Site Of Origin Research Articles

Optimizing electrophysiology studies to prevent sudden cardiac death after myocardial infarction.

This study assessed associations of minimum final extrastimulus coupling interval utilized within electrophysiology study (EPS) after myocardial infarction (MI) and possible site of origin of induced ventricular tachycardia (VT) with long-term occurrence of spontaneous ventricular tachyarrhythmia and long-term survival. This prospective study recruited consecutive patients with left ventricular ejection fraction (LVEF) ≤ 40% who underwent EPS days 3-5 after MI between 2004 and 2017. Positive EPS was defined as sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter duration if haemodynamic compromise occurred. Each of the four extrastimuli was shortened by 10 ms at a time, until it failed to capture the ventricle (ventricular refractoriness) or induced ventricular tachyarrhythmia. Outcomes included spontaneous ventricular tachyarrhythmia occurrence and all-cause mortality. Shorter coupling interval length of final extrastimulus that induced VT was associated with higher risk of spontaneous ventricular tachyarrhythmia (P < 0.001). Significantly higher rates of spontaneous ventricular tachyarrhythmia (65.2% vs. 23.2%; P < 0.001) were observed for final coupling interval at EPS <200 ms vs. >200 ms. Right bundle branch block (RBBB) morphology of induced VT, with possible site of origin from the left ventricle, was associated with all-cause mortality [hazard ratio (HR) 3.2, P = 0.044] and a composite of spontaneous ventricular tachyarrhythmia recurrence or mortality (HR 1.8, P = 0.043). Ventricular tachycardia induced with shorter coupling intervals was associated with higher risk of spontaneous ventricular tachyarrhythymia on follow-up, indicating that the final extrastimulus coupling interval at EPS early after MI should be determined by ventricular refractoriness. Induced VT with possible origin from left ventricle was associated with increased risk of spontaneous ventricular tachyarrhythmia recurrence or death.

Paced P-wave morphology templates to guide atrial tachycardia localization: A derivation and validation study.

Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). We aimed to construct 12-lead ECG templates for P-wave morphology (PWM) during endocardial pacing from different sites in both atria in patients with no apparent structural heart disease (derivation cohort), with the goal of creating a localization algorithm, which could subsequently be validated in a cohort of patients undergoing catheter ablation of focal AT (validation cohort). We prospectively enrolled consecutive patients who underwent electrophysiology study, had no structural heart disease and no atrial enlargement. Atrial pacing, at twice diastolic threshold, was carried out at different anatomical sites in both atria. Paced PWM and duration were assessed. An algorithm was generated from the constructed templates of each pacing site. The algorithm was applied on a retrospective series of successfully ablated AT patients. Overall and site-specific accuracy were determined. Derivation cohort included 65 patients (25 men, age 37±13 years). Atrial pacing was performed in 1025 sites in 61 patients (95%) in RA and in 15 patients (23%) in LA. The validation cohort included 71 patients (28 men, age 52±19 years). AT were right atrial in 66.2%. The algorithm successfully predicted AT origin in 91.5% of patients (100% in LA and 87.2% in RA). It was off by one adjacent segment in the remaining 8.5%. A simple ECG algorithm based on paced PWM templates was highly accurate in localizing site of origin of focal AT in patients with structurally normal hearts.

Proximal forearm nerve branching patterns: an anatomical study and its clinical significance.

The aim of this study was to add to the understanding of nerve branching patterns in the proximal forearm and consider optimal nerve transfer options to address the various injuries that affect the function of the upper extremity. Eleven upper-extremity cadaveric specimens were dissected to expose the radial, median, and ulnar nerves in the proximal forearm. The site of origin of nerve branches from the major nerves was assessed, with measurements made in reference to the lateral epicondyle for the radial nerve branches and the medial epicondyle for the median and ulnar nerve branches. The distances to where these branches entered their respective muscles (muscle entry point) were assessed using the same landmarks. To plan a transfer, the length of the nerve branches was then calculated as the difference from the apparent origin from the main nerve trunk to the location where the nerve entered the muscle. Importantly, the nerve branch origin was established as the location of obvious separation from the main nerve trunk without additional fascicular dissection from the major nerve trunk. The number of branches was determined, and the diameter for each branch was measured using a Vernier caliper. The radial nerve branch to the extensor carpi radialis brevis (ECRB) muscle had an average length of 50.7 mm and average diameter of 1.6 mm. The mean medial and lateral lengths of the radial branches to the supinator muscle were found to be 22.2 mm (diameter 1.4 mm) and 15.3 mm (diameter 1.3 mm), respectively. The anterior interosseous nerve (AIN) branch of the median nerve was found 67.8 mm distal to the medial epicondyle with a diameter of 2.3 mm. The flexor carpi ulnaris (FCU) muscle innervation from the ulnar nerve was provided by 3 or 4 branches in most specimens. The second and third of these branches were the longest, with means of 30.5 mm (diameter 1.4 mm) and 30.7 mm (diameter 1.3 mm), respectively. While there is variability of the nerve branching pattern in the proximal forearm between specimens, the authors provide evidence of commonalities (branching patterns and distances) that can facilitate planning for upper-extremity nerve reconstructions. Importantly, all measurements are provided with reference to easily identified bony landmarks and to their muscle entry points to aid operative decision-making. These data complement the growing practice of nerve transfers in the upper extremity for a variety of pathologies.

Investigating supraventricular tachyarrhythmias on cardiac electrophysiology: A basic introduction

Abstract Interest in cardiac electrophysiology is increasing in sub Saharan Africa, but the interpretation of results is poorly understood. Cardiac electrophysiology is the study of the electrical activity of the heart by virtue of catheters that are positioned in the heart in addition to leads placed on the chest surface. It is useful in identifying sites of origin of various cardiac arrhythmias, diagnosing conduction abnormalities, and treating various arrhythmias. This is the second in a series reviewing cardiac electrophysiology methods. The first introduced cardiac electrophysiology and assessment of the sinus and atrioventricular nodes. This paper reviews the assessment of supraventricular tachycardias.

A descriptive study of weaned piglet transport practices in Alberta, Ontario, and Saskatchewan, Canada between 2014 and 2018.

Canadian transport practices for shipments of newly weaned piglets are not well-described despite documentation requirements for those conducting the movement of these animals. The objective of this study was to describe the characteristics of weaned piglet transport events that occurred between 2014 and 2018 using records provided by five Canadian swine companies. Following cleaning and validation, the dataset included records from 6203 transport events involving the transport of approximately 6.9 million piglets (5.7kg, 4.1-7.9kg) from 62 origin sites in Alberta, Ontario, or Saskatchewan, Canada. This represents approximately 4.7% of the piglets estimated to have been weaned in Canada between 2014 and 2018, and 1.7% of sow farms in Canada according to 2016 National census data. Most transport events ended at farms in Canada (71.3%), while the remaining delivered piglets to one of eight American states. The predominant trailer types used were Straightdeck (51.4%) and Potbelly (36.6%), but this did not reflect the number of piglets transported as Potbelly trailers have greater load capacity. Transport events most frequently involved loading piglets from one origin barn and delivering them to a single destination barn (78.1%). Only transport events involving export to the United States picked up piglets from, or delivered them to, more than one farm site. Most transport events had very short trip distances (median distance: 48.0km; IQR: 497.0), but a marked range was observed (1.8-2931.2km). Average daily temperature data matched to the transport records by origin and destination location demonstrated ambient environmental conditions during these transport events ranged from -30.3-28.7°C. Overall, less than 10% of transport events had mortality occur. Comparable with other observational studies documenting weaned piglet mortality, the average in-transit mortality rate observed over the multiple seasons, companies, trip distances, and other characteristics in this dataset was 0.027%. However, instances of mortality over 1% did sporadically occur and could translate to considerable losses given the large load sizes common for piglets of this age and size (median load size: 1105 piglets; IQR: 1036 piglets). These data provide a better understanding of the interconnectedness of the Canadian swine industry as well as common transport practices which may inform future research on disease transmission in swine transport networks, or piglet welfare during transport. Additionally, variables that were not present in this dataset that would further strengthen these types of investigations are highlighted (e.g., space allowance).

Craniofacial malignant tumors, their extensions, and surgical strategy for their treatment

Purpose: To identify extension routes of craniofacial malignancies and formulate a surgical treatment plan based thereupon. Material and Methods: We retrospectively reviewed the medical records of 253 patients with craniofacial malignancies who underwent surgical treatment at the Romodanov Neurosurgery Institute from 2002 through 2022. Of the 253 patients, 112 had a primary tumor, and 141, a secondary tumor. Preoperative Karnofsky performance scores ranged from 50 to 70 points. Patients underwent neurological and ophthalmological status assessment, as per routine protocols. Results: Epithelial malignancies were the most common (53.7%), whereas anaplastic meningioma and embryonal malignancies were rather uncommon (1.2% and 0.4%, respectively) craniofacial malignancies. The presence of certain clinical symptoms was associated primarily with tumor origin and extension. A high rate of general brain and rhinological symptoms in our study sample was caused by a high percentage of intracranial and paranasal sinus tumors. Craniofacial malignancies most commonly originate from the midline (particularly, anterior midline skull base). Ethmoidal labyrinth was the most common site of origin (45.0%), followed by a sphenoid sinus (12.2%), pterygopalatine and infratemporal fossae (9.9%), whereas the cavernous sinus and olfactory fossa were the least common sites of origin (0.4% and 1.2%, respectively). Craniofacial tumors extended most commonly intracranially (transdurally, epidurally, via adhesion to the dura mater, and/or cavernous sinus growth) or intraorbitally. Anterior craniofacial resection (bifrontal craniotomy with combined with either lateral rhinotomy or supraorbital advancement; or a subcranial approach) was the most common surgical treatment. Postoperative cerebrospinal fluid rhinorrhea and infectious complications (meningitis and meningoencephalitis) were the most frequent complications. The overall postoperative mortality rate was 2.0%. Conclusion: First, compared to the transcranial and facial approaches, the craniofacial resection is advantageous in terms of the radicality of tumor excision. Second, the subcranial approach is preferable to the bifrontal approach in the presence of marked extracranial tumor component, whereas the transbasal Derome approach is effective in the presence of marked extracranial and/or intracranial tumor components. Finally, both the orbitozygomatic and infratemporal approaches allow for the radicality of excision of lateral skull base malignancies, but the latter approach is associated with a lower rate of complications.

Flower and fruit formation of Hexachlamys edulis in Buenos Aires, Argentina

Hexachlamys edulis (O. Berg) Kausel &amp; D. Legrand, “ubajay” is a Myrtaceae species autochthonous of South America. It is a prominent species, with potentially nutraceutical fruits, leaves and other organs with important uses with great benefits for human health and new alternatives for production systems. Levels of polyphenols and pigments together with the antioxidant activity allow us to consider H. edulis fruit as a functional food. Nevertheless, there are not yet enough scientific studies on its physiology and productive capacity. The objectives of this work were i) describe the development of flower bud to mature fruit of H. edulis in the agro ecological conditions of the locality of Moreno (Buenos Aires provinc ); ii) study of pollination methods; iii), evaluate the floral phenology evolution and iv) compare the climatic conditions of Moreno (Buenos Aires province) with Federación (Entre Ríos province), which is the original place of the plants. Nine floral phenological stages (B, C, D, E, F1; F2, F3, G, H) have been recognized during the blooming period. Results of pollination treatments were very diverse. SP and CPS did not produce fruits while OP and CPA produced 5.6% and 20.0% respectively. Climatic condition of Moreno was very appropriate during the year 2018, when the levels of flower anthesis and fruit set were the highest. Fruits ripened during the last three weeks of December, without significant differences between 2019 and 2020. Despite the climatic differences between the site of origin and the experimental plot, it can be confirmed that the biological cycle of Hexachlamys edulis was perfectly fulfilled without anthropic intervention in the Moreno site, confirming that this species presents a high plasticity and that fruit production could be incremented with appropriate cultural practices.

The neuropathological landscape of Hispanic and non-Hispanic White decedents with Alzheimer disease

Despite the increasing demographic diversity of the United States’ aging population, there remain significant gaps in post-mortem research investigating the ethnoracial heterogeneity in the neuropathological landscape of Alzheimer Disease (AD). Most autopsy-based studies have focused on cohorts of non-Hispanic White decedents (NHWD), with few studies including Hispanic decedents (HD). We aimed to characterize the neuropathologic landscape of AD in NHWD (n = 185) and HD (n = 92) evaluated in research programs across three institutions: University of California San Diego, University of California Davis, and Columbia University. Only persons with a neuropathologic diagnosis of intermediate/high AD determined by NIA Reagan and/or NIA-AA criteria were included. A frequency-balanced random sample without replacement was drawn from the NHWD group using a 2:1 age and sex matching scheme with HD. Four brain areas were evaluated: posterior hippocampus, frontal, temporal, and parietal cortices. Sections were stained with antibodies against Aβ (4G8) and phosphorylated tau (AT8). We compared the distribution and semi-quantitative densities for neurofibrillary tangles (NFTs), neuropil threads, core, diffuse, and neuritic plaques. All evaluations were conducted by an expert blinded to demographics and group status. Wilcoxon’s two-sample test revealed higher levels of neuritic plaques in the frontal cortex (p = 0.02) and neuropil threads (p = 0.02) in HD, and higher levels of cored plaques in the temporal cortex in NHWD (p = 0.02). Results from ordinal logistic regression controlling for age, sex, and site of origin were similar. In other evaluated brain regions, semi-quantitative scores of plaques, tangles, and threads did not differ statistically between groups. Our results demonstrate HD may be disproportionately burdened by AD-related pathologies in select anatomic regions, particularly tau deposits. Further research is warranted to understand the contributions of demographic, genetic, and environmental factors to heterogeneous pathological presentations.

Spectrum of neuroendocrine neoplasms of GIT – a histomorphological study in a tertiary care centre

Background. Neuroendocrine neoplasms are diverse in terms of sites of origin, functional status, and degrees of aggressiveness. Since neuroendocrine cells are ubiquitous in the human body, these neoplasms can arise in different organs, with gastrointestinal tract being most frequently involved. The past few years have seen a surge in the diagnosis of these neoplasms, which were earlier considered to be rare. Their nomenclature, classification, and diagnostic criteria are revamped frequently, as new knowledge emerges. Aim. To study the histopathological spectrum of neuroendocrine neoplasms of gastrointestinal tract and assess the immunohistochemical expression of neuroendocrine markers in them. Material and methods. Ours is a descriptive study of the distribution and pathologic characteristics of gastrointestinal neuroendocrine neoplasms in a tertiary care hospital in Kerala, over a three year period. Neoplasms were categorised based on 2019 updated WHO classification. Results. Among the 59 cases, we observed a male predominance. (Male to female ratio - 1.8:1). Most patients were in 6th and 7th decades of life. Duodenum was most frequently involved followed by rectum and appendix. NET G2 and G1 constituted the predominant histologic grades (47% and 24% respectively). NEC and MiNEN were infrequent. All cases were positive for synaptophysin, with variable positivity for chromogranin. Ki67 helped establish the histologic grade. We also came across a rare case of neuroendocrine tumor with coexisting mucinous neoplasm in appendix. Conclusions. With evolving knowledge and advanced imaging modalities, the incidence of these neoplasms is increasing with time. Histopathology is the mainstay of diagnosis and plays a decisive role in influencing management protocols and prognosis.

Does Diffusely Infiltrating Lobular Carcinoma of the Breast Arise from Epithelial-Mesenchymal Hybrid Cells?

Classic diffusely infiltrating lobular carcinoma has imaging features divergent from the breast cancers originating from the terminal ductal lobular units and from the major lactiferous ducts. Although the term "invasive lobular carcinoma" implies a site of origin within the breast lobular epithelium, we were unable to find evidence supporting this assumption. Exceptional excess of fibrous connective tissue and the unique cell architecture combined with the aberrant features at breast imaging suggest that this breast malignancy has not originated from cells lining the breast ducts and lobules. The only remaining relevant component of the fibroglandular tissue is the mesenchyme. The cells freshly isolated and cultured from diffusely infiltrating lobular carcinoma cases contained epithelial-mesenchymal hybrid cells with both epithelial and mesenchymal properties. The radiologic and histopathologic features of the tumours and expression of the mesenchymal stem cell positive markers CD73, CD90, and CD105 all suggest development in the direction of mesenchymal transition. These hybrid cells have tumour-initiating potential and have been shown to have poor prognosis and resistance to therapy targeted for malignancies of breast epithelial origin. Our work emphasizes the need for new approaches to the diagnosis and therapy of this highly fatal breast cancer subtype.

Improving localization accuracy for non-invasive automated early left ventricular origin localization approach.

Background: We previously developed a non-invasive approach to localize the site of early left ventricular activation origin in real time using 12-lead ECG, and to project the predicted site onto a generic LV endocardial surface using the smallest angle between two vectors algorithm (SA). Objectives: To improve the localization accuracy of the non-invasive approach by utilizing the K-nearest neighbors algorithm (KNN) to reduce projection errors. Methods: Two datasets were used. Dataset #1 had 1012 LV endocardial pacing sites with known coordinates on the generic LV surface and corresponding ECGs, while dataset #2 included 25 clinically-identified VT exit sites and corresponding ECGs. The non-invasive approach used "population" regression coefficients to predict the target coordinates of a pacing site or VT exit site from the initial 120-m QRS integrals of the pacing site/VT ECG. The predicted site coordinates were then projected onto the generic LV surface using either the KNN or SA projection algorithm. Results: The non-invasive approach using the KNN had a significantly lower mean localization error than the SA in both dataset #1 (9.4 vs. 12.5mm, p < 0.05) and dataset #2 (7.2 vs. 9.5mm, p < 0.05). The bootstrap method with 1,000 trials confirmed that using KNN had significantly higher predictive accuracy than using the SA in the bootstrap assessment with the left-out sample (p < 0.05). Conclusion: The KNN significantly reduces the projection error and improves the localization accuracy of the non-invasive approach, which shows promise as a tool to identify the site of origin of ventricular arrhythmia in non-invasive clinical modalities.

Vieussens' Arterial Ring: Historical Background, Medical Review and Novel Anatomical Classification.

In coronary artery disease, the presence of Vieussens' arterial ring (VAR), a ring-shaped anastomosis between the conus branch of the right coronary artery with the left anterior descending artery (LAD), will allow blood flow to return to the obstructed coronary system. We have conducted a literature review, aiming to collect all the existing information about the documented VAR cases and any related pathological conditions. A total of 54 studies entered the review, including 56 patients. The mean age of the patients was 56.12 ± 16.2 years. Angina was present in 53.6% of the patients, with 7.2% of the cases being asymptomatic. Coronary artery disease outweighed (58.9%) as the patients' most frequent diagnosis. We propose a novel VAR anatomical classification, based on the sites of origin and termination of its course, with six distinct types, for a better understanding and surgical management of VAR. Type IA, originating from the conus branch and terminating in the proximal segment of the LAD was most frequently reported (51.8%). The recognition and the subsequent evaluation of the ring's anatomy and course are crucial for a customized clinical intervention. When right and left coronary angiographies fail to reveal any collateral circulation, selective conus artery catheterization should be in order. The proposed classification offers a manageable and comprehensive context for the assessment, evaluation and planning of therapeutic strategies of VAR and sets a new terminology frame for treatment guidelines.

DP18 Extraocular sebaceous carcinoma in situ

Abstract Extraocular sebaceous carcinoma in situ (SCIS) is exceedingly rare with &amp;lt; 10 cases reported in the literature (Jeong KM, Seo JY, Kim A et al. Extraocular sebaceous carcinoma in situ concurrent with actinic keratosis: a case report and review of the literature. Korean J Dermatol 2021; 59:307–9). An 80-year-old man reported a 3-month history of a right forehead lesion that had been bleeding. This was a subtle 5 × 5 mm papule on clinical examination, and dermoscopy showed arborizing telangiectasia. Past medical history was significant for 20 basal cell carcinomas, one squamous cell carcinoma, Bowen disease and actinic keratoses. Histology showed sun-damaged skin with a partially eroded neoplasm of lobular architecture, with surface and infundibular epithelium containing atypical sebocytes and squamous cells with no infiltrative growth pattern, which was consistent with SCIS and was fully excised. Immunohistochemistry revealed patchy adipophilin and androgen receptor staining and stronger epithelial membrane antigen staining. Furthermore, there was preserved expression of MSH2, MSH6, MLH1 and PMS2. Sebaceous carcinoma in situ is a debated entity not formally recognized in the classification of sebaceous neoplasms. Kazakov et al. reported five cases of dermal sebaceous tumours with ‘benign’ architectural features (well-circumscribed and no evidence of invasion) but with cytological atypia (abnormal mitoses and pleomorphism) (Kazakov D, Kutzner H, Spagnolo DV et al. What is extraocular cutaneous sebaceous carcinoma in situ? Am J Dermatopathol 2010; 32:857–8). The authors questioned whether these cases represented sebaceous adenomas with atypia or sebaceous carcinomas (Kazakov et al.). In response, it has been argued that such architectural–cytological discordant tumours can be regarded as SCIS owing to the fact that, by definition, carcinoma in situ is a cancer that remains wholly at the site of origin. However, it is argued that these lesions have an unclear origin and may not arise from sebaceous glands in the skin, unlike the more common aggressive periorbital sebaceous carcinomas that arise from meibomian glands and glands of Zeis (Kazakov et al.). It has been postulated that a SCIS diagnosis should be reserved for intraepidermal tumours not extending beyond the epidermal basement membrane, which is a vanishing minority of sebaceous neoplasms (Kazakov et al.). Similar to our case, a 2021 case report identified SCIS without any connection to an adnexal component but concurrent with actinic keratosis. These authors proposed that the tumour cells of intraepidermal squamous neoplasia can differentiate towards malignant sebocytes (Jeong et al.). Although controversial, SCIS appears to have reasonable, clear histological criteria for diagnosis and an excellent prognosis, with no reports of recurrence following surgical excision. We feel it is important to increase identification to avoid the overtreatment of such lesions.

Microinjection of NMDA-neurotoxin into the superior salivatory nucleus of the rat: Short-term secretory and long-term drinking behavior effects

The anatomical location of the superior salivatory nucleus (SSN), the site of origin of the parasympathetic preganglionic cell bodies that innervate the submandibular-sublingual salivary glands, is well established in rats. However, as of yet there is no functional data that convincingly shows the secretory nature of this region. Previous studies have not been able to differentiate between interventions on efferent or afferent fibers connected to the SSN versus interventions on the salivatory nucleus itself. Taking advantage of the fact that salivatory neurons express NMDA-receptors on their somas, in the present study SSN cell bodies were activated and lesioned sequentially by means of intracerebral application of NMDA-neurotoxin. In exp. 1 two effects, a short- and a long-term effect, were observed following NMDA administration. The first effect was high submandibular-sublingual saliva secretion during the hour following administration of the neurotoxin and the second was a profound change in drinking behavior once the animals recovered from the lesion. Thus, on post-surgery days 16, 17 and 18, the rats exhibited hyperdipsia in the presence of dry food but not in the presence of wet food. In expt. 2 results showed that saliva hypersecretion observed after NMDA-microinjection was completely blocked by the administration of atropine (a cholinergic blocker) but not after the administration of dihydroergotamine plus propranolol (α and β-adrenergic blockers, respectively). From a functional perspective, these data suggest that the somata of the parvocellular reticular formation control the secretory activity of the submandibular-sublingual salivary glands and thus constitute the SSN.

Leaf spectroscopy of resistance to Ceratocystis wilt of 'Ōhi'a.

Plant pathogens are increasingly compromising forest health, with impacts to the ecological, economic, and cultural goods and services these global forests provide. One response to these threats is the identification of disease resistance in host trees, which with conventional methods can take years or even decades to achieve. Remote sensing methods have accelerated host resistance identification in agricultural crops and for a select few forest tree species, but applications are rare. Ceratocystis wilt of 'ōhi'a, caused by the fungal pathogen Ceratocystis lukuohia has been killing large numbers of the native Hawaiian tree, Metrosideros polymorpha or 'Ōhi'a, Hawaii's most common native tree and a biocultural keystone species. Here, we assessed whether resistance to C. lukuohia is detectable in leaf-level reflectance spectra (400-2500 nm) and used chemometric conversion equations to understand changes in leaf chemical traits of the plants as indicators of wilt symptom progression. We collected leaf reflectance data prior to artificially inoculating 2-3-year-old M. polymorpha clones with C. lukuohia. Plants were rated 3x a week for foliar wilt symptom development and leaf spectra data collected at 2 to 4-day intervals for 120 days following inoculation. We applied principal component analysis (PCA) to the pre-inoculation spectra, with plants grouped according to site of origin and subtaxon, and two-way analysis of variance to assess whether each principal component separated individuals based on their disease severity ratings. We identified seven leaf traits that changed in susceptible plants following inoculation (tannins, chlorophyll a+b, NSC, total C, leaf water, phenols, and cellulose) and leaf chemistries that differed between resistant and early-stage susceptible plants, most notably chlorophyll a+b and cellulose. Further, disease resistance was found to be detectable in the reflectance data, indicating that remote sensing work could expedite Ceratocystis wilt of 'ōhi'a resistance screenings.

Plasticity in plant defense and the role of phytochemical dissimilarity in limiting specialist herbivory

Phytochemical diversity is an effective plant defensive attribute, but much more research has focused on genetic and environmental controls of specific defensive compounds than phytochemical diversity per se. Documenting plasticity in phytochemical richness and plant chemical composition as opposed to individual compounds is important for understanding plant defense. This study outlines a multi-site transplant experiment in Cerrado gallery forests in central Brazil, utilizing Piper arboreum (Piperaceae), a prevalent and widespread neotropical shrub. Clones from four distinct populations were planted either at their origin site or in a different forest. Secondary metabolite composition varied between populations initially and then changed after transplanting. Interestingly, clones with chemical profiles that were distinct from the populations where they were introduced experienced reduced specialist chrysomelid herbivory compared to clones that were more chemically similar to the existing P. arboreum populations where they were planted. Specialist Lepidoptera herbivory also declined in clones transplanted to a new forest, but this change could not be ascribed to chemical profiles. In contrast, generalist herbivory was unaffected by chemical dissimilarity and transplanting. This research adds to the expanding body of evidence suggesting that phytochemical diversity is a dynamic trait exerting unique effects on different herbivore guilds.

Multi-cancer early detection test in symptomatic patients referred for cancer investigation in England and Wales (SYMPLIFY): a large-scale, observational cohort study

Analysis of circulating tumour DNA could stratify cancer risk in symptomatic patients. We aimed to evaluate the performance of a methylation-based multicancer early detection (MCED) diagnostic test in symptomatic patients referred from primary care. We did a multicentre, prospective, observational study at National Health Service (NHS) hospital sites in England and Wales. Participants aged 18 or older referred with non-specific symptoms or symptoms potentially due to gynaecological, lung, or upper or lower gastrointestinal cancers were included and gave a blood sample when they attended for urgent investigation. Participants were excluded if they had a history of or had received treatment for an invasive or haematological malignancy diagnosed within the preceding 3 years, were taking cytotoxic or demethylating agents that might interfere with the test, or had participated in another study of a GRAIL MCED test. Patients were followed until diagnostic resolution or up to 9 months. Cell-free DNA was isolated and the MCED test performed blinded to the clinical outcome. MCED predictions were compared with the diagnosis obtained by standard care to establish the primary outcomes of overall positive and negative predictive value, sensitivity, and specificity. Outcomes were assessed in participants with a valid MCED test result and diagnostic resolution. SYMPLIFY is registered with ISRCTN (ISRCTN10226380) and has completed follow-up at all sites. 6238 participants were recruited between July 7 and Nov 30, 2021, across 44 hospital sites. 387 were excluded due to staff being unable to draw blood, sample errors, participant withdrawal, or identification of ineligibility after enrolment. Of 5851 clinically evaluable participants, 376 had no MCED test result and 14 had no information as to final diagnosis, resulting in 5461 included in the final cohort for analysis with an evaluable MCED test result and diagnostic outcome (368 [6·7%] with a cancer diagnosis and 5093 [93·3%] without a cancer diagnosis). The median age of participants was 61·9 years (IQR 53·4-73·0), 3609 (66·1%) were female and 1852 (33·9%) were male. The MCED test detected a cancer signal in 323 cases, in whom 244 cancer was diagnosed, yielding a positive predictive value of 75·5% (95% CI 70·5-80·1), negative predictive value of 97·6% (97·1-98·0), sensitivity of 66·3% (61·2-71·1), and specificity of 98·4% (98·1-98·8). Sensitivity increased with increasing age and cancer stage, from 24·2% (95% CI 16·0-34·1) in stage I to 95·3% (88·5-98·7) in stage IV. For cases in which a cancer signal was detected among patients with cancer, the MCED test's prediction of the site of origin was accurate in 85·2% (95% CI 79·8-89·3) of cases. Sensitivity 80·4% (95% CI 66·1-90·6) and negative predictive value 99·1% (98·2-99·6) were highest for patients with symptoms mandating investigation for upper gastrointestinal cancer. This first large-scale prospective evaluation of an MCED diagnostic test in a symptomatic population demonstrates the feasibility of using an MCED test to assist clinicians with decisions regarding urgency and route of referral from primary care. Our data provide the basis for a prospective, interventional study in patients presenting to primary care with non-specific signs and symptoms. GRAIL Bio UK.

Prognostic impact of morphology and duration of premature ventricular contractions in a population without structural heart disease.

Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavorable prognosis in patients with structural heart disease. It is unclear whether PVCs site of origin and QRS-width has a prognostic significance in patients without structural heart disease. The aim of this study was to assess the prognostic importance of PVCs morphology and duration in this patient group. We included 511 consecutive patients without a history of previous heart disease. They were examined with echocardiography and exercise test with normal findings. We categorized the PVCs from a 12 lead ECG according to morphology and width of the QRS-complex and analyzed the outcome in terms of a composite endpoint of total mortality and cardiovascular morbidity. During a median follow-up time of 5.3 years, 19 patients (3.5%) died and 61 (11.3%) met the composite outcome. Patients with PVCs originating from the outflow tracts had a significantly lower risk for the composite outcome compared to patients with non-OT-PVCs. Similarly, patients with PVC originating from the right ventricle had a better outcome than patients with left ventricular PCVs. No difference in outcome depending on QRS-width during PVCs was noticed. In our cohort of consecutively included PVC patients without structural heart disease PVCs from the outflow tracts were associated with a better prognostic outcome than non-OT PVCs; the same was true for right ventricular PVCs when compared to left ventricular ones. The classification of the origin of the PVCs was based on 12-lead ECG morphology. QRS-width during PVC did not seem to have prognostic significance.

Ancient river fishing utensils in the northwest of the Iberian Peninsula: the Miño river basin between the 4th century BC and the 4th century AD

This paper presents a brief overview of fishing in Galicia during Antiquity on the basis of fishing equipment—in particular hooks and weights—recovered from several sites of indigenous origin (castros or hill forts) and newly-established Roman settlements around the basin of the Miño river. Although the topic has often passed unnoticed by archaeological research and suffers from a distinct lack of literature to guide future efforts, the more or less recent publication of papers dealing with this topic in depth has facilitated the study of the Galician record, which is supported by literary and iconographic sources as well as ethnographic documents. The latter have proved relevant in this context, as the world of fishing tends to hold on to traditions. The author sets out to establish a correlation between the remains of fishing implements found and the possible fishing gear they would have been attached to.

A rare case of bilateral pulse granuloma of maxilla

Pulse or hyaline ring granulomas are rare but are well-defined oral and extraoral lesions due to implantation of the cellulose moiety of plant foods in contrast starch components. Implantation could be through extraction sockets, deep periodontal pockets, associated with tumor growth, interdental areas of teeth, unfilled root canals, and grossly decayed teeth. These get rapidly digested and altered by host responses. It is Microscopic oral inflammatory lesion characterized by the presence of giant cells and hyaline rings. The features of pulse granuloma are not considered clinically distinctive and remain primarily microscopic. Extensive knowledge of abnormal sites of origin and clinical manifestations enables clinicians to recognize the diagnostic risks of confusing pulse granuloma with other entities.