Main Trunk Research Articles

Corneal Sensitivity and Neuropathy in Patients With Ocular Graft-Versus-Host Disease.

To assess corneal sensitivity changes in patients with ocular graft-versus-host disease using a non-contact and Cochet-Bonnet esthesiometer. In addition, we evaluate the association between corneal sensitivity and subbasal nerve changes and epitheliopathy in these patients. In this retrospective study, the clinical data and images were evaluated for 36 patients (19 female, 17 male) who fulfilled the inclusion criteria. The analyzed data included demographic and ocular surface parameters, including best-corrected visual acuity, corneal sensitivity with non-contact (mbar) and Cochet-Bonnet (cm) esthesiometer, corneal fluorescein staining (CFS) and symptoms scores, tear volume (Schirmer-I test, mm/5'), and subbasal nerve density (μm/mm2; assessed with in vivo confocal microscopy). The mean age of the study cohort was 59.9 ± 10.5 years. The mean corneal sensitivity assessed by Cochet-Bonnet and non-contact esthesiometer was 5.9 ± 0.3 cm and 7.3 ± 2.0 mbar, respectively. The ocular surface parameters included a corneal fluorescein staining (CFS) score, as per the National Eye Institute grading scheme, of 6.9 ± 3.5, and a Schirmer-I test result of 7.5 ± 6.2 mm/5 minutes.. Total corneal subbasal nerve density was inversely associated with CFS scores (r = -0.74; P < 0.001). Moreover, similar correlations between CFS scores and main trunk (r = -0.62; P < 0.001) and branch (r = -0.59; P < 0.001) nerve densities were observed. A significant correlation was found between reduced corneal sensitivity and higher CFS scores (r = 0.66; P < 0.001). Higher pressures were correlated with lower total (r = -0.83; P < 0.001), main trunk (r = -0.62; P < 0.001), and branch (r = -0.72; P < 0.001) nerve densities. The univariate analysis showed that corneal sensitivity loss (assessed with non-contact esthesiometer) was correlated with advanced age of the patients (P = 0.049) and inversely associated with total (P < 0.001), main trunk (P < 0.001), and branch (P < 0.001) nerve densities. In addition, sensitivity loss was inversely associated with punctal occlusion (cauterization (P = 0.001) or plug placement (P < 0.001). The multivariate analysis adjusted for age and punctal occlusion confirmed the associations in the univariate analysis. In this study, we observed that corneal sensitivity loss was associated with reduced main trunk, branch, and total nerve density in patients with ocular graft-versus-host disease. In addition, a significant correlation was observed between reduced corneal nerve density, corneal sensitivity, and severity of epitheliopathy.

Diversity and ecology of deadwood-inhabiting mushrooms in Yankari Game Reserve, North-East Nigeria

This study investigated the diversity and ecology of deadwood-inhabiting mushrooms in Yankari Game Reserve. Stratified random sampling was used for the data collection. A total of 23 different mushroom species belonging to 12 different families were found growing on deadwood in the study area, with Polyporaceae and Hymenochaetaceae as the most dominant mushroom families. The distribution, composition, and diversity of the different mushroom species differed according to their local habitats, growth substrate and tree species. The habitats with the highest mushroom species diversity were the Lowland Combretaceous Woodland, Pteleopsis habeensis Woodland. Their Shannon Index (H′) values were 2.31 and 1.96 respectively, and Simpson Index (D) values were 6.81 and 4.74, respectively. Their mushroom abundance was significantly (α = 0.05, p = 0.00) higher than that of Afzelia africana Woodland and Upland Combretaceous Woodland. The Main Trunk was the growth substrate with the highest H′ and D, which were 2.11 and 6.32, respectively; while the Branch had a significantly (α = 0.05, p = 0.00) higher abundance of mushrooms than the soil. Pteleopsis habeensis was the tree species that had the highest mushroom species richness and abundance with H′ (2.06) and D (5.07). The P. habeensis had significantly (α = 0.05, p = 0.00) higher mushroom abundance than all the rest of the thirteen different tree species. Trametes pubescens was the most abundant mushroom species, which was significantly (α = 0.05, p = 0.00) higher than the abundance of 10 species other mushroom species found in the study area. The result of this study can help forest managers conserve the diversity of deadwood-inhabiting mushrooms.

The Channel Branches &amp; Network Channels on the Tianhui Lacquered Meridian Figurine — Taking the Heart-Regulated Channel as an Example

Abstract: Along with the surge of unearthed medical literature and cultural relics in recent years, the network of channels in the system of medical channels (meridians) during the early Western Han dynasty have become much clearer gradually. Among them, the increasing number of channel branches, network channels and needle insertion holes (acupoints) is an important feature of the development of classical channel medicine during the Western Han dynasty. This is not only a reflection of the expanding requirements of the theoretical system of the main trunk channels, but also an inevitable result of the continuous enrichment and accumulation of clinical experience. This article integrates the information about channel branches, network channels, inscriptions, dots and further relics on the Tianhui (天回) Lacquered Meridian Figurine to compare the unearthed literature of the channel genre with the transmitted classical literature about acupuncture. The "Heart-Regulated Channel" in Medical Manuscripts on Bamboo Slips from Tianhui (《天回医简》) serves as an example to explain the occurrence, development and changes of the channel branches and network channels in the early system of medical channels.

Recordings of Superior Laryngeal Nerve Sensory Nerve Action Potentials in a Rat Model.

Superior laryngeal nerve (SLN) function is critical to laryngeal sensation. Sensory dysfunction in the larynx, mediated through the internal branch of the superior laryngeal nerve (iSLN), is thought to occur with aging and neurodegenerative disease. However, objective analysis of iSLN neurophysiology is difficult due to its anatomic location and small diameter. This study measures sensory nerve action potentials (SNAP) from the iSLN in a rat model. SNAP data were obtained from two adult rat strains (Sprague-Dawley, SD and Fischer 344 × Brown Norway F1 Hybrid rats, FBN). Evoked responses were obtained by stimulating the main trunk of the SLN and recording the response using a 160-μm cuff electrode placed around the iSLN. SNAP were averaged from 10 stimulations. Laryngeal adductor reflex (LAR) threshold measurements were obtained with stimulation of the iSLN and direct laryngoscopy. The sections of the iSLN were obtained for histologic analysis. SLN-evoked responses were successfully obtained in 18 hemi-laryngeal preparations (SD n = 13 and FBN n = 5) with corresponding LAR threshold measurements. Mean(±SD) SNAP latency, total duration, amplitude, negative durations, and intensity were 2.28 ms (±0.56), 2.13 ms (±0.70), 879 μV (±535), and 0.69 mA (±0.25), respectively. SLN stimulation threshold to elicit an LAR was of 0.84 mA (±0.31). It is feasible to record evoked SLN responses in two adult rat strains. This work may lead to a tractable animal model for objective measurements of SLN neurophysiology with various disease states. N/A Laryngoscope, 2024.

Control of Mal secco disease in lemon by drip irrigation with fungicide

Mal secco disease of citrus is caused by the mitosporic ascomycete fungus Plenodomus tracheiphilus (formerly Phoma tracheiphila [Petri]). Mal secco is a highly destructive vascular disease of lemon and other citrus which is presently confined to the Mediterranean basin and has a marked economic impact on the citrus industry. The fungal pathogen infects the host tree by penetrating through wounds in the roots or canopy. Infection spreads quickly into the main branches and trunk and tree mortality usually ensues. The most typical symptoms are veinal chlorosis, leaf wilt, red discoloration of the xylem and dieback of twigs and branches. Current accepted control of the disease is mainly by sanitation of infected wood, and copper application during the winter to prevent germinating spores from infecting the plant. No effective chemical control for this disease has been reported. We present a drip-irrigation protocol to protect trees and control the disease in which we apply 250 g/ha of the triazole fungicide flutriafol five times a year. Progression of disease symptoms in the treated trees was inhibited by up to 81% compared to the untreated control, thereby significantly shortening the sanitation process and making it less costly than in untreated trees. Moreover, disease symptoms became less severe as the duration of treatment increased. We have treated orchards for 3 years, and present an effective commercial protocol for the growers which will help them control Mal secco disease.

Characterization of the Posterior Femoral Cutaneous Nerve and Its Clinical Application for Autologous Breast Reconstruction

IntroductionAutologous breast reconstruction (ABR) uses a harvested tissue flap from the abdomen, posterior thigh, or buttocks to rebuild the breast postmastectomy. Identification of nerves for use in autologous sensate breast reconstruction flaps is an important surgical consideration as loss of breast sensation is a common risk of ABR. The posterior femoral cutaneous nerve (PFCN) and its branches supply sensory innervation to skin of the posterior thigh, leg, perineum, and buttocks, creating a feasible candidate for sensate profunda artery perforator (PAP) flaps for reestablishing breast sensation through ABR. This study characterized PFCN perforating branches located within the PAP flap region as compared to an anatomical landmark intersection (ALI). Twenty-three posterior thigh regions from 15 formalin-embalmed donors were dissected to the level of deep fascia to identify PFCN branches. PFCN branch diameter (mean, 1.34 ± 0.35 mm) and length (mean, 8.82 ± 5.78 mm) piercing the deep fascia were measured; branches were retro-dissected proximally to the PFCN trunk and the distance recorded (mean, 92.55 ± 38.00 mm). The distance to branch emergence from ALI (mean, 113.55 ± 19.80 mm) and from the midline of the posterior thigh (mean, 18.90 ± 11.17 mm) were calculated. Two-Tailed T-tests comparing the left and right limb of 7 donors determined bilateral, statistically significant difference between the length of branch emergence back to the main trunk of PFCN (P = .00). These findings illustrate the presence of adequate yet variable PFCN branches within the PAP flap region in regards to diameter, length, and location for use in sensate ABR.

Rare Case of a Left Anterior Descending to Main Pulmonary Trunk Fistula Presenting as Acute Coronary Syndrome

Rare Case of a Left Anterior Descending to Main Pulmonary Trunk Fistula Presenting as Acute Coronary Syndrome

Classification of anatomy and treatment approaches for aneurysms originating from the proximal of the A1 segment of the anterior cerebral artery in clinical settings.

To explore the spatial relationship between A1 segment proximal anterior cerebral artery aneurysms and their main trunks, classify them anatomically and develop targeted treatment strategies. This single-center retrospective analysis involved 39 patients diagnosed with aneurysms originating from the proximal of A1 segment of the anterior cerebral artery (2014-2023). Classify the patient's aneurysm into 5 types based on the location of the neck involving the carrier artery and the spatial relationship and projection direction of the aneurysm body with the carrier artery, and outcomes from treatment methods were compared. Among 39 aneurysms, 18 cases underwent endovascular intervention treatment, including 6 cases of stent assisted embolization, 1 case of flow-diverter embolization, 5 cases of balloon assisted embolization, and 6 cases of simple coiling. At discharged, the mRS score of all endovascularly treated patients was 0, and the GOS score was 5 at 6 months after discharge. At discharge, the mRS score of microsurgical clipping treated patients was 0 for 15 cases, 3 for 1 case, 4 for 1 case and 5 for 2 cases. Six months after discharge, the GOS score was 5 for 16 cases, 4 for 2 cases, 3 for 2 cases, and 1 for 1 case. GOS outcomes at 6 months were better for endovascularly treated patients (p = 0.047). Results showed better outcomes for the endovascular treatment group compared to microsurgical clipping at 6 months after surgery. The anatomical classification of aneurysms in this region may be of help to develop effective treatment strategies.

New 3-D Technologies in Salivary Gland Surgery: The Exoscope-Assisted Surgery for Treatment of Benign Tumors of Parotid Gland.

New technologies are increasingly widespread in medical practice. Particularly, the 3D view is considered among the most useful innovations for surgery. It allows the operator to reconstruct the patient's anatomy in his own mind, going beyond his personal imagination. In the last few years, a new facility has been experienced, it's the Exoscopy. Exoscopy is a magnified vision system, similar to Microscopy, but which also allows a tridimensional vision of the surgical anatomy. Despite Exoscopy having been used for years in Neurosurgery, it has been just rarely described in parotid surgery. We intend to report our experience with Exoscope Aesculap AEOS used to remove benign tumors of the parotid gland. We treated 14 patients with benign tumors of the parotid gland, since September 2023 to November 2023. Each surgery was conducted by the same expert surgeon which also reported his experience about intra-operative complications (as bleeding) in comparison to the traditional procedure without Exoscope. We evaluated the learning curve of Exoscope-Assisted Parotid Surgery comparing, among them, the operative times of the same procedures performed in chronological order. Each patient underwent the same follow-up which included three checks at one month, three months and six months. The follow-up was especially about the evaluation of palsy of the VII C.N. which was assessed through House-Brackmann score (H-B score). The results of our experience reports that the Exoscope is a useful tool for parotid gland surgery. It allows an excellent visualization of the facial nerve main trunk and its branches. Although the first procedures presented longer times in comparison to traditional surgery, the progressive reduction of the operative times demonstrates that the learning curve of Exoscopy is very fast. Certainly, more experience is required for the full introduction of Exoscopy in surgery practice of parotid gland but, now, its potentialities are highly exciting.

Efficacy and safety of hepatic arterial infusion chemotherapy combined with tyrosine kinase inhibitors and immune checkpoint inhibitors in the treatment of advanced hepatocellular carcinoma with portal vein tumor thrombosis in the main trunk.

To evaluate the efficacy and safety of mFOLFOX-based hepatic arterial infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) in the treatment of advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). This retrospective study included patients who received mFOLFOX-based HAIC combined with TKIs and ICIs from January 2021 to January 2023. The primary outcome was the objective response rate of PVTT response, and the secondary outcomes were 6-month, 1-year survival rate, overall survival (OS), and corresponding adverse events and complications were also evaluated. PVTT responses were assessed using ITK-SNAP software. A total of 37 patients were included in the analysis, 18.92% achieved a complete response and 56.76% achieved a partial response in PVTT response. The objective response rate (ORR) of PVTT was 75.68%. The 6-month survival rate was 89%, the 1-year survival rate was 66%, and the median OS was 15.8 months. In univariate analysis, Child-Pugh score (P=0.010) was important factor for predicting OS; in multivariate analysis, Child-Pugh score (P=0.015, HR= 3.089, 95%CI: 1.250-7.633) was the important factor for predicting OS. In terms of adverse reactions, the most common adverse reactions associated with HAIC are pain and thrombocytopenia associated with oxaliplatin. FOLFOX-based HAIC combined with TKIs and ICIs induced an objective response rate of 75.68% in PVTT. FOLFOX-based HAIC combined with TKIs and ICIs provides more treatment options for PVTT.

The Treatment of Hepatocellular Carcinoma with Major Vascular Invasion.

Vascular invasion of hepatocellular carcinoma involves tumor plugs in the main trunk of the portal vein, bile ducts, and veins, and it indicates poor prognosis. It is often associated with portal hypertension, which requires evaluation and management. Treatment includes hepatic resection, systemic pharmacotherapy, hepatic arterial infusion chemotherapy, and radiation therapy. Recurrence rates post-hepatic resection are high, and systemic drug therapy often has limited therapeutic potential in patients with a poor hepatic reserve. Single therapies are generally inadequate, necessitating combining multiple therapies with adjuvant and systemic pharmacotherapy before and after hepatectomy. This narrative review will provide an overview of the treatment of hepatocellular carcinoma with vascular invasion.

Analysis of factors related to recanalization of portal vein thrombosis in liver cirrhosis: a retrospective cohort study

BackgroundPortal vein thrombosis (PVT) is a common complication of liver cirrhosis, yet there are fewer studies about predictors of PVT recanalization. We aimed to further explore the predictors of recanalization in cirrhotic PVT to facilitate accurate prediction of patients’ clinical status and timely initiation of appropriate treatment and interventions. To further investigate the benefits and risks of anticoagulant therapy in cirrhotic PVT patients.MethodsA retrospective cohort study of patients with cirrhotic PVT in our hospital between January 2016 and December 2022, The primary endpoint was to analyze predictors of PVT recanalization by COX regression. Others included bleeding rate, liver function, and mortality.ResultsThis study included a total of 82 patients, with 30 in the recanalization group and 52 in the non-recanalization group. Anticoagulation therapy was the only independent protective factor for portal vein thrombosis recanalization and the independent risk factors included massive ascites, history of splenectomy, Child-Pugh B/C class, and main trunk width of the portal vein. Anticoagulation therapy was associated with a significantly higher rate of PVT recanalization (75.9% vs. 20%, log-rank P < 0.001) and a lower rate of PVT progression (6.9% vs. 54.7%, log-rank P = 0.002). There was no significant difference between different anticoagulation regimens for PVT recanalization. Anticoagulation therapy did not increase the incidence of bleeding complications(P = 0.407). At the end of the study follow-up, Child-Pugh classification, MELD score, and albumin level were better in the anticoagulation group than in the non-anticoagulation group. There was no significant difference in 2-year survival between the two groups.ConclusionAnticoagulation, massive ascites, history of splenectomy, Child-Pugh B/C class, and main portal vein width were associated with portal vein thrombosis recanalization. Anticoagulation may increase the rate of PVT recanalization and decrease the rate of PVT progression without increasing the rate of bleeding. Anticoagulation may be beneficial in improving liver function in patients with PVT in cirrhosis.

Biopsy of the facial nerve in slow-onset facial palsy

IntroductionPrimary squamous cell carcinoma of the parotid gland typically presents as a palpable, often painless mass. Peripheral facial palsy as the only sign of malignant neoplasia is rare. In these cases, the diagnosis is regularly confirmed by radiological imaging followed by surgical exploration and biopsy. However, if there is no detection of malignant lesions and no evidence of a tumor, the reluctance to take a biopsy of an unremarkable nerve can lead to misdiagnoses.Case reportA 40-year-old female patient without medical history presented to our clinic with a complete right-sided peripheral facial palsy that had slowly progressed for 2.5 years. All other otorhinolaryngological examination findings were within normal limits. Magnetic resonance imaging examination of the head and neck and 18-fluorodeoxyglucose positron emission tomography showed unremarkable results. We proceeded with surgical exploration, which revealed no evidence of a tumor and an externally completely unremarkable facial nerve. A biopsy from the main trunk area of the nerve revealed an infiltration by a squamous cell carcinoma. Total parotidectomy with resection and reconstruction of the facial nerve and neck dissection was performed. Considering the absence of a primary tumor and other tumor formations the diagnosis of a completely regressive primary squamous cell carcinoma of the parotid gland was confirmed.ConclusionIn conclusion, in the case of slow-onset peripheral facial palsy that persists without signs of recovery, a gadolinium-enhanced MRI should be performed. If imaging is unremarkable and there is no primary tumor detection along the course of the facial nerve, a surgical exploration with biopsy of the facial nerve is necessary.

Brain lymphatic vessels accompanying meningeal arteries in the human

IntroductionRecent studies showed the connection between cerebrospinal fluid (CSF) and deep cervical lymph nodes (dCLN) via lymphatic vessels (LV)s. These LVs accompany dural sinuses, cranial nerves, and arteries. The present study aimed to show in addition to the main trunk of the middle meningeal artery (MMA) whether the anterior and posterior branches of MMA; the anterior (AMA) and posterior (PMA) meningeal arteries also have a role in brain lymphatic drainage in humans. Materials and methodSamples of the middle meningeal artery (MMA) and its two main branches (anterior and posterior), anterior and posterior meningeal arteries (AMA and PMA) were obtained from 3 cadavers and 6 autopsies. Podoplanin (PDPN) (lymphatic endothelial marker) and CD31 (vascular endothelial marker) immunohistochemistry (IHC) were applied to 5 μm thick transverse sections and counterstained with hematoxylin. Furthermore, western blotting techniques were applied to the same tissue samples in 3 autopsy cases to demonstrate the presence of PDPN. ResultsWe observed the presence of the LVs along the main trunk of MMA and its two branches, AMA, and PMA. The LVs along the MMA (main trunk) had a larger diameter range than its branches and the AMA and PMA. The diameter of LVs of the PMA was larger than AMA. Furthermore, fluid channels with varying diameters and densities were closely localized to the LVs. The western blot PDPN protein expression confirmed IHC results. ConclusionThe LVs along the main trunk, anterior and posterior branches of the MMA, AMA, and PMA also provide an extracranial pathway for thought drainage of waste from the brain tissue in humans. Thus, the organization of the extracranial transport of LVs of the brain should be well-defined for understanding the role of lymphatic drainage in various neurological diseases.

The sex prevalence of lower limb varicose vein networks

ObjectiveTo determine the sex prevalence of lower limb varicose networks fed by reflux of the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein singularly or in combination. MethodsWe scanned by the means of the same color Doppler ultrasound protocol 3000 lower limbs in 1500 consecutive patients, affected by symptomatic chronic venous insufficiency from 2013 to 2023. Limbs with normal venous function, incomplete scans, or that were affected by post-thrombotic syndrome, pelvic reflux, isolated perforator reflux, venous malformation, phlebolymphedema and Clinical, Etiological, Anatomical, Pathophysiological clinical class C5 and C6 were excluded from the final analysis. ResultsOverall, 1072 patients—252 (23.5%) males and 820 (76.5%) females (P < .0001) matched for age (P = .692)—were included in the study for a total of 1956 limbs affected by primary chronic venous insufficiency, clinical class C2 to C4. The main finding was the significant prevalence of varicose networks fed by reflux of the AASV alone (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.26-3.06; P = .001) or combined with GSV (OR, 1.84; 95% CI, 1.34-2.52; P = .0002) in females. In contrast, GSV insufficiency alone was significantly prevalent in males (OR, 0.54; 95% CI, 0.43-0.68; P < .0001). No significant sex differences regarding SSV reflux were detected. Moreover, we considered the presence of competent terminal valve (TV+) at the level of the saphenofemoral junction, which resulted more significantly present in female (OR, 1.57; 95% CI, 1.12-2.19; P = .0083); to the contrary incompetent terminal valve (TV−) was more common in males (OR, 0.64; 95% CI, 0.46-0.89; P = .0083). Finally, considering reflux in the AASV territory in the presence of a TV+, a strong prevalence in females was detected (OR, 2.28; 95% CI, 1.48-3.52; P = .0002), whereas males developed reflux along the GSV when a concomitant TV− was present (OR, 0.62; 95% CI, 0.41-0.94; P = .0244). ConclusionsThe analysis of the lower limb varicose networks highlights that reflux along the AASV alone, in presence of a TV+ at the junction or coupled with GSV insufficiency, is more prevalent in females. In contrast, GSV resulted the main trunk feeding varicose veins in males, in particular when a TV− was detected. Our findings suggest that females could be more prone to developing varicose veins with an ascending mechanism, whereas in males the descending one seems to be more common.

A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer

BackgroundThe preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential “hernia ring,” increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue.MethodsThis new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the “hernia ring” to preserve the connective tissue between the “hernia ring” and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients’preoperative baseline characteristics and intraoperative, postoperative complications were examined.ResultsAll patients’ potential “hernia rings” were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30–90). The total harvested lymph nodes was 13.0(range12−19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed.ConclusionsThis technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.

Deciphering Transcriptomic and Metabolomic Wood Responses to Grapevine Trunk Disease-Associated Fungi

Esca is one of the main grapevine trunk diseases affecting vineyards worldwide. Phaeoacremonium minimum and Phaeomoniella chlamydospora are thought to be two of the main causal agents of this disease. However, the molecular mechanisms underlying plant defense responses in the grapevine trunk against esca-associated pathogens are poorly understood. To provide a first glimpse at the trunk responses to P. minimum and P. chlamydospora, transcriptomic and metabolomic analyses were performed to compare and contrast host responses to these pathogens. Transcriptomic analysis revealed different gene expression reprogramming in the trunk in response to each fungus. The main significant differences were found among genes associated with secondary metabolism, signaling, and hormone signaling. An untargeted liquid chromatography–high resolution mass spectrometry metabolomic approach performed 3 weeks after inoculation was used, and dereplication mainly highlighted flavonoids and stilbenes as plant defense metabolites in the infected trunk. Some metabolites were overproduced with both fungi, but specific responses were also observed. Particularly, a lipophilic flavonoid cluster was emphasized after P. minimum inoculation. The assessment of fungal infection 6 weeks postinfection showed more copies of P. minimum than P. chlamydospora. This dissimilarity in the level of colonization could be linked to the metabolomic responses observed. Our results reveal both different gene expression reprogramming and metabolomic-specific signatures depending on the wood pathogen. Altogether, these observations suggest that grapevine trunks can differently perceive and respond to P. minimum and P. chlamydospora. [Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .

Study of Left Coronary Artery and Its Variations: A Cadaveric Study from Gujarat Region

Background: A lot of variations have been analyzed in the case of the left coronary artery (LCA) which makes it a leading cause of death globally. Therefore, awareness of normal and variant anatomy of this artery in relation to its main trunk and branches is the key to physicians, cardiologists, and radiologists in the management of various cardiac pathologies. Materials and Methods: Eighty embalmed and formalin-fixed adult human cadaveric hearts of both genders with no history or signs of pathology were dissected meticulously during educational hours. Results and Conclusion: Among 80 hearts studied, 71 hearts left coronary ostia were located below the sinotubular junction. The mean distance of left coronary ostia from the supravalvular ridge lying above and below was 2.93 ± 0.39 mm and 2.72 ± 0.92 mm, respectively. The mean diameter of the left coronary ostium was 3.67 ± 0.94 mm. The mean length and diameter of the LCA main trunk (LCAMT) were 13.06 ± 2.42 mm and 4.93 ± 0.60 mm, respectively. The most common branching pattern of LCAMT was bifurcation. The most frequent range of length of left anterior descending (LAD) and circumflex (Cx) artery was 10–12 cm and 6.5–8 cm, respectively. The most common termination point of LAD was at the anterior one-third part of posterior interventricular sulcus and for Cx artery was between the crux and obtuse border of the heart. Right coronary dominance was the most common.

Вплив результатів внутрішньосудинного дослідження на безпосередній результат стентування основного стовбура лівої коронарної артерії

The purpose of the study is to optimize the immediate results of stenting of the main trunk of the left coronary artery (LCA) in patients with coronary heart disease (CHD) using intravascular imaging methods and modern technological approaches.Materials and methods. We present the experience of 186 consecutive patients with coronary artery disease in whom stenting of the Left Main (LM) coronary artery was performed.Results. Patients were divided into 2 groups – group I, «historical» (100 patients), where the intervention was performed without the use of intravascular imaging methods and proximal optimization methods (POT), and group II, which consisted of 86 patients in whom LM stenting was performed using intravascular imaging and modern methods of optimizing the stented segment. In general, groups I and II were comparable. About 20 % of patients had an isolated LM lesion. In other cases, according to the results of coronary angiography, multivessel lesions of the coronary vessels were recorded in the patients. The localization of the lesion was defined as ostial in 7.5 %, stem – 6.9 %, and distal with the involvement of LAD&amp;CX in 85.6 %. Stenting with 1 stent was used in 132 patients (71 % of cases).Analyzing the final size of the stented LM segment in the groups, we noticed, that in group I, this figure was 3.41±0.41 mm, while in group II it was 3.97±0.61 mm (p&lt;0.0001). In 3 patients of group I in 30 day period cardiac death were recorded, in the group II there were 2 (2.3 %) cases of LM dissection treated with additional stent implantation.In 3 patients (3 %) group I sudden cardiac death was registered in the 30-day period. In group II, there were 2 (2.3 %) cases of ossification, which were resolved by additional stent implantation.Conclusions. Intravascular imaging to assess the size and results of the intervention, as well as the use of the POT technique, significantly improves the positioning of the stent in the artery and provides a significantly larger diameter of the stented LM. Adequate optimization of the size of the stented LM can be obtained only with the help of intravascular imaging methods.

Simultaneous ST-elevation in lead augmented vector right (aVR) and III in non-ST-elevation acute coronary syndromes.

The value of ST-elevation in lead augmented vector right (aVR) remains controversial in clinical practice. This study aimed to investigate the association of simultaneous ST-elevation in lead aVR and III with angiographic findings and clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS). In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms. A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26). The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.