis of Bioactive ent-Pimaranes.

We present the first total synthesis of eight ent-pimaranes via a short and enantioselective route (11-16 steps). Key features of the divergent synthesis are a Sharpless asymmetric dihydroxylation, a Brønsted acid catalyzed cationic bicyclization, and a mild Rh-catalyzed arene hydrogenation for rapid access to a late synthetic branching point. From there on, selective functional group manipulations enable the synthesis of ent-pimaranes bearing different modifications in the A- and C-rings.

279. CLONAL RELATIONSHIP AND ALCOHOL CONSUMPTION-ASSOCIATED MUTATIONAL SIGNATURE IN SYNCHRONOUS HYPOPHARYNGEAL TUMORS AND ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract The patients with dual esophageal squamous cell carcinoma (ESCC) and head and neck cancers have poor prognosis, but the underlying genetic pathogenesis is unclear. We hypothesize that independent origin rather than multifocality, which means local or lateral spreading involves the development of synchronous ESCC and hypopharyngeal cancer (HPC). We also hypothesize that multi-regional assessment provides better understanding of the evolution of tumor subclones and assessment of intra-tumor heterogeneity to guide personalized treatment with prognostic implications. Multiple region whole-exome sequencing (M-WES) and clonality analysis were used to assess clonal relationship and spatial inter- or intra-tumor heterogeneity (ITH) in 62 tumor regions, six normal tissues, and 15 blood samples from eight dual ESCC/HPC and ten ESCC patients. All synchronous ESCC/HPC patients had COSMIC 16 mutation signature compared to only 40% ESCC in the current study (p = 0.013) and public ESCC dataset (n = 165, p = 0.003). The mutational landscape and copy number variation (CNV) profiles were completely distinct between the ESCC/HPC; clonality analysis further suggested the two primary tumors shared no or only one clone accompanying independent subclone evolution. The M-WES strategy demonstrated higher sensitivity and accuracy for detection of mutational prevalence and the late branch mutations among different regions in the ESCC tumors compared to traditional single biopsy strategy. Patients with high ITH was significantly associated with both relapse and survival. Our hypothesis-generating M-WES ITH assessment data have implications for prognostication. We are the first to show a distinctive CNV and genetic mutation profile, the predominant alcohol-related COSMIC 16 mutational signature in synchronous ESCC/HPC, providing genetic evidence for a multi-centric independent origin for clonal evolution and the theory of field cancerization implicating an etiologic role of alcohol metabolism in dual ESCC/HPC carcinogenesis.

Anatomical Study of Variations in the Branching Patterns of Neurovascular Pedicle of Latissimus Dorsi

Introduction Variations in the branching and position of the dominant pedicle of the Latissimus Dorsi (LD) muscle has been noted during dissection of the posterior aspect of the cadaver. Knowledge about the point of branching of the pedicle is highly valuable for the surgeon while performing various reconstructive surgeries. Aims and Objectives To analyze and study the insertion and branching of the dominant neurovascular pedicle of LD. Material and Methods A total 40 LD muscles were excised from the point of origin and retracted superior-laterally towards its insertion. The pedicle was then cleared of any unwanted fascia by strip dissection and the point of branching was identified with respect to the level of the inferior scapular angle (ISA). Results An anatomical variation was observed in the study of the branching of the neurovascular pedicle. Upon consideration via statistical calculations, the following levels of branching locations were noted. ~12.5% - 2.0-inch superior to level of ISA ~37.5% - 1.0-inch superior to level of ISA ~25.0% - 1.5-inch superior to level of ISA ~25.0% - 0.4-inch inferior to level of ISA The first three types were considered as early branching whereas the last type was considered as late branching of LD. Conclusion This study shows the variations in the branching in the pedicle of the LD at various points that were considered. This is hence of surgical importance that must be noted to prevent surgical vascular damage that may occur during procedures and increase the methodology of pre-operative planning

A multipath mitigation algorithm for GNSS signals based on the steepest descent approach

Multipath interference seriously degrades the performance of Global Navigation Satellite System (GNSS) positioning in an urban canyon. Most current multipath mitigation algorithms suffer from heavy computational load or need external assistance. We propose a multipath mitigation algorithm based on the steepest descent approach, which has the merits of less computational load and no need for external aid. A new ranging code tracking loop is designed based on the steepest descent method, which can save an early branch or a late branch compared with the narrow-spacing correlation method. The power of the Non-Line-of-Sight (NLOS) signal is weaker than that of the Line-of-Sight (LOS) signal when the LOS signal is not obstructed and with a relatively high Carrier Noise Ratio (CNR). The peak position in the X-axis of the ranging code autocorrelation function does not move with the NLOS interference. Meanwhile, the cost function is designed according to this phenomenon. The results demonstrate that the proposed algorithm outperforms the narrow-spacing correlation and the Multipath Estimated Delay Locked Loop (MEDLL) in terms of the code multipath mitigation and computation time. The Standard Deviation (STD) of the tracking error with the proposed algorithm is less than 0.016 chips. Moreover, the computation time of the proposed algorithm in a software defined receiver is shortened by 24.21% compared with the narrow-spacing correlation.

Planetary Nebulae as Sources of Chemical Enrichment of the Galaxy

During the late asymptotic giant branch (AGB) phase of stellar evolution, the element carbon is created through the triple-α nuclear reaction. This is followed by the synthesis of other heavy elements via neutron capture in the core and the dredge-up of these elements to the surface by convection. Simple molecules and solid-state minerals begin to form in the upper photosphere. These molecules and solids are ejected into the interstellar medium by a strong stellar wind. During the subsequent post-AGB evolution, complex organics with aromatic and aliphatic structures are synthesized in the circumstellar envelope. Planetary nebulae, formed by swept-up circumstellar material, are found to show strong spectral signatures of ions, atoms, molecules, and inorganic and organic solids. These ejected materials of planetary nebulae serve as primordial ingredients of formation of new stars and planetary systems. Stellar synthesized organic solids may survive their journeys through the interstellar medium and evidence for remnants of such organics can be found in our own Solar System. In this paper, we summarize the recent observations of circumstellar synthesis of molecules and solids and discuss the implications of these ejected circumstellar materials on the chemical enrichment of the Galaxy and planetary systems.

Branch pulmonary artery stenosis after arterial switch operation: The effect of preoperative anatomic factors on reintervention

We hypothesized that preoperative patient characteristics and branch pulmonary artery (PA) size might influence the rate of postoperative branch PA reintervention in patients with transposition of the great arteries who undergo the arterial switch operation (ASO). The retrospective single-center study included 262 consecutive (2008-2017) newborns who underwent the ASO. Demographic characteristics, echocardiography, and clinical outcomes were reviewed. Competing risk analysis modeled incidence of branch PA reintervention and cause-specific hazard regression for predictors analyses. Median age and weight were 7 (range, 5-11) days and 3.4 (range, 3.1-3.8) kg, respectively. Various types of early branch PA reinterventions (concomitant revision or reintervention during the intensive care unit stay) were required in 28 (10.7%) patients. These patients had prolonged ventilation (P<.001), intensive care unit duration (P<.001), worse right ventricular function (P=.043), and high in-hospital mortality (P=.010). Branch PA dimensions significantly decreased immediately after ASO compared with baseline measurements. The median follow-up duration was 20.8 (range, 0.9-44.7) months. Branch PA reintervention was common among survivors without early reinterventions (9.4%), and even more frequent among those with early reinterventions (25%). Subsequent reintervention (all catheter-based) was necessary for more than one-third of patients after initial branch PA reintervention. The multivariable analysis showed preoperative dimension of the left PA (hazard ratio, 0.527 [95% CI, 0.337-0.823]; P=.005), and right PA (hazard ratio, 0.503 [95% CI, 0.318-0.796]; P=.003) were independently associated with late branch PA reinterventions. Branch PA reintervention was common and often required surgical or catheter-based reinterventions after ASO. PA branch diameters became significantly smaller after ASO. Smaller preoperative branch PA predicted late branch PA reintervention, indicating a smaller margin of geometrical tolerance to this effect.

A neomorphic ossification connecting the braincase, squamosal, and quadrate in choristoderan reptiles: insights from µCT data

Choristoderes are extinct semi-aquatic to aquatic diapsid reptiles, occupying a similar niche as modern crocodilians from the Jurassic to the Miocene. Distinct from other diapsids, choristoderes have a neomorphic ossification between the braincase, squamosal, and quadrate. This neomorphic bone is described as thin and plate-like in long-snouted choristoderes (Neochoristodera), yet little is known about its presence and morphology in short-snouted non-neochoristoderes that are sister groups to Neochoristodera. Using X-ray micro-CT scanning, this study describes in detail the neomorph of two non-neochoristoderes, Coeruleodraco jurassicus and Philydrosaurus proseilus. The neomorph of both species is found between the parietal, quadrate, and squamosal. The shape of the neomorph resembles a pyramid in three-dimensions, with a triangular dorsal surface and a prominent ventral process. This confirms the neomorph is shared among early and late branching choristoderes; therefore, presence of the neomorph is a potential synapomorphy of Choristodera. In addition, the pterygoquadrate foramen is identified in non-neochoristoderes for the first time, located between the neomorph and quadrate in C. jurassicus. In the holotype of P. proseilus, the neomorph and quadrate were dislocated, but a possible pterygoquadrate foramen is identified between the two bones. Although the neomorph and pterygoquadrate foramen have been suggested to be homologous with the stapes and stapedial foramen in Champsosaurus, more evidences are required to confirm this homology in non-neochoristoderes, because 1) the neomorph is long and plate-like in neochoristoderes, but pyramid-shaped in non-neochoristoderes; 2) in Champsosaurus, the neomorph is situated lateral to the prootic and opisthotic; in C. jurassicus and P. proseilus, articulation between the neomorph and prootic (or opisthotic) cannot be confirmed due to damage to the braincase during preservation. To understand the origin of the neomorph, more intact specimens are needed to assess contact relationships between the neomorph and otic region in non-neochoristoderes.

Efficacy of drug coated balloon versus conventional balloon in the treatment of coronary de novo bifurcation lesions: a meta-analysis

Objective: To systematically evaluate the efficacy of drug coated balloon (DCB) versus conventional balloon in the treatment of coronary de novo bifurcation lesions. Methods: The databases of PubMed, Embase, Cochrane Library, Web of science, CNKI (China National Knowledge Infrastructure), Wanfang database, VIP, China Biology Medicine disc, Chinese clinical trial registry, American clinical trial registry and cardiovascular related websites until September 2020 were retrieved for collecting the randomized controlled trials (RCT) comparing DCB versus conventional balloon in the treatment of coronary de novo bifurcation lesions. The risk of bias of included studies was assessed using the Cochrane risk assessment tool. The meta-analysis was performed by using Revman 5.3 and Stata 14.0 software. Results: Seven RCTs with a total of 613 patients were included in this meta-analysis. Among the included studies, 4 articles reached the low risk of bias, and the other 3 articles reached the medium risk of bias. The results of meta-analysis showed that there was no significant difference in the major adverse cardiac events (RR=0.65, 95%CI 0.39-1.08, P=0.10), myocardial infarction (RR=0.68, 95%CI 0.25-1.80, P=0.43), target lesion revascularization (RR=0.94, 95%CI 0.53-1.67, P=0.83) between DCB group and conventional balloon group. Late lumen loss of side branch was less in the DCB group than that in the conventional balloon group (WMD=-0.25, 95%CI -0.41--0.09, P<0.01) and the risk of side branch restenosis was also lower in the DCB group than that in the conventional balloon group (RR=0.47, 95%CI 0.22-0.98, P<0.05). However, subgroup analysis showed that the conclusions of domestic studies and foreign studies on late lumen loss and side branch restenosis were inconsistent. The meta-analysis based on domestic literature showed that the risk of side branch restenosis after DCB treatment was lower compared with conventional balloon group (RR=0.29, 95%CI 0.15-0.57, P<0.05), while this parameter derived from foreign literatures remained unchanged between two groups (P=0.53). The meta-analysis results of domestic literature showed that late lumen loss in DCB group was less than that in conventional balloon group (WMD=-0.32, 95%CI -0.51--0.13, P<0.05), but this phenomenon was not observed in foreign literatures (P=0.30). Conclusions: The use of DCB in the treatment of coronary de novo bifurcation lesions has the potential to reduce the rate of restenosis and late lumen loss of side branch compared with conventional balloon group. However, due to the limitation on quantity, quality and results of published studies, more high-quality and large scale RCTs are still needed to confirm these findings.

Evolutionary trends and diversity of major floral nectary types across Solanaceae.

In a co-evolutionary crosstalk amid plants and their pollinators, nectaries serve as a labile link between the relatively fixed structural domains of divergent flower forms and associated pollination syndromes. Floral nectary plays a crucial role in sexual plant reproduction by enabling interaction between plants and their pollinators. It is known to associate with different floral whorls, and exhibits variations in structure and location in different clades across angiosperms. To infer evolutionary patterns, it is important to map key features associated with the trait at various taxonomic ranks. In the present study, we analysed variability and distribution of floral nectaries in Solanaceae for the first time. Floral nectaries of 23 taxa representing different clades in the family were studied using bright-field and scanning electron microscopy. The study reveals that although floral nectaries share anatomical similarity, they differ in morphology, composition within cells, and locations within a flower across the clades. The analysis suggests that (i) there is a shift from symmetric, lobed type nectary in the early branching sub-families to asymmetric, annular type in the late branching ones, (ii) floral organization has shifted from asymmetry (zygomorphy) to symmetry (actinomorphy) in corolla, and (iii) the lobed nectary correlates with zygomorphic floral forms that are pollinated by birds and long-tongued vectors, while the annular nectary is predominant among species with bee-pollinated actinomorphic flowers.