Slight Dilatation Research Articles

A brief look at sexual dimorphism in the midgut morphology of lower Diptera and its implications for hematophagy

The insect digestive system is divided into three sections: the foregut, the midgut, and the hindgut. Specific subdivisions and modifications in these regions can characterize distinct insect groups, representing apomorphies. Since only females of hematophagous insects from nematoceran Diptera feed on blood, nearly all studies have focused on specimens of this sex, often neglecting the studies on the males’ internal anatomy. In our studies of Lower Diptera (Nematocera) (Lutzomyia longipalpis Lutz & Neiva, 1912, Aedes aegypti Linnaeus, 1762, and Culex quinquefasciatus Say, 1823), we observed differences in midgut morphology between males and females. In hematophagous species, within both Culicomorpha and Psychodomorpha, females exhibit a prominent dilation in the posterior midgut. In contrast, in Culicomorpha males only a slight dilation in the posterior region of the midgut was observed. For Psychodomorpha males, the midgut remained tubular and narrow throughout its length. Interestingly, in the non-hematophagous insect Clogmia albipunctata Williston, 1893 (Diptera: Psychodidae) both males and females possess a tubular and narrow midgut. Our showed that the observed differences are related to hematophagy, where all hematophagous females have a midgut with prominent posterior dilation, while females from non-hematophagous species have a narrowed midgut. These observations, if further validated, could significantly impact future studies in insect physiology and evolutionary biology, inspiring new research directions and methodologies.

Assessing the Impact of Clove (Syzygium Aromaticum) Extract on Intestinal and Hepatic Histological Alterations in Broiler Chickens Infected with Salmonella typhimurium

This study investigated effects of aqueous and ethanolic clove extracts in small intestine and liver of chickens exposed to Salmonella typhimurium. Two hundred fifty-day-old chicks were divided into five groups. Group 1 served as the control and received a basic diet.Group 2 was orally infected with Salmonella typhimurium. Group 3 received same infection but was treated with Ciprofloxacin. Groups 4 and 5 were infected but received treatments of aqueous and ethanolic clove extracts, respectively. The findings revealed that Group 1 exhibited normal small intestine, while Group 2 displayed severe abnormalities, including flattened mucosa, damaged villi, and inflammation. Group 3 showed improvements, increased cell growth and goblet cells in the small intestine. Group 4 displayed nearly normal intestinal features. Group 5 had fully restored intestinal health. In the liver, Group 1 showed typical hepatic structure, whereas Group 2 exhibited signs of inflammation and hepatocyte necrosis. Group 3 displayed severe hepatocyte damage, while Group 4 demonstrated restored liver structure with slight sinusoidal dilation. Group 5 had a well-preserved hepatic architecture with minor inflammation. Administration of 2 mg/kg of aqueous and ethanolic clove extracts demonstrated alleviate histological alterations in small intestine and liver caused by Salmonella typhimurium infection. Notably, the aqueous extract is more effective than ethanolic extract in reducing liver and intestine damage.

A Novel Rat Model of Venous Hypertensive Myelopathy Produced by Arteriovenous Bypass Plus Venous Stenosis.

Venous hypertensive myelopathy (VHM), mainly induced by the spinal dural arteriovenous fistula, is a congestive spinal cord injury that currently has no appropriate animal model available in preclinical research. Sprague Dawley rats (280-320 g) were used. The rats were divided into 3 groups: (1) Group 1, which underwent renal artery-dorsal spinal venous bypass (AVB group); (2) Group 2, which underwent renal artery-dorsal spinal venous bypass and drainage vein stenosis (AVB/VS group); and (3) Control group, with T13 dorsal vein ligation. The success of the model was assessed using Doppler ultrasound and 7.0-T magnetic resonance imaging. Transmission electron microscopy, histochemistry, proteomics, and western blot analysis were used to evaluate ultrastructural, pathological, and molecular features in the spinal cord and cerebrospinal fluid (CSF). The success rate of the arteriovenous bypass was 100% at 5 days and 83% at 2 weeks. The locomotor assessment showed decreased lower extremity strength in the AVB/VS group ( P = .0067), whereas unremarkable changes were found in the AVB and Control groups. Histochemical staining suggested a 2-fold expansion of the dorsal spinal vein in the AVB/VS group, which was lower than that in the AVB group ( P < .05); however, the former displayed greater myelin and neuronal damage ( P < .05) and slight dilatation of the central canal ( P > .05). Proteomics analysis revealed that the complement and coagulation cascade pathways were upregulated in the CSF of AVB/VS rats, whereas the C3 level was elevated both in the CSF and bilateral spinal cord. Furthermore, overexpression of C3, ITGB2, and CD9 in the spinal cord was confirmed by immunoblotting. These findings suggest that the AVB/VS model can effectively mimic the clinical and molecular characteristics of VHM. Furthermore, they suggest that impaired deep intramedullary venous drainage is the key reason for the VHM.

Histological characterization of liver involvement in systemic mastocytosis.

Systemic mastocytosis (SM) is characterized by the accumulation of atypical mast cells (MCs) in organs. Liver histology of SM has been marginally described and accurate histological classification is critical, given the consequences of aggressive SM diagnosis. We aimed to describe the histological features associated with liver SM using updated tools. Using the database of the French Reference Centre for Mastocytosis, we retrospectively identified patients with a liver biopsy (LB) and a diagnosis of SM. All LB procedures were performed according to the local physician in charge and centrally reviewed by an expert pathologist. A total of 28 patients were included: 6 had indolent SM, 9 had aggressive SM, and 13 had SM with an associated hematologic neoplasm. Twenty-five (89%) patients presented hepatomegaly, and 19 (68%) had portal hypertension. The LB frequently showed slight sinusoid dilatation (82%). Fibrosis was observed in 3/6 indolent SM and in almost all advanced SM cases (21/22), but none of them showed cirrhosis. A high MC burden (>50 MCs/high-power field) was correlated with elevated blood alkaline phosphatase levels (p = .030). The presence of portal hypertension was associated with a higher mean fibrosis grade (1.6 vs. 0.8 in its absence; p = .026). In advanced SM, the presence of nodular regenerative hyperplasia (NRH) was associated with decreased overall survival (9.5 vs. 46.3 months, p = .002). MC infiltration induced polymorphic hepatic lesions and the degree of fibrosis is associated with portal hypertension. NRH identifies a poor prognosis subgroup of patients with advanced SM. Assessing liver histology can aid in SM prognostic evaluation.

Enforcing accurate volume conservation in VOF‐based long‐term simulations of turbulent bubble‐laden flows on coarse grids

AbstractThis study proposes two different strategies to enforce accurate volume conservation in volume‐of‐fluid (VOF)‐based simulations of turbulent bubble‐laden flows on coarse grids. It is demonstrated that, without a correction, minimal volume errors on a time‐step level, caused by the under‐resolution of the interface, can accumulate to significant deviations from the intended flow conditions despite the comparably good volume conservation properties of the geometric VOF method. In particular, large volume errors are observed for challenging setups combining coarse grid resolutions and comparably high Reynolds and Eötvös numbers. The problem is reinforced for long‐term simulations in periodic domains, which are often performed to collect flow statistics of bubbly flows. The first proposed volume conservation method simply corrects the volume error of a bubble by uniformly adding or removing the respective amount of gas volume in the interface cells. The second proposed method performs an additional reconstruction and advection step of the VOF field using a non‐divergence‐free velocity field, which can be interpreted as a slight dilatation or contraction of the bubble. A comparison between the global flow statistics as well as the individual bubble dynamics for both volume conservation methods reveals that the results are quasi‐identical for a number of challenging test cases, while the gas volume is accurately conserved. The proposed methods allow to perform numerical simulations of freely deformable bubbles in turbulent flows for setups that have previously been out of reach for this numerical framework.

Mechanisms of acupuncture for primary dysmenorrhea based on PI3K/Akt/mTOR signaling pathway in rats.

To observe the effect of electroacupuncture(EA) on phosphatidylinositol-3-kinases(PI3K)/protein kinase B(Akt)/mammalian target of rapamycin(mTOR) signaling pathway of uterus tissue in rats with primary dysmenorrhea(PDM), so as to investigate its mechanisms underlying improvement of PDM. Thirty healthy non-pregnant female SD rats were randomly divided into blank, model and EA groups, with 10 rats in each group. The PDM model was established by subcutaneous injection of estradiol diphenhydrate combined with intraperitoneal injection of oxytocin. For rats of the EA group, EA(50 Hz, a tolerable current intensity) was applied to "Guanyuan"(CV4) and bilateral "Sanyinjiao"(SP6) for 20 min, once a day for 10 consecutive days. The number of writhing, wri-thing score, and writhing latency were observed. The uterine histopathological changes were observed by H.E. staining, and the ultrastructural changes of uterine tissue cells in each group were observed by transmission electron microscopy. The contents of prostaglandin E2(PGE2), prostaglandin F2α(PGF2α) and ratios of PGF2α/PGE2 in the serum and uterine tissue were detected by ELISA. The relative expression levels of PI3K, Akt and mTOR and their phosphorylation proteins in the uterine tissue were detected by Western blot and the ratios were calculated. Compared with the blank group, the number and score of writhing, latency of writhing, pathological injury score, contents of PGF2α and ratios of PGF2α/PGE2 in the serum and uterine tissue, and the levels of p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR in the uterine tissue were significantly increased in the model group(P<0.01, P<0.05), while contents of PGE2 in the serum and uterine tissue were reduced(P<0.05). In comparison with the model group, the number of writhing and writhing score, pathological injury score, contents of PGF2α and ratios of PGF2α/PGE2 in both the serum and uterine tissue, the levels of p-PI3K/PI3K, p-Akt/Akt and p-mTOR/mTOR were obviously decreased(P<0.05, P<0.01), whereas the writhing latency was considerably prolonged in the EA group(P<0.01), with elevated contents of PGE2 in the serum and uterine tissue(P<0.05). H.E. staining showed slight dilation of uterine glandular cavity, and severe endometrial edema with extensive cell shedding and a large number of vacuole-like degeneration, apoptosis, pyknosis or fragmentation or disappearance of the nucleus, and neutrophil infiltration in the model group, which were relatively milder in the EA group. Ultrastructural results showed irregular fibroblasts of uterine tissue cells, obvious cytoplasmic edema, reduction in cytoplasmic electron density, seriously irregular nuclei, severe edema of mitochondria with dissolved matrix, fracture and disappearance of mitochondrial crests and vacuolation, and moderate dilation of rough endoplasmic reticulum in the model group, which were milder in the EA group. EA can improve pain and uterine inflammatory response in PDM rats, which may be associated with its functions in reducing uterine PGF2α and down-regulating PI3K/Akt/mTOR signaling.

Hexavalent chromium caused DNA damage repair and apoptosis via the PI3K/AKT/FOXO1 pathway triggered by oxidative stress in the lung of rat

Hexavalent chromium [Cr(VI)] is an occupational carcinogen that accumulates in the lungs and causes lung injury and even lung cancer. 36 SD male rats received inhalable intratracheal instillation of Cr(VI) (0.05, 0.25 mg Cr/kg) or the same volume (3 ml/kg) of normal saline weekly for 28 days (total 5 times). After 28 days of exposure, half of the rats in each group were sacrificed for investigation, and the rest stopped exposure and began to be self-repaired for two weeks. Histopathology analyses revealed that Cr(VI) induced slight dilatation and hemorrhage of perialveolar capillaries, pulmonary bronchodilation, and congestion with peripheral flaky-like necrosis accompanied by inflammatory cell infiltration, especially the 0.25 mg Cr/kg group. Cr(VI) exposure caused the increase of blood Cr, urinary Cr, MDA, urinary 8-hydroxy-2′ -deoxyguanosine (8-OHdG), and the decrease of GSH and MDA, while two-week repair only reduced urinary Cr. Exposure to Cr(VI) significantly upregulated FOXO1 and downregulated p-AKT and p-FOXO1 for two weeks. PI3K in the 0.25 mg Cr/kg group was inhibited after two weeks of repair. Cr(VI) exposure mainly promoted GADD45a and CHK2 in the exposure group, promoted Bim, Bax/Bcl-2, and suppressed Bcl-2 and Bcl-xL in the repair group. These results demonstrate that Cr(VI) may induce DNA damage repair and apoptosis in the lung by activating the PI3K/AKT/FOXO1 pathway. Two-week repair may alleviate oxidative stress and DNA damage induced by Cr(VI) exposure but couldn’t eliminate its effects. This study provides a new perspective for exploring the Cr(VI) induced lung cancer mechanism.

Visualized direct shear test of the interface between gravelly sand and concrete pipe

The shear stress–shear displacement relationship and shear strength parameters of the interface between the pipe and the surrounding soil are important for designing the jacking force. One most commonly used method to measure the shear strength of the pipe–soil interface is the direct shear test. This paper presents the results of a series of direct shear tests conducted in the laboratory on the pipe–soil interfaces for different moisture contents. Simultaneously, digital image correlation is used to supplement the research of the horizontal displacement field of the interface. The results show that the increase of normal stress will makes the interface more prone to strain hardening during the shearing process, and the influence of the change of specimen moisture content on the interface strain characteristics gradually weakens. The shearing process of the specimen mainly involved shearing contraction, and slight shear dilation occurs only when the moisture content is small. We proposed a unified model for describing the shear volumetric change caused by the combined action of moisture content and normal stress. The shear displacement field presents a layered distribution, which is related to the shear displacement corresponding to the shear stress.

P104 LASER BALLOON APPROACH FOR PULMONARY VEIN ISOLATION IN MARFAN SYNDROME

Abstract Background Marfan syndrome (MFS) is an autosomal dominant disorder of the connective tissue and it’s associated with an increased incidence of atrial fibrillation (AF), due to scar–mediated processes and sites of atrial ectopy. Limited data exist regarding ablation techniques in these patients. The frailty of atrial walls correlated to connective disease makes the ablation challenging with an increased risk of complications. Laser–balloon (LB) approach for pulmonary vein isolation (PVI) could be a promising strategy due to the possibility to ablate a large volume of tissue with a single application of energy, short procedure times, and real–time monitoring of balloon–tissue contact. We present a case in which LB technology was applied for PVI in an MFS patient Clinical case A 44–year–old woman with MFS and paroxysmal AF underwent PVI. The echocardiographic examination showed mild aortic and mitral valve regurgitation, the first due to a slight dilation of the aortic root, the latter associated with mitral valve prolapse. Atrial volume was normal. No other comorbidities were present. The procedure was executed in general anesthesia. A decapolar catheter was inserted in the coronary sinus and used later to stimulate the phrenic nerve during the ablation of the right pulmonary veins (Fig.1C). Left atria (LA) was reached after an ultrasound–guided transeptal puncture. High–density mapping of the LA was performed to assess the number and geometry of PVs (Fig.1A). A LB catheter was used to perform laser ablation at the level of PV antrum, delivering 13 W in automatic rapid mode in regions with optimal contact and 5.5 W in areas with more represented blood–tissue interface. LA mapping after ablation assessed the effective isolation of pulmonary veins (Fig.1B). No complications occurred during the procedure. Conclusion a laser–balloon approach for PVI in MFS patients seems feasible and safe. To our knowledge, this is the first application of this technology on MFS patients. Larger data are needed to confirm our findings.

1103 A SINGLE CENTER EXPERIENCE ON RIGHT VENTRICULAR VS. BIVENTRICULAR FAILURE ASSESSMENT GUIDED BY CMRI AND 3-D ECHOCARDIOGRAPHY

Abstract Background Currently, echocardiography represents the first-line diagnostic test for risk stratification in myocardial dysfunctions, cardiomyopathies (CM) and valvular heart diseases. Three-dimensional (3D) echo imaging improves the accuracy of cardiac chamber volumes evaluation in complex cardiac anatomies and eliminates the need for geometric modelling as well as the errors caused by foreshortened views. On the other side, cardiac magnetic resonance imaging (CMRi) has limited availability and relative high costs, whereas it provides the most accurate and reproducible measurement of atrial, biventricular global and regional systolic function, and can detect myocardial oedema, fibrosis, infiltration, and perfusion defects. Moreover, fibrosis detection by late gadolinium enhancement (LGE) contributes to ventricular tachyarrhythmias (VT) risk stratification. Our experience considers the diagnostic and prognostic role of an integrated approach guided by CMRi and 3-D echocardiography in two different subtypes of arrhythmogenic cardiomyopathy (ACM). Methods In December 2018, a sixty-six-year-old man, without familiar history of sudden cardiac death (SCD) or cardiomyopathies was admitted to emergency department for dyspnoea and chest pain. First ECG showed a VT with right bundle branch block morphology, rapidly cardioverted. In July 2019, a fifty-six-year-old woman, without family history of SCD or ACM, with previous sustained VT episode with right ventricular (RV) outflow tract pattern was admitted to our centre for further examinations. In both cases routine exams were carried out, and, in the suspicious of ACM, genetic tests, 3-D echo and CMRi were performed. Results in the first case, 3-D echo showed hypo-akinesia of left ventricular posterior-lateral wall, reduced ejection fraction (EF) 40%; enlargement of right chambers (RV end-diastolic volume, EDV, 194 ml; RV end-systolic volume, ESV, 152 ml) with reduced indices of systolic function (TAPSE 13 mm; FAC 25%; RV S’ 7 cm/s). CMRi showed global hypokinesia and free lateral wall bulging with RV EDV 235 ml; RV ESV 147 ml; RV EF 26% and reduced left ventricular EF 36%. In the second case, 3-D echo documented RV EDV 175 ml; RV ESV 64 ml with preserved systolic function (TAPSE 20 mm; FAC 47%; global longitudinal strain, GLS, -19%) and bulging of medio-distal free wall, normal EF 57%; GLS -22.7%. At CMRi there was evidence of slight RV dilatation (RV EDV 193 ml; RV ESV 88 ml) and hypokinetic, mildly-reduced global systolic function (EF 49%), images of LGE due to possible diffuse myocardial fibrosis of the free wall with morpho-functional anomalies of the RV. Both cases had negative genetic tests. ACM diagnosis was made according to Padua criteria, and programmed ventricular stimulation (sustained VT induction with hemodynamic instability) mandated cardioverter/defibrillator implantation in both cases. Conclusions In our experience, an integrated approach guided by CMRi and 3-D echocardiography in subtypes of ACM plays a pivotal role for assessing diagnosis by refining disease characterization through additional parameters. The non-invasive high-risk stratification was confirmed by electrophysiologic studies. Further studies for prognostic correlation between CMRi/advanced echocardiography and arrhythmic phenotype are mandatory.

Cardiological Monitoring - A Cornerstone for Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 Outcome: A Case Report and a Review from the Literature.

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a rare life-threatening condition requiring a complex management and multidisciplinary approach, whose outcome depends on the early diagnosis. We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein - CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution. Echocardiographic monitoring might be a lifesaving diagnostic tool in the management of PIMS-TS.

P11.31.B Pseudotumor Cerebri - a rare paraneoplastic manifestation

Abstract Background Pseudotumor Cerebri (PC) is defined by an elevated intracranial pressure of unidentified cause, associated with normal cerebrospinal fluid (CSF) composition and no cause for hypertension on the neuroimaging evaluations. The symptoms described in association are headache, papilledema, changes in vision, and sometimes tinnitus. Its pathophysiology is far from being elucidated and the mechanisms proposed are multiple. There are some cases described in the literature in which PC is the first manifestation of a systemic neoplasm, most probably due to an abnormal response of the immune system to cancerous growth. We aim to emphasize a possible connection between adenocarcinoma of the lung and PC as the first paraneoplastic manifestation. Material and Methods We present the case of a 59-year-old patient, female, non-obese, who presented to the hospital for severe headache, blurred vision, tinnitus, and paresthesia on both her upper limbs. On the first evaluation, the usual blood tests showed an increased creatinine level, and the subsequent abdominal echography and CT scan revealed bilateral ureter hydronephrosis, without an obvious obstacle, for which nephrostomies were implanted. On the ophthalmological evaluation bilateral papillary edema was described, although the cerebral CT with angiography and MRI showed no pathological modifications. A lumbar puncture with manometry was performed, that showed a CSF pressure of approximately 500 mmH2O. Results Following the clinical, imagistic, and biological manifestations, the diagnosis of PC was established. The decision to start the corticotherapy was made, followed by the addition of acetazolamide. Although the treatment tented was not efficient, the neurosurgery team decided that she is not a suitable candidate for a CSF shunting procedure and the ophthalmologist advised against an optic nerve sheath fenestration. The evolution was unfavorable, with the persistence of the symptoms. She underwent extensive investigations, the second cerebral MRI showing a slight dilation of the ventricles. On the thoracic-abdominal-pelvic CT, a pulmonary nodule with a malignant aspect was described, the histopathological results pleading for adenocarcinoma. The decision to excise the lesion was made, but after the surgery, the patient developed a cardiorespiratory arrest, without response to resuscitation. Conclusion Although there is scarce evidence of PC as a paraneoplastic syndrome, the evolution and investigations results support the possibility of a causal relationship. This is, to our knowledge, the second case of adenocarcinoma of the lung that primarily presents with PC. Further studies must be conducted to understand the underlying pathophysiology of this condition and to develop new treatment possibilities.

CD 4 +, CD 8 + and CD 19 +cell surface antigen and abnormal mitochondria ultrastructure of peripheral blood P-type atypical lymphocytes in patients with schizophrenia

Objective P-type atypical lymphocytes may play important roles in the etiology and therapy of schizophrenia. However, there is merely a direct immunological characterization of it. The aim of this study is to explore the surface antigens of these cells and their comparative ultrastructure in schizophrenia. Methods We recruited 25 age-and gender-matched patients with unmedicated schizophrenia, other mental diseases and healthy individuals. Peripheral venous blood was smeared and stained. CD4+, CD8+ and CD19+ cell surface antigen- positive lymphocytes were purified using magnetic beads and prepared for light microscopy and electron microscopy. Results The percentages of P-type atypical lymphocyte (34.53% ± 9.92%) were significantly higher (P <0.0001) in schizophrenia than that of other mental diseases (9.79% ± 3.45%) . These cells could present CD4+, CD8+ and CD19+ surface antigens. Their relative ultrastructure differed from that of normal lymphocytes, especially in mitochondria, which showed abundant, aggregated and quite irregular mitochondria, for example, slight dilation of the foci, swelling, degeneration, and even cavity. Conclusions P-type atypical lymphocytes could be found among CD4+, CD8+, and CD19 + lymphocytes with schizophrenia. Their abnormal ultrastructure of mitochondria implied that energy metabolism might play an important role in the etiology of schizophrenia.

Retroaortic left renal vein: a clinically significant vascular variation with suggestion of a practical typological scheme

The retroaortic left renal vein (RLRV) is a rare vascular variant with a typical position of the vein between the abdominal aorta and the vertebral column. Despite usually asymptomatic, RLRV might be associated with posterior nutcracker syndrome, other vascular pathologies and may cause major surgical complications. An existing but not expected RLRV might hamper aortic surgical dissection and to cause a life threatening bleeding. A case of a RLRV was observed during routine dissection of a formalin fixed 62-year-old female cadaver. The left kidney was found to be ectopic and located lower than usual between the level of L1 and L4 vertebra. The left renal vein was formed in the renal hilum at the level of L2/L3 intervertebral disc, and then passed obliquely downwards behind the abdominal aorta to join in the inferior vena cava at the level of upper border of L4 vertebra. The length of the RLRV was 7.5 cm. The main tributaries were the left suprarenal and left ovarian veins. Measuring the diameters of the renal vein showed slight dilation at its origin. Based on the literature review, the vascular variation reported here can be classified as Type II – RLRV draining at a lower than normal level of the inferior vena cava. An extended classification scheme of the left renal vein variations is presented here as well as an optional typological scheme.

Experimental characterisations of deformation mechanisms in 2D dense assemblies subjected to shearing

This study explored the deformation mechanisms and, in particular, the features of particle pair motions in response to shearing. A specially designed biaxial testing system with a flexible boundary equipped with an image system was set up for experimental tests. The whole testing system was modified from a CKC triaxial testing system. The particle image velocimetry (PIV) technique and close-range photogrammetry were used together to help with the investigation. The test samples TA and TB were made of randomly packed 3 D printed elliptical rods with different particle eccentricities e = 0.1, 0.2, respectively. In the examinations, the motion of a particle pair was divided into three modes, i.e. the contact deformation, the Type 4 rolling and the rigid body motion. It is found that each mode of the motion has different contributions to the sample deformation at different strain levels. The normal component of contact deformation dominates volumetric contraction at small strains and dilation at larger strains. The rigid body rotation only induces a slight dilation in sample TA and even leads to contraction in sample TB as the particles used in TB assembly become more elongated. For the sample distortion, it is mainly due to the rigid body rotation while the normal component of contact deformation makes a second contribution. The tangential component of contact deformation and the Type 4 rolling have relatively small contributions to both volumetric strain and sample distortion. The local volumetric strains arising from the contact deformation (including normal and tangential components) and Type 4 rolling mainly take place at the interfaces between moving particle clusters and vortices, also at the boundaries of micro bands or shear bands. The associated local volumetric strain due to the rigid body rotation mainly occurs inside the shear band.

Pancreatic intraepithelial neoplasia with carcinoma in situ with repeated distally localized pancreatitis: a case report

BackgroundAcute pancreatitis could be an early symptom of pancreatic cancer. However, repeated pancreatitis caused by pancreatic cancer is very rare.Case presentationA 69-year-old man was referred to our hospital with severe abdominal pain, and serial imaging studies showed acute distally localized pancreatitis with a pseudocyst. Although he had successful conservative medical treatment followed by discharge from the hospital, he was re-admitted with severe abdominal pain for recurrent distal pancreatitis with splenic artery aneurysm followed by its rupture. No pancreas mass was detected by imaging studies including endoscopic ultrasound and cytologic studies of the pancreas juice did not show any malignant cells, although slight dilatation of distal pancreas duct was observed only in the initial computed tomography. Because of the episodes of repeated distally localized pancreatitis caused by possible pancreatic ductal neoplasm, we planned and performed laparoscopy-assisted distal pancreatectomy after full-informed consent. Pathological examination revealed pancreatic intraepithelial neoplasia (PanIN) with carcinoma in situ in the distal main pancreas duct. The post-surgical course of the patient was uneventful and he was discharged 10 days after surgery from recurrent disease for over a year.ConclusionsWe encountered a case of repeated episodes of acute distally localized pancreatitis, for which distal pancreatectomy was performed, resulting in pathological diagnosis of PanIN with carcinoma in situ.

Left atrial appendage velocity as an instrument of predicting atrial fibrillation recurrence after successful catheter ablation – a useful tool?

Abstract Introduction Catheter ablation for the treatment of Atrial Fibrillation (AF) is a modality of treatment in growing expansion. However the sustained long term response in preventing AF recurrence is poor for most patients, namely in those with a dilated left atrium. Purpose Our aim was to assess the utility of an echocardiographic parameter for left atrium function, the left atrial appendage velocity (LAAV), in predicting recurrences after catheter ablation. Methods We performed a 9 year retrospective analysis of all patients who underwent a successful catheter ablation for the treatment of atrial fibrillation and had a valid pre-procedural transesophagic echocardiogram in a single expert centre. Medical records were analysed for demographic, procedural data and outcomes. Results Seventy-three (73) patients fulfilled all inclusion criteria and were analysed. The mean age was 62±11 with a male preponderance (58,7%). The majority of patients (82,7%) had preserved left ventricle ejection fraction. Only 46% of patient had a volumetric assessment of the left atrium dimensions prior to ablation, with slight, moderate and severe dilation of the left atrium in 20%; 8,6% and 28,6% of patients. Of the patients subjected to an AF ablation the average LAAV was 50,6±19 cm/s, with 78% of patients with normal atrial appendage velocities. Patients with low LAAV (&amp;lt;40cm/s) had a higher proportion of AF recurrences at 3 and 6 months (58,3 vs 12,8% and 89% vs 21,7%; p&amp;lt;0,05 for all) with a linear correlation between the presence of recurrences and LAAV (LAAV of 39,1 vs 57,5 cm/s; p&amp;lt;0,05 OR 0,91 (CI 95% = 0,85–0,97); r2=0,34 at 3 months and LAAV of 43,5 vs 59 cm/s; p=0,01; OR 0,94 (CI 95% = 0,89–0,99); r2=0,24 at 6 months respectively). There was a trend towards association with recurrences at 1 year although it did not reach statistical significance. There was no significant difference in the use of antiarritmic drugs, either prior or post ablation, in both groups. It was not possible to assess the additive predictive value to the left atrium dimensions due to the low percentage of volumetric assessment of left atrium prior to AF ablation. Conclusions Patients with low left atrial appendage velocities had a lower long term success rate of catheter ablation, with higher rates of recurrence at 3 and 6 months and a trend towards higher recurrences at 1 year, with linear correlation which hypothesises the use of the left atrial appendage velocity as novel predictive parameter for an integrative model. Funding Acknowledgement Type of funding sources: None.

Analysis of 3 Cases of Refractory Urinary Tract Infection Caused by Enterococcus Faecium and Literature Review

Objective: To explore the clinical features, drug resistance, treatment and prognosis of refractory urinary tract infection caused by Enterococcus faecium infection. Methods: A retrospective analysis of 3 cases of Enterococcus faecium infection admitted to the Children’s Hospital of Shaanxi Provincial People’s Hospital from January 2017 to December 2019, And the clinical manifestations of refractory urinary tract infections caused by it, routine laboratory examinations, mid-stage urine culture and drug sensitivity, urinary ultrasound, magnetic resonance (or CT) examination, treatment process and prognosis, and search and review relevant literature. Result: The three children in this group were all women, aged 5 years, 2 months, 9 years and 11 years old. One case had renal abscess, one case had acute pyelonephritis, and one case had bladder-ureteritis. Clinical features: 2 cases had fever with a temperature of 38-39.5°C, and children with renal abscess were accompanied by chills; 2 cases had frequent urination, dysuria, and urethral irritation; 1 case of 5-year-old child had only transient urinary retention, All 3 cases were treated with conventional antibiotics orally and intravenously outside the hospital. During the course of 2 cases, the leukocytes were more than 25×109/L, 3 cases had neutrophils above 70%, CRP was high, and 3 cases of mid-stage urine culture were Enterococcus faecium;2 cases were sensitive to vancomycin and linezolid, Others are resistant.3 cases had negative blood cultures, 1 case of urinary B-mode ultrasound had a thicker bladder wall, and a slightly thicker wall in the lower right ureter. Considering the inflammatory changes, 1 case had left hydronephrosis and 1 case had left kidney urinary salt crystals. MRI plain scan of both kidneys and ureters + MRU showed: 1 case had a thicker bladder wall, and the wall of the lower ureter was slightly thickened, considering the inflammatory changes. One case had a slight dilation of the upper left ureter and the renal pelvis and calyces. 1 case of CT enhanced scan + CTU showed: 1. Left nodular superior nodules and strip low-density shadow, considering the repeated deformity of the left renal pelvis and ureter with dilation of the ureter (upper renal pelvis is small, hypoplasia); [2]. Abnormal strengthening of the left kidney and a slight thickening of the fascia around the kidney; consider pyelonephritis with abscess formation or cystic lesions. 3. Mild water accumulation in the left kidney and upper middle ureter [4]. There are multiple lymph nodes in the retro peritoneum and the left side of the spine, and some are swollen. Treatment 3 cases were initially ineffective with three generations of cephalosporins, and 2 cases had obvious effect of intravenous infusion of vancomycin based on drug sensitivity. After 7-10 days of treatment, cefepime was changed for consolidation treatment and cured. One case of meropenem treatment improved. Three cases were followed up for 1 year without recurrence. 1 case relapsed 20 days after discharge, intravenous infusion of cefepime for 17 days, and nitrofurantoin was taken preventively for 2 weeks before relapse. Conclusion: Most of the urinary tract infections caused by Enterococcus faecium infections are refractory upper urinary tract infections, which have many complications, timely and mid-stage urine culture, and urinary tract B ultrasound. Magnetic resonance imaging and hydrography of both kidneys and ureters play an important role in the diagnosis of complications. High drug resistance, timely adjustment of treatment according to drug susceptibility, selection of effective drugs is very important, given a sufficient course of treatment, can improve the prognosis.

Encapsulating peritoneal sclerosis in an AMA-M2 positive patient: A case report

BACKGROUNDEncapsulating peritoneal sclerosis (EPS) is hard to diagnose because of nonspecific symptoms and signs. It is a general consensus that EPS is classified as primary and secondary. There have been several studies discovering some high-risk factors such as liver cirrhosis, of which AMA-M2 is a biomarker, and intra-abdominal surgery such as laparoscopic surgery. Imaging studies help to diagnose EPS and exploratory laparotomy might be an alternative if imaging fails. Nowadays, laparotomy plays a key role in treating EPS, especially when medical treatments do not work and medical therapy fails to ease patients’ symptoms.CASE SUMMARYA 58-year-old man complained of unexplained vomiting and abdominal distension 2 mo after laparoscopic cholecystectomy. Increased alkaline phosphatase and liver enzymes were discovered. An autoimmune liver disease test showed that AMA-M2 was positive. A gastroscopy revealed bile reflux gastritis. A magnetic resonance imaging scan showed a slight dilatation of the intrahepatic bile duct. A colonoscopy showed that there was a mucosal eminence lesion in the sigmoid colon (24 cm away from the anus), with a size of 3 cm × 3 cm and erosive surface. At last, the small intestine and the stomach were found to be encased in a cocoon-like membrane during the surgery. The membrane was dissected and adhesiolysis was done to release the trapped organs. The patient recovered and was discharged 44 d after the operation, and there was no recurrence during a follow-up period of 3 mo.CONCLUSIONAMA-M2 is a marker of primary biliary sclerosis and may help to make a preoperative diagnosis of EPS.

In vivo Dominant-Negative Effect of an SCN5A Brugada Syndrome Variant.

Loss-of-function mutations in the cardiac Na+ channel α-subunit Nav1.5, encoded by SCN5A, cause Brugada syndrome (BrS), a hereditary disease characterized by sudden cardiac death due to ventricular fibrillation. We previously evidenced in vitro the dominant-negative effect of the BrS Nav1.5-R104W variant, inducing retention of wild-type (WT) channels and leading to a drastic reduction of the resulting Na+ current (INa). To explore this dominant-negative effect in vivo, we created a murine model using adeno-associated viruses (AAVs).MethodsDue to the large size of SCN5A, a dual AAV vector strategy was used combining viral DNA recombination and trans-splicing. Mice were injected with two AAV serotypes capsid 9: one packaging the cardiac specific troponin-T promoter, the 5′ half of hSCN5A cDNA, a splicing donor site and a recombinogenic sequence; and another packaging the complementary recombinogenic sequence, a splicing acceptor site, the 3′ half of hSCN5A cDNA fused to the gfp gene sequence, and the SV40 polyA signal. Eight weeks after AAV systemic injection in wild-type (WT) mice, echocardiography and ECG were recorded and mice were sacrificed. The full-length hSCN5A-gfp expression was assessed by western blot and immunohistochemistry in transduced heart tissues and the Na+ current was recorded by the patch-clamp technique in isolated adult GFP-expressing heart cells.ResultsAlmost 75% of the cardiomyocytes were transduced in hearts of mice injected with hNav1.5 and ∼30% in hNav1.5-R104W overexpressing tissues. In ventricular mice cardiomyocytes expressing R104W mutant channels, the endogenous INa was significantly decreased. Moreover, overexpression of R104W channels in normal hearts led to a decrease of total Nav1.5 expression. The R104W mutant also induced a slight dilatation of mice left ventricles and a prolongation of RR interval and P-wave duration in transduced mice. Altogether, our results demonstrated an in vivo dominant-negative effect of defective R104W channels on endogenous ones.ConclusionUsing a trans-splicing and viral DNA recombination strategy to overexpress the Na+ channel in mouse hearts allowed us to demonstrate in vivo the dominant-negative effect of a BrS variant identified in the N-terminus of Nav1.5.