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Medicine Nov 2022Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries arise entirely or predominantly from the left ventricle. An...
RATIONALE
Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries arise entirely or predominantly from the left ventricle. An extracardiac conduit is the first surgical option for repairing DOLV, specifically because its placement of the extracardiac conduit can be customized to accommodate all possible anatomical variations. The bovine jugular veins and homograft valves are often used as conduits. There have been no reports on the use of handmade trileaflet-valved conduits for correcting DORV.
PATIENT CONCERNS
A 1-year old male was admitted for significant heart murmur and cyanosis, according to the results of transthoracic echocardiography, computed tomography angiography, and cardioangiography, and was diagnosed with DOLV and pulmonary stenosis.
DIAGNOSIS AND INTERVENTIONS
The patient underwent biventricular repair with a handmade trileaflet-valved extracardiac conduit. The postoperative course was uneventful.
OUTCOME
Three months after the surgery, TTF indicated mild right ventricular outflow obstruction and pulmonary valve regurgitation.
LESSONS
Correction of the left ventricular double outlet with a handmade trileaflet-valved conduit has been shown to have excellent performance, and long-term outcomes should be followed over time.
Topics: Male; Animals; Cattle; Humans; Infant; Heart Ventricles; Pulmonary Valve Stenosis; Prostheses and Implants; Echocardiography; Cyanosis
PubMed: 36451474
DOI: 10.1097/MD.0000000000032070 -
The Kurume Medical Journal Feb 2023The infraorbital canal serves as a conduit for the infraorbital nerve. The canal travels anteriorly beneath the globe where it emerges onto the face at the infraorbital...
The infraorbital canal serves as a conduit for the infraorbital nerve. The canal travels anteriorly beneath the globe where it emerges onto the face at the infraorbital foramen. Variations in the morphology of the infraorbital canal have been reported and classified based on their relationship with the maxillary sinus. Similarly to the other orbital fat compartments, fat in the infraorbital canal serves as protection to the structures it surrounds. Generally, the orbital fat compartments do not undergo hypertrophy without a pathological etiology, therefore, it has been hypothesized that herniations of orbital fat are a result of age-related bony changes in the orbit. The inferior orbital rim, in particular, acts to support structures of the orbit including the fat compartments, ligaments, and muscles. The most commonly reported herniations are those of the infraorbital fat pads, which either prolapse into the inferior orbital fissure or move anteriorly to give patients the appearance of a bulging lower eyelid. Additionally, there are reports of traumatic injuries that result in herniation of the buccal fat pad into the maxillary sinus. Herein, we report a rare case of a herniation of the infraorbital canal fat into the maxillary sinus and review the salient literature.
Topics: Humans; Maxillary Sinus; Orbit; Cheek; Maxillary Nerve; Cadaver
PubMed: 36450485
DOI: 10.2739/kurumemedj.MS674004 -
Nature Communications Nov 2022Influenza A virus (IAV) genetic exchange through reassortment has the potential to accelerate viral evolution and has played a critical role in the generation of...
Influenza A virus (IAV) genetic exchange through reassortment has the potential to accelerate viral evolution and has played a critical role in the generation of multiple pandemic strains. For reassortment to occur, distinct viruses must co-infect the same cell. The spatio-temporal dynamics of viral dissemination within an infected host therefore define opportunity for reassortment. Here, we used wild type and synonymously barcoded variant viruses of a pandemic H1N1 strain to examine the within-host viral dynamics that govern reassortment in guinea pigs, ferrets and swine. The first two species are well-established models of human influenza, while swine are a natural host and a frequent conduit for cross-species transmission and reassortment. Our results show reassortment to be pervasive in all three hosts but less frequent in swine than in ferrets and guinea pigs. In ferrets, tissue-specific differences in the opportunity for reassortment are also evident, with more reassortants detected in the nasal tract than the lower respiratory tract. While temporal trends in viral diversity are limited, spatial patterns are clear, with heterogeneity in the viral genotypes detected at distinct anatomical sites revealing extensive compartmentalization of reassortment and replication. Our data indicate that the dynamics of viral replication in mammals allow diversification through reassortment but that the spatial compartmentalization of variants likely shapes their evolution and onward transmission.
Topics: Animals; Guinea Pigs; Humans; Swine; Influenza A virus; Reassortant Viruses; Orthomyxoviridae Infections; Influenza A Virus, H1N1 Subtype; Ferrets; Influenza, Human; Mammals; Swine Diseases
PubMed: 36369504
DOI: 10.1038/s41467-022-34611-z -
Journal of Clinical Medicine Nov 2022This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis.
BACKGROUND
This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis.
METHODS
The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality and perioperative complication-related morbidity; the secondary endpoints were re-infection (RI) rates, primary and secondary graft patency, overall mortality, duration of antibiotic therapy, and the number of antibiotic types used in treatment.
RESULTS
There was no significant difference in the 30-day mortality and perioperative-related complications between the conservative treatment, in-situ reconstruction (ISR), and extra-anatomic reconstruction (EAR) groups. The ISR group had lower re-infection rates and better overall survival rates than the EAR and conservative treatment groups. Different bypass graft conduits had no significant influence on the RI rate or primary and secondary graft patency. AGI patients infected with high-virulence pathogens had higher RI and overall mortality rates than those infected with low virulence pathogens, but this was not statistically significant. Initial procedures prior to the AGI also had no influence on the prognosis of AGI patients. Patients undergoing ISR or EAR surgery received antibiotic therapy for a longer duration than patients undergoing conservative treatment. Patients without RI received more types of antibiotics than patients with RI.
CONCLUSIONS
ISR had lower RI rates and better overall survival rates than EAR and conservative treatment and may be a better choice for patients with AGI. Several factors were found to have no influence on patients' prognosis however, further studies are required.
PubMed: 36362816
DOI: 10.3390/jcm11216588 -
Aorta (Stamford, Conn.) Jun 2022Current treatments of aortic aneurysm include surgical or endovascular, respectively, anatomical or functional, substitution of the aneurysm tract; however, with these...
Current treatments of aortic aneurysm include surgical or endovascular, respectively, anatomical or functional, substitution of the aneurysm tract; however, with these methods, perfusion of at least some collateral branches cannot be fully restored, leading to the risk of paraplegia. We present a novel endovascular "net" prosthesis to strengthen the aortic wall while preserving perfusion of collateral branches. This consists of a polyester mesh "net"-layered conduit in a variable cylindrical shape, which is personalized based on patient computed tomography scan images, and is defined by circular crossing spirals of a thin nitinol wire. The prosthetic conduit, shrunk by compressing the nitinol spirals, can be inserted into the vascular lumen and expanded in situ. Then, the insertion control device can be fully removed. Thus, the, "net" prosthesis, positioned inside the aorta in stable contact with the intimal wall for 2 to 5 months, is colonized by neointima and spontaneously moved deeper into the aortic wall in contact with the media, thus being ideally able to stabilize aortic diameter without interference with collateral branch blood perfusion. This new, (ideally) paraplegia-free procedure is aimed at curing the aortic wall structural defect, thus arresting the aneurysm from further progression. This contrasts with current treatments, indicated by aneurysm dimensions for their implied complication risk, which are actually for prophylaxis of impending rupture or dissection rather than fortification of the natural aorta. Moreover, this new approach can be used alongside open surgical procedures (personalized external aortic root support) as well as a frozen "net" elephant trunk technique, for full aortic stabilization.
PubMed: 36318930
DOI: 10.1055/s-0042-1748842 -
Plant Physiology Jan 2023The cause of reduced leaf-level transpiration under elevated CO2 remains largely elusive. Here, we assessed stomatal, hydraulic, and morphological adjustments in a...
The cause of reduced leaf-level transpiration under elevated CO2 remains largely elusive. Here, we assessed stomatal, hydraulic, and morphological adjustments in a long-term experiment on Aleppo pine (Pinus halepensis) seedlings germinated and grown for 22-40 months under elevated (eCO2; c. 860 ppm) or ambient (aCO2; c. 410 ppm) CO2. We assessed if eCO2-triggered reductions in canopy conductance (gc) alter the response to soil or atmospheric drought and are reversible or lasting due to anatomical adjustments by exposing eCO2 seedlings to decreasing [CO2]. To quantify underlying mechanisms, we analyzed leaf abscisic acid (ABA) level, stomatal and leaf morphology, xylem structure, hydraulic efficiency, and hydraulic safety. Effects of eCO2 manifested in a strong reduction in leaf-level gc (-55%) not caused by ABA and not reversible under low CO2 (c. 200 ppm). Stomatal development and size were unchanged, while stomatal density increased (+18%). An increased vein-to-epidermis distance (+65%) suggested a larger leaf resistance to water flow. This was supported by anatomical adjustments of branch xylem having smaller conduits (-8%) and lower conduit lumen fraction (-11%), which resulted in a lower specific conductivity (-19%) and leaf-specific conductivity (-34%). These adaptations to CO2 did not change stomatal sensitivity to soil or atmospheric drought, consistent with similar xylem safety thresholds. In summary, we found reductions of gc under elevated CO2 to be reflected in anatomical adjustments and decreases in hydraulic conductivity. As these water savings were largely annulled by increases in leaf biomass, we do not expect alleviation of drought stress in a high CO2 atmosphere.
Topics: Trees; Carbon Dioxide; Plant Leaves; Water; Soil
PubMed: 36250901
DOI: 10.1093/plphys/kiac482 -
Heart Views : the Official Journal of... 2022Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required.
INTRODUCTION
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Surgical correction has improved survival but re-intervention is often required.
OBJECTIVES
The objective is to assess outcomes after surgical repair of TOF, long-term follow-up, and factors that influence these results.
MATERIALS AND METHODS
This is a retrospective study conducted in a tertiary care center. Records of patients diagnosed with TOF from 1992 to 2019 (37 years) were retrieved from a detailed database. Patients who underwent complete correction were grouped according to diagnosis, the technique utilized in surgical repair, need for staged repair, and syndromic association. Univariate actuarial and event-free survival analysis was performed. The endpoint for an event was death or re-intervention.
RESULTS
A total of 230 patients were diagnosed with TOF and 174 patients underwent complete surgical repair. At 40 years postoperatively, survival was 96%. Actuarial survival was independent of syndromic associations, anatomical diagnosis, type of surgery, or previous shunt. Event-free survival (EFS) survival was 8.12%. EFS was significantly worse for patients with pulmonary atresia (PA) (Hazard ratio, 4.1125; 95% confidence interval [CI], 1.2654-13.3657; < 0.0001) and for those that required homograft/conduit. The median duration for EFS was 22.73 years, 19.58 years, and 9.12 years for transannular patch (TAP), pulmonary valve-sparing (PVS), and homograft group, respectively. The survival curve for the PVS group merged with that of TAP 20 years postoperatively. Similarly, it merged at 22 years for staged versus primary repair and at 22.73 years for syndromic versus nonsyndromic patients. A weak correlation was found between age at surgery and event-free duration (cc, 0.309; < 0.0001). The need for TAP was not influenced by the previous palliation, χ(1, = 154) = 3.36, = 0.0667, or with interval to complete correction after the shunt procedure ( = 0.9672).
CONCLUSIONS
Total correction of TOF has low perioperative mortality and good long-term survival, but the need for re-interventions is high. This study demonstrated that patients requiring homograft/conduit and those with a diagnosis of PA had worse outcomes. Comparison between different surgical groups showed merging of survival curves in follow-up that signifies gradual loss of survival advantage over time.
PubMed: 36213434
DOI: 10.4103/heartviews.heartviews_77_21 -
Frontiers in Bioengineering and... 2022Neural tissue is an important soft tissue; for instance, craniofacial nerves govern several aspects of human behavior, including the expression of speech, emotion... (Review)
Review
Neural tissue is an important soft tissue; for instance, craniofacial nerves govern several aspects of human behavior, including the expression of speech, emotion transmission, sensation, and motor function. Therefore, nerve repair to promote functional recovery after craniofacial soft tissue injuries is indispensable. However, the repair and regeneration of craniofacial nerves are challenging due to their intricate anatomical and physiological characteristics. Currently, nerve transplantation is an irreplaceable treatment for segmental nerve defects. With the development of emerging technologies, transplantation donors have become more diverse. The present article reviews the traditional and emerging alternative materials aimed at advancing cutting-edge research on craniofacial nerve repair and facilitating the transition from the laboratory to the clinic. It also provides a reference for donor selection for nerve repair after clinical craniofacial soft tissue injuries. We found that autografts are still widely accepted as the first options for segmental nerve defects. However, allogeneic composite functional units have a strong advantage for nerve transplantation for nerve defects accompanied by several tissue damages or loss. As an alternative to autografts, decellularized tissue has attracted increasing attention because of its low immunogenicity. Nerve conduits have been developed from traditional autologous tissue to composite conduits based on various synthetic materials, with developments in tissue engineering technology. Nerve conduits have great potential to replace traditional donors because their structures are more consistent with the physiological microenvironment and show self-regulation performance with improvements in 3D technology. New materials, such as hydrogels and nanomaterials, have attracted increasing attention in the biomedical field. Their biocompatibility and stimuli-responsiveness have been gradually explored by researchers in the regeneration and regulation of neural networks.
PubMed: 36159691
DOI: 10.3389/fbioe.2022.978980 -
Frontiers in Plant Science 2022Climbing plants are an abundant and taxonomically diverse plant group that competes intensely with trees and thus substantially affects forest diversity and structure....
Climbing plants are an abundant and taxonomically diverse plant group that competes intensely with trees and thus substantially affects forest diversity and structure. The growth and physiology of climbing plants largely depend on their root tip structure and function. However, little is known regarding the mechanisms through which anatomical traits regulate root tip diameter in climbing plants. Therefore, our study sought to explore the relationships between root tip diameter and seven anatomical traits (e.g., cortex thickness and stele diameter) in three lianas and three vine species sampled from a tropical forest in Hainan. Root tip diameter was significantly positively correlated with cortex thickness ( = 0.94-0.99) and stele diameter ( = 0.72-0.94) within species, especially with cortex thickness. Cortex thickness was significantly positively correlated with mean cortical cell diameter in six species ( = 0.72-0.93), but was only correlated with the number of cortical cell layers in three species ( = 0.42-0.66). Stele diameter displayed significant positive correlations with mean conduit diameter ( = 0.58-0.88) and the number of conduits per stele ( = 0.50-0.66, except for ), and was negatively correlated with conduit density in all species ( = -0.65 to -0.77). The correlations between cortical cells and conduit traits and root tip diameter were similar to that with cortex thickness and stele diameter, respectively. Compared with vines, liana root tips showed closer relationships between root diameter and cortex thickness and stele diameter, and between cortex thickness and mean diameter of cortical cells. Moreover, the root tip of lianas possesses significantly higher stele proportion and denser conduits, significantly lower cortex proportion, and smaller conduit size than those of vines. However, the specific conductivity was similar. Overall, these results suggest that the cortex is the main driver for the change in root tip diameter rather than the stele. Nevertheless, both factors were responsible for variations in diameter-related traits when compared with number-related traits, with lianas and vines exhibiting distinct regulatory mechanisms.
PubMed: 36119575
DOI: 10.3389/fpls.2022.961214