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Plant Methods Nov 2023The evolution of plants to efficiently transport water and assimilates over long distances is a major evolutionary success that facilitated their growth and colonization... (Review)
Review
The evolution of plants to efficiently transport water and assimilates over long distances is a major evolutionary success that facilitated their growth and colonization of land. Vascular tissues, namely xylem and phloem, are characterized by high specialization, cell heterogeneity, and diverse cell components. During differentiation and maturation, these tissues undergo an irreversible sequence of events, leading to complete protoplast degradation in xylem or partial degradation in phloem, enabling their undisturbed conductive function. Due to the unique nature of vascular tissue, and the poorly understood processes involved in xylem and phloem development, studying the molecular basis of tissue differentiation is challenging. In this review, we focus on methods crucial for gene expression research in conductive tissues, emphasizing the importance of initial anatomical analysis and appropriate material selection. We trace the expansion of molecular techniques in vascular gene expression studies and discuss the application of single-cell RNA sequencing, a high-throughput technique that has revolutionized transcriptomic analysis. We explore how single-cell RNA sequencing will enhance our knowledge of gene expression in conductive tissues.
PubMed: 37981669
DOI: 10.1186/s13007-023-01109-8 -
Translational Pediatrics Oct 2023Bovine jugular valved conduit (BJVC) has been reported as an optional material for right ventricular outflow tract (RVOT) reconstruction in patients with complex...
BACKGROUND
Bovine jugular valved conduit (BJVC) has been reported as an optional material for right ventricular outflow tract (RVOT) reconstruction in patients with complex congenital heart disease (CHD). It showed comparable or even better performance than homograft. However, the durability of BJVC is still very poor in infants and children. Herein, we retrospectively analyzed and evaluated the mid-term results of RVOT reconstruction by using bovine jugular vein valved conduits (Balance BJVCs) in CHD patients, with a special focus on the functional status of the conduits.
METHODS
Pediatric patients undergoing RVOT reconstruction using Balance BJVC in Guangzhou Women and Children's Medical Center from January 2018 to December 2020 were enrolled in this study. The demographic information, cardiac anatomical abnormalities, preoperative hemodynamic characteristics, surgical details, postoperative outcomes, and follow-up data of the patients were reviewed retrospectively.
RESULTS
Ninety-four patients were enrolled in this study. The median age at implantation was 22 months (range, 2-168 months), the median weight was 10.8 kg (range, 3.8-40.0 kg); 34 children (36.2%) were younger than 1 year. The most common disease in these children was pulmonary atresia with ventricular septal defect (PA/VSD) (66/94, 70.2%). The patients were followed up for a median of 43.5 months (range, 6-60 months). Late mortality occurred in 4 (4.3%). Cumulatively, conduit dysfunction at different levels occurred in 31 (33%), conduit failure in 9 (9.6%), 6 patients underwent reoperation for conduit replacement, 5 (5.3%) developed infective endocarditis (IE) within 24 months (range, 12-36 months) after the surgery. Five-year survival rate is 95.7%. The free of conduit dysfunction rates at 1, 3, and 5 years was 91.4%, 68.5%, and 50.4%, respectively. In addition, the rates of patients who were free of conduit failure at 1, 3, and 5 years were 100%, 88.9%, and 88.9%, respectively.
CONCLUSIONS
Despite the high risk of BJVC dysfunction, approximately 90% of children are free from conduit failure at 5 years after conduit implantation through aggressive transcatheter intervention without increasing the incidence of IE. Thus, BJVC remains a useful alternative material for RVOT reconstruction in patients with complex CHD.
PubMed: 37969123
DOI: 10.21037/tp-23-287 -
Annals of Gastroenterological Surgery Nov 2023Risk prediction of anastomotic leakage using anatomical and vascular factors has not been well established. This study aimed to assess the anatomical and vascular...
BACKGROUND
Risk prediction of anastomotic leakage using anatomical and vascular factors has not been well established. This study aimed to assess the anatomical and vascular factors affecting the hemodynamics of the gastric conduit and develop a novel risk stratification system in patients undergoing esophagectomy with retrosternal reconstruction.
METHODS
This retrospective cohort study analyzed 202 patients with esophageal cancer who underwent subtotal esophagectomy with gastric tube retrosternal reconstruction between January 2008 and December 2020. Risk factors for anastomotic leakage (AL), including the anatomical index (AI) and anastomotic viability index (AVI), were evaluated using a logistic regression model.
RESULTS
According to the logistic regression model, the independent risk factors for AL were preoperative body mass index ≥23.6 kg/m (odds ratio [OR], 7.97; 95% confidence interval [CI], 2.44-26.00; 0.01), AI <1.4 (OR, 23.90; 95% CI, 5.02-114.00; 0.01), and AVI <0.62 (OR, 8.02; 95% CI, 2.57-25.00; 0.01). The patients were stratified into four AL risk groups using AI and AVI as follows: low-risk group (AI ≥1.4, AVI ≥0.62 [2/99, 2.0%]), intermediate low-risk group (AI ≥1.4, AVI <0.62 [2/29, 6.9%]), intermediate high-risk group (AI <1.4, AVI ≥0.62 [8/53, 15.1%]), and high-risk group (AI <1.4, AVI <0.62 [11/21, 52.4%]).
CONCLUSION
The combination of AI and AVI strongly predicted AL. Additionally, the use of AI and AVI enabled the stratification of the risk of AL in patients who underwent esophagectomy with retrosternal reconstruction.
PubMed: 37927915
DOI: 10.1002/ags3.12693 -
Journal of Clinical Medicine Sep 2023Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and... (Review)
Review
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
PubMed: 37762834
DOI: 10.3390/jcm12185891 -
Journal of Vascular Surgery Cases and... Sep 2023Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cm minimum clavicle to carotid...
Transcarotid artery revascularization (TCAR) provides a safe alternative to carotid endarterectomy. The anatomic requirements include a 5-cm minimum clavicle to carotid bifurcation distance for sheath access proximal to the lesion. In the present report, we describe our experience with conduit use for patients not meeting that requirement. Patients undergoing elective TCAR with a conduit from 2021 to 2022 were retrospectively identified. After carotid artery exposure, a 6-mm prosthetic graft was anastomosed to the common carotid artery in an end-to-side fashion. After stent delivery, the conduit was ligated and oversewn. The patient demographics, procedural details, and outcomes were recorded and compared with our nonconduit TCAR experience. A total of 11 patients (64% male; age, 75 ± 5 years) underwent TCAR with a conduit, 5 (46%) for symptomatic disease, and 77 patients underwent TCAR with no conduit, 52 (60%) with symptomatic disease ( = .50). Other than a higher rate of prior coronary interventions in the conduit group (55% vs 47%; = .007), no significant differences were found in age, gender, race, comorbidities, or high risk for carotid endarterectomy criteria. In the conduit group, the average skin to carotid artery depth was 4.2 cm (range, 1.9-6.1 cm). The average clavicle to bifurcation distance was 4.4 cm (range, 3.3-4.9 cm) vs 6.5 cm (range, 3.3-9.7 cm; = .002) in the nonconduit group. Dacron was the most common conduit material used (73%). No differences were found in the mean procedure times (121 ± 32 vs 129 ± 53 minutes; = .785) or flow reversal times (14 ± 5 vs 19 ± 13 minutes; =.989) for the conduit and nonconduit cohorts, respectively. Technical success was achieved in 100% of the conduit and nonconduit cases. Excluding one outlier of a prolonged stay (7 days) for management of unrelated medical issues (gastrostomy tube placement for chronic dysphagia after mass resection and neck radiation), the mean hospital stay was 2 days (1.2 ± 0.4 intensive care unit days) compared with 3.8 ± 5.7 days for our nonconduit cohort ( = .2). Hypotension was the most common reason for delayed discharge for the conduit group (n = 3; 27%). The average follow-up was 2.7 months (range, 1-10 months). For all 11 conduit patients, the stent remained patent without stenosis, thrombus, or pseudoaneurysm at the conduit stump site on surveillance duplex ultrasound. No strokes or complications had occurred at 30 days in the conduit group compared with four strokes or transient ischemic attacks ( = .469) and 18 minor complications in the nonconduit group ( = .091). For patients lacking a sufficient distance between the clavicle and carotid artery bifurcation, a prosthetic conduit facilitates safe use of flow reversal for stent delivery and can be ligated at procedural completion without consequences.
PubMed: 37662565
DOI: 10.1016/j.jvscit.2023.101271 -
Plants (Basel, Switzerland) May 2023ecotypes adapted to native habitats with different daylengths, temperatures, and precipitation were grown experimentally under seven combinations of light intensity and...
ecotypes adapted to native habitats with different daylengths, temperatures, and precipitation were grown experimentally under seven combinations of light intensity and leaf temperature to assess their acclimatory phenotypic plasticity in foliar structure and function. There were no differences among ecotypes when plants developed under moderate conditions of 400 µmol photons m s and 25 °C. However, in response to more extreme light or temperature regimes, ecotypes that evolved in habitats with pronounced differences in either the magnitude of changes in daylength or temperature or in precipitation level exhibited pronounced adjustments in photosynthesis and transpiration, as well as anatomical traits supporting these functions. Specifically, when grown under extremes of light intensity (100 versus 1000 µmol photons m s) or temperature (8 °C versus 35 °C), ecotypes from sites with the greatest range of daylengths and temperature over the growing season exhibited the greatest differences in functional and structural features related to photosynthesis (light- and CO-saturated capacity of oxygen evolution, leaf dry mass per area or thickness, phloem cells per minor vein, and water-use efficiency of CO uptake). On the other hand, the ecotype from the habitat with the lowest precipitation showed the greatest plasticity in features related to water transport and loss (vein density, ratio of water to sugar conduits in foliar minor veins, and transpiration rate). Despite these differences, common structure-function relationships existed across all ecotypes and growth conditions, with significant positive, linear correlations (i) between photosynthetic capacity (ranging from 10 to 110 µmol O m s) and leaf dry mass per area (from 10 to 75 g m), leaf thickness (from 170 to 500 µm), and carbohydrate-export infrastructure (from 6 to 14 sieve elements per minor vein, from 2.5 to 8 µm cross-sectional area per sieve element, and from 16 to 82 µm cross-sectional area of sieve elements per minor vein); (ii) between transpiration rate (from 1 to 17 mmol HO m s) and water-transport infrastructure (from 3.5 to 8 tracheary elements per minor vein, from 13.5 to 28 µm cross-sectional area per tracheary element, and from 55 to 200 µm cross-sectional area of tracheary elements per minor vein); (iii) between the ratio of transpirational water loss to CO fixation (from 0.2 to 0.7 mol HO to mmol CO) and the ratio of water to sugar conduits in minor veins (from 0.4 to 1.1 tracheary to sieve elements, from 4 to 6 µm cross-sectional area of tracheary to sieve elements, and from 2 to 6 µm cross-sectional area of tracheary elements to sieve elements per minor vein); (iv) between sugar conduits and sugar-loading cells; and (v) between water conducting and sugar conducting cells. Additionally, the proportion of water conduits to sugar conduits was greater for all ecotypes grown experimentally under warm-to-hot versus cold temperature. Thus, developmental acclimation to the growth environment included ecotype-dependent foliar structural and functional adjustments resulting in multiple common structural and functional relationships.
PubMed: 37653958
DOI: 10.3390/plants12102041 -
Rhode Island Medical Journal (2013) Aug 2023Urinary diversion in renal transplant patients can take a variety of forms - bladder augmentation, continent cutaneous pouch, or intestinal conduits, to name a few....
Urinary diversion in renal transplant patients can take a variety of forms - bladder augmentation, continent cutaneous pouch, or intestinal conduits, to name a few. Herein, we present a unique case of an appendicocecal urinary diversion in a patient with history of end stage renal disease, pelvic radiation, and complex surgical history who underwent deceased-donor renal transplantation. During the renal transplant, the transplant ureterovesical anastomosis could not be performed due to inherent anatomical hindrances. A temporary modified cutaneous ureterostomy using a single-J stent was therefore used for drainage of the transplant kidney. Given that the cutaneous ureterostomy was not a durable, long-term option, we sought to develop a creative surgical solution. This report presents a unique case of urinary diversion post renal transplant and reviews the literature of renal transplantation in patients with anatomical abnormalities.
Topics: Humans; Urinary Diversion; Kidney; Ureterostomy; Ureter; Kidney Transplantation
PubMed: 37494618
DOI: No ID Found -
Tomography (Ann Arbor, Mich.) Jun 2023The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating... (Review)
Review
The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.
Topics: Humans; Skull Base Neoplasms; Diagnostic Imaging; Brain
PubMed: 37489465
DOI: 10.3390/tomography9040097